{
  "abstract": "Objective To evaluate the cost-effectiveness of implementing a penicillin allergy assessment pathway (PAAP) versus usual care within the NHS.Design A decision tree analysis over a 5-year time-period, informed by a randomised controlled trial (RCT) of PAAP and systematic review. Value of information analysis was also conducted to estimate the value of conducting a new trial.Data sources Model inputs were informed by the ALABAMA RCT participants included in the primary analysis, 811 adults with penicillin allergy labels and recent antibiotic prescriptions, and data from published literature.Interventions Participants in the ALABAMA trial included in the primary analysis: PAAP (n=401) and usual care (n=410).Primary and secondary outcome measures Costs are presented in GBP (£) at 2022–2023 prices, quality-adjusted life years (QALYs), incremental cost-effectiveness ratio, incremental net monetary benefit (INMB), the probability of cost-effectiveness at the £20,000 and £30,000 per QALY threshold, and the cost effectiveness of a new follow-on trial.Results PAAP had incremental costs of £−83 (probability of cost saving 47.5%) and incremental QALYs of 0.036 (probability of positive benefits 47.5%). The INMBs (probability of cost-effectiveness) were £806 (48%) and £1167 (48%) under the decision thresholds of £20,000 and £30,000 per QALY, respectively. PAAP was more cost-effective among females, people aged >65 years, and more frequent antibiotic users. A new follow-on trial involving 1267 participants was estimated to cost £2.4 million and, by reducing uncertainty in the evidence, would avoid £19.6 million in costs of incorrect management decisions for eligible patients over the next 10 years.Conclusion The PAAP was considered cost-effective, but significant uncertainty remained. Future trials with adequate power and longer follow-up are needed to determine the most cost-effective models for penicillin allergy testing.Trial registration number ISRCTN20579216.",
  "authors": [
    {
      "affiliations": [
        "Leeds Institute of Health Sciences, University of Leeds, Leeds, UK"
      ],
      "name": "Miaoqing Yang"
    },
    {
      "affiliations": [
        "Leeds Institute of Health Sciences, University of Leeds, Leeds, UK"
      ],
      "name": "Rebecca Bestwick"
    },
    {
      "affiliations": [
        "Leeds Institute of Health Sciences, University of Leeds, Leeds, UK"
      ],
      "name": "Daniel Howdon"
    },
    {
      "affiliations": [
        "St James’s University Hospital, Leeds, UK"
      ],
      "name": "S Ahmed"
    },
    {
      "affiliations": [
        "Royal Cornwall Hospitals NHS Trust, Truro, UK"
      ],
      "name": "Neil Powell"
    },
    {
      "affiliations": [
        "Nuffield Department of Primary Care Health Sciences, Clinical Trials Unit, University of Oxford, Oxford, UK"
      ],
      "name": "Kelsey Fiona Armitage"
    },
    {
      "affiliations": [
        "Dental Translational and Clinical Research Unit, School of Dentistry, University of Leeds, Leeds, UK"
      ],
      "name": "Joanne Fielding"
    },
    {
      "affiliations": [
        "Dental Translational and Clinical Research Unit, School of Dentistry, University of Leeds, Leeds, UK"
      ],
      "name": "Catherine E Porter"
    },
    {
      "affiliations": [
        "Clinical Immunology and Allergy, University of Leeds, Leeds Institute of Medical Research at St James’s, Leeds, UK"
      ],
      "name": "Sinisa Savic"
    },
    {
      "affiliations": [
        "Leeds Institute of Health Sciences, University of Leeds, Leeds, UK"
      ],
      "name": "Robert M West"
    },
    {
      "affiliations": [
        "School of Health Care, University of Leeds, Leeds, UK"
      ],
      "name": "Philip Howard"
    },
    {
      "affiliations": [
        "Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK"
      ],
      "name": "Ushma Galal"
    },
    {
      "affiliations": [
        "Dental Translational and Clinical Research Unit, School of Dentistry, University of Leeds, Leeds, UK"
      ],
      "name": "Sue Pavitt"
    },
    {
      "affiliations": [
        "Department of Microbiology, University of Leeds, Faculty of Medicine and Health, Leeds, UK",
        "Leeds teaching Hospitals NHS Trust, Leeds, UK"
      ],
      "name": "Jonathan AT Sandoe"
    },
    {
      "affiliations": [
        "Leeds Institute of Health Sciences, University of Leeds, Leeds, UK",
        "Health and Community Sciences, University of Exeter, Exeter, UK"
      ],
      "name": "Ruben Ernesto Mujica-Mota"
    }
  ],
  "title": "The cost-effectiveness of penicillin allergy assessment pathway (PAAP): a decision analysis",
  "uid": "7dc7790e-41f7-56d1-8c69-62aacd821203"
}