Penicillin Allergy Delabeling Program: an exploratory economic evaluation in the Australian context

Natasha K. Brusco, Susan Bury, Kyra Y.L. Chua, Sara Vogrin, Natasha E. Holmes, Jason A. Trubiano

Research output: Contribution to journalArticleResearchpeer-review

5 Citations (Scopus)


Background: Internationally, clinical and economic advantages of low-risk penicillin delabelling have been explored, supporting changes to healthcare delivery systems where penicillin delabelling is embedded into inpatient usual care. Aims: To determine if economic advantages of low-risk inpatient penicillin delabelling, described in the international literature, are realised in the Australian context. Methods: This explorative economic evaluation had prospective patient data collection between January and August 2019, across two Australian health services. Part 1: determine the cost per effectively delabelled patient for Penicillin Allergy Delabeling Program inpatients (PADP cohort) compared with Outpatient Antibiotic Allergy Testing Service outpatients (OAATS cohort). Part 2: a cost analysis to compare hospital costs for inpatients with low-risk penicillin allergy who did (PADP cohort) and did not (usual care cohort) undergo PADP delabelling. Results: Part 1: the PADP (n = 350) and OAATS (n = 27 patients, n = 36 individual visits) cohorts were comparable. In PADP, costs/proportion delabelled was $20.10/0.98, equating to $20.51 per effectively delabelled patient; in OAATS, it was $181.24/0.50, equating to $362. Compared with OAATS, PADP was associated with savings of $341.97 per effectively delabelled patient, indicating the outpatient testing was the dominated strategy, being more costly and less effective. Part 2: the PADP (n = 218) and usual care (n = 32) cohorts were comparable. Significantly favouring the delabelled PADP cohort, the mean difference per patient was −4.41 days (95% confidence interval: −7.64, −1.18) and −$9467.72 (95% confidence interval: −$15 419.98, −$3515.46). Conclusions: Consistent with international literature, delabelling low-risk penicillin allergies in the inpatient setting had economic advantages in the Australian context. Fully powered economic evaluations are urgently required to consolidate these findings.

Original languageEnglish
Pages (from-to)74-83
Number of pages10
JournalInternal Medicine Journal
Issue number1
Publication statusPublished - Jan 2023


  • Antibiotics
  • Delabeling
  • Health Economics
  • Health Service Research

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