The cost-effectiveness of beta-lactam desensitization in the management of penicillin-allergic patients

Abstract

Background/Objectives: Antibiotic management of hospitalized penicillin-allergic patients (PAPs) is associated with prolonged hospital stays, adverse reactions and treatment failure, resulting in increased healthcare costs. This study aimed to estimate the cost-effectiveness of beta-lactam desensitization (DES) in the management of PAPs. Methods: A cost-effectiveness analysis was performed using a probabilistic model with 1000 s-order Monte Carlo simulations. Hospital costs (in 2025 Euros) and effectiveness outcomes (cure and survival rates) were derived from a Spanish retrospective case–control study conducted between 2015 and 2022, which included 56 PAPs (14 in the desensitization group [DES] and 42 in the control group without DES [NDES]; ratio 1:3), and collected healthcare costs per patient. Results: The incremental cost of the DES group was EUR 37,805 (95% CI: EUR 2023–EUR 126,785), with a 100% probability of incurring additional costs compared to the NDES group. The cure rate was 16.5% higher in the DES group (95% CI: 13.3–20.0%), and the estimated gain in life-years per patient (LYG) was 1.42 (95% CI: 1.15–1.73) versus NDES. The cost per life-year gained (LYG) with DES versus NDES was EUR 24,618 ± EUR 19,535 (95% CI: EUR 1755–EUR 73,488). The probability that DES would be cost-effective (cost per LYG < EUR 25,000 and <EUR 30,000) was 61.1% and 100%, respectively. Conclusions: According to this analysis, DES appears to be a cost-effective option for managing PAPs. These findings should be confirmed in clinical studies with larger sample sizes.