| Title: |
Direct oral penicillin challenge in secondary care with low-risk patients: the SPACE mixed-methods study with cost-effectiveness analysis |
| Authors: |
Krishna, MT; Jani, YH; Williams, I; Mujica-Mota, R; Bestwick, R; Siciliano, M; West, RM; Bhogal, R; Ng, BY; Kildonaviciute, K; Pollard, R; Jones, N; Dunsmure, L; McErlean, M; Powell, N; Hullur, CC; Balaji, A; Sandoe, J; Warner, A; Daniels, R; Thomas, C; Misbah, SA; Savic, L |
| Source: |
Health and Social Care Delivery Research , 13 (9) (2025) |
| Publisher Information: |
National Institute for Health and Care Research |
| Publication Year: |
2025 |
| Collection: |
University College London: UCL Discovery |
| Description: |
Background: One in five inpatients carries a penicillin allergy label. However, 90-95% of labels are incorrect. Penicillin allergy labels lead to increased risk for serious hospital infections and longer hospital stay and are associated with higher estimated healthcare costs. Penicillin allergy testing is onerous and requires a specialist. Routine inpatient testing is not available. Recent evidence suggests that a direct oral penicillin challenge delivered by non-allergy specialists is safe in 'low risk' patients, who are highly unlikely to be allergic based on history. Aims: To explore behaviour, attitudes and acceptability of patients, healthcare professionals and managers regarding a direct oral penicillin challenge in 'low risk' patients. To inform development of an implementation framework and determine potential cost-effectiveness. / Methods: This study (1 May 2021-30 April 2023) involved delivery of direct oral penicillin challenge by non-allergy specialists across three clinical settings (medical/infectious diseases wards, presurgical and haematology-oncology units) at three hospitals. The study had three workstreams: Workstream 1: Screening for potential suitability. Patients were stratified into 'low risk' and 'high risk'. 'Low-risk' patients underwent direct oral penicillin challenge. Workstream 2: One-to-one semistructured interviews with patients (N = 43) and focus group (N = 28) discussions with stakeholders. Workstream 3: Care pathway mapping, decision-analytic modelling and value of information analysis were carried out to determine potential cost-effectiveness of direct oral penicillin challenge. / Results: One thousand and fifty-four of 2257 screened patients were eligible, 270 of 643 approached patients consented (42%). Two hundred and fifty-nine patients were risk-stratified (155 'low risk'; 104 'high risk'). Of the 155 'low risk' patients, 126 underwent direct oral penicillin challenge, 122 (97%) were de-labelled with no serious allergic reactions and 43 patients were interviewed. Low-risk ... |
| Document Type: |
article in journal/newspaper |
| File Description: |
text |
| Language: |
English |
| Relation: |
https://discovery.ucl.ac.uk/id/eprint/10208246/1/3047611.pdf; https://discovery.ucl.ac.uk/id/eprint/10208246/ |
| Availability: |
https://discovery.ucl.ac.uk/id/eprint/10208246/1/3047611.pdf; https://discovery.ucl.ac.uk/id/eprint/10208246/ |
| Rights: |
open |
| Accession Number: |
edsbas.582A8A10 |
| Database: |
BASE |