8e5450f45459be6cebec4d27be5443c5  antibiotics-14-00646_003.pdf
312e36b353fa450d018c2cb6e687b2e014c599a9  antibiotics-14-00646_003.pdf
d782a5f79dccdcafaa660a4b366bd317658264d3d0fcfbadbfecb7d473bf1dc7  antibiotics-14-00646_003.pdf

Title:           The Cost-Effectiveness of Beta-Lactam Desensitization in the Management of Penicillin-Allergic Patients
Subject:         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.
Keywords:        desensitization; cost-effectiveness; penicillin allergy; antimicrobial stewardship programs
Author:          Alicia Rodríguez-Alarcón, Santiago Grau, Silvia Gómez-Zorrilla and Carlos Rubio-Terrés
Creator:         LaTeX with hyperref
Producer:        pdfTeX-1.40.25
CreationDate:    Wed Jun 25 12:06:57 2025 CEST
ModDate:         Wed Jun 25 18:07:35 2025 CEST
Custom Metadata: no
Metadata Stream: yes
Tagged:          no
UserProperties:  no
Suspects:        no
Form:            none
JavaScript:      no
Pages:           8
Encrypted:       no
Page size:       595.276 x 841.89 pts (A4)
Page rot:        0
File size:       194794 bytes
Optimized:       yes
PDF version:     1.7


name                                 type              encoding         emb sub uni object ID
------------------------------------ ----------------- ---------------- --- --- --- ---------
MIKRSI+VnURWPalladioL                Type 1            Custom           yes yes yes    187  0
RSSKOV+URWPalladioL-Roma             Type 1            Custom           yes yes yes    191  0
GAGRAB+URWPalladioL-Bold             Type 1            Custom           yes yes yes    194  0
VPOAAC+URWPalladioL-Ital             Type 1            Custom           yes yes yes    197  0
LGTZLE+CMSY10                        Type 1            Builtin          yes yes yes    200  0


Jhove (Rel. 1.28.0, 2023-05-18)
 Date: 2025-06-26 02:38:09 CEST
 RepresentationInformation: antibiotics-14-00646_003.pdf
  ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16)
  LastModified: 2025-06-25 18:08:16 CEST
  Size: 194794
  Format: PDF
  Version: 1.7
  Status: Well-Formed and valid
  SignatureMatches:
   PDF-hul
  MIMEtype: application/pdf
  Profile: Linearized PDF
  PDFMetadata: 
   Objects: 0
   FreeObjects: 1
   IncrementalUpdates: 0
   DocumentCatalog: 
    PageLayout: SinglePage
    PageMode: UseNone
    Outlines: 
     Item: 
      Title: Introduction 
      Destination: section.1
     Item: 
      Title: Results 
      Destination: section.2
      Children: 
       Item: 
        Title: Deterministic Cost and Effectiveness Analysis 
        Destination: subsection.2.1
       Item: 
        Title: Probabilistic Cost Analysis 
        Destination: subsection.2.2
       Item: 
        Title: Probabilistic Effectiveness Analysis 
        Destination: subsection.2.3
       Item: 
        Title: Probabilistic Cost-Effectiveness Analysis 
        Destination: subsection.2.4
     Item: 
      Title: Discussion 
      Destination: section.3
     Item: 
      Title: Materials and Methods 
      Destination: section.4
     Item: 
      Title: Conclusions 
      Destination: section.5
     Item: 
      Title: References
      Destination: section.6
   Filters: 
    FilterPipeline: FlateDecode
   Fonts: 
    Type1: 
     Font: 
      BaseFont: GAGRAB+URWPalladioL-Bold
      FontSubset: true
      FirstChar: 3
      LastChar: 243
      FontDescriptor: 
       FontName: GAGRAB+URWPalladioL-Bold
       Flags: Symbolic
       FontBBox: -152, -301, 1000, 935
       FontFile: true
      EncodingDictionary: 
       Differences: true
      ToUnicode: true
     Font: 
      BaseFont: VPOAAC+URWPalladioL-Ital
      FontSubset: true
      FirstChar: 40
      LastChar: 150
      FontDescriptor: 
       FontName: VPOAAC+URWPalladioL-Ital
       Flags: Symbolic
       FontBBox: -170, -305, 1010, 941
       FontFile: true
      EncodingDictionary: 
       Differences: true
      ToUnicode: true
     Font: 
      BaseFont: LGTZLE+CMSY10
      FontSubset: true
      FirstChar: 6
      LastChar: 6
      FontDescriptor: 
       FontName: LGTZLE+CMSY10
       Flags: Symbolic
       FontBBox: -29, -960, 1116, 775
       FontFile: true
      ToUnicode: true
     Font: 
      BaseFont: MIKRSI+VnURWPalladioL
      FontSubset: true
      FirstChar: 225
      LastChar: 225
      FontDescriptor: 
       FontName: MIKRSI+VnURWPalladioL
       Flags: Symbolic
       FontBBox: -166, -283, 1021, 943
       FontFile: true
      EncodingDictionary: 
       Differences: true
      ToUnicode: true
     Font: 
      BaseFont: RSSKOV+URWPalladioL-Roma
      FontSubset: true
      FirstChar: 2
      LastChar: 252
      FontDescriptor: 
       FontName: RSSKOV+URWPalladioL-Roma
       Flags: Symbolic
       FontBBox: -166, -283, 1021, 943
       FontFile: true
      EncodingDictionary: 
       Differences: true
      ToUnicode: true
   XMP: <x:xmpmeta xmlns:x="adobe:ns:meta/" x:xmptk="Adobe XMP Core 9.1-c001 79.675d0f7, 2023/06/11-19:21:16        ">
   <rdf:RDF xmlns:rdf="http://www.w3.org/1999/02/22-rdf-syntax-ns#">
      <rdf:Description rdf:about=""
            xmlns:dc="http://purl.org/dc/elements/1.1/"
            xmlns:xmp="http://ns.adobe.com/xap/1.0/"
            xmlns:pdf="http://ns.adobe.com/pdf/1.3/"
            xmlns:xmpMM="http://ns.adobe.com/xap/1.0/mm/">
         <dc:format>application/pdf</dc:format>
         <dc:creator>
            <rdf:Seq>
               <rdf:li>Alicia Rodríguez-Alarcón, Santiago Grau, Silvia Gómez-Zorrilla and Carlos Rubio-Terrés</rdf:li>
            </rdf:Seq>
         </dc:creator>
         <dc:description>
            <rdf:Alt>
               <rdf:li xml:lang="x-default">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 &lt; EUR 25,000 and &lt;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.</rdf:li>
            </rdf:Alt>
         </dc:description>
         <dc:title>
            <rdf:Alt>
               <rdf:li xml:lang="x-default">The Cost-Effectiveness of Beta-Lactam Desensitization in the Management of Penicillin-Allergic Patients</rdf:li>
            </rdf:Alt>
         </dc:title>
         <xmp:CreateDate>2025-06-25T18:06:57+08:00</xmp:CreateDate>
         <xmp:CreatorTool>LaTeX with hyperref</xmp:CreatorTool>
         <xmp:ModifyDate>2025-06-25T18:07:35+02:00</xmp:ModifyDate>
         <xmp:MetadataDate>2025-06-25T18:07:35+02:00</xmp:MetadataDate>
         <pdf:Keywords>desensitization; cost-effectiveness; penicillin allergy; antimicrobial stewardship programs</pdf:Keywords>
         <pdf:Producer>pdfTeX-1.40.25</pdf:Producer>
         <xmpMM:DocumentID>uuid:e3e0e5cc-51a6-4b2f-a912-dd9c9c0e68ff</xmpMM:DocumentID>
         <xmpMM:InstanceID>uuid:be86365c-c04d-4327-b079-d3d284631080</xmpMM:InstanceID>
      </rdf:Description>
   </rdf:RDF>
</x:xmpmeta>
   Pages: 
    Page: 
     Sequence: 1
     Annotations: 
      Annotation: 
       Subtype: Link
       Rect: 77, 177, 152, 186
      Annotation: 
       Subtype: Link
       Rect: 34, 166, 123, 174
      Annotation: 
       Subtype: Link
       Rect: 36, 75, 152, 84
      Annotation: 
       Subtype: Link
       Rect: 34, 63, 89, 72
      Annotation: 
       Subtype: Link
       Rect: 34, 773, 151, 809
      Annotation: 
       Subtype: Link
       Rect: 515, 773, 560, 809
      Annotation: 
       Subtype: Link
       Rect: 164, 663, 175, 677
      Annotation: 
       Subtype: Link
       Rect: 277, 663, 288, 677
      Annotation: 
       Subtype: Link
       Rect: 418, 663, 429, 677
      Annotation: 
       Subtype: Link
       Rect: 541, 140, 548, 149
       ActionDest: 16
      Annotation: 
       Subtype: Link
       Rect: 549, 140, 556, 149
       ActionDest: 16
      Annotation: 
       Subtype: Link
       Rect: 200, 98, 207, 108
       ActionDest: 16
      Annotation: 
       Subtype: Link
       Rect: 208, 99, 215, 108
       ActionDest: 16
      Annotation: 
       Subtype: Link
       Rect: 335, 71, 342, 80
       ActionDest: 16
      Annotation: 
       Subtype: Link
       Rect: 343, 71, 350, 80
       ActionDest: 16
      Annotation: 
       Subtype: Link
       Rect: 399, 27, 560, 37
      Annotation: 
       Subtype: Link
       Rect: 34, 332, 87, 351
    Page: 
     Sequence: 2
     Annotations: 
      Annotation: 
       Subtype: Link
       Rect: 471, 758, 478, 767
       ActionDest: 16
      Annotation: 
       Subtype: Link
       Rect: 312, 717, 319, 726
       ActionDest: 16
      Annotation: 
       Subtype: Link
       Rect: 320, 717, 327, 726
       ActionDest: 16
      Annotation: 
       Subtype: Link
       Rect: 327, 717, 334, 726
       ActionDest: 16
      Annotation: 
       Subtype: Link
       Rect: 337, 717, 349, 726
       ActionDest: 16
      Annotation: 
       Subtype: Link
       Rect: 240, 689, 252, 698
       ActionDest: 16
      Annotation: 
       Subtype: Link
       Rect: 253, 689, 265, 698
       ActionDest: 16
      Annotation: 
       Subtype: Link
       Rect: 261, 647, 273, 656
       ActionDest: 16
      Annotation: 
       Subtype: Link
       Rect: 347, 619, 358, 628
       ActionDest: 16
      Annotation: 
       Subtype: Link
       Rect: 359, 619, 371, 628
       ActionDest: 16
      Annotation: 
       Subtype: Link
       Rect: 300, 591, 307, 600
       ActionDest: 16
      Annotation: 
       Subtype: Link
       Rect: 308, 591, 315, 600
       ActionDest: 16
      Annotation: 
       Subtype: Link
       Rect: 544, 563, 556, 572
       ActionDest: 16
      Annotation: 
       Subtype: Link
       Rect: 201, 522, 213, 531
       ActionDest: 16
      Annotation: 
       Subtype: Link
       Rect: 214, 494, 226, 503
       ActionDest: 16
      Annotation: 
       Subtype: Link
       Rect: 226, 494, 238, 503
       ActionDest: 16
      Annotation: 
       Subtype: Link
       Rect: 490, 452, 497, 461
       ActionDest: 16
      Annotation: 
       Subtype: Link
       Rect: 497, 452, 509, 461
       ActionDest: 16
      Annotation: 
       Subtype: Link
       Rect: 485, 438, 497, 447
       ActionDest: 16
      Annotation: 
       Subtype: Link
       Rect: 500, 438, 512, 447
       ActionDest: 16
      Annotation: 
       Subtype: Link
       Rect: 544, 410, 556, 419
       ActionDest: 16
      Annotation: 
       Subtype: Link
       Rect: 273, 341, 285, 350
       ActionDest: 16
      Annotation: 
       Subtype: Link
       Rect: 484, 181, 491, 193
       ActionDest: 4
      Annotation: 
       Subtype: Link
       Rect: 418, 170, 430, 179
       ActionDest: 16
      Annotation: 
       Subtype: Link
       Rect: 397, 153, 404, 165
       ActionDest: 4
    Page: 
     Sequence: 3
     Annotations: 
      Annotation: 
       Subtype: Link
       Rect: 391, 611, 398, 623
       ActionDest: 4
      Annotation: 
       Subtype: Link
       Rect: 470, 358, 477, 370
       ActionDest: 4
      Annotation: 
       Subtype: Link
       Rect: 471, 276, 478, 288
       ActionDest: 4
      Annotation: 
       Subtype: Link
       Rect: 231, 180, 238, 189
       ActionDest: 16
      Annotation: 
       Subtype: Link
       Rect: 239, 180, 246, 189
       ActionDest: 16
      Annotation: 
       Subtype: Link
       Rect: 246, 180, 253, 189
       ActionDest: 16
    Page: 
     Sequence: 4
     Annotations: 
      Annotation: 
       Subtype: Link
       Rect: 469, 731, 481, 740
       ActionDest: 19
      Annotation: 
       Subtype: Link
       Rect: 407, 675, 419, 684
       ActionDest: 16
      Annotation: 
       Subtype: Link
       Rect: 294, 549, 306, 559
       ActionDest: 16
      Annotation: 
       Subtype: Link
       Rect: 196, 508, 208, 517
       ActionDest: 16
      Annotation: 
       Subtype: Link
       Rect: 311, 494, 323, 503
       ActionDest: 19
      Annotation: 
       Subtype: Link
       Rect: 224, 424, 231, 433
       ActionDest: 16
      Annotation: 
       Subtype: Link
       Rect: 232, 424, 238, 433
       ActionDest: 16
      Annotation: 
       Subtype: Link
       Rect: 239, 424, 246, 433
       ActionDest: 16
      Annotation: 
       Subtype: Link
       Rect: 248, 424, 260, 433
       ActionDest: 16
      Annotation: 
       Subtype: Link
       Rect: 199, 118, 211, 127
       ActionDest: 16
    Page: 
     Sequence: 5
     Annotations: 
      Annotation: 
       Subtype: Link
       Rect: 206, 717, 218, 726
       ActionDest: 16
      Annotation: 
       Subtype: Link
       Rect: 221, 381, 233, 390
       ActionDest: 19
      Annotation: 
       Subtype: Link
       Rect: 233, 381, 245, 390
       ActionDest: 19
      Annotation: 
       Subtype: Link
       Rect: 530, 353, 541, 363
       ActionDest: 16
      Annotation: 
       Subtype: Link
       Rect: 411, 340, 423, 349
       ActionDest: 19
      Annotation: 
       Subtype: Link
       Rect: 423, 340, 435, 349
       ActionDest: 19
      Annotation: 
       Subtype: Link
       Rect: 279, 270, 291, 279
       ActionDest: 16
      Annotation: 
       Subtype: Link
       Rect: 522, 228, 534, 237
       ActionDest: 16
      Annotation: 
       Subtype: Link
       Rect: 535, 228, 547, 237
       ActionDest: 19
      Annotation: 
       Subtype: Link
       Rect: 194, 184, 201, 196
       ActionDest: 4
      Annotation: 
       Subtype: Link
       Rect: 310, 128, 317, 140
       ActionDest: 4
      Annotation: 
       Subtype: Link
       Rect: 495, 114, 502, 126
       ActionDest: 4
    Page: 
     Sequence: 6
     Annotations: 
      Annotation: 
       Subtype: Link
       Rect: 281, 744, 293, 754
       ActionDest: 16
      Annotation: 
       Subtype: Link
       Rect: 492, 731, 504, 740
       ActionDest: 19
    Page: 
     Sequence: 7
     Annotations: 
      Annotation: 
       Subtype: Link
       Rect: 183, 728, 221, 739
      Annotation: 
       Subtype: Link
       Rect: 227, 728, 263, 739
      Annotation: 
       Subtype: Link
       Rect: 361, 689, 399, 700
      Annotation: 
       Subtype: Link
       Rect: 405, 689, 441, 700
      Annotation: 
       Subtype: Link
       Rect: 460, 676, 498, 687
      Annotation: 
       Subtype: Link
       Rect: 504, 676, 540, 687
      Annotation: 
       Subtype: Link
       Rect: 104, 652, 142, 662
      Annotation: 
       Subtype: Link
       Rect: 174, 588, 211, 598
      Annotation: 
       Subtype: Link
       Rect: 377, 562, 415, 573
      Annotation: 
       Subtype: Link
       Rect: 388, 536, 425, 547
      Annotation: 
       Subtype: Link
       Rect: 105, 499, 142, 509
      Annotation: 
       Subtype: Link
       Rect: 442, 485, 480, 496
      Annotation: 
       Subtype: Link
       Rect: 255, 459, 293, 470
      Annotation: 
       Subtype: Link
       Rect: 481, 434, 518, 445
      Annotation: 
       Subtype: Link
       Rect: 404, 408, 441, 419
      Annotation: 
       Subtype: Link
       Rect: 140, 358, 177, 368
      Annotation: 
       Subtype: Link
       Rect: 108, 307, 146, 317
      Annotation: 
       Subtype: Link
       Rect: 59, 282, 96, 292
      Annotation: 
       Subtype: Link
       Rect: 134, 192, 171, 202
      Annotation: 
       Subtype: Link
       Rect: 109, 167, 146, 177
      Annotation: 
       Subtype: Link
       Rect: 404, 140, 442, 151
      Annotation: 
       Subtype: Link
       Rect: 416, 103, 453, 113
    Page: 
     Sequence: 8
     Annotations: 
      Annotation: 
       Subtype: Link
       Rect: 459, 756, 560, 767
      Annotation: 
       Subtype: Link
       Rect: 56, 743, 560, 754
      Annotation: 
       Subtype: Link
       Rect: 56, 731, 557, 742
      Annotation: 
       Subtype: Link
       Rect: 206, 629, 243, 639
      Annotation: 
       Subtype: Link
       Rect: 250, 629, 286, 639
  Checksum: af937eca
   Type: CRC32
  Checksum: 8e5450f45459be6cebec4d27be5443c5
   Type: MD5
  Checksum: 312e36b353fa450d018c2cb6e687b2e014c599a9
   Type: SHA-1
  Checksum: d782a5f79dccdcafaa660a4b366bd317658264d3d0fcfbadbfecb7d473bf1dc7
   Type: SHA-256