The economic impacts of a penicillin allergy de-labelling program in special populations: a cost analysis

Background Over 90% of patients with a documented penicillin allergy are found to be incorrectly labelled when formally tested. The high incidence and lifelong impacts of an unconfirmed penicillin allergy label not only negatively impact patient outcomes, but also result in significant healthcare system costs. Therefore, we aimed to analyze the potential healthcare cost savings associated with the implementation of a provincial de-labelling initiative. Methods This was a retrospective review study using data from a provincial quality improvement de-labelling program in collaboration with BC Children’s Hospital, BC Women’s Hospital and the BC Centre for Disease Control (BCCDC) in Vancouver, Canada between 2019 and 2024. Patient populations of interest included pediatric patients, antepartum pregnant people and rural populations. Drug-cost differentials, hospitalization costs and costs associated with secondary complications was calculated based on information extracted from the program as well as reference data from existing North American and European databases from 2020 to 2025, to assess overall cost savings following implementation of the de-labelling programs. Results Amongst our special populations, including pediatric, antepartum and rural populations, we estimate lifetime savings of up to $6,581 and immediate (three-year) savings of up to $949 per patient with implementation of a penicillin allergy de-labelling program. We found that the overall lifetime savings was highest in populations with a higher risk for infection, such as peripartum populations, compared to others in their age cohort. Additionally, the largest lifetime drug cost savings were seen in our pediatric population, particularly in those less than 5 years of age. Furthermore, we highlight that local de-labelling services in remote and rural centres supported by primary care providers can further increase cost savings for rural populations with a cost differential of up to $350 per patient. Conclusions Our findings suggest that, irrespective of the population, de-labelling is associated with significant cost savings. This supports the need for more widespread implementation of penicillin allergy de-labelling programs, with a particular focus on these special populations.