D1.252 - A model based economic evaluation to assess impact of Penicillin Allergy in COPD patients

COPD is a common condition characterised by persistent respiratory symptoms and airflow obstruction. It affects around 2% of the population and is a leading cause of hospitalisation and deaths in the UK. Penicillin allergy (Pen A) affects about 10% of the population and has important consequences for infection frequency, hospitalisation and mortality in these patients. There are no estimates of the cost and quality of life years (QALY) impact of having Pen A in COPD patients.

A Markov decision model was developed to compare the costs and QALYs accrued by COPD patients with and without PenA respectively over a period of 20 years.The start age of individuals was 60 years and each model cycle was 3 months long. Data inputs were derived mainly from published literature. One-way and probabilistic sensitivity analyses were performed to account for data uncertainty. Discounted costs and QALYs were calculated using a UK NHS perspective. 

COPD patients with Pen A costed and additional £2,833 and lost 0.6 QALYs over the model duration compared with those without Pen A. Given that 1.4 million individuals are affected by COPD in the UK, the annual excess cost of a Pen A label to the UK health economy is around £18.6 million with a loss of 4200 QALYs. The costs are higher if only individuals with severe COPD are considered in the model. The base case estimation was robust to multiple one-way sensitivity analyses. Probabilistic sensitivity analysis showed that Pen A was the more costly option 96% of the time and always resulted in a QALY loss.

Pen A label carries considerable cost and QALY consequences for individuals with COPD. There is a need for strong antibiotic stewardship and to look closely at allergy labelling and de-labelling practices in order to reduce costs for the health service and to improve outcomes for these individuals.