OBJECTIVES: To perform a cost-effectiveness analysis of drug provocation test (DPT) compared to serum specific IgE measurement (sIgE) for the diagnosis of patients with penicillin allergy.

METHODS: a decision tree model was used to assess DPT versus sIgE, considering sensitivity and specificity of both technologies as outcome in a 1-year time horizon. The analytical model considered considering the following diagnostic tests-related probabilities: DPT sensitivity = 88%; DPT specificity = 100%; sIgE sensitivity = 39%; DCT = 75% specificity. The costs included in the model consisted in: DPT = US$ 211.16; sIgE = US$ 88.35; complications associated with the diagnostic test = US$ 74.32.

RESULTS: DPT had an additional cost of US$ 211.42 and incremental effectiveness of 25% when compared to sIgE. The multivariate probabilistic sensitivity analysis showed that after 100,000 iterations, DPT was the first considered an efficient technology when the willingness to pay threshold was set at US$ 740.

CONCLUSIONS: In the proposed analytical model, DPT may be more effective than sIgE for the diagnosis of patients with penicillin allergy, though it was associated with increased costs.