A pharmacoeconomic evaluation of intravenous fosphenytoin (Cerebyx) versus intravenous phenytoin (Dilantin) in hospital emergency departments.

The cost of emergency department services has become a major concern for patients, providers, and payers. Solid economic information is needed to provide a rationale for the selection of therapeutic options and the provision of care that is both clinically and financially prudent. To assess the full cost of care for patients with seizures who are treated in an acute care setting, a modified activity-based cost-accounting model was developed. The model was populated with data from a double-masked, parallel-group, single-dose, multicenter clinical trial designed to investigate the safety and tolerability of phenytoin (Dilantin) and fosphenytoin (Cerebyx) given intravenously in equivalent loading doses according to established recommendations. A total of 52 patients were enrolled in the trial; 13 were given phenytoin and 39 were given fosphenytoin. Salaries and benefits of emergency medical services personnel, drug acquisition costs, and direct and indirect overhead expenditures common to a large hospital emergency department comprised the total costs to treat enrolled patients and manage adverse events. The average cost to treat patients with fosphenytoin was lower than the cost to treat similar patients with phenytoin based on the frequency of adverse events associated with each comparator and the resources (human and material) consumed in the management of those events.