Cost-minimization analysis of phenytoin and fosphenytoin in the emergency department.
OBJECTIVE
To determine the value of fosphenytoin compared with phenytoin for treating patients admitted to an emergency department following a seizure.


METHODS
Cost-minimization analysis performed from a hospital perspective.


METHODS
Hospital emergency department.


METHODS
Two hundred fifty-six patients participating in a comparative clinical trial.


METHODS
Estimation of adverse event rates and resource use.


RESULTS
In our base case, phenytoin was the preferred option, with an expected total treatment cost of $5.39 compared with $110.14 for fosphenytoin. One-way sensitivity analyses showed that the frequency and cost of treating purple glove syndrome (PGS) possibly could affect the decision. Monte Carlo simulation showed phenytoin to be the preferred option 97.3% of the time.


CONCLUSIONS
When variable costs of care are used to calculate the value of phenytoin compared with fosphenytoin in the emergency department, phenytoin is preferred. The decision to administer phenytoin was very robust and changed only when both the frequency and cost of PGS was high.
Department of Pharmacy Practice, College of Pharmacy, Oregon State University, Portland 97201-3098, USA.
D R
DR
Touchette
D H
DH
Rhoney
D000927:Anticonvulsants / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D003363:Cost Control / Q000379:methods; D004632:Emergency Medical Services / Q000191:economics; D006801:Humans; D018803:Models, Economic; D009010:Monte Carlo Method; D010672:Phenytoin / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D011355:Prodrugs / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D011446:Prospective Studies; D013226:Status Epilepticus / Q000188:drug therapy* / Q000191:economics*
D000927:Anticonvulsants; D011355:Prodrugs; D010672:Phenytoin; C043114:fosphenytoin