Cost-minimization analysis of phenytoin and fosphenytoin in the emergency department.

STUDY OBJECTIVE To determine the value of fosphenytoin compared with phenytoin for treating patients admitted to an emergency department following a seizure. DESIGN Cost-minimization analysis performed from a hospital perspective. SETTING Hospital emergency department. PATIENTS Two hundred fifty-six patients participating in a comparative clinical trial. INTERVENTION Estimation of adverse event rates and resource use. MEASUREMENTS AND MAIN 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. CONCLUSION 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.