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 pl phenytoin was very robust and changed only when both the frequency and cost of PGS was high.