Is Fosfomycin more expensive than Moxifloxacin for treating urinary tract infections?

Fosfomycin is More Expensive Than Moxifloxacin for Treating Urinary Tract Infections

Based on the available evidence, fosfomycin is generally more expensive than moxifloxacin for treating urinary tract infections, with cost-effectiveness analyses showing significantly higher incremental cost-effectiveness ratios for fosfomycin compared to other first-line antibiotics.

Cost Comparison of UTI Treatments

Fosfomycin Cost Considerations

• Fosfomycin is consistently identified as more expensive than other first-line UTI treatments in multiple cost analyses 1, 2, 3
• A 2022 cost-effectiveness analysis found that fosfomycin had the highest total treatment cost among first-line UTI antibiotics, with an incremental cost-effectiveness ratio (ICER) of $2264.29 per additional UTI case resolved 1
• The World Health Organization (WHO) specifically noted that cost was a factor in their decision to exclude fosfomycin from their recommended treatments for lower UTIs, stating "fosfomycin is more expensive than nitrofurantoin" 4

Moxifloxacin and Fluoroquinolone Costs

• While specific moxifloxacin cost data isn't directly provided in the evidence, fluoroquinolones as a class (which includes moxifloxacin) have been shown to have lower treatment costs than fosfomycin 1, 2
• A Canadian cost-minimization analysis found that the cost-per-patient for treating UTIs with fluoroquinolones was $98.85, compared to $105.12 for fosfomycin 2

Clinical Considerations Beyond Cost

Treatment Recommendations

• Despite its higher cost, fosfomycin has several advantages that may justify its use in specific situations:
  • Single-dose administration (3g once) improves compliance 5, 6
  • Effective against multidrug-resistant pathogens including ESBL-producing gram-negative bacteria 4
  • Low resistance profile with minimal cross-resistance to other antibiotics 6

Current Guidelines on UTI Treatment

• The Infectious Diseases Society of America (IDSA) recommends fosfomycin as a first-line agent for uncomplicated UTIs, despite its higher cost 4
• The European Association of Urology also recommends fosfomycin as a first-line option 5
• The WHO excluded fosfomycin from their essential medicines list for lower UTIs based on both efficacy and cost considerations 4

Cost-Effectiveness Thresholds

• Trimethoprim-sulfamethoxazole is generally the most cost-effective option when resistance is <30% 3
• When trimethoprim resistance exceeds 30-35%, fosfomycin becomes more cost-effective despite its higher price 3
• A 2017 cost-effectiveness analysis found that at trimethoprim resistance rates of ≥35%, both fosfomycin and nitrofurantoin become more cost-effective options 3

Practical Implications

• When selecting between fosfomycin and moxifloxacin for UTI treatment, consider:
  1. Local resistance patterns (particularly important for empiric therapy)
  2. Patient-specific factors (compliance concerns, allergy history)
  3. Cost considerations (fosfomycin being more expensive)
  4. FDA warnings about fluoroquinolones (including moxifloxacin) regarding serious adverse effects affecting tendons, muscles, joints, nerves, and the central nervous system 4

In conclusion, while fosfomycin carries a higher cost than moxifloxacin and other fluoroquinolones, its unique advantages in terms of resistance profile, single-dose administration, and safety may justify its use in specific clinical scenarios despite the price difference.