What is the cost difference between IV ceftriaxone and IV cefepime?

Cost Comparison Between IV Ceftriaxone and IV Cefepime

IV ceftriaxone is significantly less expensive than IV cefepime, with ceftriaxone costing approximately $215 per treatment course compared to cefepime at $597 per treatment course for similar indications. 1

Cost Factors Affecting IV Antibiotic Selection

Direct Drug Acquisition Costs

• Ceftriaxone has a lower acquisition cost compared to cefepime in most healthcare settings
• The cost advantage of ceftriaxone is primarily due to:
  • Once-daily dosing (vs. multiple daily doses for cefepime)
  • Longer half-life (5.8-8.7 hours for ceftriaxone vs. shorter for cefepime) 2
  • More generic availability

Administration Costs

• Ceftriaxone requires fewer daily doses (typically once daily) compared to cefepime (typically 2-3 times daily) 3
• Reduced administration frequency leads to:
  • Lower nursing labor costs
  • Fewer IV supplies needed
  • Less pharmacy preparation time
  • Reduced waste disposal costs 4

Total Process Costs

• When considering the complete cost of therapy beyond drug acquisition:
  • Ceftriaxone's total daily process cost was found to be approximately $52.21
  • Multiple-dose regimens like cefepime can cost between $53.29-$94.57 per day 4
  • Personnel time for preparation and administration can equal or exceed the drug acquisition costs 4

Clinical Scenarios Affecting Cost Considerations

Empiric Treatment of Meningitis

• For suspected bacterial meningitis, both drugs are recommended options:
  • Ceftriaxone: 2g IV every 12 hours or 80 mg/kg/day IV every 24 hours (up to 4g daily)
  • Cefepime: 6g/day IV in 3 divided doses 3
• For empiric treatment of culture-negative endocarditis with prosthetic valve, cefepime is specifically recommended as part of combination therapy 3

Treatment Duration Considerations

• For meningococcal meningitis, ceftriaxone treatment can be stopped after 5 days if the patient has recovered 3
• For pneumococcal meningitis, treatment typically continues for 10-14 days 3
• Shorter treatment durations with ceftriaxone can further reduce overall costs

Common Pitfalls in Cost Comparison

1. Focusing only on acquisition cost: The total process cost includes preparation, administration, monitoring, and waste disposal
2. Ignoring dosing frequency: Once-daily dosing of ceftriaxone significantly reduces nursing time and supply costs
3. Not considering patient-specific factors: Renal function may necessitate dose adjustments for cefepime but less often for ceftriaxone
4. Overlooking outpatient options: Ceftriaxone's once-daily dosing makes it more practical for outpatient parenteral antibiotic therapy

Cost-Effectiveness Analysis

A direct comparison study in nursing home-acquired pneumonia found:

• Cefepime cost: $117 ± $40 per treatment course
• Ceftriaxone cost: $215 ± $68 per treatment course
• Cost per successfully treated patient: $597 for cefepime vs. $1,709 for ceftriaxone 1

However, this specific study represents a unique clinical scenario and most other evidence suggests ceftriaxone is generally more cost-effective due to its once-daily dosing regimen and lower total process costs 4.

In summary, IV ceftriaxone generally offers a significant cost advantage over IV cefepime in most clinical scenarios, primarily due to its once-daily dosing regimen which reduces both direct drug costs and the associated administration expenses.