Containing cefoxitin costs through a program to curtail use in surgical prophylaxis.

Area of Science:

• Pharmacoeconomics
• Infectious Disease Management
• Surgical Antibiotic Prophylaxis

Background:

• High drug costs associated with anti-anaerobic cephalosporins, particularly cefoxitin, necessitate cost-containment strategies.
• Cefoxitin was frequently used in surgical prophylaxis, contributing significantly to overall drug expenditures.

Purpose of the Study:

• To reduce hospital drug costs by decreasing the use of cefoxitin in surgical prophylaxis.
• To evaluate the impact of revised surgical prophylaxis guidelines on cefoxitin utilization and associated costs.

Main Methods:

• A comparative study was conducted in a tertiary care hospital, analyzing cefoxitin use before and after an intervention.
• Pharmacy records and chart reviews identified primary cefoxitin users and indications, guiding targeted cost containment.
• Hospital acquisition costs and grams of cefoxitin used were tracked quarterly.

Main Results:

• Surgery and obstetrics/gynecology departments were the main prescribers of cefoxitin, primarily for surgical prophylaxis (63%).
• Implementation of new guidelines led to a substantial decrease in quarterly cefoxitin use (from 6093g to 1316g) and costs (from $70,076 to $11,515).
• Cefazolin use increased to partially offset the reduction, with a smaller cost increase ($9,131).

Conclusions:

• Rationalizing cefoxitin use through guideline development is an effective first step in reducing hospital costs for anti-anaerobic cephalosporins.
• This approach is preferable to formulary interchange with alternatives like ceftizoxime or cefotetan for initial cost containment.
• Optimizing antibiotic prescribing practices can lead to significant pharmacoeconomic benefits.