Socioeconomic and Cost Analysis of Off-Label Nebulized Ciprofloxacin-Dexamethasone Use Following Airway Surgery

Nebulized ciprofloxacin-dexamethasone (CPD) is an adjuvant, off-label treatment used to optimize healing after airway surgery, but there is limited data regarding its accessibility. This study examined socioeconomic factors influencing CPD utilization and assessed its cost.

Retrospective chart review.

Single institution tertiary care center.

All patients prescribed nebulized CPD after endoscopic airway surgery from 2021 to 24 by a single surgeon were analyzed for associations between CPD access and socioeconomic factors including insurance type and Area Deprivation Index (ADI). The typical regimen was 2 mL CPD ophthalmic solution nebulized twice daily for 4 weeks. A model to estimate CPD cost combined retail pricing from GoodRx with cost-sharing calculations from Medicare plans including Aetna, Blue Cross Blue Shield (BCBS), and Cigna, incorporating co-pays, coinsurance, and deductibles.

Out of 59 patients prescribed CPD postoperatively, 52 (88.1%) filled their prescription. Patients with Medicaid and Medicare were less likely to access CPD than those with commercial insurance (P = .037). There was no association between ADI and CPD utilization (P = .514). CPD otic and ophthalmic solutions cost $420 and $255, respectively, utilizing GoodRx without insurance. The estimated price of CPD otic solution for patients with Medicare Advantage PPO plans was $340 (Aetna), $1362 (BCBS), and $47 (Cigna), whereas the ophthalmic solution cost $53, $51, and $40, respectively.

Nebulized CPD was utilized by most patients regardless of ADI, but less accessible for those with Medicaid and Medicare. Prescribing the ophthalmic formulation instead of otic may significantly reduce cost and promote more equitable care postoperatively.