COST-EFFECTIVENESS DECISION-ANALYSIS OF INTRAMUSCULAR CEFTRIAXONE VERSUS ORAL CEFIXIME IN ADOLESCENTS WITH GONOCOCCAL CERVICITIS

Study objective: We compared the cost-effectiveness of two single-dose treatment strategies for adolescents with uncomplicated Neisseria gon orrhoeae cervicitis. Methods: We used a cost-effectiveness decision-an alysis model to compare the two methods: the standard, ceftriaxone 125 mg given by IM injection; and an alternative, cefixime 400 mg given o rally. The effect of the costs associated with the risk of accidental needlestick during IM administration was also evaluated. Key baseline assumptions (with ranges, when tested) were from the literature or cos ts to our hospital. These included ceftriaxone, $8.60 per dose; cefixi me, $4.67 per dose; ceftriaxone efficacy, 98% (range, 94.9% to 100%); cefixime efficacy, 97% (94.1% to 100%); and a 15% probability of pelvi c inflammatory disease (PID) related to failed treatment. We included costs for PID necessitating hospitalization, disseminated gonococcal i nfection, infertility, and ectopic pregnancy. Assumptions related to a ccidental needlestick included the rate of needlesticks with the dispo sable syringe, 6.9 per 100,000 injections (range, 0 to 69); cost of ac cidental needlestick to hospital; risk of HIV seroconversion after nee dlestick exposure to HIV-infected blood, .36% (range, 0% to .86%); rat e of HIV infection in 15- to 19-year-olds attending sexually transmitt ed diseases clinics, .4% (range, 0 to 5); and lifetime treatment costs for a person with HIV. Results: At baseline values the model favored ceftriaxone ($45 per patient) over cefixime ($59 per patient). However , over the range of efficacy of both drugs, two-way sensitivity analys is revealed no consistent cost advantage for either drug. The model wa s also insensitive to the economic effects associated with the risk of accidental needlestick during IM injection. Conclusion: Over the rang e of efficacy defined by the 95% confidence intervals of both drugs, o ur analysis demonstrated no clear cost advantage for either. The econo mic effects of accidental needlestick do not change this conclusion. C ompared with the IM alternative, oral cefixime is painless to the pati ent and simpler for the practitioner to administer. Oral cefixime also eliminates the psychologic effects associated with needlesticks in he alth care workers. For these reasons, we favor the use of oral cefixim e for uncomplicated gonococcal cervicitis in adolescents.