Ceftriaxone More Cost-Effective Than Standard Care for Post-Stroke Infection Prevention

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There were no differences between the ceftriaxone and standard care groups in terms of institutional care resources, out-of-pocket expenses, or productivity losses.

Ceftriaxone for the prevention of infection in patients with acute ischemic stroke is more cost-effective than standard care without preventive antimicrobial therapy, according to a randomized, open-label study published in Neurology.

In the Preventive Antibiotics in Stroke Study, a total of 2550 patients with acute stroke were randomly assigned to receive either ceftriaxone (n=1268) or standard treatment (n=1270). The investigators assessed and compared the economic advantages of each treatment over a span of 3 months. Specifically, investigators evaluated the volumes and costs of direct, indirect, medical, and nonmedical care. The cost per unit of the modified Rankin scale as well as the per quality-adjusted life-year (QALY) for cost utility and cost-effectiveness comprised the primary outcome.

There were no differences between the ceftriaxone and standard care groups in terms of institutional care resources (€9399 vs €9653, respectively; P =.577), out-of-pocket expenses (€68 vs €64, respectively; P =.537), or productivity losses (€1215 vs €1307, respectively; P =.481). A significant difference was observed between treatment and control groups for the number of QALYs (0.163 [95% CI, 0.159-0.166] vs 0.155 [95% CI, 0.152-0.158], respectively; difference 0.008 [95% CI, 0.003-0.012]; P =.006), leaning in favor of ceftriaxone at 3-month follow-up.

Additionally, ceftriaxone saved €5983 with the costs of productivity loss vs €4517 without the costs of productivity loss. If society were willing to pay extra contingent on a decreased modified Rankin scale, the probability of ceftriaxone being cost-effective was 0.89. Conversely, the probability of the treatment’s cost-effectiveness was 0.697 if society was not willing to pay the extra costs. If society is willing to pay per additional QALY, the probability of ceftriaxone’s cost-effectiveness ranged from 0.697 to 0.999.

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The use of QALYs during a 3-month time period limits the analysis of treatment benefit to the single time point.

In future research focused on the cost-effectiveness of antibiotics in patients with stroke at high risk for infection, the investigators suggest “the economic benefit must be weighed against the potential risk of antibiotic resistance development.”


Westendorp WF, Zock E, Vermeij JD, et al; for the PASS investigators. Preventive antibiotics in stroke study (PASS): a cost-effectiveness study. Neurology. 2018;90(18):e1553-e1560.