Background This study investigates potential cost reduction by replacing erythromycin with azithromycin for managing PPROM. Effective strategies are vital due to the high risks associated with PPROM. Targeting Hispanic PPROM patients at Centro Medico Episcopal San Lucas in Ponce, Puerto Rico, this research focuses on comparing the cost-effectiveness of azithromycin and erythromycin in extending pregnancy latency.

Methods Using a retrospective study design with predictive model elements, patient data from 2020 to 2021 at Centro Medico Episcopal San Lucas was analyzed, projecting the expected number of PPROM diagnoses in 2022. Detailed cost data for azithromycin and erythromycin were obtained from hospital’s pharmacy. Costs for erythromycin encompassed the 250mg IV bag and vial, 100 mL saline bag, primary line for initial dosing, and erythromycin 500 mg tablets for treatment continuation. Azithromycin costs were evaluated for each dosing tablet (1g, 250mg, and 500mg). Average total cost of treatment per year was computed based on the projected number of PPROM patients in 2022. Statistical analysis, including a 95% confidence interval, guided the estimation of the sample size.

Results The expected number of patients with PPROM in 2022 at Centro Médico Episcopal San Lucas is 136 patients. The combined IV and PO erythromycin regimen, incurs a per- patient cost of $449.30, resulting in a total cost of $60,880 for 136 expected PPROM cases in 2022. In contrast, azithromycin costs per patient varies from $1.16 (1g = 4 tablets of 250mg) and $0.98 (1g = 2 tablets of 500mg) with an estimated total cost of $163.50 and $132.80, respectively, for 136 average expected patients in 2022. A population size of 114 measurements are needed for the confidence level to be at 95%. A 99% cost reduction is projected if azithromycin is employed as standard of care for PPROM compared to erythromycin. The economic advantage of azithromycin lies in its lower cost and single-dose regimen, which is effective for managing PPROM. This regimen benefits from improved pharmacokinetics, slower elimination, and rapid intracellular uptake and concentration.

Conclusion In conclusion, our study provides insights into the potential cost- reduction with the substitution of azithromycin for erythromycin as the standard treatment for PPROM, without compromising clinical efficacy. This study lays the groundwork for conducting a larger clinical trial to further evaluate the safety, efficacy and economic benefits of this treatment approach. The findings of such a trial could have significant implications for optimizing PPROM management protocols and improving healthcare resource utilization.