OBJECTIVES: The efficacy and safety of cefoperazone sulbactam vs. ceftazidime + amikacin + metronidazole in the treatment of intra-abdominal infections was assessed in a prospective multi-centre study in India.  Pharmacoeconomic analysis was included as a secondary endpoint to assess cost effectiveness of the two arms.METHODS: This prospective, open label, phase IV study was conducted across 17 institutes (included private and government/ municipal hospitals) across India and randomized subjects to receive either cefoperazone-sulbactam or the combination. Pharmacoeconomic analysis was conducted in the clinical efficacy-evaluable (CEE) and the successfully treated patients.  All comparisons between treatment groups were conducted using analysis of variance (ANOVA) or Wilcoxon Two-Sample tests.  All costs were reported as Indian Rupee (INR) and actual unit costs were used for the analyses.  RESULTS: In the CEE and the successfully treated subset of patients the average cost of treatment was numerically lower in the cefoperazone-sulbactam arm (not statistically significant). The analyses found that the cost effectiveness ratio (CER) for cefoperazone-sulbactam was INR 17,640.53 and that for the comparator group was INR 22,075.16. Also, as expected the average cost for treatment was higher in a private setting as compared to the government institutes.  Additionally, the incremental cost effectiveness ratio (ICER) results showed that the cost of treatment was INR 21,505.59 lower per additional successfully treated patient in the cefoperazone-sulbactam group. CONCLUSIONS: The present abstract is one of the primary studies on cost effectiveness in intra-abdominal infections to be conducted in the “cost sensitive” Indian healthcare scenario. Though the study was not powered for the difference in average cost of treatments, there was a trend favoring cefoperazone sulbactam.  This study should further the conduct of similar analyses across therapeutic areas and increase the awareness regarding pharmacoeconomics in India.