Michael Levine1, Sam Stellpflug2, Anthony F Pizon3, Stephen Traub4, Rais Vohra5, Timothy Wiegand6, Nicole Traub7, David Tashman8, Shoma Desai8, Jamie Chang9, Dhruv Nathwani3, Stephen Thomas10,11. 1. a Department of Emergency Medicine , Division of Medical Toxicology, University of Southern California , Los Angeles , CA , USA. 2. b Department of Emergency Medicine , Division of Medical Toxicology, Regions Healthcare , St. Paul , MN , USA. 3. c Department of Emergency Medicine , Division of Medical Toxicology, University of Pittsburgh , Pittsburgh , PA , USA. 4. d Department of Emergency Medicine , Mayo Clinic , Scottsdale , AZ , USA. 5. e Department of Emergency Medicine , UCSF Fresno Medical Center and the California Poison Control System , Fresno , CA , USA. 6. f Department of Emergency Medicine , University of Rochester Medical Center , Rochester , NY , USA. 7. g Department of Medicine , Division of Gastroenterology, Mayo Clinic , Scottsdale , AZ , USA. 8. h Department of Emergency Medicine , University of Southern California , Los Angeles , CA , USA. 9. i Department of Emergency Medicine , UCSF Fresno Medical Center , Fresno , CA , USA. 10. j Hamad General Hospital , Hamad Medical Corporation , Doha , Qatar. 11. k Emergency Department , Weill Cornell Medical College in Qatar , Doha , Qatar.
Abstract
BACKGROUND: Acetaminophen toxicity is common in clinical practice. In recent years, several European countries have lowered the treatment threshold, which has resulted in increased number of patients being treated at a questionable clinical benefit. OBJECTIVE: The primary objective of this study is to estimate the cost and associated burden to the United States (U.S.) healthcare system, if such a change were adopted in the U.S. METHODS: This study is a retrospective review of all patients age 14 years or older who were admitted to one of eight different hospitals located throughout the U.S. with acetaminophen exposures during a five and a half year span, encompassing from 1 January 2008 to 30 June 2013. Those patients who would be treated with the revised nomogram, but not the current nomogram were included. The cost of such treatment was extrapolated to a national level. RESULTS: 139 subjects were identified who would be treated with the revised nomogram, but not the current nomogram. Extrapolating these numbers nationally, an additional 4507 (95%CI 3641-8751) Americans would be treated annually for acetaminophen toxicity. The cost of lowering the treatment threshold is estimated to be $45 million (95%CI 36,400,000-87,500,000) annually. CONCLUSIONS: Adopting the revised treatment threshold in the U.S. would result in a significant cost, yet provide an unclear clinical benefit.
BACKGROUND:Acetaminophentoxicity is common in clinical practice. In recent years, several European countries have lowered the treatment threshold, which has resulted in increased number of patients being treated at a questionable clinical benefit. OBJECTIVE: The primary objective of this study is to estimate the cost and associated burden to the United States (U.S.) healthcare system, if such a change were adopted in the U.S. METHODS: This study is a retrospective review of all patients age 14 years or older who were admitted to one of eight different hospitals located throughout the U.S. with acetaminophen exposures during a five and a half year span, encompassing from 1 January 2008 to 30 June 2013. Those patients who would be treated with the revised nomogram, but not the current nomogram were included. The cost of such treatment was extrapolated to a national level. RESULTS: 139 subjects were identified who would be treated with the revised nomogram, but not the current nomogram. Extrapolating these numbers nationally, an additional 4507 (95%CI 3641-8751) Americans would be treated annually for acetaminophentoxicity. The cost of lowering the treatment threshold is estimated to be $45 million (95%CI 36,400,000-87,500,000) annually. CONCLUSIONS: Adopting the revised treatment threshold in the U.S. would result in a significant cost, yet provide an unclear clinical benefit.