A cost effectiveness analysis of the preferred antidotes for acute paracetamol poisoning patients in Sri Lanka

Abstract

BackgroundAcute paracetamol poisoning is a rapidly increasing problem in Sri Lanka. The antidotes are expensive and yet no health economic evaluation has been done on the therapy for acute paracetamol poisoning in the developing world. The aim of this study is to determine the cost effectiveness of using N-acetylcysteine over methionine in the management of acute paracetamol poisoning in Sri Lanka.MethodsEconomic analysis was applied using public healthcare system payer perspective.Costs were obtained from a series of patients admitted to the National Hospital of Sri Lanka with a history of acute paracetamol overdose. Evidence on effectiveness was obtained from a systematic review of the literature. Death due to hepatotoxicity was used as the primary outcome of interest. Analysis and development of decision tree models was done using Tree Age Pro 2008.ResultsAn affordable treatment threshold of Sri Lankan rupees 1,537,120/death prevented was set from the expected years of productive life gained and the average contribution to GDP. A cost-minimisation analysis was appropriate for patients presenting within 10 hours and methionine was the least costly antidote. For patients presenting 10-24 hours after poisoning, n-acetylcysteine was more effective and the incremental cost effectiveness ratio of Sri Lankan rupees 316,182/life saved was well under the threshold. One-way and multi-way sensitivity analysis also supported methionine for patients treated within 10 hours and n-acetylcysteine for patients treated within 10-24 hours as preferred antidotes.ConclusionsPost ingestion time is an important determinant of preferred antidotal therapy for acute paracetamol poisoning patients in Sri Lanka. Using n-acetylcysteine in all patients is not cost effective. On economic grounds, methionine should become the preferred antidote for Sri Lankan patients treated within 10 hours of the acute ingestion and n-acetylcysteine should continue to be given to patients treated within 10-24 hours.

Low rates of hepatotoxicity among Asian patients with paracetamol overdose: a review of 1024 cases

“…Although differences in the clinical characteritics of paracetamol overdose between Western and Asian patients are recognised, it is possible that intrinsic differences in paracetamol metabolism may be a contributory factor as well. Our data supports the findings from a recent study demonstrating that N-acetyl cysteine therapy is not cost-effective in the management of Asian patients with paracetamol overdose [26], and treatment algorithms developed in the West may not be appropriate in the East.…”

Effect of a Brief Outreach Educational Intervention on the Translation of Acute Poisoning Treatment Guidelines to Practice in Rural Sri Lankan Hospitals: A Cluster Randomized Controlled Trial

“…It had been anticipated that primary hospital use of methionine would have reduced the need for patients to be transferred to secondary hospitals following paracetamol poisoning. Inter-hospital transfers and antidote costs for paracetamol poisoning had been identified as the major driver of costs [28], [29]. As methionine was not available and there was no change in transfer rates the planned cost analysis was not performed.…”

Predicting the requirement for N-acetylcysteine in paracetamol poisoning from reported dose

“…3 N-acetylcysteine (NAC) is an effective treatment in the vast majority of cases if given early. 4–6 The decision to give NAC is usually based on a paracetamol concentration measured at least 4 h after ingestion or later if the patient presents to hospital after this time.…”