Document Detail

Cost minimization analysis comparing enteral N-acetylcysteine to intravenous acetylcysteine in the management of acute acetaminophen toxicity.
MedLine Citation:
PMID:  20095817     Owner:  NLM     Status:  MEDLINE    
CONTEXT: Acetaminophen poisoning is one of the most common exposures and causes of poisoning-related fatalities as reported to U.S. poison information centers. Acetylcysteine is indicated for the antidotal treatment of acetaminophen poisoning to prevent or minimize acetaminophen-related hepatotoxicity. Available as either an enteral or intravenous (IV) formulation, both forms of acetylcysteine have been proven to be efficacious. Because of the differences in the acquisition costs and the length of treatment, it is unclear which treatment route is the most cost-effective. OBJECTIVE: The purpose of this study was to compare the total hospitalization charges associated with patients who received either enteral or IV acetylcysteine therapy. MATERIALS AND METHODS: A retrospective, IRB-approved cohort study of patients treated with either enteral or IV acetylcysteine at a university-related hospital for the treatment of acute acetaminophen overdose was conducted. Patients included were over 18 years of age, admitted during the 5-year periods of 1996-2000 (enteral) and 2004-2008 (IV), had an ICD-9 discharge diagnosis for acetaminophen overdose, had no transplant history, and were admitted within 24 h of the overdose. The primary endpoint was the total cost associated with the hospital stay. The Consumer Price Index (CPI) inflation calculator from the U.S. Bureau of Labor Statistics was used to adjust all monetary values to 2008 dollars. RESULTS: Of a total of 1,647 patients, 261 met the inclusion criteria with 70 patients being treated with enteral acetylcysteine and 191 patients treated with IV acetylcysteine. The associated cost was greater in the enteral group than in the IV group ($18,287.63 vs. $7,607.82; p < 0.001). The average length of stay was longer in the enteral group compared to the IV group (7 days vs. 4 days; p < 0.001). CONCLUSIONS: Patients who were treated with IV acetylcysteine had a decreased length of stay and cost of hospitalization compared with those patients who were treated with enteral acetylcysteine.
Jay L Martello; Tara L Pummer; Edward P Krenzelok
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Clinical toxicology (Philadelphia, Pa.)     Volume:  48     ISSN:  1556-9519     ISO Abbreviation:  Clin Toxicol (Phila)     Publication Date:  2010 Jan 
Date Detail:
Created Date:  2010-01-25     Completed Date:  2010-02-17     Revised Date:  2010-06-01    
Medline Journal Info:
Nlm Unique ID:  101241654     Medline TA:  Clin Toxicol (Phila)     Country:  England    
Other Details:
Languages:  eng     Pagination:  79-83     Citation Subset:  AIM; IM    
Department of Pharmacy and Therapeutics, West Virginia University School of Pharmacy, Morgantown, WV, USA.
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MeSH Terms
Acetaminophen / poisoning*
Acetylcysteine / administration & dosage*,  economics,  therapeutic use*
Administration, Oral
Analgesics, Non-Narcotic / poisoning*
Antidotes / administration & dosage*,  economics,  therapeutic use*
Chemistry, Pharmaceutical
Cohort Studies
Cost-Benefit Analysis
Costs and Cost Analysis
Drug-Induced Liver Injury / prevention & control
Infusions, Intravenous
Length of Stay
Liver Function Tests
Middle Aged
Retrospective Studies
Reg. No./Substance:
0/Analgesics, Non-Narcotic; 0/Antidotes; 103-90-2/Acetaminophen; 616-91-1/Acetylcysteine
Comment In:
Clin Toxicol (Phila). 2010 May;48(4):399; author 399-400   [PMID:  20507252 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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