Medical Education and Research Alliance of America, Inc., 145 West 58th Street, New York, NY 10019, USA.
J Med Econ. 2009;12(4):384-91. doi: 10.3111/13696990903435829.
Acetaminophen (APAP) overdose, which can lead to hepatotoxicity, is the most commonly reported poisoning in the United States and has the highest rate of mortality, with more than 100,000 exposures and 300 deaths reported annually (1) . The treatment of choice, N-acetylcysteine (NAC), is effective in both oral (PO) and intravenous (IV) formulations. The main difference in therapies, other than administration route, is time to complete delivery--72 hours for PO NAC versus 21 hours for IV NAC, according to full prescribing information. This distinction is the primary basis for variation in management costs for hospitalized patients receiving these products.
To quantify and compare full treatment costs from the provider perspective to manage acute APAP poisoning with either PO or IV NAC in a standard treatment regimen.
A cost model was developed and populated with published data comprising probabilities of potential clinical outcomes and the costs of resources consumed during patient care.
For patients who present <10 hours post-ingestion, the estimated total cost of care with PO NAC in the treatment regimen is $5,817 (ICU patients) or $3,850, (ward patients) compared with $3,765 and $2,768 for similar care with IV NAC. Potential cost savings equal - $2,052 (-35%) or -$1,083 (-28%), respectively, in favor of IV NAC. Similar potential savings were estimated for patients presenting 10-24 hours post-ingestion.
IV NAC is the less costly therapeutic option for APAP poisonings, based on simulation modeling and retrospective data. The current economic evaluation is restricted by the absence of comparative data from head-to-head, matched-cohort studies and the limitations common to retrospective APAP toxicology datasets. Additional research could refine these results.
对乙酰氨基酚（APAP）过量会导致肝毒性，是美国最常见的中毒报告，死亡率最高，每年报告超过 10 万例中毒，300 例死亡（1）。首选的治疗方法是 N-乙酰半胱氨酸（NAC），无论是口服（PO）还是静脉内（IV）制剂都有效。除了给药途径之外，治疗方法的主要区别是完成给药的时间 - PO NAC 为 72 小时，IV NAC 为 21 小时，根据完整的处方信息。这一区别是接受这些产品治疗的住院患者管理成本差异的主要基础。
从提供者的角度量化和比较使用 PO 或 IV NAC 进行标准治疗方案管理急性 APAP 中毒的全治疗成本。
开发了一个成本模型，并使用包含潜在临床结果概率和患者护理期间消耗资源成本的已发表数据进行填充。
对于摄入后 <10 小时就诊的患者，PO NAC 治疗方案中的估计总治疗费用为 5817 美元（ICU 患者）或 3850 美元（病房患者），而 IV NAC 的类似治疗费用为 3765 美元和 2768 美元。分别有利于 IV NAC 的潜在成本节约为 -2052 美元（-35%）或-1083 美元（-28%）。对于摄入后 10-24 小时就诊的患者，估计也有类似的潜在节省。
基于模拟建模和回顾性数据，IV NAC 是 APAP 中毒治疗的成本较低的选择。目前的经济评估受到缺乏头对头、匹配队列研究的比较数据以及回顾性 APAP 毒理学数据集的常见限制的限制。进一步的研究可以改进这些结果。
