US EPA

1230342 

Journal Article 

An economic analysis: Is fomepizole really more expensive than ethanol for the treatment of ethylene glycol poisoning? 

Shiew, CM; Dargan, PI; Greene, SL; Jones, AL 

2005 

1 

Clinical Toxicology
ISSN: 1556-3650
EISSN: 1556-9519 

Taylor & Francis Ltd., 11 New Fetter Lane London EC4P 4EE UK, [mailto:info@tandf.co.uk], [URL:http://www.tandf.co.uk] 

43 

6 (Oct 2005) 

690. 

Fomepizole offers many potential advantages over ethanol as an antidote for ethylene glycol (EG)/methanol poisoning. It is expensive and so hospitals can be reluctant to stock it. Ethanol therapy requires critical care nursing and frequent ethanol assays, which also have associated costs. This study aims to compare the real costs of these two antidotes in the management of EG poisoning. Costs were based on treating a patient at a teaching hospital in central London (UK). These include the costs of ethanol, a critical care bed and 2 hourly ethanol assays for a patient treated with ethanol vs. the costs of fomepizole and a general medical (GM) ward bed for a patient treated with fomepizole. These cases can be complex with a number of variables including treatment duration and patient weight, which greatly influence costs, we have therefore included two recent real case examples. A critical care bed day costs US$3093 compared to a GM ward bed day cost of US$468. Ethanol assays cost US$45 per assay. A box containing 5 x 100 mg vials of Fomepizole OPi is $667. Thus a 3 day course of fomepizole for a 70 kg adult on a GM ward would cost $7673 vs. 3 days ethanol therapy on ICU costing $10367. Two recent case examples: A 2 year old child weighing 14 kg who ingested methanol was treated with 390 mg of fomepizole over 50 hours on a GM ward, the total cost was $1469. Ethanol therapy on PICU would have cost $7092. A 27 year old female weighing 65 kg with EG poisoning was treated with IV ethanol on ICU for 44 hours, costing $7092. Fomepizole therapy on a GM ward would have cost $4937. Despite the higher drug cost of fomepizole vs. ethanol, the additional expenses associated with ethanol therapy mean that fomepizole is often cheaper, particularly in pediatric patients due to the lower total doses of fomepizole. The overall costs of both therapies should be considered and not just the upfront drug costs. Additionally, fomepizole is well tolerated, easy to administer and has predictable kinetics. Clinical toxicologists need to reconsider which of these two agents should be the antidote of choice for EG and methanol poisoning.