US EPA

1230439 

Journal Article 

Cost-effectiveness of fomepizole versus ethanol in the management of acute ethylene glycol exposure 

Marraffa, JM; Stork, CM; Medicis, JJ 

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) 

691. 

Many hospital pharmacies do not stock fomepizole due to the high drug acquisition cost and lack of consensus as to whether ethanol or fomepizole is preferred for the treatment of methanol and ethylene glycol poisoning. The objective of this study is to determine the cost per ADE (adverse drug event) avoided when using either intravenous fomepizole or ethanol in the treatment of acute ethylene glycol exposure; over a 24-h period. Using decision tree pharmacoeconomic analysis, our model used a hypothetical cohort of ethylene glycol exposed patients and considered comparative costs between fomepizole and ethanol as well as a breakdown of the occurrence of incidences of ADEs within the adult and pediatric population over a 24 hour period. The probability of occurrences of ADEs was determined from literature-based references. The outcome costs of each ADE was calculated by multiplying the direct/indirect cost (the cost of no ADE plus cost of ADE) with the probability associated with the respective ADE. We compared direct costs, indirect costs and costs related to treating the ADEs for each line of therapy. Direct/Indirect costs for ethanol therapy and fomepizole therapy within the reference case were $1,272.20 and $4,605.50, respectively. Effectiveness in preventing ADEs between ethanol and fomepizole was 0.061 and 0.813. We observed a lower cost per ADE avoided in our model (Fomepizole $5,413 per ADE avoided versus Ethanol $10, 775 per ADE avoided). Despite the higher acquisition cost of fomepizole compared to ethanol, the frequencies of ADEs are considerably lower resulting in a more cost-effective model for fomepizole compared to ethanol in the management of acute ethylene glycol exposure.