Michelle S.

Tolentino 2F-Pharmacy

Source: Goldfrank's Toxicologic Emergencies (Chapter 135. Poison Centers and Poison Epidemiology)
http://www.accesspharmacy.com/Content.aspx?searchStr=cost+effectiveness&aid=6534136

HEALTHCARE SAVINGS

By: Robert S. Hoffman

When visits to pediatric EDs for acute poisoning were analyzed, one study demonstrated that 95% of parents had not contacted the PC before coming to the hospital and 64% of those children required no hospital services.19 In contrast, when parents called the PC first, fewer than 1% sought emergency services afterward. When 589 callers to one PC were surveyed, 464 (79%) stated that they would have used the emergency care system if the PC were unavailable.43 In a similar, more recent study 36% of callers would have selected a more costly alternative if the PC were unavailable.7 Poison center data confirm that approximately 75% of reported exposures that originate outside of healthcare facilities can be safely managed onsite with limited telephone follow up. Suggesting simple techniques or reassurance can successfully reduce hospital visits for patients who typically call PCs which, as defined, may only represent a potential exposure. Unfortunately, this approach is less applicable to adults and the population as a whole. Limited data suggest that direct bedside consultation and care help reduce length of hospital stay and healthcare costs.26 In a recent assessment, consult with a PC for patients already in hospital is associated with a significant decrease in length of stay and total health care costs.11,80 The national average cost to the PC for a single human exposure call is on the order of $35.90 A federally funded study concluded that in 1 year PCs reduced the number of patients who were treated but not hospitalized by 350,000 and reduced hospitalizations by an additional 40,000 patients.63 Each call to a PC prevented at least $175 in subsequent medical costs, providing strong theoretical evidence to support the cost efficacy of PCs. In fact, two natural experiments support these calculations: In 1988, Louisiana closed its state-sponsored PC. During the year that followed, the cost of emergency medical services for poisoning in Louisiana increased by more than $1.4 million. This additional expenditure represented a greater than 3-fold increase above the operating cost of that center.45 Similarly, because of financial disputes in California, direct access to the San Francisco PC was electronically restricted for one major county, with a recording referring callers instead to the 911 system for assistance. 67 The result of each blocked call was to increase healthcare costs by approximately $33. Moreover, these calculations cannot account for the unmeasured benefits to society from PC

interventions that reduce waiting times for ambulance availability and hospital treatments because of lower volumes, money saved by the prevention or reduction of injury from early intervention, or lives saved by enhancing access to or utilization of the healthcare system for seriously poisoned patients. However, many barriers prevent a person from calling a PC, including lack of familiarity with its available services, intellectual and cultural factors, language difficulties, and confidentiality concerns.25,44,81Epidemiological studies demonstrate that areas of increased population density with high percentages of minority inhabitants have lower utilization of PC services.79 Additional barriers include the absence of caregiver comfort with the extensive personal contact provided by the healthcare system and a concern regarding implications of child abuse or neglect when reporting to agencies such as PC, many of which have governmental ties.73 Data demonstrate that public educators can help overcome some of these barriers.76One good example of an effort to overcome reporting barriers was the institution of a single national toll-free number for poisoning (1-800-222-1222). Although it is clear that this intervention improved access and increased total calls to the PC,48 it has yet to be determined if this has altered the patterns of use.