94 Cost Impact of Hydroxocobalamin as Treatment for Patients With Known or Suspected Cyanide Toxicity Due to Smoke Inhalation Injury

Abstract

Cyanide toxicity can occur in persons who are exposed to smoke in a closed-space fire. Hydroxocobalamin (HC) is a cyanide antidote indicated for treatment in persons with known or suspected cyanide poisoning including that due to smoke inhalation. The objective of the present analysis was to estimate the cost impact of outcomes with administration of HC compared to historical controls not receiving cyanide antidote. A one-year economic model was developed to assess treatment cost differences for individuals who received or did not receive HC for known or suspected cyanide toxicity due to smoke inhalation. Nearly all surviving patients who were transported to the emergency department (ED) were intubated prior to admission to the intensive care unit (ICU). Clinical outcomes (ie, pre-ICU intubation, pneumonia or in-hospital mortality) and health care resource utilization (ie, ICU and hospital length of stay [LOS], and duration of mechanical ventilation [MV]) were estimated by Nguyen, et al. (2017) in a prospective cohort analysis that compares outcomes in HC-treated individuals [2008-2014] to a historical control [2002-2008]). Cost parameters were estimated using published literature and publicly-available hospital charges. All charges were adjusted to reflect costs by applying a cost-to-charge ratio based on data from the Healthcare Cost and Utilization Project. Results are reported as per-patient cost of treatment as well as total days of care based on nearly 16,000 fire-related injuries in the US in 2014 (US Fire Administration 2014). The per-patient cost of treatment was estimated to decrease by $7,227 with the use of HC (HC, $15,381; no HC, $22,608). The primary drivers of this cost difference were days spent in the ICU (HC, 6 days; no HC, 10 days; $8,203 vs $13,671) and non-ICU hospital days (HC, 7 days; no HC, 11 days; $3,997 vs $6,281). Cost-savings were also observed from a reduction in number of MV days (HC, 4 days; no HC, 7 days; $1,616 vs $1,892). Use of HC also contributed to a reduction in the number of pneumonia cases. Differences in costs and clinical outcomes are reported in the table below.Tabled 1OutcomeHydroxocobalamin (HC)No Cyanide AntidoteDifferencePer-patient costs (US dollars) Hydroxocobalamin$800$0$800 ED admission$763$763$0 ICU$8,203$13,671-$5,468 Non-ICU$3,997$6,281-$2,284 MV$1,618$1,892-$275 Total Cost$15,381$22,608-$7,227National impact (based on 15,775 fire injuries per year) ICU LOS, days78,749131,248-52,499 Hospital LOS, days91,874144,373-52,499 Patients with MV11,79312,250-457 Duration of MV, days47,17385,749-38,575 Pneumonia, cases2,9486,417-3,468 Open table in a new tab Use of HC in the out-of-hospital setting, as treatment of known or suspected cyanide poisoning, may provide cost-savings through decreases in ICU and hospital LOS; these provide the largest source of benefit, and are expected to offset the cost of HC. Further observational studies are needed to show the benefit of HC on both short- and long-term clinical outcomes (eg, neurological sequelae and cardiovascular outcomes) with cyanide exposure.