Is scorpion antivenom cost-effective as marketed in the United States?

Edward P Armstrong, Maja Bakall, Grant H. Skrepnek, Leslie V Boyer

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Purpose The purpose of this study was to analyze the cost-effectiveness of scorpion antivenom compared to no antivenom, in the United States, using a decision analysis framework. Methods A decision analytic model was created to assess patient course with and without antivenom. Costs were determined from the perspective of a health care payer. Cost data used in the model were extracted from Arizona Medicaid. The probability of clinical events occurring with and without antivenom was obtained from the published literature, medical claims obtained from Arizona Medicaid, and results of recent clinical trials. Patients that became so ill that mechanical ventilator support was necessary were considered treatment failures. A Monte Carlo simulation was run 1000 times and sampled simultaneously across all variable distributions in the model. Results The mean success rate was 99.87% (95% CI 99.64%-99.98%) with scorpion antivenom and 94.31% (95% CI 91.10%-96.61%) without scorpion antivenom. The mean cost using scorpion antivenom was $10,708 (95% CI $10,556 - $11,010) and the mean cost without scorpion antivenom was $3178 (95% CI $1627 - $5184). Since the 95% CIs do not overlap for either the success or cost, use of the scorpion antivenom was significantly more effective and significantly more expensive than no antivenom. Cost-effectiveness analysis found that the scorpion antivenom was not cost-effective at its current price as marketed in the United States. Conclusion The scorpion antivenom marketed in the United States is extremely effective, but too costly to justify its use in most clinical situations. Formulary committees should restrict the use of this antivenom to only the most severe scorpion envenomations.

Original languageEnglish (US)
Pages (from-to)394-398
Number of pages5
JournalToxicon
Volume76
DOIs
StatePublished - Dec 15 2013

Fingerprint

Antivenins
Scorpions
Costs and Cost Analysis
Costs
Medicaid
Cost effectiveness
Cost-Benefit Analysis
Pharmacy and Therapeutics Committee
Decision Support Techniques
Decision theory
Mechanical Ventilators
Treatment Failure
Health care

Keywords

  • Cost-effectiveness
  • Costs
  • Envenomation
  • Scorpion antivenom

ASJC Scopus subject areas

  • Toxicology

Cite this

Is scorpion antivenom cost-effective as marketed in the United States? / Armstrong, Edward P; Bakall, Maja; Skrepnek, Grant H.; Boyer, Leslie V.

In: Toxicon, Vol. 76, 15.12.2013, p. 394-398.

Research output: Contribution to journalArticle

Armstrong, Edward P ; Bakall, Maja ; Skrepnek, Grant H. ; Boyer, Leslie V. / Is scorpion antivenom cost-effective as marketed in the United States?. In: Toxicon. 2013 ; Vol. 76. pp. 394-398.
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abstract = "Purpose The purpose of this study was to analyze the cost-effectiveness of scorpion antivenom compared to no antivenom, in the United States, using a decision analysis framework. Methods A decision analytic model was created to assess patient course with and without antivenom. Costs were determined from the perspective of a health care payer. Cost data used in the model were extracted from Arizona Medicaid. The probability of clinical events occurring with and without antivenom was obtained from the published literature, medical claims obtained from Arizona Medicaid, and results of recent clinical trials. Patients that became so ill that mechanical ventilator support was necessary were considered treatment failures. A Monte Carlo simulation was run 1000 times and sampled simultaneously across all variable distributions in the model. Results The mean success rate was 99.87{\%} (95{\%} CI 99.64{\%}-99.98{\%}) with scorpion antivenom and 94.31{\%} (95{\%} CI 91.10{\%}-96.61{\%}) without scorpion antivenom. The mean cost using scorpion antivenom was $10,708 (95{\%} CI $10,556 - $11,010) and the mean cost without scorpion antivenom was $3178 (95{\%} CI $1627 - $5184). Since the 95{\%} CIs do not overlap for either the success or cost, use of the scorpion antivenom was significantly more effective and significantly more expensive than no antivenom. Cost-effectiveness analysis found that the scorpion antivenom was not cost-effective at its current price as marketed in the United States. Conclusion The scorpion antivenom marketed in the United States is extremely effective, but too costly to justify its use in most clinical situations. Formulary committees should restrict the use of this antivenom to only the most severe scorpion envenomations.",
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N2 - Purpose The purpose of this study was to analyze the cost-effectiveness of scorpion antivenom compared to no antivenom, in the United States, using a decision analysis framework. Methods A decision analytic model was created to assess patient course with and without antivenom. Costs were determined from the perspective of a health care payer. Cost data used in the model were extracted from Arizona Medicaid. The probability of clinical events occurring with and without antivenom was obtained from the published literature, medical claims obtained from Arizona Medicaid, and results of recent clinical trials. Patients that became so ill that mechanical ventilator support was necessary were considered treatment failures. A Monte Carlo simulation was run 1000 times and sampled simultaneously across all variable distributions in the model. Results The mean success rate was 99.87% (95% CI 99.64%-99.98%) with scorpion antivenom and 94.31% (95% CI 91.10%-96.61%) without scorpion antivenom. The mean cost using scorpion antivenom was $10,708 (95% CI $10,556 - $11,010) and the mean cost without scorpion antivenom was $3178 (95% CI $1627 - $5184). Since the 95% CIs do not overlap for either the success or cost, use of the scorpion antivenom was significantly more effective and significantly more expensive than no antivenom. Cost-effectiveness analysis found that the scorpion antivenom was not cost-effective at its current price as marketed in the United States. Conclusion The scorpion antivenom marketed in the United States is extremely effective, but too costly to justify its use in most clinical situations. Formulary committees should restrict the use of this antivenom to only the most severe scorpion envenomations.

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