title: Analysis of the use of digoxin immune fab for the treatment of non-life-threatening digoxin toxicity.
abstract: BACKGROUND
  Studies indicate that digoxin toxicity often results in lengthy hospitalizations and considerable costs, both of which may be decreased through the routine use of digoxin immune Fab (FAB).
  
  
  METHODS
  A computer-based decision analysis model was developed to compare the treatment of non-life-threatening digoxin toxicity with either FAB or standard therapy from the hospital perspective. A cost-minimization analysis was then performed to compare overall total costs (primary endpoint) for each treatment branch. A secondary endpoint of length of hospital stay (LOS) was also compared between the 2 groups. Clinical variables (serum digoxin concentration [SDC], creatinine clearance [Clcr], and body weight), event probabilities, and other model-specific variables were varied in univariate and multivariate sensitivity analyses.
  
  
  RESULTS
  FAB was associated with an incremental cost of $54 compared with standard therapy ($2,784 vs. $2,730, respectively) but reduced LOS by 1.5 days (1.5 days vs. 3.0 days, respectively). Sensitivity analyses show that FAB is less costly at SDC > 3.5 ng/mL and Clcr < 22 mL/min. FAB reduced LOS at SDC > 2.3 ng/mL. Monte Carlo simulation revealed that FAB was less costly in 37% of the cases and reduced LOS 72% of the time compared with standard therapy.
  
  
  CONCLUSIONS
  The abbreviated LOS associated with the use of FAB in patients with non-life-threatening digoxin toxicity may translate into lower treatment costs in many clinical scenarios, making it a cost-saving alternative to standard therapy in patients with high SDC and renal dysfunction.
authors.affiliation: Departments of Pharmacy Practice and Pharmacy Administration at the College of Pharmacy, University of Illinois at Chicago, IL, USA.
authors.forename: R J
authors.initials: RJ
authors.lastname: DiDomenico
authors.forename: S M
authors.initials: SM
authors.lastname: Walton
authors.forename: C A
authors.initials: CA
authors.lastname: Sanoski
authors.forename: J L
authors.initials: JL
authors.lastname: Bauman
mesh_terms: D002316:Cardiotonic Agents / Q000009:adverse effects*; D003363:Cost Control; D003658:Decision Making, Computer-Assisted; D004077:Digoxin / Q000009:adverse effects*; D017721:Hospital Costs; D006760:Hospitalization; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000191:economics / Q000627:therapeutic use*; D007902:Length of Stay
chemical_list: D002316:Cardiotonic Agents; D007140:Immunoglobulin Fab Fragments; D004077:Digoxin