Analysis of the use of digoxin immune fab for the treatment of non-life-threatening digoxin toxicity.
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.
DiDomenico
R J
RJ
Departments of Pharmacy Practice and Pharmacy Administration at the College of Pharmacy, University of Illinois at Chicago, IL, USA.
Walton
S M
SM
Sanoski
C A
CA
Bauman
J L
JL
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
D002316:Cardiotonic Agents; D007140:Immunoglobulin Fab Fragments; D004077:Digoxin