title: Cost Minimization Analysis of Different Strategies of Management of Clinically Significant Scorpion Envenomation Among Pediatric Patients.
abstract: OBJECTIVE
  Scorpion antivenom was recently approved for use in patients with clinically significant scorpion envenomation in the United States; no formal economic analysis on its impact on cost of management has been performed.
  
  
  METHODS
  Three different strategies of management of scorpion envenomation with systemic neurotoxic symptoms in children were compared for cost minimization from a societal perspective. In strategy I, patients were managed with supportive care only without antivenom. In strategy II, an aggressive strategy of full-dose antivenom (initial dose of 3 vials with the use of additional vials administered 1 vial at a time) was considered. In strategy III, a single-vial serial antivenom dosing strategy titrated to clinical response was considered. Clinical probabilities for the different strategies were obtained from retrospective review of medical records of patients with scorpion envenomation over a 10-year period at our institution. Baseline cost values were obtained from patient reimbursement data from our institution.
  
  
  RESULTS
  In baseline analysis, strategy I of supportive care only with no antivenom was least costly at US $3466.50/patient. Strategy III of single-vial serial dosing was intermediate but less expensive than strategy II of full-dose antivenom, with an incremental cost of US $3171.08 per patient. In a 1-way sensitivity analysis, at a threshold antivenom cost of US $1577.87, strategy III of single-vial serial dosing became the least costly strategy.
  
  
  CONCLUSIONS
  For children with scorpion envenomation, use of a management strategy based on serial dosing of antivenom titrated to clinical response is less costly than a strategy of initial use of full-dose antivenom.
authors.affiliation: From the *Department of Pediatrics, Arizona Children's Center at Maricopa Integrated Health System; and †Department of Emergency Medicine, Maricopa Integrated Health System; and ‡Department of Research, Maricopa Integrated Health System, Phoenix, AZ.
authors.forename: Madhumita
authors.initials: M
authors.lastname: Sinha
authors.forename: Dan
authors.initials: D
authors.lastname: Quan
authors.forename: Fred W
authors.initials: FW
authors.lastname: McDonald
authors.forename: André
authors.initials: A
authors.lastname: Valdez
mesh_terms: D000293:Adolescent; D000997:Antivenins / Q000008:administration & dosage* / Q000191:economics*; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis / Q000379:methods; D003661:Decision Support Techniques; D019468:Disease Management; D004334:Drug Administration Schedule; D006801:Humans; D007223:Infant; D012189:Retrospective Studies; D065008:Scorpion Stings / Q000188:drug therapy* / Q000191:economics*; D012604:Scorpion Venoms / Q000037:antagonists & inhibitors; D016896:Treatment Outcome; D014481:United States
chemical_list: D000997:Antivenins; D012604:Scorpion Venoms