title: Cost-effectiveness of hospital treatment and outcomes of acute methanol poisoning during the Czech Republic mass poisoning outbreak.
abstract: During an outbreak of mass methanol poisoning in the Czech Republic in 2012-2014, we compared the total hospital costs and one-year medical costs in the patients treated with different antidotes (fomepizole versus ethanol) and modalities of hemodialysis (intermittent hemodialysis, IHD, versus continuous renal replacement therapy, CRRT).
  
  
  
  Cross-sectional study in 106 patients with confirmed diagnosis treated in 30 ICU settings. For each patient, the following data were analyzed: admission laboratory data, GCS, PSS, ICU length of stay, organ failures, treatment, outcome, and total hospital costs. Of 83 survivors, in 54 (65%) patients the follow-up examination, quality of life measurement with SF36 questionnaire two years after discharge, and one-year medical costs analysis were performed.
  
  
  
  The median total hospital costs were 7200 (IQR 1500-10,900) euros and the median one-year medical costs were 1447 (IQR 133-1163) euros in the study population. The total hospital costs were higher in the patients treated with fomepizole comparing to ethanol: 12,890 (IQR 6910-16,210) versus 5590 (IQR 1430-6940) euros (p<0.001). The hospital costs in the patients treated with IHD were 5400 (IQR 1520-6910) versus 12,410 (IQR 5380-16,960) euros in the patients with CRRT (p=0.317). The geometric mean ratio for increased hospital costs in the patients treated with fomepizole versus ethanol adjusted for the severity of poisoning was 3.30 (1.70-3.80 CI 95%), p<0.001, and in the patients treated with IHD versus CRRT - 0.70 (0.60-0.99 CI 95%), p=0.047. The patients with visual sequelae had higher total hospital costs than those without sequelae: 10,419 (IQR 2984-14,355) versus 4605 (IQR 1303-4505) euros (p=0.009). The patients with GCS≤13 on admission had higher one-year medical costs as well (p<0.001). No difference was found in physical and mental condition scores in the patients treated with different antidotes and modalities of hemodialysis two years after discharge (both p>0.05).
  
  
  
  The total hospital costs in the patients with acute methanol poisoning were more than three times higher in the patients treated with fomepizole than in the patients treated with ethanol after adjustment for the severity of poisoning. The dialysis modality did not affect the total hospital costs, but the trend to lower costs was present in IHD-group.
authors.affiliation: Department of Anesthesia and Intensive Care, 1st Faculty of Medicine, Charles University and General University Hospital, U Nemocnice 2, 120 00 Prague 2, Czech Republic. Electronic address: Jan.Rulisek@vfn.cz.
authors.forename: Jan
authors.initials: J
authors.lastname: Rulisek
authors.affiliation: Department of Anesthesia and Intensive Care, 1st Faculty of Medicine, Charles University and General University Hospital, U Nemocnice 2, 120 00 Prague 2, Czech Republic. Electronic address: Martin.Balik@vfn.cz.
authors.forename: Martin
authors.initials: M
authors.lastname: Balik
authors.affiliation: Department of Anesthesia and Intensive Care, 1st Faculty of Medicine, Charles University and General University Hospital, U Nemocnice 2, 120 00 Prague 2, Czech Republic. Electronic address: Ferdinand.Polak@vfn.cz.
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Polak
authors.affiliation: Department of Anesthesia and Intensive Care, 3rd Faculty of Medicine, Charles University and Royal Vinohrady Teaching Hospital, Prague, Czech Republic. Electronic address: petrwaldauf@gmail.com.
authors.forename: Petr
authors.initials: P
authors.lastname: Waldauf
authors.affiliation: Department of Occupational Medicine, 1st Faculty of Medicine, Charles University and General University Hospital, Toxicological Information Centre, Na Bojisti 1, 120 00 Prague 2, Czech Republic. Electronic address: Daniela.pelclova@lf1.cuni.cz.
authors.forename: Daniela
authors.initials: D
authors.lastname: Pelclova
authors.affiliation: 2nd Department of Cardiology and Angiology, 1st Faculty of Medicine, Charles University and General University Hospital, U Nemocnice 2, 120 00 Prague 2, Czech Republic. Electronic address: jan.belohlavek@vfn.cz.
authors.forename: Jan
authors.initials: J
authors.lastname: Belohlavek
authors.affiliation: Department of Occupational Medicine, 1st Faculty of Medicine, Charles University and General University Hospital, Toxicological Information Centre, Na Bojisti 1, 120 00 Prague 2, Czech Republic. Electronic address: Sergey.Zakharov@vfn.cz.
authors.forename: Sergey
authors.initials: S
authors.lastname: Zakharov
mesh_terms: D000328:Adult; D000437:Alcoholism; D000931:Antidotes / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003430:Cross-Sectional Studies; D018153:Czech Republic; D004196:Disease Outbreaks; D004469:Economics, Hospital; D000431:Ethanol / Q000627:therapeutic use; D005260:Female; D000077604:Fomepizole; D017048:Health Care Costs; D017721:Hospital Costs; D006760:Hospitalization; D006801:Humans; D008297:Male; D000432:Methanol / Q000506:poisoning*; D008875:Middle Aged; D011041:Poisoning / Q000188:drug therapy* / Q000191:economics*; D011446:Prospective Studies; D011720:Pyrazoles / Q000627:therapeutic use; D011788:Quality of Life; D006435:Renal Dialysis; D016896:Treatment Outcome
chemical_list: D000931:Antidotes; D011720:Pyrazoles; D000431:Ethanol; D000077604:Fomepizole; D000432:Methanol
keywords: Acute methanol poisoning; Cost-effectiveness; Ethanol; Fomepizole; Hemodialysis