Availability and cost of extracorporeal treatments for poisonings and other emergency indications: a worldwide survey.
BACKGROUND
Extracorporeal treatments (ECTRs) are used for different conditions, including replacement of organ function and poisoning. Current recommendations for ECTRs in various poisonings suggest that intermittent haemodialysis (IHD) is the most efficient technique. However, the practicality of these recommendations is poorly defined in view of limited information on availability and cost worldwide.


METHODS
A survey invitation to an Internet-based questionnaire was emailed between January 2014 and March 2015 to members of international societies to determine the availability, time to initiation and cost of ECTRs (including filters, dialysate, catheter, anticoagulant and nursing/physician salary). The median cost ratio of every ECTR compared with IHD performed in the same institution were presented.


RESULTS
The view rate was estimated at 28.1% (2532/9000), the participation rate was 40.1% (1015/2532) and the completion rate was 16.0% (162/1015). Respondents originated from 89 countries, and nearly three-fourths practiced in a tertiary care centre. A total of 162 respondents provided sufficient data for in-depth analysis. IHD was the most available acute ECTR (96.9%), followed by therapeutic plasma exchange (TPE; 68.3%), continuous renal replacement therapy (CRRT; 62.9%), peritoneal dialysis (PD; 44.8%), haemoperfusion (HP; 30.9%) and liver support devices (LSDs; 14.7%). IHD, CRRT and HP were the shortest to initiate (median = 60 min). The median cost ratios of each ECTR compared with IHD were 1.7 for CRRT and HP, 2.8 for TPE, 6.5 for LSDs and 1.4 for PD (P < 0.001 for all). The median cost ratio of a 4-h IHD treatment compared with 1 day in the intensive care unit was 0.6 (P =  0.2).


CONCLUSIONS
IHD appears to be the most widely available ECTR worldwide and is at least 30% less expensive than other ECTRs. The superior efficacy of IHD for enhanced elimination, added to its lower cost and wider availability, strengthens its preference as the ECTR of choice in most cases of acute poisoning.


BACKGROUND
costing, CRRT, EXTRIP, hemodialysis, hemoperfusion.
Department of Medicine, Hopital du Sacré-Coeur de Montréal, Montreal, Canada.
Josée
J
Bouchard
Department of Medical Biology, Hopital du Sacre-Coeur de Montreal, Montreal, Canada.
Valery
V
Lavergne
Burns, Trauma and Critical Care Research Centre, Medical School, Australian National University, Australian Capital Territory, Australia.
Darren M
DM
Roberts
Department of Medicine, Verdun Hospital, University of Montreal, Montreal, Canada.
Monique
M
Cormier
Department of Medicine, Hopital du Sacré-Coeur de Montréal, Montreal, Canada.
Genevieve
G
Morissette
Department of Medicine, Verdun Hospital, University of Montreal, Montreal, Canada.
Marc
M
Ghannoum
D058186:Acute Kidney Injury / Q000150:complications*; D003362:Cost-Benefit Analysis; D006801:Humans; D007362:Intensive Care Units; D011041:Poisoning / Q000191:economics* / Q000628:therapy*; D006435:Renal Dialysis / Q000191:economics* / Q000706:statistics & numerical data*; D017582:Renal Replacement Therapy / Q000009:adverse effects*; D011795:Surveys and Questionnaires; D013806:Theophylline / Q000506:poisoning*; D014665:Vasodilator Agents / Q000506:poisoning
D014665:Vasodilator Agents; D013806:Theophylline