Cost impact of hydroxocobalamin in the treatment of patients with known or suspected cyanide poisoning due to smoke inhalation from closed-space fires

Background & objectives: Cyanide poisoning can occur due to exposure to smoke in closed -space fires. With no point of care cyanide test at the scene of a fire, first responders and clinicians base decisions to treat with cyanide antidote on patient history, clinical signs, and other indirect data points that have not been proven to correspond with actual sys- temic levels of cyanide. The aim of this exploratory study was to determine the economic implications of treating patients with known or suspected cyanide poisoning due to smoke inhalation with hydroxocobalamin.Methods: A decision analysis model was developed from the US hospital perspective. Healthcare resource utilization was estimated from a retrospective evaluation of clinical outcomes in hydroxocobalamin-treated patients and in historical controls without hy- droxocobalamin use (Nguyen, et al. 2017). Epidemiologic parameters and costs were esti- mated from the published literature, and publicly-available hospital charges were identified. Outcomes reported in the analysis included expected healthcare resource uti- lization in the US population and per-patient costs with and without the use of hydro- xocobalamin. A cost-to-charge ratio was applied so that all costs would reflect hospital costs rather than hospital charges. Deterministic sensitivity analysis was performed to identify the most influential model parameters. All costs were reported in 2017 US dollars.Results: Use of hydroxocobalamin reduces healthcare resource utilization and contributes to decreased per-patient hospital costs ($15,381 with hydroxocobalamin treatment versus $22,607 with no cyanide antidote). The most substantive cost-savings resulted from decreased hospital length of stay (i.e., intensive care unit [ICU] and non-ICU). Costs at-tributed to mechanical ventilation also decreased with use of hydroxocobalamin. A uni-variate sensitivity analysis demonstrated that the most impactful variables in the cost analysis were related to hospital length of stay (ICU followed by non-ICU stay), followed by the daily cost of ICU stay.Conclusions: Use of hydroxocobalamin in patients with known or suspected cyanide poi-soning from closed-space fire smoke inhalation may decrease hospital costs and contribute to more efficient healthcare resource utilization.(c) 2022 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).