ArticleBMC clinical pharmacology2012
A cost effectiveness analysis of the preferred antidotes for acute paracetamol poisoning patients in Sri Lanka.
Article in BMC clinical pharmacology, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
10 citing papers in PubMed, 1 synthesis or guideline pooled it, 25 citations in OpenAlex.
- Interventions for paracetamol (acetaminophen) overdose.The Cochrane database of systematic reviews · 2018Pooled it
- Trial
- Evaluation of cut-off values in acute paracetamol poisoning for safe termination of N-acetylcysteine.BMC pharmacology & toxicology · 2025Article
- Evaluation of cut-off values in acute paracetamol overdose following the United Kingdom guidelines.BMC pharmacology & toxicology · 2022Article
- Using ex-ante economic evaluation to inform research priorities in pesticide self-poisoning prevention: the case of a shop-based gatekeeper training programme in rural Sri Lanka.Tropical medicine & international health : TM & IH · 2020Article
- Pharmacoeconomics of three Therapeutic Schemes for Anti-tuberculosis Therapy Induced Liver Injury in China.Open medicine (Warsaw, Poland) · 2018Article
- Cost-effectiveness of antivenoms for snakebite envenoming in Nigeria.PLoS neglected tropical diseases · 2015Article
- Low rates of hepatotoxicity among Asian patients with paracetamol overdose: a review of 1024 cases.BMC pharmacology & toxicology · 2012Review
- Assessment of N-acetylcysteine use for acetaminophen overdose in the emergency department of a community teaching hospital: A pilot study.Saudi journal of anaesthesiaArticle
- Predicting the requirement for N-acetylcysteine in paracetamol poisoning from reported dose.Clinical toxicology (Philadelphia, Pa.)Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundAcute paracetamol poisoning is a rapidly increasing problem in Sri Lanka. The antidotes are expensive and yet no health economic evaluation has been done on the therapy for acute paracetamol poisoning in the developing world. The aim of this study is to determine the cost effectiveness of using N-acetylcysteine over methionine in the management of acute paracetamol poisoning in Sri Lanka.
methodsEconomic analysis was applied using public healthcare system payer perspective. Costs were obtained from a series of patients admitted to the National Hospital of Sri Lanka with a history of acute paracetamol overdose. Evidence on effectiveness was obtained from a systematic review of the literature. Death due to hepatotoxicity was used as the primary outcome of interest. Analysis and development of decision tree models was done using Tree Age Pro 2008.
resultsAn affordable treatment threshold of Sri Lankan rupees 1,537,120/death prevented was set from the expected years of productive life gained and the average contribution to GDP. A cost-minimisation analysis was appropriate for patients presenting within 10 hours and methionine was the least costly antidote. For patients presenting 10-24 hours after poisoning, n-acetylcysteine was more effective and the incremental cost effectiveness ratio of Sri Lankan rupees 316,182/life saved was well under the threshold. One-way and multi-way sensitivity analysis also supported methionine for patients treated within 10 hours and n-acetylcysteine for patients treated within 10-24 hours as preferred antidotes.
conclusionsPost ingestion time is an important determinant of preferred antidotal therapy for acute paracetamol poisoning patients in Sri Lanka. Using n-acetylcysteine in all patients is not cost effective. On economic grounds, methionine should become the preferred antidote for Sri Lankan patients treated within 10 hours of the acute ingestion and n-acetylcysteine should continue to be given to patients treated within 10-24 hours.
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