Costs of Poisoning in the United States and Savings From Poison Control Centers: A Benefit-Cost Analysis

doi:10.1016/S0196-0644(97)70275-0

Annals of Emergency Medicine

Volume 29, Issue 2, February 1997, Pages 239-245

https://doi.org/10.1016/S0196-0644(97)70275-0 Get rights and content

Abstract

See related editorial, p 246.

Data on incidence, medical spending, and payment sources for poisoning were taken from the 1987 National Medical Expenditure Survey, 1991 US Vital Statistics, the 1992 National Hospital Discharge Survey, and 1992 poison control center surveillance data. Benefits, measured as percentage reductions in medical spending attributable to use of poison control centers, were calculated from analyses of published and unpublished studies of jurisdictions in which services became unavailable. Medical spending (payments) for poisoning treatment totaled $3 billion in 1992. Spending averaged $925 per case. Poison control center services were available for 86% of poisonings. As used, they reduced the number of patients who were medically treated but not hospitalized for poisoning by an estimated 350,000 (24%) and the number of hospitalizations by 40,000 (12%) in 1992. The average public call to a poison control center for aid prevented $175 in other medical spending. Poison control centers offer a large return on investment. Despite their proven benefits, many poison control centers are unstably funded and financially strapped, in part because the federal government pays far less than its fair share of center costs. [Miller TR, Lestina DC: Costs of poisoning in the United States and savings from poison control centers: A benefit-cost analysis. Ann Emerg Med February 1997;29:239-245.]

Section snippets

INTRODUCTION

Poison control centers in the United States provide a telephone hotline service staffed by toxicology professionals. Most centers offer 24-hour service. Without charge, callers receive immediate information and treatment advice regarding suspected toxic exposures to drugs, chemicals, plants, and other substances. In 1994, there were 87 poison control centers in the United States.¹ These centers served most of the US population at least part-time. Almost 72% of reported poisoning cases were

MATERIALS AND METHODS

The analysis of poison control centers presented here follows generally accepted principles for benefit-cost analyses.³ The analysis assumes that poison control centers do not affect poisoning outcomes other than medical spending. Although we revisit this assumption in sensitivity analysis, we believe it provides a conservative yet realistic picture. The American Association of Poison Control Centers (AAPCC), without supporting data, asserts that outcomes improve. They suggest that the

RESULTS

Incidence and Costs of Poisoning In 1992, 3.2 million poisonings were handled by US poison control centers or more costly medical providers. Of the victims, more than 13,000 died and another 285,000 were hospitalized (Table 1). Poisonings resulted in almost 1.2 million days of acute care hospitalization.

As Table 1 shows, medical spending on poisoning averages $925 per case (in 1992 dollars). Poison control centers are involved in almost three fourths of the cases, at an average cost of $28.

DISCUSSION

This analysis has serious limitations. The underlying effectiveness estimates are shaky. Credible studies assessing poison control center effectiveness in reducing unnecessary medical visits or preventing poisonings are surprisingly scarce. The only two studies that reflect actual decision making by victims and their families examined health care utilization changes by a subset of the population in the year after poison control center services ceased. No one has examined the effect of poison

Acknowledgements

The authors thank Jean Athey of the US Department of Health and Human Services, Joseph Morales of the California Emergency Medical Services Authority, and several anonymous reviewers for helpful comments on drafts. The analysis and conclusions in this paper are strictly the authors'.

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In 2020, webPOISONCONTROL handled 7.3% as many human poison exposure cases as were reported to U.S. phone-based poison centers. Online cases are skewed towards younger ages (53% in children younger than 4 years vs 37% of phone-based cases) and towards nonpharmaceuticals (58.5% vs 43.5%). Near real-time data visualizations enabled detection of COVID-19-related increases in exposures to hand sanitizers and cleaners, illustrating the public health surveillance and hazard detection capabilities of webPOISONCONTROL.
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The US poison control network saw rapid changes in the 1990s. Financing of PCCs remained piecemeal and unstable. Some centers closed, leaving portions of the nation underserved. By 1983, the number of active PCCs in the United States had already consolidated down to 395. By 1994, that number was further pared to 87 centers, and only 4 years later, it was down to 73 PCCs. A decade-long campaign for a nationwide solution culminated in success with Federal funding secured by the start of the new century. The advent of the computer age, the electronic Internet-based World Wide Web, and advanced telecommunications opened new opportunities to innovate and thereby improve operations of information-based community services like poison control. The scope of services of PCCs continued to expand, with new prescient calls for disaster preparedness and integration into the emergency planning activities of local, state, and Federal public health agencies. No one could have anticipated how such changes would be made necessary by tragic events that would transpire both in the United States and worldwide in the coming millennium.
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Poison control centers (PCC) are an effective means to prevent unnecessary emergency department (ED) visits associated with poisoning exposures. However, not all patients with poison exposures utilize the PCC. The purpose of this study was to identify unintentional pediatric poisoning exposures presenting to a large US children's hospital that could have been managed onsite (i.e., at home) if consultation with a PCC had occurred prior to the ED visit.
Using ED encounters from a tertiary children's hospital, unintentional pharmaceutical, chemical, or fume exposures occurring between October 1, 2014 and September 30, 2015 were identified from ICD-9-CM billing codes. Two specialists in poison information reviewed the medical records of the identified patients who had no contact with the PCC and determined whether these encounters were preventable through PCC triage. Descriptive statistics examined the differences between the encounters. Data were analyzed in R v3.2.4 (Vienna, Austria) and SAS v9.4 (SAS Institute, Cary, NC).
In the total study population (n = 231), 98 (42.4%) were PCC triaged and 133 (57.6%) were caregiver self-referred to the ED. For those who self-referred, 62 (46.6%) patients would have been recommended to be managed onsite instead of presenting at the ED for medical care. Analgesics and household cleaning products were the most common pharmaceutical and chemical exposures, respectively.
Nearly half of ED visits for pediatric patients with unintentional poisoning exposures could have been avoided by contacting a PCC. Educational and self-efficacy-based interventions are needed to expand the public's use of PCC services.
The value of a poison control center in preventing unnecessary ED visits and hospital charges: A multi-year analysis
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The clinical value provided by PCCs, such as the reduction in hospital length of stay, guiding care given during emergency department (ED) visits, and preventing unnecessary healthcare utilization, contribute to the economic value of PCCs [1]. Previous research demonstrates that PCCs are on par with the cost savings generated from pediatric immunizations, saving $6.50 for every $1 spent [2]. Multiple studies have quantified the cost-savings generated by PCCs across different regions in the US [3-7].
The purpose of this study is to determine the economic value of the Utah Poison Control Center (UPCC) by examining its contribution to the reduction of unnecessary emergency department (ED) visits and associated charges across multiple years.
A multi-year (2009–2014) analysis of cross-sectional data was performed. Callers were asked what they would do for a poison emergency if the UPCC was not available. Healthcare charges for ED visits averted were calculated according to insurance status using charges obtained from a statewide database.
Of the 10,656 survey attempts, 5018 were completed. Over 30,000 cases were managed on-site each year. Using the proportion of callers who noted they would call 911, visit an ED, or call a physician's office, between 20.0 and 24.2 thousand ED visits were potentially prevented each year of the survey. Between $16.6 and $24.4 million dollars in unnecessary healthcare charges were potentially averted annually.
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webPOISONCONTROL: can poison control be automated?
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With an estimated 4 million US poison exposures annually [1], poison control telephone guidance prevents unnecessary emergency department visits and reduces health care expenses [2–9].
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Of 9256 cases, 73.3% were triaged to home, 2.1% to an emergency department, and 24.5% directed to call poison control. Children younger than 6 years were involved in 75.2% of cases. Automated follow-up was done in 31.2% of home-triaged cases; 82.3% of these had no effect. No major or fatal outcomes were reported. More than 91% of survey respondents found the tool quick and easy to use. Median case completion time was 4.1 minutes.
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^☆: From the National Public Services Research Institute, Landover, Maryland.

^☆☆: Supported by the Maternal and Child Health Bureau, US Department of Health and Human Services, and the National Highway Traffic Safety Administration under grant MCJ-113A36-01.

^★: Reprint no.47/1/76686

^★★: Address for reprints: Ted R Miller, PhD, 8201 Corporate Drive, Suite 220, Landover, Maryland 20785, 301-731-9891 ext 103, Fax 301-731-6649, E-mail [email protected]

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Costs of Poisoning in the United States and Savings From Poison Control Centers: A Benefit-Cost Analysis☆,☆☆,★,★★

Abstract

Section snippets

INTRODUCTION

MATERIALS AND METHODS

RESULTS

DISCUSSION

Acknowledgements

Am J Emerg Med

Am J Emerg Med

Cost-effectiveness and cost-benefit analyses in the medical literature: Are the methods being used correctly?

Ann Intern Med

Letter to JR Maurer and JH Trestrail from Blue Cross Blue Shield of Michigan, 8/12/93, in Poison Control Centers: Is There an Antidote for Budget Cuts? Hearing before the Subcommittee on Human Resources and Intergovernmental Relations, Committee on Government Operations, US House of Representatives

Poison control centers: Can their value be measured?

South Med J

Monroe County Poison Prevention Demonstration Project: Final Report to U.S. Consumer Product Safety Commission

Patterns in hospitals’ use of a regional poison information center

Am J Public Health

Cost of Injury in the United States: A Report to Congress