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Objective: The United States (US) opioid epidemic is a continued burden on the healthcare system and on the lives of individuals affected by the consequences of opioid abuse/misuse. The objective of this study was to use real-world data from intentional abuse/misuse exposures managed by US poison centers to compare clinical outcomes and quantify healthcare costs among three study cohorts: -exposures that involved Xtampza ER®, other oxycodone extended-release (ER), and oxycodone immediate-release (IR)., Study Design: A real-world, observational study., Main Outcome Measures: Descriptive statistics were used to describe patient and exposure characteristics. Drug utilization-adjusted rates of intentional abuse/misuse and clinical outcomes were used to determine relative risk. Healthcare cost estimates were calculated by extrapolating average charge per opioid-related disorder emergency department (ED) visit and per inpatient stay based upon case disposition rates, adjusted for population and drug utilization., Results: Compared to Xtampza ER, exposures that involved other oxycodone ER were 7.4 times more likely to be intentional abuse/misuse, 25.9 times more likely to result in major effect or death, 9.7 times more likely to require a visit to the ED, and 14.3 times more likely to result in hospital admission. Similar results were found for oxycodone IR when compared to Xtampza ER., Conclusions: This study is the first of its kind to synthesize clinical outcomes with opioid-related healthcare costs, suggesting that even when Xtampza ER is abused/misused, the rates of major effect/death, ED visits, and hospital admissions were significantly lower than those for other oxycodone-containing medications, resulting in relatively low downstream opioid-related healthcare costs.

Objective: Aims were (1) to assess the characteristics, associated factors and compliance of patients with acute poisoning advised by the Belgian Poison Centre (BPC) to go (conditionally) to the hospital, (2) to assess the compliance and potential health-economic impact., Methods: Three types of referrals to the hospital of patients who called the BPC between 1 January and 30 June 2018 were analysed: referrals in case of deterioration in the patient's condition (Hosp-watchful-wait), referrals (Hosp-referral) or urgent referrals (Hosp-urgent-referral). Factors associated with type of recommendation were registered. A survey was conducted on a second dataset of patients who called the BPC between 1 March and 15 May 2019 and referred (conditionally) to the hospital., Results: 5476 referrals were included: 72.4% accidental poisoning, 25.3% intentional self-harm, 1.2% substance abuse and 1.1% unclear intentionality. There were 2368 (43.2%) Hosp-watchful-wait cases, 2677 (48.9%) Hosp-referrals and 431 (7.9%) Hosp-urgent-referrals. In Hosp-watchful-wait cases, soaps and detergents were represented most (20.5%). In Hosp-referrals and Hosp-urgent-referrals, benzodiazepines (12.7% and 15.1%, respectively) predominated. Factors associated with hospitalisation type were number of symptoms, intentionality, type of agent(s) involved and advising antidotes. The survey showed that 7.8% of Hosp-watchful-wait patients went to the hospital versus 57.3% of Hosp-referrals and 59.6% of Hosp-urgent-referrals. The mean cost for Hosp-watchful-wait patients, Hosp-referrals and Hosp-urgent-referrals was estimated at €127, €767 and €796, respectively., Conclusion: Only a small proportion of patients followed the advice of the BPC to go (conditionally) to the hospital. A systematic follow-up of cases is warranted to examine the appropriateness of referrals and the compliance of patients., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: To estimate cost savings from the Australian Poisons Information Centres (PIC) through reductions in unnecessary health resources following unintentional low toxicity poisonings. Methods: Two telephone surveys were conducted. The first to PIC callers over a one-week period about unintentional exposures where the callers' alternate course of action in the hypothetical situation in which the PIC did not exist was questioned. The second survey to determine the proportion of callers followed PIC advice. We estimated cost savings associated with instances where individuals acted on advice not to present to hospital, when they indicated they would have otherwise as well as savings from preventing unnecessarily utilisation of medical resources. Database records of unintentional poisonings from all Australian PICs for 2017 were used. Results: A total of 958 consecutive callers were surveyed. PIC advised 91% of callers to stay at home, remaining callers were referred to hospital (5%), to their GP (3%) or given other recommended management advice (1%). PIC advice was followed by 97.6% of callers. In PIC absence, 22% of callers who were advised to stay home would have presented to hospital (3% via ambulance), 8% would visit their General Practitioner (GP) and only 9% would stay at home. In 2017, PICs were called about 94,913 unintentional poisonings; and PICs generated at least $10.1 million in annual savings. Conclusion: In 2017, PICs provided at least a three-fold return on investment for every dollar invested, demonstrating that PICs are a highly cost effective service.

Objectives: This study evaluates the impact of the Belgian Poison Centre (BPC) on national healthcare expenses for calls from the public for unintentional poisonings., Methods: The probability of either calling the BPC, consulting a general practitioner (GP) or consulting an emergency department (ED) was examined in a telephone survey (February-March 2016). Callers were asked what they would have done in case of unavailability of the BPC. The proportion and cost for ED-ambulatory care, ED 24-h observation or hospitalisation were calculated from individual invoices. A cost-benefit analysis was performed., Results: Unintentional cases (n = 485) from 1045 calls to the BPC were included. After having called the BPC, 92.1% did not seek further medical help, 4.2% consulted a GP and 3.7% went to an ED. In the absence of the BPC, 13.8% would not have sought any further help, 49.3% would have consulted a GP and 36.9% would have gone to the hospital. The cost-benefit ratio of the availability of the BPC as versus its absence was estimated at 5.70., Conclusions: Financial savings can be made if people first call the BPC for unintentional poisonings.

Background: The public commonly calls 911 for unintentional ingestions, rather than calling the local poison center. By utilizing a series of scripted questions, 911 dispatchers in Los Angeles determine if an ingestion meets "omega-1" classification. Under such circumstances, the regional poison center is contacted prior to dispatch of paramedics. If the poison center advises that the patient can remain at home, EMS is not dispatched and the patient is followed at home by the poison center. The primary objective is to determine the number of averted transports through involvement of a poison center. A secondary objective is to determine the potential costs and charges saved with the use of such a strategy., Methods: A retrospective review of all overdose calls with an "omega-1" classification to a single EMS system between 1/2008-6/2012. Each call culminating in an EMS dispatch was subsequently reviewed by two additional reviewers. The cost savings was determined by utilizing data from the Medical Expenditure Panel Survey (MEPS) from 2000 to 2010. Monetary values were adjusted to 2012 dollars., Results: Three hundred eighteen cases received "omega-1" dispatch classification. EMS was dispatched 19 times (5.98 %), and 11 patients (3.46 %) were ultimately transported. The most common reasons for transport were ambiguity over the ingested agent or amount, and caller insistence. Using these estimates, routine consultation of a regional poison center as part of EMS dispatch averted $486,595 in charges, and $183,279 in payments., Conclusions: Routine consultation of a poison center by emergency medical dispatchers can reduce unnecessary dispatches, ambulance transports, and ED visits with significant associated cost savings.

Objective: 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., Methods: 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., Results: 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., Conclusions: Compared to the cost of operation, the service UPCC provides demonstrates economic value by reducing ED visits and associated charges. As the majority of patients have private insurance, the largest benefit falls to private payers., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Deaths from drug overdose have become the leading cause of injury death in the United States, where the poison center system is available to provide real-time advice and collect data about a variety of poisonings. In 2012, emergency medical providers were confronted with new poisonings, such as bath salts (substituted cathinones) and Spice (synthetic cannabinoid drugs), as well as continued trends in established poisonings such as from prescription opioids. This article addresses current trends in opioid poisonings; new substances implicated in poisoning cases, including unit-dose laundry detergents, bath salts, Spice, and energy drinks; and the role of poison centers in public health emergencies such as the Fukushima radiation incident., (Copyright © 2014 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.)

Context: In the United States (US) and Europe, surveillance based on calls to poison control centres has identified new hazards and evolving exposure trends. In Canada, the value of poison control centre calls as a tool for health hazard surveillance is largely unrecognized., Objectives: This preliminary survey was undertaken to describe current operational characteristics and surveillance capacities at Canadian poison control centres and to determine potential for developing a Canadian poison control centre collaborative network., Methods: A structured quantitative-qualitative survey was administered to medical directors and clinical supervisors at the five Canadian poison control centres between March and May, 2012., Results: All five Canadian poison control centres operate 24/7 with each serving more than one province/territory. Annual call volumes range from 10,000 to 58,000. Data analysis is limited to detection of previously unrecognized hazards and short-term event-based adverse health monitoring. Currently no centre maintains systematic ongoing collection, integration and analysis of data. Constraints on personnel, resources and funding were identified as barriers to increasing capacity to provide and analyse call data., Conclusions: The potential exists to use Canadian poison control data as a novel source of public health surveillance. That they serve as sentinels for new or unexpected exposure events, have real-time electronic call-record capacity and demonstrate an interest in developing and sharing their call-record information supports their integration into existing public health networks.

Since 2008, a National Serum Depot is operational in the Netherlands, guaranteeing antivenom supply, 24 h per day, during medical emergencies. In this article the organisation structure, choice of antivenoms, problems encountered during the establishment, and the results from establishment in 2008 till December 2011 are discussed. The Serum Depot is organised by the National Institute for Public Health and the Environment in cooperation with the Dutch National Poisons Information Center. During establishing and maintaining of the Serum Depot several antivenom purchase difficulties were encountered. Some antivenom producers did not respond upon (initial) contact and some antivenoms were (temporarily) unavailable. Good contacts with professional herpetologists are necessary in order to keep the content of the depot up-to-date. At the same time, it is important to remain well informed concerning the safety and efficacy of the currently available antivenoms and development of new antivenoms. During the first four years of the National Serum Depot, the Dutch National Poisons Information Center was consulted on average 10 times a year about exotic venomous bites and stings in which antivenom treatment might play a role. Almost half of these consultations were related to bites by venomous exotic snakes, the other half to scorpion and fish stings. Antivenom was delivered in five cases, all after a bite by an exotic venomous snake, and actually administered twice because of the severity of local effects. To reduce costs and extend coverage of the Serum Depot of antivenoms for more unfamiliar snake species, international cooperation between the various owners of the antivenom Serum Depots in Europe is recommended., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Objectives: The aim of this study was to summarize and assess economic evaluations of poison centers (PCs) from the perspectives of society, the payer, and the healthcare system., Methods: A systematic review was performed to identify complete economic evaluations regardless of the language or publication status. Two reviewers evaluated the abstracts for eligibility, extracted the data, and assessed the study quality using a standardized tool., Results: In total, 422 non-duplicated studies were retrieved, but only nine met the eligibility criteria. Five of the eligible studies were published in the 1990s, and four were published in the 2000s. Six studies met at least seven of ten quality criteria. In all studies, the presence of PCs was compared with a scenario of their absence. Eight studies used cost-benefit analyses and one used a cost-effectiveness approach. The cost-benefit ratios ranged from 0.76 to 7.67, which indicates that each United States dollar (USD) spent on poison centers can save almost 8 USD on medical spending. A cost-effectiveness analysis showed that each successful outcome achieved by a PC avoids a minimum of 12,000 USD to 56,000 USD in other healthcare spending., Conclusions: The data in our review show that PCs are economically viable. PCs improve the efficiency of healthcare expenditure and contribute to the sustainability of the healthcare system. An investment in PCs is a rational public health policy approach that contrasts the current trend of reducing spending on PCs.

The funding of United States's poison control centers is threatened. The following Commentary argues for support of the current outstanding poison control system by presenting the evidence for its cost-effectiveness.

Federal funding of poison centers (PCs) in the United States was established in 2000 through the Poison Control Center Enhancement and Awareness Act. Unfortunately, the problems with financial stability of PCs that this legislation was intended to improve persist because of continued reliance on fragile local funding sources. In the past few months budget cuts have had an impact on PC activity and threaten the continued existence of a nationwide network of PCs in the United States. This commentary discusses the problems faced by PCs in this changing environment and illustrates the many competing tasks that the PC network performs for the U.S. population. PCs face continuing challenges in coming months and a unified approach at a national level may provide the best opportunity for a solution to this crisis.

Objectives: The aim of the study was to find out how satisfied users are with the National Poison Center of Norway and to make a health economic evaluation of the service., Method: The material consisted of telephone interviews with 310 users of the service from the general public and 665 completed questionnaires from doctors and nurses., Results: Most respondents were satisfied with the information and had followed the advice. They also felt safer after making a phone call. It was found that the running costs of the Poison Center are approximately the same as the estimated additional costs the health care system would incur if the service did not exist., Conclusions: Both users and health care personnel are highly satisfied with the Poison Center hotline. Even though the Norwegian health system does not necessarily save money by providing the service, the safety it provides cannot be measured in economic terms.

Introduction: In 2007, medication identification requests (MIRs) accounted for 26.2% of all calls to U.S. poison centers. MIRs are documented with minimal information, but they still require an inordinate amount of work by specialists in poison information (SPI). An analysis was undertaken to identify options to reduce the impact of MIRs on both human and financial resources., Methods: All MIRs (2003-2007) to a certified regional poison information center were analyzed to determine call patterns and staffing. The data were used to justify an efficient and cost-effective solution., Results: MIRs represented 42.3% of the 2007 call volume. Optimal staffing would require hiring an additional four full-time equivalent SPI. An interactive voice response (IVR) system was developed to respond to the MIRs., Discussion: The IVR was used to develop the Medication Identification System that allowed the diversion of up to 50% of the MIRs, enhancing surge capacity and allowing specialists to address the more emergent poison exposure calls. This technology is an entirely voice-activated response call management system that collects zip code, age, gender and drug data and stores all responses as .csv files for reporting purposes. The query bank includes the 200 most common MIRs, and the system features text-to-voice synthesis that allows easy modification of the drug identification menu. Callers always have the option of engaging a SPI at any time during the IVR call flow., Conclusions: The IVR is an efficient and effective alternative that creates better staff utilization.

Introduction: Patient home management by a regional poison control center has potential to save public healthcare dollars by preventing unnecessary utilization of emergency department services. We wished to conservatively quantify such savings at a large regional poison center and compare savings to funds received in state support., Methods: Banner Poison Control Center (BPCC) serves a population of about four million in central AZ. A telephone survey of callers who were managed at home in February and March of 2007 after nontoxic exposures was used to calculate what percentage of such callers would have sought unnecessary medical care in emergency departments. Twelve emergency departments geographically dispersed in the region were surveyed, and a state database of hospital charges was queried to determine hospital charges and physician professional charges for conservative management of a patient who would have been advised to remain at home by BPCC., Results: BPCC managed 28,883 callers at home in 2007. Seventy percent of home-managed patients would have sought unnecessary care in emergency departments. Using most conservative assumptions, a median of $33 million [range $18 million to $45 million] in unnecessary health care charges were prevented by BPCC home-management in 2007. A median of about $36 in unnecessary health care charges were prevented for each dollar of state funding BPCC received., Conclusions: Home management by BPCC provides large dollar savings to residents compared to dollars received in state support.

Introduction: Poison Control Centers (PCCs) have been shown to reduce health expenditures by reducing emergency department and clinic visits. The effect or association of PCC call frequency on acute hospitalization rates for poisonings has not been studied extensively., Methods: All nonfederal hospital discharges for acute poisoning principal diagnosis codes (960-979, 980-989, 9956X, 3030, and 005) in California between October 1999 and June 2002 were examined. Approximately 3.3% of the discharges had county/hospital information suppressed in the public-use database because of confidentiality criteria and were excluded from the analysis. U.S. Census Bureau population estimates for appropriate years by counties were also obtained. The 58 California counties were condensed to 48 counties and 3 "small-county" geographic groupings. Exposure calls by counties/groupings to the California Poison Control System(CPCS) for the same period were tabulated., Results: In California, rates of hospital discharges for poisoning averaged 0.54/1000 person years with a range of 0.25/1000 person years (Central Counties) to 1.53/1000 person years (Del Norte County). Poison call rates averaged 8.5/1000 person years with a range of 4.9/1000 person years (Los Angeles County) to 19.6/1000 person years (Napa County). Poisoning discharges per 1000 person years positively correlated with PCC calls per 1000 person years (Spearman correlation 0.41, p = 0.0003). The average hospital length of stay (LOS) did not correlate with PCC call frequency or poisoning discharges per 1000 person years., Conclusion: The CPCS call frequency or county penetrance was not correlated with a reduction in the number of hospitalizations for poisoning nor was it associated with reduced average LOS in this study. Further study is needed to understand the etiology of the large differences in county rates of poisoning hospitalization and average LOS.

Background: Funding poison center (PC) operations has become a major challenge nationwide. Increasingly, state and federal budget cuts have resulted in diminished funding to PCs., Objectives: In an effort to demonstrate the value of current PC phone services, a cost-benefit analysis of a regional center was completed., Methods: A telephone survey was used to collect data from PC callers during an 8-week period in 2004. Callers with human exposure poisonings determined by the PC to be of minimal or no risk were asked to complete the phone survey. Callers were asked their alternative plan if the PC staff had not been available to assist them. Benefits were measured as healthcare charges potentially avoided., Results: A total of 652 caller surveys were completed. The benefit-to-cost ratio was 7.67 (95% C.I. 6.83, 8.50)., Conclusion: In addition to non-monetary benefits, the operation of a regional poison center provides significant positive return on investment.

Purpose: This study analyzes the association between center usage rates and the rates of nonadmitted visits to emergency departments (EDs) for poisoning., Basic Procedures: With a log-normal regression model, we analyzed the association between the number of human exposure calls per hospitalized poisoning patient and the number of nonhospitalized ED visits. The data were from 14 states at county level., Main Findings: A 1% higher poison control center (PCC) human exposure call rate for unintentional poisoning is associated, but not necessarily causally, with a 0.18% lower ED visit rate (P < .0001). If the observed association is causative, 15.5 PCC human poison exposure calls prevent one nonadmitted ED visit, yielding a $205 net cost saving and a benefit-cost ratio of 1.4. The savings ignore any reduction in hospital admissions., Principal Conclusions: Increased PCC exposure calls appear to be associated with reduced ED use for unintentional poisoning and appear to reduce net medical spending.

Background: Most published data on the characteristics and direct hospital costs of deliberate self-poisoning (DSP) were collected from developed countries. This study was conducted to investigate hospital costs of DSP cases and relevant factors in a university-based emergency department (ED) in Turkey., Material/methods: All patients referred to the ED due to DSP in the one-year period between October 1, 2005, and September 30, 2006, were investigated prospectively. Clinical and demographic features were analyzed., Results: The female-to-male ratio was 6.3 (189/30). Mean age of the patients was 24.5+/-5.7 years. Medical drugs comprised 93.6% (n=205) of the substances ingested in admissions due to DSP. The mean cost of patients with DSP was calculated to be $144.06+/-90.83. Treatment costs constituted 36.2% of the total figure ($52.27). Total costs showed statistically significant differences with respect to sex, type of intoxicants, and location of treatment. Venipuncture, monitoring, nasogastric tube insertion, and gastric lavage were the procedures most commonly applied. Activated charcoal was administered to 66.9% (n=146) of the study sample., Conclusions: The study sample had many differences in demographic and clinical outcomes of patients with DSP as well as hospital costs compared with global reports. Gender, ingestion of non-medical substances, and treatment location affected the total hospital costs of these patients. Strategies focusing on high-risk subgroups and conditions may help to reduce unnecessary expenses.

Introduction: The distinctive yellow Lance Armstrong 'Live Strong' silicon wristbands, which support cancer research, have reached iconic status and spawned substantial interest from other organizations seeking to capitalize on the same awareness opportunity. To promote the national toll-free Poison Help telephone number, a regional poison information center developed and introduced a Poison Help wristband., Methods: The RPIC worked with a marketing firm to design the Poison Help wristband, conduct a feasibility analysis to determine the financial viability of the project and develop a plan to market and sell the wristbands. The wristbands were a unique color, contained the words Poison Help and the national toll-free telephone number., Results: Approximately 50,000 wristbands were distributed in the first four months., Conclusions: By developing a practical application for a popular item, the RPIC increased poison center awareness and, as a secondary benefit, generated revenue to support other poison prevention education endeavors.

Objectives: To explore the effects of population, staffing, location, and funding on cost per human poison exposure call; and organizational characteristics differentiating higher- and lower-cost centers., Methods: Data from 65 poison control centers (2001) were analyzed with linear multiple regression; qualitative data from 10 centers were compared., Results: The most important predictor of expenses per call was 24-hour coverage by Specialists in Poison Information ($15.70 of $40.53/call). Other factors increasing total expenses included northeast location and more health educator FTEs. Qualitative information revealed that more complex organizational forms, including multiple reporting and accountability relationships, characterized higher-cost centers. Surprisingly, having a wider range of reported activities (less specialization) was more common among lower-cost centers., Conclusions: Wide variability in cost per call suggests that inefficiencies exist. While elimination of inefficient poison control centers could reduce costs, the loss of training and collaborative opportunities, and preparedness for public health emergencies and bio-terrorism events, might mitigate against such restructuring.

Poison centers save money and lives. Individual patients and their doctors benefit from local poison center availability, as do healthcare facilities and insurance companies. All have a stake in a stable poison control system. It is likely that the greatest contribution of poison control centers to society has yet to be realized. Poison control centers already possess an efficient, realtime surveillance mechanism (TESS). With increased funding, this can be expanded and made more available outside the poison control community. TESS can be used to detect chemical releases or attacks and environmental and infectious disease outbreaks as they occur - long before individual healthcare providers could connect the dots. In conclusion, while the value of a nationwide poison control system to society is well recognized, its future is not as clear. Establishing a stable system to monitor and treat poisonings in the US will take political will at the local, state, and federal levels to ensure full funding for years to come.

The Pittsburgh Poison Center (PPC), a department of Children's Hospital of Pittsburgh, was established in 1971 to provide emergency poison information to the residents of western Pennsylvania, especially the children. The PPC provides comprehensive poison information center services to the lay public and to medical professionals, poison prevention education, professional education and specialized services to the business and industry sector and governmental agencies.

This project determined whether the massive distribution of poison center telephone number (Poison Help 800-222-1222) awareness stickers via a direct mail campaign, as a passive education technique, enhanced poison center awareness and was cost-effective. A regional ambulance service conducts an annual membership renewal/solicitation drive via mail to all residents within its service area. A sheet of Poison Help stickers was inserted in each ambulance service recruitment envelope and mass-mailed in 3 separate mailings over 4 w to 51% of households in a single county (population 368,983) at a direct expense of 4,477 dollars. Call volumes from zip codes that received the mailing were compared to an identical benchmark time period from the previous year. Analysis of call volume data over the study period revealed that call volume decreased by 1.3% during the study period. A mass-mail campaign to enhance poison center awareness failed to increase poison center call volume from the targeted county and, cannot be construed as cost-effective.

Prior to the implementation of the nationwide toll-free telephone number, most poison centers already provided toll-free service; therefore, the impact of toll-free access to a poison center on call volume is difficult to assess in the majority of poison centers. This analysis examined the effect that the new nationwide toll-free telephone number had on total call volume (exposures and information calls) in a poison center without previous toll-free access and serving a large urban and rural population. All calls received by a Regional Poison Information Center (RPIC) over a consecutive 27-mo period (2000, 2001, Jan-Jun 2002) were analyzed. April 2001 was the first full month of toll-free service. Data from January-March and January-June for 2000, 2001 and 2002 served as 3 and 6-mo benchmark and study periods. The 3 and 6-mo periods for each of the 3 years were used to conduct comparative trend analysis. Over 1.1 million pieces of literature and sheets of stickers that contained the toll-free number were distributed throughout the region over the study period. Use of the toll-free number increased from 590 calls in July 2001 to 2,157 in June 2002. Total call volume increased by 11.2%. Trend analysis revealed a 9.9% increase in exposure volume when comparing 2001 and 2002 data. There was a significant increase in utilization of the toll-free number for information purposes from people residing in rural counties. Toll-free access to the RPIC increased the volume of information calls dramatically. Initial trend analysis indicated that the availability of toll-free access has reversed the erosion of exposure-related calls.

Our evaluation using postal and interview surveys suggests that the telephone hotline service at the Swedish Poisons Information Centre ('Giftinformationscentralen') may be cost-effective for society. Advice to physicians--which was highly regarded for its speed, competence and applicability--was time-saving and facilitated better treatment. Similarly, advice direct to households eliminated many unnecessary emergency visits. Indeed, we found that the annual costs of running the centre can be completely offset by savings in health care resources. Improved outcomes, time savings for individual households, and reduced uncertainty for both households and health care staff provide additional benefits.

The State of Washington mandated the use of imprints on all prescription drugs in 1980 and for "OTC's" in 1991. The FDA implemented federal requirements in 1995. Unfortunately, the FDA permitted the continued use of symbols, logotypes, and trademarks as code components, limiting the use of automated recognition systems. Analyses of several week-long samples of phone inquiries documented imprinting calls, the staff's ability to respond with an identification, the information sources used, and apparent reasons for any failure. In the first week we received 666 decoding requests, which when projected for the year amounted to > 25,000 calls. A review of 1999 data exceeded that number. Staff was able to reach drug identification in 93.8% of inquiries. Uninterpretable symbols and absence of code listings contributed to the 36 failures. Projecting over the US suggested as many as 1.25 million calls costing poison centers $25 million/y. A touch-tone telephone or website response system could permit automated responses. Neither solution is feasible without the elimination of symbols or logotypes when using an exclusively alpha-numeric code.

A 1998 survey of all 73 US poison centers, including 52 certified centers and 21 noncertified centers, is presented. Despite a continued decline of the number of poison centers operating in the US, the volume of calls has steadily increased. In 1997 these centers handled 3.65 million telephone consultations, including 2,475,010 human poison exposure cases, 134,646 animal poison exposures, and 1,036,148 information calls. Nearly the entire US population had access to a poison center (99.9%), although only 78.5% of the US population was served by a certified center. Certified poison centers handled 83.6% of human poison exposure cases reported to US poison centers. Calls to certified centers were twice as likely to be handled by staff who were certified as specialists in poison information. On average, poison center utilization was 9.2 human exposure consultations/1,000 population. Total national poison center expenses approached $81 million. The average cost/human exposure case was $33.30 in certified centers, a substantial savings when compared with the alternative of emergency department management. State governments provided the single largest source of funding. Poison center funding remains unstable, with 41% of centers reporting a possible or definite budget reduction anticipated in the next budget year. In the past 5 y, 47.9% of centers faced threat of closure. Center certification and increased public education activity, especially the distribution of poison prevention materials and number of media contacts, were associated with greater utilization of the poison center in the region served.

Problem: Telephone contact with a poison control center may determine that accidental poison ingestion may not pose a risk of developing adverse clinical effect. Over 50% of reported human poisonings occur in children less than 6 years old. Yet most of these accidental childhood ingestions do not produce clinical toxicity. Such nontoxic ingestions can be managed by telephone rather than treated in a health care facility. This study evaluated the clinical effects produced, and the cost of emergency department care, versus obtaining telephone advice from a poison control center, following accidental poison ingestion in children age 6 and under., Methods: 1 year review of all cases of accidental ingestion in children 6 years and under evaluated in a pediatric emergency department. Utilizing the hospital's poison control center criteria, cases were grouped as nontoxic (no risk of adverse effect) or toxic (significant risk for adverse effect). Groups were compared for demographics, clinical effect, dispositions, charges., Results: 467 cases were seen; 141 met nontoxic criteria. Toxicity was not related to race or gender. Children age 2 and less accounted for the majority of cases (p = .003) [table: see text] Estimated poison control center costs are less than $25 per telephone call., Conclusion: Significant charges are billed to health care payers when an emergency department is utilized as the primary means of evaluating children with nontoxic ingestions. Utilization of a poison control center as the initial means of intervention following an accidental pediatric ingestion results in significant savings in health care expenditures.

Objective: To determine the impact and safety of diverting poisoning calls from 911 to a regional poison center., Methods: A prospective six-month review was performed of all calls transferred from 911 dispatchers to a regional poison center for management. Recommendations for management and transport were made by the poison center using existing protocols. Patients were followed with telephone contact by poison center staff until symptoms resolved or until hospital discharge. Medical outcomes were categorized using the American Association of Poison Control Center guidelines for medical outcome., Results: A total of 262 cases were reviewed; four were excluded. The poison center was contacted prior to ambulance dispatch in 210 cases (81%). An ambulance was sent before the poison center was contacted 48 times (19%). The majority of patients originally calling 911 were managed at home (175/258; 68%). Patients experienced either no effect or minor effects in 254 cases (98%). Two patients developed moderate effects (0.8%), one developed a major effect (0.4%), and one died (0.04)%. No adverse effects or treatment delays resulted from diversion of calls to the poison center., Conclusions: Appropriate poisoning and toxic exposure cases may be diverted safely from emergency medical services dispatch to a regional poison center for management, reducing unnecessary responses, with substantial cost savings.

Objectives: The authors examined the costs and outcomes resulting from a natural experiment during which direct public access to poison control centers was restricted and then restored., Methods: Both societal and health care purchaser perspectives were used. Probability data were obtained from a natural experiment during which public callers from a large county in California were electronically blocked from directly accessing the poison control center. Callers were referred to 911, which had direct access to the poison control center, if they thought they had a poisoning emergency. We conducted telephone interviews of: (a) persons who attempted to call the poison control center for a child's poisoning exposure but who did not have direct access (n = 270) and (b) persons who called the poison control center after direct access was restored (n = 279). Cost data were obtained from primary data collection and from other sources. The outcome measure was the appropriateness of the treatment location (at home or at a health care facility). Caller-reported outcomes were also examined., Results: The average additional cost per blocked call was $10.89 from a societal perspective, or $33.14 from a health care purchaser perspective. Fourteen percent of callers with restricted access were treated at an inappropriate location, compared with only 2% of callers with direct poison control center access. Also, 14% did not obtain any professional advice after they attempted to call the poison control center, although 66% of these cases involved potentially toxic substances. Results were robust across a range of sensitivity analyses., Conclusion: Restricting direct public access to poison control centers created additional costs to society, the health care sector, and callers.

Benefits of the Hawaii Poison Center (HPC) to the public, providers, and third party payers are enumerated. Financial advantages to third party payers during 1996-7 were quantified by comparing costs for the home management of poisonings with alternative sources of care reported by callers, if the HPC were closed. The value for third party payers exceeded $2.5 million, greater than eight times the investment in operating the HPC, similar to national data. Since third party payers are the most visible beneficiary of cost savings, a case is made for their financial support of the HPC.

Poison centers contribute importantly to public health. They provide expert emergency advice without charge, offer early telephone triage of poisoning cases, assist parents and caretakers in managing simple exposures at home, and recommended hospital evaluation for patients suspected of serious exposure. Their efforts lead to significant cost savings by averting unnecessary medical evaluations. Poison centers offer physicians and other clinicians consultation with board-certified medical toxicologists to arrange for definitive care or, more often, to help provide good, cost-effective care in local communities. The Poison Center's efforts to prevent accidental poisoning and to increase awareness and utilization of its services benefit both patients and health care providers by reducing morbidity and costs associated with poisonings.

We used the willingness-to-pay (WTP) method to value the benefits of poison control centers when direct access was blocked, comparing WTP among: (1) blocked callers (n = 396), (2) callers after access was restored (n = 418), and (3) the general population (n = 119). Mean monthly WTP was $6.70 (blocked callers), $6.11 (non-blocked callers), and $2.55 (general population). Blocked and non-blocked callers had a significantly higher WTP than general population respondents (p < 0.001). We conclude that the WTP method measured benefits that are difficult to quantify; however, WTP surveys need to be carefully conducted to minimize bias. We discuss how this approach could be useful for other health care services.