Background: The decision to treat a patient with an acute acetaminophen overdose is determined by plotting the acetaminophen concentration on the Rumack-Matthew nomogram. In 2012, the United Kingdomfs Medicines and Healthcare Products Regulatory Agency lowered the treatment threshold by 50%, mandating treatment if a four-hour acetaminophen concentration exceed 100 mcg/mL. Using a multi-center study in emergency departments throughout the US, we had previously estimated that changing the treatment threshold from the current threshold to the new UK threshold of 100 mcg/mL would result in treating an additional 6,951 adults annually. The purpose of this study was to estimate the financial burden of such a decision Methods: The averages charges and payments for emergency department visits were obtained by reviewing the Emergency Room Visits (ERV) file of the Medical Expenditure Panel Survey (MEPS) from 2000-2012. The search utilized only patients discharged from the emergency department who were treated for gpoisoning by drugs, medicinal and biological substances.h The monetary values were subsequently adjusted to 2012 dollars using the medical component of the Consumer Price Index. Results: For patients discharged from the emergency department, the average total charge per patient was $2221, with an average corresponding patient of $772. Extrapolating these values to the estimated number of additional patients who would require treatment if the treatment threshold were changed yielded an estimated $5.4 million in payments and $15.4 million in charges. Discussion: Changing the acetaminophen treatment nomogram guidelines in the US to that of the UK would result in estimated charges of more than $15 million and estimated payments of more than $5 million annually. Our estimates do not include costs associated with increased ED referrals from poison centers or costs associated with admissions for the additional patients requiring antidotal therapy. The last step necessary for a full fiscal evaluation will be to estimate if the treatment threshold change will eliminate any patients from developing end-stage liver failure requiring transplantation, thus potentially balancing some of the additional cost incurred from the change. Conclusions: Changing the treatment threshold would result in significant healthcare costs for a set of extremely low-risk patients for unclear benefit.
