The cost of maintaining adequate antidote supplies

David Juurlink and colleagues reported recently that most acute care hospitals in Ontario do not stock adequate amounts of antidotes.1 We previously showed that the availability of 13 antidotes was also poor in Quebec (we used more stringent criteria to define adequate stocking).2

Although the situation is worrying, it is probably not as expensive to correct as it may seem. The antidote inventory would only have to be increased by 6 to 18% to correct the problem in Quebec,3 because there is gross overstocking of some antidotes by some hospitals. Because we set our recommended minimal stock of 18 antidotes on the basis of levels of hospital care, we think that keeping an adequate antidote inventory should not be a problem even for smaller hospitals with limited pharmacy budgets; the annual costs in 2000 would have been $4697 for primary care hospitals, $7450 for secondary care hospitals and $14 273 for tertiary care hospitals. Our recommended minimal amount of stock was that which would provide an adequate amount of antidote to treat a 70-kg adult for 12 hours in a primary or secondary care hospital and 24 hours in a tertiary care hospital.3 Most antidotes are used infrequently: the turnover of antidote inventory is 0.3 to 7.4 per year compared with an average of 8.9 per year for all medications in Canadian pharmacies.3 If a hospital uses antidotes appropriately the cost of maintaining an adequate stock should not be a concern, considering that most antidotes can be credited if unused.