The cost of maintaining adequate antidote supplies

We thank Benoit Bailey and Jean-François Bussières for their thoughtful comments on the costs of maintaining appropriate supplies of antidotes. The actual cost of an adequate inventory is influenced by variables other than acquisition cost, including the drug's shelf life and the manufacturer's policy on issuance of credit for outdated product.1 For example, a course of treatment with digoxin immune Fab antibody fragments may cost up to $8000. This sticker shock, coupled with the infrequency of use, may lead some hospitals to purposefully not stock the drug. Consider, however, that the manufacturer will credit hospitals for outdated product, and the cost becomes a justifiable one-time expense.

How much of each antidote should a hospital stock? There is no right answer, but suggestions have been published.2^,3^,4^,5 For some toxins, such as acetaminophen, methanol and ethylene glycol, a hospital should be prepared for the simultaneous treatment of more than one patient. Clearly, every hospital should keep at least enough of each antidote in the emergency department to be able to initiate treatment immediately.

Our survey6 generated substantial media attention, and this may have helped to mitigate the problem of inadequate antidote stocking at some hospitals. In addition, the simple act of completing our questionnaire may also have led hospitals to recognize and address the deficiencies in their antidote supplies. We were pleased to receive calls from 4 different hospitals in the days after publication asking if they could announce that they were the one hospital in the province with all 10 antidotes on hand. Such corrective actions are encouraging.