Oleander self-poisoning is common in Sri Lanka-especially among young women-and an effective antitoxin was withdrawn after one year of use due to its high cost-around $2650 per treatment.
Michael Eddleston from the University of Colombo, Sri Lanka, and colleagues investigated the effect of the antitoxin's introduction and withdrawal on case fatality, and determined its cost-effectiveness. They report how the antitoxin strikingly reduced the case fatality; its absence resulted in a three-fold rise in deaths. At the present price of US$2650 per course, every life saved cost around $10,000, and every life year cost around $250. Reduction of the antitoxin's price to $400 would reduce costs to $1137 per life gained; a further reduction to $103 would save money for every life gained. Michael Eddleston comments: "There is presently a worldwide effort to develop and make available affordable drugs for tropical diseases; however, this effort seems to be passing by poisoning and envenoming. Treatments for poisoning and envenoming should be included in the campaign to increase the availability of affordable treatments. Both are significant problems in poor rural areas of the tropics, yet there is a dearth of affordable antivenoms for snake bites and antitoxins for plant poisoning. Although digoxin-specific antibodies were not patented on ethical grounds when developed in 1975, they are now unavailable in Sri Lanka because of their cost."
Contact: Dr Michael Eddleston, Department of Clinical Medicine, Faculty of Medicine, University of Colombo, PO Box 271, 25 Kynsey Road, Colombo-08, Sri Lanka;
F) 44-20-7900-3445 (distant internet-linked fax in London;