Deaths due to absence of an affordable antitoxin for plant poisoning

There is a severe shortage of affordable antivenoms and antitoxins in the developing world. An anti-digoxin antitoxin for oleander poisoning was introduced in Sri Lanka in July, 2001, but because of its cost, stocks ran out in July, 2002. We looked at the effect of its introduction and withdrawal on case fatality, and determined its cost-effectiveness. 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 $10 209 and every life year cost $248. 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. Treatments for poisoning and envenoming should be included in the present campaign to increase availability of affordable treatments in the developing world.