The impact of poisoning in British Columbia: a cost analysis

Fahra Rajabali; Kate Turcotte; Alex Zheng; Roy Purssell; Jane A. Buxton; Ian Pike

doi:10.9778/cmajo.20220089

Article Figures & Tables

Tables

View popup

Table 1:

Direct and indirect cost components of poisoning in British Columbia by patient disposition

Death	Hospital admission	ED	Ambulance	BC DPIC
Direct cost components
Ambulance service (attendance and transportation, pharmaceuticals, medical supplies)	Calls to BC DPIC and transferred to hospital	Calls to BC DPIC and seen in ED	Calls to BC DPIC and attended by ambulance	Calls to BC DPIC and not attended by ambulance, seen in ED or transferred to hospital
ED treatment (physician care, pharmaceuticals, medical supplies)	Ambulance service (attendance and transportation, pharmaceuticals, medical supplies)	Ambulance service (attendance and transportation, pharmaceuticals, medical supplies)	Ambulance service (attendance, pharmaceuticals, medical supplies)
Hospital care (physician care, pharmaceuticals, medical supplies)	ED treatment (physician care, pharmaceuticals, medical supplies)	ED treatment (physician care, pharmaceuticals, medical supplies)
Coroner service and autopsy	Hospital care (physician care, pharmaceuticals, medical supplies)	Long-term medical care
Funeral cost	Long-term medical care	Long-term rehabilitation
Funeral cost	Long-term rehabilitation
Indirect cost components
Deaths	Hospital admission
Future income forgone from potential years of life lost and premature death	Time away from work due to hospital admission Years of disability resulting in forgone income

Note: BC DPIC = British Columbia Drug and Poison Information Centre, ED = emergency department.

View popup

Table 2:

Incidence of poisoning and characteristics of patients in British Columbia by patient disposition, 2016

Characteristic	Patient disposition, no. (%)
Characteristic	Deaths n = 1224 (3%)	Hospital admission^* n = 4657 (10%)	ED^† n = 13 764 (30%)	Ambulance^‡ n = 4135 (9%)	BC DPIC^§ n = 21 411 (47%)	Total^¶ n = 45 191 (100%)
Sex
Male	920 (75)	1921 (41)	9256 (67)	2090 (51)	10 221 (48)	24 408 (54)
Female	304 (25)	2736 (59)	4508 (33)	1136 (27)	10 974 (51)	19 658 (43)
Age group, yr
< 15	0	237 (5)	581 (4)	94 (2)	11 885 (56)	12 797 (28)
15–24	127 (10)	1074 (23)	2772 (20)	543 (13)	1200 (6)	5716 (13)
25–64	1031 (84)	2765 (59)	8668 (63)	2118 (51)	2642 (12)	17 224 (38)
65–74	47 (4)	317 (7)	941 (7)	264 (6)	484 (2)	2053 (5)
> 75	19 (2)	264 (6)	803 (6)	206 (5)	526 (2)	1818 (4)

Note: BC DPIC = British Columbia Drug and Poison Information Centre, ED = emergency department.
↵* Excludes in-hospital deaths.
↵† Excludes patients admitted to the hospital.
↵‡ Patients not transported to the hospital. There were 909 (22%) ambulance patients with missing information on sex and 910 (23%) for age group.
↵§ Patients who had called the BC DPIC and who were not seen by the ambulance or transferred to the hospital. There were 218 (1%) BC DPIC patients with missing information on sex and 4674 (22%) for age group.
↵¶ There were 1125 (3%) of all patients with missing information on sex and 5583 (12%) with missing information on age.

View popup

Table 3:

Poisoning in British Columbia by patient disposition, age group (years) and sex, 2016 (rate per 100 000 population)

Age group and sex	Patient disposition rate per 100 000 population
Age group and sex	Deaths	Hospital admission	ED	Ambulance	BC DPIC
Total	25.2	95.8	283.3	85.1	440.6
< 15	0	33.7	82.6	13.4	1690.2
15–24	21.6	182.3	470.3	92.2	203.6
25–64	37.9	101.6	318.5	77.8	94.8
65–74	9.6	64.7	192.2	53.9	111.1
> 75	5.3	74.2	225.5	58.0	148.3
Males	38.2	79.9	384.8	86.9	346.4
< 15	0	16.7	80.3	11.0	1754.2
15–24	28.6	102.7	494.7	93.8	163.1
25–64	58.6	96.6	465.6	108.7	83.0
65–74	13.8	55.3	266.6	70.0	90.5
> 75	7.7	74.0	356.8	86.3	115.5
Females	12.4	111.5	183.7	46.3	339.7
< 15	0	51.6	85.0	15.9	1614.2
15–24	13.9	269.2	443.6	90.5	245.8
25–64	17.7	106.5	175.4	47.8	103.7
65–74	5.6	73.7	121.4	38.5	130.3
> 75	3.5	74.2	122.3	35.7	175.1

Note: BC DPIC = British Columbia Drug and Poison Information Centre, ED = emergency department.

View popup

Table 4:

Costs of poisoning in British Columbia by patient disposition and intent, 2016

Patient disposition	Intent, cost, $				Total costs, $	Average cost per case, $
Patient disposition	Unintentional	Suicide or self-harm	Violence	Undetermined	Total costs, $	Average cost per case, $
Direct costs^*
Total	50 602 083	49 065 296	104 880	9 098 550	108 870 809	2409
Deaths	10 477 741	1 637 934	0	659 361	12 775 036	10 437
Hospital admission	26 781 476	34 494 494	54 972	5 869 147	67 200 090	14 430
ED	11 594 162	11 817 653	8806	2 383 395	25 804 015	1875
Ambulance	873 134	1 070 241	3751	184 495	2 131 621	516
BC DPIC	875 570	44 973	37 351	2152	960 047	45
Indirect costs^*
Total	629 238 926	66 669 581	1711	7 704 320	703 614 538	15 570
Deaths	628 747 121	65 677 574	0	7 585 509	702 010 205	573 538
Hospital admission	491 805	992 007	1711	118 811	1 604 333	344
Total costs^*	679 841 009	115 734 877	106 591	16 802 870	812 485 347	17 979
Deaths	639 224 862	67 315 508	0	8 244 870	714 785 241	583 975
Hospital admission	27 273 281	35 486 501	56 683	5 987 958	68 804 423	14 774
ED	11 594 162	11 817 653	8806	2 383 395	25 804 015	1875
Ambulance	873 134	1 070 241	3751	184 495	2 131 621	516
BC DPIC	875 570	44 973	37 351	2152	960 047	45

Note: BC DPIC = British Columbia Drug and Poison Information Centre, ED = emergency department.
↵* Bolded values are total values for direct costs, indirect costs and total costs.

View popup

Table 5:

Costs of poisonings in British Columbia by patient disposition, age group (years) and sex, 2016

Age group (population) and sex	Patient disposition, cost, $					Total direct costs, $	Per capita cost, $
Age group (population) and sex	Deaths	Hospital admission	ED	Ambulance	BC DPIC	Total direct costs, $	Per capita cost, $
Direct costs^*
Total^* (4 859 250)	12 498 167	67 174 801	25 801 820	2 125 344	750 654	108 350 785	22.30
< 15 (703 176)	0	2 051 030	784 021	71 172	531 563	3 437 786	4.89
15–24 (589 297)	1 186 425	11 344 913	4 401 531	357 789	54 119	17 344 777	29.43
25–64 (2 721 148)	10 456 162	41 992 987	16 577 542	1 387 134	116 291	70 530 116	25.92
65–74 (489 618)	608 735	5 980 987	2 175 265	172 653	24 651	8 962 292	18.30
> 75 (356 011)	246 845	5 804 884	1 863 461	136 595	24 030	8 075 816	22.68
Male (2 405 364)	9 303 546	31 279 613	18 312 276	1 371 506	375 990	60 642 931	25.21
< 15 (360 168)	0	512 236	359 625	31 324	283 281	1 186 467	3.29
15–24 (307 750)	844 537	3 647 082	2 488 168	189 146	22 834	7 191 766	23.37
25–64 (1 342 218)	7 949 242	22 027 025	12 657 557	953 496	51 677	43 638 997	32.51
65–74 (238 563)	361 378	2 900 353	1 582 795	108 847	9912	4 963 285	20.80
> 75 (156 665)	148 389	2 192 917	1 224 131	88 693	8286	3 662 416	23.38
Female (2 453 886)	3 194 621	35 895 187	7 489 544	753 837	374 664	47 707 854	19.44
< 15 (343 008)	0	1 538 794	424 396	39 847	248 282	2 251 319	6.56
15–24 (281 547)	341 889	7 697 831	1 913 363	168 643	31 285	10 153 011	36.06
25–64 (1 378 930)	2 506 920	19 965 961	3 919 985	433 638	64 614	26 891 118	19.50
65–74 (251 055)	247 357	3 080 634	592 470	63 806	14 739	3 999 007	15.93
> 75 (199 346)	98 455	3 611 967	639 330	47 903	15 744	4 413 399	22.14
Indirect costs^*
Total (4 859 250)	702 010 205	1 604 333	N/A	N/A	N/A	703 614 538	144.80
15–24 (589 297)	143 391 615	341 970				143 733 584	243.91
25–64 (2 721 148)	558 618 590	1 262 364				559 880 954	205.75
Male (2 405 364)	525 000 709	697 236				525 697 944	218.55
15–24 (307 750)	98 586 712	100 694				98 687 406	320.67
25–64 (1 342 218)	426 413 997	596 542				427 010 538	318.14
Female (2 453 886)	177 009 496	907 098				177 916 594	72.50
15–24 (281 547)	44 804 902	241 276				45 046 178	160.00
25–64 (1 378 930)	132 204 594	665 822				132 870 416	96.36

Note: BC DPIC = British Columbia Drug and Poison Information Centre, ED = emergency department, N/A = not applicable.
↵* Bolded values are total values for direct costs, indirect costs and total costs.

View popup

Table 6:

Sensitivity analysis, effects of changes in discount rate, unemployment rate and participation rate in economic costs of poisoning (Can$ million), British Columbia, 2016

Key driver	Direct costs	Indirect costs	Total costs
Discount rate
1%	$108.87	$746.06	$854.93
1.5% (base case)	$108.87	$703.61	$812.49
3%	$108.87	$597.97	$706.84
5%	$108.87	$494.02	$602.89
change (1.5–1.0), %	0	6.0	5.2
change (1.5–3.0), %	0	−15.0	−13.0
change (1.5–5.0), %	0	−29.8	−25.8
Unemployment rate
4%	$108.87	$718.59	$827.46
6% (base case)	$108.87	$703.61	$812.49
8%	$108.87	$688.64	$797.51
change (6.0–4.0), %	0	2.1	1.8
change (6.0–8.0), %	0	−2.1	−1.8
Participation rate
54.4%	$108.87	$594.36	$703.23
64.4% (base case)	$108.87	$703.61	$812.49
74.4%	$108.87	$812.87	$921.74
change (64.4–54.4), %	0	−15.5	−13.4
change (64.4–74.4), %	0	15.5	13.4

* Bolded values are the key drivers (base case) that were used to calculate the costs in this study. This table is showing the sensitivity of what the costs would have been using key driver values below or above the base case values.