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 US2650 dollars per course, every life saved cost 10209 dollars
and every life year cost 248 dollars. Reduction of the antitoxin's price to 400
dollars would reduce costs to 1137 dollars per life gained; a further reduction
to 103 dollars 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.