services. They did this in the context of four typical poison exposures (e.g., acute cough or cold preparation overdose in children younger than 13 years of age).

For cough or cold preparation overdose, they concluded that when calls go through a poison control center first, the costs per case average $414 (in 1995 dollars), with a probability of .004 of morbidity and .000006 of mortality. In contrast, without a poison control center, the costs per case are $664, with a probability of .01 of morbidity and .00002 of mortality. The authors concluded that for cold preparation overdoses, and under the assumptions of their model, poison control centers lead to lower costs to the health care system and better outcomes in terms of morbidity and mortality. The cost savings result both from the centers triaging visits to the emergency departments and from the cost savings associated with better health outcomes for those cases going to the emergency departments that have already gone through the centers. These cost savings amount to an average of $250 per case ($664 minus $414). This compares with a cost per call to the poison control center in the $25-to-$30 range (Zuvekas et al., 1997).

Applying the same methodology to acetaminophen overdoses, the cost savings are $343 per case. For antidepressant overdoses, the cost savings are estimated to be $347 per case. For a standard cleaning substance exposure in children, the cost savings are estimated to be an average of $297 per case. In each of these cases as well, each dollar of poison control center expenditure on treatment management guidance results in a cost savings to the health care system of $10 or more. This is a lower bound estimate insofar as it does not take into account the benefits of poison control centers in terms of time and anxiety to the public, nor to their substantial positive impact on morbidity and mortality outcomes.

Miller and Lestina (1997) provided an analysis of cost savings from poison control centers that has been widely cited in legislation, congressional testimony, and many popular venues. It concluded that for every dollar invested in poison control centers, there are savings of about $6.50 to the health care system as a whole. While this magnitude of cost savings is not wildly different from other convincing analyses, there are significant limitations to the Miller and Lestina analysis.

Miller and Lestina estimated that the total societal costs of poisonings would be reduced from $3,315 million if there were no poison control centers to $2,905 million if the whole population of the country had access to a center, a savings of $310 million. They compared this with the cost of centers, which they indicated to be between $60 and $80 million. These data form the basis of their conclusion that there is a 6.5-to-1 cost savings for each dollar invested in poison control centers.

The $390 million in savings, an amount greater than Miller and



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