Estimating economic and disease burden of snakebite in ASEAN countries using a decision analytic model

Abstract

Background Understanding the burden of snakebite is crucial for developing evidence-informed strategies to pursue the goal set by the World Health Organization to halve morbidity and mortality of snakebite by 2030. However, there was no such information in the Association of Southeast Asian Nations (ASEAN) countries. Methodology A decision analytic model was developed to estimate annual burden of snakebite in seven countries, including Malaysia, Thailand, Indonesia, Philippines, Vietnam, Lao PDR, and Myanmar. Country-specific input parameters were sought from published literature, country’s Ministry of Health, local data, and expert opinion. Economic burden was estimated from the societal perspective. Costs were expressed in 2019 US Dollars (USD). Disease burden was estimated as disability-adjusted life years (DALYs). Probabilistic sensitivity analysis was performed to estimate a 95% credible interval (CrI). Principal findings We estimated that annually there were 242,648 snakebite victims (95%CrI 209,810–291,023) of which 15,909 (95%CrI 7,592–33,949) were dead and 954 (95%CrI 383–1,797) were amputated. We estimated that 161,835 snakebite victims (69% of victims who were indicated for antivenom treatment) were not treated with antivenom. Annual disease burden of snakebite was estimated at 391,979 DALYs (95%CrI 187,261–836,559 DALYs) with total costs of 2.5 billion USD (95%CrI 1.2–5.4 billion USD) that were equivalent to 0.09% (95%CrI 0.04–0.20%) of the region’s gross domestic product. >95% of the estimated burdens were attributed to premature deaths. Conclusion/Significance The estimated high burden of snakebite in ASEAN was demonstrated despite the availability of domestically produced antivenoms. Most burdens were attributed to premature deaths from snakebite envenoming which suggested that the remarkably high burden of snakebite could be averted. We emphasized the importance of funding research to perform a comprehensive data collection on epidemiological and economic burden of snakebite to eventually reveal the true burden of snakebite in ASEAN and inform development of strategies to tackle the problem of snakebite.

Potential economic and clinical implications of improving access to snake antivenom in five ASEAN countries: A cost-effectiveness analysis

“…We selected the five most impacted ASEAN countries for this study, including Indonesia, Philippines, Vietnam, Lao PDR, and Myanmar because the previous estimates in these countries found that only 4–64% of victims who were indicated for antivenoms were treated with antivenoms [ 5 ].…”

“…A decision analytic model ( Fig 1 ) was adapted from the previously developed model to estimate the number of snakebite victims occurring in one year in ASEAN countries and the economic and disease burden of snakebite victims [ 5 ]. Briefly, victims who were bitten by snakes sought either conventional treatment or traditional treatment.…”

“…There were four key assumptions of the model [ 5 ]. First, one person can be bitten by a snake only once in a lifetime.…”

“…Our previous study estimated that there were approximately 243,000 snakebite victims with 16,000 deaths and 950 amputations from snakebite envenoming in seven ASEAN countries, namely, Malaysia, Thailand, Indonesia, Philippines, Vietnam, Lao PDR, and Myanmar. The annual economic and disease burden of snakebite in these countries was estimated at approximately 2.5 billion US Dollars (USD) and 392,000 disability-adjusted life years (DALYs) lost due to snakebite [ 5 ].…”

“…However, not all victims with snakebite envenoming in ASEAN countries could access to geographically appropriate antivenoms for many reasons including inadequate supplies of antivenom, inefficient supply chain system, and inappropriate treatment seeking behavior [ 9 ]. Especially in Indonesia, Philippines, Vietnam, Lao PDR, and Myanmar, where 4–64% of victims with snakebite envenoming were treated with antivenoms [ 5 ].…”