Resource Utilization of Pediatric Patients Exposed to Venom

Abstract

BACKGROUND AND OBJECTIVE:Treating envenomation with antivenom is costly. Many patients being treated with antivenom are in observation status, a billing designation for patients considered to need care that is less resourceintensive, and less expensive, than inpatient care. Observation status is also associated with lower hospital reimbursements and higher patient cost-sharing. The goal of this study was to examine resource utilization for treatment of envenomation under observation and inpatient status, and to compare patients in observation status receiving antivenom with all other patients in observation status. METHODS:This was a retrospective study of patients with a primary diagnosis of toxic effect of venom seen during 2009 at 33 freestanding children's hospitals in the Pediatric Health Information System. Data on age, length of stay, adjusted costs (ratio cost to charges), ICU fl ags, and antivenom utilization were collected. Comparisons were conducted according to admission status (emergency department only, observation status, and inpatient status), and between patients in observation status receiving antivenom and patients in observation status with other diagnoses. RESULTS:A total of 2755 patients had a primary diagnosis of toxic effect of venom. Of the 335 hospitalized, either under observation (n = 124) or inpatient (n = 211) status, 107 (31.9%) received antivenom. Of those hospitalized patients receiving antivenom, 24 (22.4%) were designated as observation status. Costs were substantially higher for patients who received antivenom and were driven by pharmacy costs (mean cost: $17 665 for observation status, $20 503 for inpatient status). Mean costs for the 47 162 patients in observation status with other diagnoses were $3001 compared with $17 665 for observation-status patients who received antivenom. 6-8 However, few studies have addressed the treatment burden associated with envenomation cases or the impact of the designated medical service type on resource utilization and costs. CONCLUSIONS:The Centers for Medicare & Medicaid Services (CMS) coined the term "observation status" to describe patients not meeting inpatient Diagnosis Related Group criteria and deemed by payers to be in a state of clinical decisionmaking between discharge-to-home and admission-to-inpatient status. 9They defined the care a patient receives while in observation status as a set of services delivered "before a decision can be made regarding whether patients will require further treatment as hospital inpatients or if they are able to be discharged from the hospital."10 Because patients in observation status have not officially been admitted to the hospital, the care they receive in emergency departments (EDs) or in the hospital is considered outpatient care and is commonly reimbursed at lower rates than care provided to patients with an inpatient status, as observation-status care is presumed to be less resourceintensive.11 Antivenom treatments followed by ongoing care (including being observed for complications)...

Chronic health effects and cost of snakebite

“… Mean income loss: US$93. Expenditure for venomous snakebite: US$231 Expenditure non-venomous snakebite: US$34 Saz-Parkinson et al (2012) Spain Mean: Euro2000 per case Narra et al (2014) 33 children's Hospitals in Pediatric Health Information System, USA Patients receiving anti-venom under observation status: US$17665 In-patients receiving anti-venom: US$20503 Kasturiratne et al (2017) Sri Lanka Annual estimated health system cost: US$10,260,651.53 Cost of anti-venom: US$6.3 million Cost of hospital care: US$3.9 million Tochie (2017) Cameroon Cost of an AVS vial: US$67–75 or US$20–23 Okumu et al, 2019 JOOTRH, Kisumu County, Western Kenya The median cost of treating snakebite: 2652 KES (US$26). Magalhães et al (2020) Brazilian Amazon Health system cost: US$3.115.861,28.…”

Emergency Department Visits by Pediatric Patients for Snakebites

“…A study in 2009 found mean charges of more than $17,000 for pediatric patients with snakebite injuries who were treated with antivenom. 30 In that study, 32% of patients received antivenom. Although we do not know how many patients in our study received antivenom and cannot differentiate charges based upon treatment, it is likely that antivenom use at least partially accounts for the higher costs of ED visits for snakebites compared with nonsnakebite visits.…”

“…Interestingly, coverage by Medicaid was more common for both age groups among children seen in the ED for a diagnosis other than snakebite than for snakebites. A study in 2009 found mean charges of more than $17,000 for pediatric patients with snakebite injuries who were treated with antivenom 30 . In that study, 32% of patients received antivenom.…”

No Change in the Use of Antivenom in Copperhead Snakebites in Ohio

“…If less severe bites are treated with antivenom, this may lead to an increase in hospital admission and possibly increased cost for these patients. 34 This is relevant in the setting of increasing concerns about healthcare costs and emergency department boarding. 35,36…”

“…If less severe bites are treated with antivenom, this may lead to an increase in hospital admission and possibly increased cost for these patients. 34 This is relevant in the setting of increasing concerns about healthcare costs and emergency department boarding. 35,36 Future studies should evaluate antivenom use across the United States as more studies are published and the current studies become more disseminated into standard emergency medicine and toxicology practice.…”