Snakebite: An Exploratory Cost-Effectiveness Analysis of Adjunct Treatment Strategies

Abstract

Abstract.The cost-effectiveness of the standard of care for snakebite treatment, antivenom, and supportive care has been established in various settings. In this study, based on data from South Indian private health-care providers, we address an additional question: “For what cost and effectiveness values would adding adjunct-based treatment strategies to the standard of care for venomous snakebites be cost-effective?” We modeled the cost and performance of potential interventions (e.g., pharmacologic or preventive) used adjunctively with antivenom and supportive care for the treatment of snakebite. Because these potential interventions are theoretical, we used a threshold cost-effectiveness approach to explore this forward-looking concept. We examined economic parameters at which these interventions could be cost-effective or even cost saving. A threshold analysis was used to examine the addition of new interventions to the standard of care. Incremental cost-effectiveness ratios were used to compare treatment strategies. One-way, scenario, and probabilistic sensitivity analyses were conducted to analyze parameter uncertainty and define cost and effectiveness thresholds. Our results suggest that even a 3% reduction in severe cases due to an adjunct strategy is likely to reduce the cost of overall treatment and have the greatest impact on cost-effectiveness. In this model, for example, an investment of $10 of intervention that reduces the incidence of severe cases by 3%, even without changing antivenom usage patterns, creates cost savings of $75 per individual. These findings illustrate the striking degree to which an adjunct intervention could improve patient outcomes and be cost-effective or even cost saving.

Delayed LY333013 (Oral) and LY315920 (Intravenous) Reverse Severe Neurotoxicity and Rescue Juvenile Pigs from Lethal Doses of Micrurus fulvius (Eastern Coral Snake) Venom

“…The inhibition of enzymatic activity of sPLA2s and other venom components by small molecule inhibitors of specific toxins could address many, but not all, limitations of antivenom. Notably, small molecule antidotes could potentially reduce the volume of antivenom administered, thus increasing the efficacy of antivenoms having a low potency against some venoms [ 8 , 21 , 43 , 44 ] while reducing the cost to the patient and to the healthcare system [ 45 ]. Recent US coral snake guidelines recommend availability of an antidote within one hour—the results of this paper suggest that LY315920 and LY333013 could fulfill these criteria.…”

Delayed Oral LY333013 Rescues Mice from Highly Neurotoxic, Lethal Doses of Papuan Taipan (Oxyuranus scutellatus) Venom

“…Poverty and proximity to hospital care are risk factors associated with poor outcomes [ 1 , 3 , 8 ]. An effective, field-administered antidote to snakebites would address many of the limitations of antivenom and reduce both the economic and technical barriers to initiating care for these life and limb threatening emergencies [ 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 ].…”

<p>Economic Evaluations of Interventions for Snakebites: A Systematic Review</p>

“…Uncertainty analyses showed the high sensitivity of the cost-effectiveness ratio to AV costs, healthcare, and effectiveness of AV in preventing mortality, 12 and to the reduction of the severity of the episode, 17 highlighting the relevance of timely care.…”