Cost-Effectiveness of Antivenoms for Snakebite Envenoming in 16 Countries in West Africa

Abstract

BackgroundSnakebite poisoning is a significant medical problem in agricultural societies in Sub Saharan Africa. Antivenom (AV) is the standard treatment, and we assessed the cost-effectiveness of making it available in 16 countries in West Africa.MethodsWe determined the cost-effectiveness of AV based on a decision-tree model from a public payer perspective. Specific AVs included in the model were Antivipmyn, FAV Afrique, EchiTab-G and EchiTab-Plus. We derived inputs from the literature which included: type of snakes causing bites (carpet viper (Echis species)/non-carpet viper), AV effectiveness against death, mortality without AV, probability of Early Adverse Reactions (EAR), likelihood of death from EAR, average age at envenomation in years, anticipated remaining life span and likelihood of amputation. Costs incurred by the victims include: costs of confirming and evaluating envenomation, AV acquisition, routine care, AV transportation logistics, hospital admission and related transportation costs, management of AV EAR compared to the alternative of free snakebite care with ineffective or no AV. Incremental Cost Effectiveness Ratios (ICERs) were assessed as the cost per death averted and the cost per Disability-Adjusted-Life-Years (DALY) averted. Probabilistic Sensitivity Analyses (PSA) using Monte Carlo simulations were used to obtain 95% Confidence Intervals of ICERs.ResultsThe cost/death averted for the 16 countries of interest ranged from $1,997 in Guinea Bissau to $6,205 for Liberia and Sierra Leone. The cost/DALY averted ranged from $83 (95% Confidence Interval: $36-$240) for Benin Republic to $281 ($159–457) for Sierra-Leone. In all cases, the base-case cost/DALY averted estimate fell below the commonly accepted threshold of one time per capita GDP, suggesting that AV is highly cost-effective for the treatment of snakebite in all 16 WA countries. The findings were consistent even with variations of inputs in 1—way sensitivity analyses. In addition, the PSA showed that in the majority of iterations ranging from 97.3% in Liberia to 100% in Cameroun, Guinea Bissau, Mali, Nigeria and Senegal, our model results yielded an ICER that fell below the threshold of one time per capita GDP, thus, indicating a high degree of confidence in our results.ConclusionsTherapy for SBE with AV in countries of WA is highly cost-effective at commonly accepted thresholds. Broadening access to effective AVs in rural communities in West Africa is a priority.

Epidemiology, ecology and human perceptions of snakebites in a savanna community of northern Ghana

“…We consistently found that young to middle-aged men (age group = 15-44 years) were most at risk of snakebites, corroborating similar findings from Ghana [22, 23, 24], other parts of West Africa [15, 25, 26, 27, 44, 46, 47] and Africa in general [30, 34, 48, 49, 50]. Adolescent and young men in their twenties are among the most active and adventurous, albeit least cautious, section of rural African people [24, 27, 44, 51].…”

“…amputations) or death, even if such treatment is administered correctly [22, 42, 44, 45]. It is therefore important to ascertain the extent of both untreated and delayed treatments in order to address these clinical and epidemiological shortcomings in the management of snakebites in remote rural parts of Ghana and sub-Saharan Africa [2, 13, 15, 40, 42]. We hope our snakebite data analyses from the Savelugu-Nanton District, a typical northern savanna community in Ghana, will aid in this direction.…”

Varespladib (LY315920) Appears to Be a Potent, Broad-Spectrum, Inhibitor of Snake Venom Phospholipase A2 and a Possible Pre-Referral Treatment for Envenomation

“…Partnership with academia, other frameworks of social cooperation and industry already in possession of valuable pre-clinical and toxicological data, especially for off-patent compounds could speed development of these and other potential therapeutics for saving lives. Similarly, if these field-treatments can reduce healthcare costs related to snakebite even small reductions in the need for ICU and operative care, which even with no reduction in antivenom use, would be tremendously cost saving [ 50 , 51 ].…”

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

“…Only two cost-effectiveness analyses on snakebite treatments were identified at the time of our study. 30 , 31 These studies have determined that antivenom (administered alongside supportive care) is cost-effective in a variety of West African settings. Our study seeks to answer the following additional question, “For what cost and efficacy values would a combination antivenom/adjunct-based treatment strategy for venomous snakebites be cost-effective when compared with using antivenom alone?”…”