Antivenom Costs Show Need for Education and Collaborative Efforts

Abstract

I read with great interest Boyer's important article1Boyer L. On 1000-fold pharmaceutical price markups, and why drugs cost more in the US than in Mexico.Am J Med. 2015; 128: 1265-1267Abstract Full Text Full Text PDF Scopus (13) Google Scholar regarding antivenom product cost, and I have 2 comments. First, the value of public health education should not be ignored. The case that prompted Boyer's important discussion, for instance, reportedly resulted from an adult male patient trying to take a “selfie” (photograph) with a rattlesnake.2Rattlesnake selfie lands man $150K doctor bill, KGTV News, July 17, 2015. Available at: http://www.10news.com/news/one-rattlesnake-bite-150k-doctor-bill. Accessed October 4, 2015.Google Scholar In the United States, prevention, training, and education strategies, such as advising discretion in handling snakes and keeping exotic/venomous snakes as pets, may have value.3Lubich C. Krenzelok E.P. Exotic snakes are not always found in exotic places: how poison centres can assist emergency departments.Emerg Med J. 2007; 24: 796-797Crossref PubMed Scopus (9) Google Scholar In the developing world, although circumstances differ, training, protocol development, and education strategies also are important.4Education and Training, Global Snakebite Initiative. Available at: http://www.snakebiteinitiative.org/?page_id=736. Accessed October 4, 2015.Google Scholar, 5Simpson I.D. Norris R.L. The global snakebite crisis–a public health issue misunderstood, not neglected.Wilderness Environ Med. 2009; 20: 43-56Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar Second, the global nature of access and market challenges5Simpson I.D. Norris R.L. The global snakebite crisis–a public health issue misunderstood, not neglected.Wilderness Environ Med. 2009; 20: 43-56Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar, 6Alirol E. Lechevalier P. Zamatto F. Chappuis F. Alcoba G. Potet J. Antivenoms for snakebite envenoming: what is in the research pipeline?.PLoS Negl Trop Dis. 2015; 9: e0003896Crossref Scopus (41) Google Scholar—it was recently announced that an important antivenom product used in Africa (Fav-Afrique, Sanofi Pasteur, Lyon, France) would be “permanently discontinued”6Alirol E. Lechevalier P. Zamatto F. Chappuis F. Alcoba G. Potet J. Antivenoms for snakebite envenoming: what is in the research pipeline?.PLoS Negl Trop Dis. 2015; 9: e0003896Crossref Scopus (41) Google Scholar—suggest it is time to think outside the box about new potential treatments and approaches. Innovative diagnostics and medical devices,7Forensic DNA test conclusively links snake bite marks on people to species. Science Daily November 11, 2014. Available at: http://www.sciencedaily.com/releases/2014/11/141104091108.htm. Accessed October 4, 2015.Google Scholar new and repurposed drug therapies,8Cures Within Reach. Available at: http://cureswithinreach.org/. Accessed October 4, 2015.Google Scholar, 9Lewin M.R. Bickler P. Heier T. Feiner J. Montauk L. Mensh B. Reversal of experimental paralysis in a human by intranasal neostigmine aerosol suggests a novel approach to the early treatment of neurotoxic envenomation.Clin Case Rep. 2013; 1: 7-15Crossref PubMed Scopus (8) Google Scholar and indigenous remedies10Gupta Y.K. Peshin S.S. Do herbal medicines have potential for managing snake bite envenomation?.Toxicol Int. 2012; 19: 89-99Crossref Scopus (48) Google Scholar should be explored further. Nontraditional partners, such as the Department of Defense, can be more fully engaged in research efforts.11Phillips MM, Fassihi F. Snake tale: how venom binds U.S., Iran Wall Street Journal. December 7, 2012. Available at: http://www.wsj.com/articles/SB10001424127887323830404578145561189737342. Accessed September 13, 2015.Google Scholar, 12Heiner J.D. Bebarta V.S. Varney S.M. Bothwell J.D. Cronin A.J. Clinical effects and antivenom use for snake bite victims treated at three US hospitals in Afghanistan.Wilderness Environ Med. 2013; 24: 412-416Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar A “One Health” approach fostering collaboration among experts from a wide variety of fields also seems vital.13One Health Initiative. Available at: http://www.onehealthinitiative.com/. Accessed October 4, 2015.Google Scholar Such approaches individually or in combination may, in the long term, benefit health care providers and victims of snakebites. On 1000-Fold Pharmaceutical Price Markups and Why Drugs Cost More in the United States than in MexicoThe American Journal of MedicineVol. 128Issue 12PreviewOn July 15, The Washington Post's Wonkblog posted a story titled “This $153,000 Rattlesnake Bite Is Everything Wrong with American Health Care,”1 accompanied by a striking photograph depicting ascending hemorrhagic lymphangitis and an image of the associated hospital bill, which included $83,341.25 in pharmacy charges, presumably for antivenom. The article quotes a wholesale cost of $2300 per vial, describes efforts by the manufacturer to squelch competition, and states that at least 1 man has died because of refusal to accept this high cost of care. Full-Text PDF The ReplyThe American Journal of MedicineVol. 129Issue 6PreviewI appreciate and agree with Mitchell Berger's comments on my editorial1 regarding the importance of education and the potential benefits of working with nontraditional partners such as One Health or the Department of Defense. Full-Text PDF