Abstract
BackgroundSnakebite envenoming is a major public health problem throughout the rural tropics. Antivenom is effective in reducing mortality and remains the mainstay of therapy. This study aimed to determine the cost-effectiveness of using effective antivenoms for Snakebite envenoming in Nigeria.MethodologyEconomic analysis was conducted from a public healthcare system perspective. Estimates of model inputs were obtained from the literature. Incremental Cost Effectiveness Ratios (ICERs) were quantified as deaths and Disability-Adjusted-Life-Years (DALY) averted from antivenom therapy. A decision analytic model was developed and analyzed with the following model base-case parameter estimates: type of snakes causing bites, antivenom effectiveness to prevent death, untreated mortality, risk of Early Adverse Reactions (EAR), mortality risk from EAR, mean age at bite and remaining life expectancy, and disability risk (amputation). End-user costs applied included: costs of diagnosing and monitoring envenoming, antivenom drug cost, supportive care, shipping/freezing antivenom, transportation to-and-from hospital and feeding costs while on admission, management of antivenom EAR and free alternative snakebite care for ineffective antivenom.Principal FindingsWe calculated a cost/death averted of ($2330.16) and cost/DALY averted of $99.61 discounted and $56.88 undiscounted. Varying antivenom effectiveness through the 95% confidence interval from 55% to 86% yield a cost/DALY averted of $137.02 to $86.61 respectively. Similarly, varying the prevalence of envenoming caused by carpet viper from 0% to 96% yield a cost/DALY averted of $254.18 to $78.25 respectively. More effective antivenoms and carpet viper envenoming rather than non-carpet viper envenoming were associated with lower cost/DALY averted.Conclusions/SignificanceTreatment of snakebite envenoming in Nigeria is cost-effective with a cost/death averted of $2330.16 and cost/DALY averted of $99.61 discounted, lower than the country's gross domestic product per capita of $1555 (2013). Expanding access to effective antivenoms to larger segments of the Nigerian population should be a considered a priority.
Highlights
Snakebite envenoming is a major public health problem among agricultural communities in the savanna region of West Africa [1,2,3]
A recent global appraisal estimated an incidence of envenomings in West Africa of 8.87–93.3/100,000 persons per year (PPY) and a mortality rate of 0.504–5.9/100,000 PPY [4]
We evaluated the cost-effectiveness of making antivenom more broadly available in Nigeria by comparing the treatment costs associated with antivenom therapy against their medical benefit in reducing the risk of mortality
Summary
Snakebite envenoming is a major public health problem among agricultural communities in the savanna region of West Africa [1,2,3]. A recent global appraisal estimated an incidence of envenomings in West Africa of 8.87–93.3/100,000 persons per year (PPY) and a mortality rate of 0.504–5.9/100,000 PPY [4]. Snakebite envenoming in Nigeria results from carpet viper (Echis ocellatus) attacks, which accounts for at least 66% of all snakebites. Non-clotting blood in the 20WBCT is diagnostic of carpet viper envenoming and is used to guide and monitor response to antivenom therapy [1,6,7]. This study aimed to determine the cost-effectiveness of using effective antivenoms for Snakebite envenoming in Nigeria
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