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.
Highlights
Snakebite poisoning is a significant cause of death and disability in rural West Africa [1,2,3,4,5,6,7]
The Probabilistic Sensitivity Analyses (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 Incremental Cost Effectiveness Ratios (ICERs) that fell below the threshold of one time per capita Gross Domestic Product (GDP), indicating a high degree of confidence in our results
In the sub-region, envenoming from snakes other than vipers mostly results from African spitting cobras (Naja nigricollis, N. katiensis), puff-adder (Bitis arietans), mambas (Dendroaspis viridis, D. polylepis), burrowing asps or stiletto snakes (Atractaspis species), night adders (Causus maculatus, C. rhombeatus, C. resimus, C. lichtensteinii) and very rarely boomslang (Dispholidus typus)
Summary
Snakebite poisoning is a significant cause of death and disability in rural West Africa [1,2,3,4,5,6,7]. Even in West Africa alone, a range of 1504 to 18,654 annual mortality from snakebite envenoming has been made [8]. This is further compounded by the variability in snakebite incidence with estimates of as high as 500 bites per 100,000 persons per year in parts of northern Nigeria [9]. Vipers (Echis ocellatus, E. leucogaster and E. jogeri) are a major cause of snakebite envenoming throughout the sub-region mainly in Benin republic, Burkina Faso, Cameroun, Chad, Gambia, Ghana, Mali, Niger, Nigeria, Togo and Senegal [1,2,3,4,5,6,7]. Romane’s carpet viper (Echis leucogaster) and Egyptian cobras (Naja haje and N. senegalensis) are causes of snakebite envenoming in the Sahelian and drier parts of West Africa while the forest cobra (Naja melanoleuca) and the Gaboon viper (Bitis gabonica) cause occasional bites in the rain forest and South-eastern parts of the sub-region [1,5,7]. Antivenom (AV) is the standard treatment, and we assessed the cost-effectiveness of making it available in 16 countries in West Africa
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