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Cost-effectiveness of Antivenoms for Snakebite Envenoming in Nigeria

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  • Abdulrazaq G Habib
  • Mohammed Lamorde
  • Mahmood M Dalhat
  • Zaiyad G Habib
  • Andreas Kuznik

Abstract

Background: Snakebite 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. Methodology: Economic 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 Findings: We 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/Significance: Treatment 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. Author Summary: Snake bite is a major public health problem throughout rural communities in West Africa and leads to a significant number of deaths and disabilities per year. Even though effective antivenoms exist against the locally prevalent carpet viper and other poisonous snakes, they are generally not available in community settings, possibly because of their high acquisition cost. 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. We find that the incremental cost effectiveness ratio (ICER) associated with making antivenom available in Nigeria was $2,330 per death averted and $100 per disability adjusted life year (DALY) averted. Both of these suggest that snakebite antivenom is highly cost-effective in Nigeria and they also compare very favorably against other commonly funded health interventions for which similar estimates exist. Since a substantial reduction in mortality and DALYs could be achieved at a relatively modest upfront cost, expanding access to antivenom to broader parts of the population should be a priority consideration for future investments in healthcare.

Suggested Citation

  • Abdulrazaq G Habib & Mohammed Lamorde & Mahmood M Dalhat & Zaiyad G Habib & Andreas Kuznik, 2015. "Cost-effectiveness of Antivenoms for Snakebite Envenoming in Nigeria," PLOS Neglected Tropical Diseases, Public Library of Science, vol. 9(1), pages 1-7, January.
  • Handle: RePEc:plo:pntd00:0003381
    DOI: 10.1371/journal.pntd.0003381
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    References listed on IDEAS

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    1. Shehan S Williams & Chamara A Wijesinghe & Shaluka F Jayamanne & Nicholas A Buckley & Andrew H Dawson & David G Lalloo & H Janaka de Silva, 2011. "Delayed Psychological Morbidity Associated with Snakebite Envenoming," PLOS Neglected Tropical Diseases, Public Library of Science, vol. 5(8), pages 1-6, August.
    2. Nicholas I Brown, 2012. "Consequences of Neglect: Analysis of the Sub-Saharan African Snake Antivenom Market and the Global Context," PLOS Neglected Tropical Diseases, Public Library of Science, vol. 6(6), pages 1-7, June.
    3. S.J. Goldie & Y. Yazdanpanah & E. Losina & M.C. Weinstein & X. Anglaret & R.P. Walensky & H.E. Hsu & A. Kimmel & C. Holmes & J.E. Kaplan & K.A. Freedberg, 2006. "Cost-effectiveness of HIV treatment in Resource-Poor Settings - The case of Côte d'Ivoire," Post-Print hal-00199992, HAL.
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    1. Muhammad Hamza & Maryam A Idris & Musa B Maiyaki & Mohammed Lamorde & Jean-Philippe Chippaux & David A Warrell & Andreas Kuznik & Abdulrazaq G Habib, 2016. "Cost-Effectiveness of Antivenoms for Snakebite Envenoming in 16 Countries in West Africa," PLOS Neglected Tropical Diseases, Public Library of Science, vol. 10(3), pages 1-16, March.
    2. Abdulrazaq G Habib & Baba M Musa & Garba Iliyasu & Muhammad Hamza & Andreas Kuznik & Jean-Philippe Chippaux, 2020. "Challenges and prospects of snake antivenom supply in sub-Saharan Africa," PLOS Neglected Tropical Diseases, Public Library of Science, vol. 14(8), pages 1-10, August.
    3. Sayem Ahmed & Guibehi B Koudou & Maïwenn Bagot & François Drabo & Windtaré R Bougma & Caisey Pulford & Moses Bockarie & Robert A Harrison, 2021. "Health and economic burden estimates of snakebite management upon health facilities in three regions of southern Burkina Faso," PLOS Neglected Tropical Diseases, Public Library of Science, vol. 15(6), pages 1-17, June.

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