Economic burden of snakebite and cost-effectiveness of improving access to snake antivenom in Asean countries

Abstract

The Association of Southeast Asian Nations (ASEAN) countries are among the tropical regions with disproportionately high incidence of snakebite. Understanding the snakebite and antivenom market situation and burden of snakebite is crucial for developing evidence-based strategies to pursue the goal set by the World Health Organization (WHO) to halve morbidity and mortality of snakebite by 2030. Firstly, we systematically review 23 cost of illness studies and 3 economic evaluations. Economic burdens of snakebite were underestimated and not extensively studied. Majority of studies only provided direct costs of snakebite patients presented to the hospitals. Thus, hospital data should be used to combine with community survey to ensure the accurate estimation of overall economic burdens of snakebite victims. Secondly, we estimated the high economic and disease burden of snakebite in ASEAN, despite the availability of domestically produced antivenoms. Almost all of the estimated economic and disease burdens were attributed to premature deaths from snakebite envenoming which suggested that the remarkably high burden of snakebite could be averted, especially in countries where large proportions of victims who needed antivenom were not treated with geographically appropriate antivenoms. Thirdly, cost-effectiveness analysis demonstrated improving access to snake antivenom from the current to the full level of access in five ASEAN countries was cost-saving. Our findings indicated that the WHO’s goal to halve the snakebite burden could be achieved by providing full access to snake antivenoms for all victims in ASEAN. In conclusion, improving the situation of snakebite and antivenom is not only about the availability of antivenom, but the whole landscape of surrounding management and supporting system. The assessment of the situation of snakebite and antivenom is crucial for countries or regions where snakebites are prevalent to recognize their current standpoint to inform the development of strategies to address snakebite problems in ASEAN countries.