Potential economic and clinical implications of improving access to snake antivenom in five ASEAN countries: A cost-effectiveness analysis

Background: Despite domestic production of antivenoms in the Association of Southeast Asian Nations (ASEAN) countries, not all victims with snakebite envenomings indicated for antivenom received the appropriate or adequate effective dose of antivenom due to insufficient supply and inadequate access to antivenoms. We aimed to conduct a cost-effectiveness analysis to project the potential economic and clinical impact of improving access to antivenoms when all snakebite envenomings in ASEAN countries were hypothetically treated with geographically appropriate antivenoms. Methodology: Using a decision analytic model with input parameters from published literature, local data, and expert opinion, we projected the impact of “full access” (100%) to antivenom, compared to “current access” in five most impacted ASEAN countries, including Indonesia (10%), Philippines (26%), Vietnam (37%), Lao PDR (4%), and Myanmar (64%), from a societal perspective with a lifetime time horizon. Sensitivity analyses were performed. Principal findings: In base-case analyses, full access compared to current access to snake antivenom in the five countries resulted in a total of 9,362 deaths averted (-59%), 230,075 disability-adjusted life years (DALYs) averted (-59%), and cost savings of 1.3 billion USD (-53%). Incremental cost-effectiveness ratios (ICERs) of improving access to antivenom found higher outcomes but lower costs in all countries. Probabilistic sensitivity analyses of 1,000 iterations found that 98.1–100% of ICERs were cost-saving. Conclusion/Significance: Improving access to snake antivenom will result in cost-saving for ASEAN countries. Our findings emphasized the importance of further strengthening regional cooperation, investment, and funding to improve the situation of snakebite victims in ASEAN countries. Author summary: In the Association of Southeast Asian Nations (ASEAN) countries, it was estimated that annually there were 242,648 snakebite victims in ASEAN of which 15,909 victims were dead. Despite domestic production of antivenoms in ASEAN countries, not all victims with snakebite envenomings indicated for antivenom received the appropriate or adequate effective dose of antivenom due to insufficient supply and inadequate access to antivenoms. Especially in Indonesia, Philippines, Vietnam, Lao PDR, and Myanmar, where 4–64% of victims who needed antivenoms were treated with antivenoms. We conducted a cost-effectiveness analysis to project the potential economic and clinical impact of improving access to antivenoms when all victims with snakebite envenomings in the five most impacted ASEAN countries were hypothetically treated with geographically appropriate antivenoms. Improving access to snake antivenom to the full level of access compared to the current level in the five ASEAN countries resulted in a total of 9,362 deaths averted (-59%), 230,075 disability-adjusted life years (DALYs) averted (-59%), and cost savings of 1.3 billion USD (-53%). Our study demonstrated improving access to snake antivenom from the current to the full level of access in ASEAN countries is a cost-saving strategy. Our findings emphasized the importance of further strengthening regional cooperation, investment, and funding to improve the situation of snakebite victims in ASEAN countries to reach the ultimate goal where all victims with snakebite envenoming needing antivenom adequately received the geographically appropriate antivenoms.