Researchers from Duke – including five from the Department of Emergency Medicine – and Brazil found the benefits of scaling up antivenom access greatly outweigh the costs
A just-published, NIH-funded study has identified three cost-effective ways to significantly reduce the death and disability caused by venomous snakebites in the Brazilian Amazon, in the state of Amazonas/Brazil. With between 45 and 235 poisonous snakebites per 100,000 people every year, Amazonas has one of the world’s highest incidence rates of snakebite envenoming (SBE).
Because snakebite antivenom drugs are not readily available to most people bitten by venomous snakes in the state, many of them suffer serious medical complications or die before they can reach a center that has it — and someone trained to administer it.
The study, “Scaling up antivenom for snakebite envenoming in the Brazilian Amazon: a cost-effectiveness analysis,” was conducted by a team of Duke scientists and physicians and collaborating researchers in Brazil from the Tropical Medicine Foundation Dr. Heitor Vieira Dourado and the Butantan Institute.
The goal was to assess the health and economic benefits, as well as to estimate the costs of scaling up the availability of snake antivenom to the state’s community health centers (CHCs) and hospitals.
The research was funded by the NIH Fogarty International Center; Conselho Nacional de Desenvolvimento Científico e Tecnológico (Drs. Monteiro and Sachett); and Fundação de Amparo à Pesquisa do Estado do Amazonas (Dr. Monteiro).
Published in the January 2024 issue of THE LANCET Regional Health - Americas, the study shows that the cost of making snake antivenom readily and proportionately available to people in Amazonas is a worthy investment.
The benefit of the investment was measured by improvement in disability-adjusted life-years (DALYs). DALYs are a commonly used way of measuring a disease’s impact on the population, created by counting the number of years of life are impacted by and/or lost due to a disease in that population.
These key findings illustrate that scaling up antivenom access — or, in other words, making antivenom available in — 95 percent of the:
- hospitals in Amazonas averts up to 2,022 DALYs; yields economic benefits to the society of up to USD $4.42 million; and would costs up to USD $460 per DALY averted.
- community health centers (CHCs) in Amazonas averts up to 3,179 DALYs; yields economic benefits to the society of up to USD $7.35 million; and costs up to USD $308 per DALY averted,.
- both hospitals and CHCs in Amazonas averts up to 3,922 DALYs; yields economic benefits of up to USD $8.98 million to the society; and would costs up to USD $328 per DALY averted.
Despite Brazil’s robust production of antivenom drugs, they’re typically available in city medical centers — not in rural, underserved regions such as Amazonas, where so many people are bitten by venomous snakes.
“We believe that ours is the first study to evaluate the health and economic benefits of increasing the accessibility of snake antivenom in Latin America,” says João Ricardo Nickenig Vissoci, PhD, chief of Duke Department of Emergency Medicine’s Division of Translational Health Sciences.
The findings, along with those from related past research, “show that expanding snake antivenom access to the communities with the greatest need – namely, rural and indigenous communities – can generate substantial health and economic returns while remaining cost-effective,” he adds.
“Policies that promote access to snake antivenom should be a priority to countries with an elevated SBE burden."
With the study now published and a feasibility assessment performed, the next step is to assess the intervention with real-world trials. Community care providers within the existing healthcare system can learn to administer treatment safely and effectively.
“According to the World Health Organization working group on SBE, an effective, cost-effective, and sustainable strategy for SBE depends on more than existing antivenom or novel therapeutics,” says Charles J. Gerardo, MD, MHS, interim chair of Duke’s Department of Emergency Medicine and joint senior author. “It depends on the decentralized distribution of treatment, as well as on the infrastructure and knowledge to deliver it.”
Five of this study’s ten authors are with the Duke Department of Emergency Medicine — a strong indicator of how important research is within the department, as is the recent creation of the Division of Translational Health Sciences. The division’s focus on rigorous research to advance access to and quality of emergency healthcare locally, nationally and globally helps set the department apart from other emergency medicine teams.
“We’re fortunate to be able to form these global partnerships and conduct valuable research like this,” Dr. Gerardo says.
This work is a product of Dr. Gerardo's NIH-funded project, and was led but Dr. Osondu Ogbouji, from DGHI and Dr, Wuelton Monteiro from FMT-HVD.
Authors
Armand Zimmerman, MS1 (Joint first author)
Wuelton Monteiro, PhD2,3,4 (Joint first author)
João Ricardo Nickenig Vissoci, PhD1,5
Emily R. Smith, PhD1,5
Thiago Rocha, PhD5
Jacqueline Sachett, PhD2,4
Fan Hui Wen, PhD 6
Catherine Staton, MD 1,5
Charles J. Gerardo, MD, MHS 1,5 (Joint senior author)
Osondu Ogbuoji, ScD 1,7 (Joint senior author, corresponding author)
1Duke Global Health Institute, Duke University, Durham, North Carolina, United States
2Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
3Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
4Programa de Pós-Graduação em Enfermagem, Universidade Federal de Santa Catarina, Florianópolis, Brazil
5Department of Emergency Medicine, Duke University School of Medicine, Duke University, Durham, North Carolina, United States
6Instituto Butantan, São Paulo, São Paulo, Brazil
7Department of Population Health Sciences, Duke University School of Medicine, Duke University, Durham, North Carolina, United States.