SNAKEBITE DOES COSTEFFECTIVENESS MATTER

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SNAKEBITE DOES COST-EFFECTIVENESS MATTER??
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• anarchy reigns! (Warrell 2008)
• and the absence of information certainly doesnt
  help

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ECONOMIC FACTORS

• cost of antivenom
• cost of treatment
• cost of sequelae
• indirect costs, eg lost productivity

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WHAT IS OUT THERE?

• Systematic review of the literature
• Medline, Embase, Cochrane Library, Web of
  Science, Scopus, CINAHL
• Online sources WHO, DNDi, AVRU, LSTM

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(No Transcript)
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Relevant papers

• Supply 27
• Burden 20
• Cost 8
• Economic evaluation 2

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Cost and economic evaluation

• There is some indication of antivenom cost
• Occasional mention of treatment/hospital costs
• No description of long-term sequelae cost
• No economic evaluation

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What is economic evaluation?

• Comparison of two or more alternative courses of
  action in terms of both costs and consequences
  (so not just how much something costs)
• Different analyses cost-effectiveness
  cost-utility cost-minimisation cost-benefit

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Cost-effectiveness

• a comparison of the relative value of two
  different treatment strategies, usually expressed
  as an incremental cost-effectiveness ratio or
  ICER. Costs are measured in dollars,
  effectiveness is measured in relevant natural
  units. An ICER is calculated using the following
  formula
• ICER cost drug A cost drug B
• effectiveness drug A effectiveness drug B

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• antivenom A is a new AV for a local snake
  species. It costs 24 per vial.
• the comparator AV B costs 4 per vial.
• rate of death using AV A is 12 and using AV B is
  17.
• 240-40 200 4,000/death avoided
• 0.12-0.17 0.05

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• How can economic evaluation help?
• Does it matter?

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• Quantify some of the issues surrounding
  snakebite, particularly in terms of cost and
  impact
• Contribute to an accurate assessment of burden
• Allow for quantifiable assessment of treatment

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• Put numbers in the form of signs in front
  of people, and the world tends to pay attention
  to these numbers
• Attention to cost-effectiveness in developing
  world