03392nas a2200349   4500000000100000008004100001260001600042653001400058653001500072653001400087653001100101653001100112653002300123653002400146653004500170100001600215700001500231700002400246700001300270700001200283700001400295700001100309700001300320700001500333700001400348245010500362856007500467300000900542490000700551520247000558022001403028       2024                            d  bElsevier BV10asnakebite10aEnvenoming10aAntivenom10aBrazil10aAmazon10acost-effectiveness10aEconomic evaluation10aLow- and middle-income countries (LMICs)1 aZimmerman A1 aMonteiro W1 aNickenig Vissoci JR1 aSmith ER1 aRocha T1 aSachett J1 aWen FH1 aStaton C1 aGerardo CJ1 aOgbuoji O00aScaling up antivenom for snakebite envenoming in the Brazilian Amazon: a cost-effectiveness analysis  uhttps://www.thelancet.com/action/showPdf?pii=S2667-193X%2823%2900225-9  a1-120 v293 a<p><strong>Background:</strong> Snakebite envenoming (SBE) affects nearly three million people yearly, causing up to 180,000 deaths and 400,000 cases of permanent disability. Brazil’s state of Amazonas is a global hotspot for SBE, with one of the highest annual incidence rates per 100,000 people, worldwide. Despite this burden, snake antivenom remains inaccessible to a large proportion of SBE victims in Amazonas. This study estimates the costs, and health and economic benefits of scaling up antivenom to community health centers (CHCs) and hospitals in the state.</p>

<p><strong>Methods: </strong>We built a decision tree model to simulate three different antivenom scale-up scenarios: (1) scale up to 95% of hospitals, (2) scale up to 95% of CHCs, and (3) scale up to 95% of hospitals and 95% of CHCs. We consider each scenario with and without a 10% increase in demand for antivenom among SBE victims. For each scenario, we model the treatment costs averted, deaths averted, and disability-adjusted life years (DALYs) averted from a societal, health system, and patient perspective relative to the status quo and over a time horizon of one year. For each scenario and perspective, we also calculate the incremental cost per DALY averted and per death averted. We use a willingness to pay threshold equal to the 2022 gross domestic product (GDP) per capita of Brazil.</p>

<p><strong>Findings: </strong>Scaling up antivenom to 95% of hospitals averts up to 2022 DALYs, costs up to USD $460 per DALY averted from a health system perspective, but results in net economic benefits up to USD $4.42 million from a societal perspective. Scaling up antivenom to 95% of CHCs averts up to 3179 DALYs, costs up to USD $308 per DALY averted from a health system perspective, but results in net economic benefits up to USD $7.35 million from a societal perspective. Scaling up antivenom to 95% of hospitals and CHCs averts up to 3922 DALYs, costs up to USD $328 per DALY averted from a health system perspective, but results in net economic benefits up to USD $8.98 million from a societal perspective.</p>

<p><strong>Interpretation: </strong>All three antivenom scale up scenarios – scale up to 95% of hospitals, scale up to 95% of CHCs, and scale up to 95% of hospitals and 95% of CHCs – avert a substantial proportion of the SBE burden in Amazonas and are cost-saving from a societal perspective and cost-effective from a health system perspective.</p>
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