Thanks for the post—this seems like a really important contribution!
[Caveat: I am not at all an expert on this and just spent some time googling]. Snake antivenom actually requires that you milk venom from a snake to produce, and I wonder how much this is contributing to the high cost ($55–$640) of snake venom [1]. I wonder if R&D would be a better investment, especially given the potentially high storage and transport costs for snake venom (see below). It would be interesting to see someone investigate this more thoroughly.
Storage costs are pretty low in that cost effectiveness estimate you cite [2], but it seems pretty plausible to me that storage and transportation costs would be much higher if you wanted to administer snake venom at smaller clinics that were closer to the victims of snake bites. The cost was based on this previous estimate, in which they say“The cost of shipping from abroad where the antivenoms are manufactured, transportation within Nigeria and freezing of antivenom (including use of supplementary diesel power electric generators in addition to national power grid) is estimated at N3,000 ($18.75) from prior experience and expert opinion. But it was assumed that appropriate storage facilities already exist at the local level through immunization/drug services and that no additional capital investment would be required to adequately store the antivenom in the field” [3]. I’m not sure exactly what facilities are required and how expensive they would be, but this seems like it could be an important consideration.
[1] Brown NI (2012) Consequences of neglect: analysis of the sub-Saharan African snake antivenom market and the global context. PLoS Negl Trop Dis. 6: e1670.
[2] Hamza M, Idris MA, Maiyaki MB, Lamorde M, Chippaux JP, et al. (2016) Cost-Effectiveness of Antivenoms for Snakebite Envenoming in 16 Countries in West Africa. PLOS Neglected Tropical Diseases 10(3): e0004568. https://doi.org/10.1371/journal.pntd.0004568
[3] Habib AG, Lamorde M, Dalhat MM, Habib ZG, Kuznik A (2015) Cost-effectiveness of Antivenoms for Snakebite Envenoming in Nigeria. PLOS Neglected Tropical Diseases 9(1): e3381. https://doi.org/10.1371/journal.pntd.0003381
I was also thinking of the high production costs as a potential area of intervention. A few minutes of browsing turned up some potential advancements in production methods of antivenom, e.g. using synthetic biology, and I would be interested in learning about the potential cost-effectiveness of implementing or scaling up such alternative production methods. It seems like many of them are still in the R&D-stage though, but this could be an area to keep a close eye on.
Since writing this article, this is actually one of the things I’ve been looking into! I think it looks very promising, as many of the issues outlined by WHO seem downstream from people simply being unable to afford high quality antivenom. (ie. why do people choose local healers? Because hospitals cost more and don’t help either!)
It also looks like the marginal cost of high quality antivenom would decrease up to an order of magnitude if you scale up production. I have yet to take an in depth look at synthetic antivenom production, but after briefly looking into it, it seems that we are not going to get synthetic antivenom just yet.
If the lateral-flow test can be cheaply produced, distributed and stored at smaller clinics—then you might be able to then quickly drive patients to larger clinics once positively diagnosed and might not then have to worry as much about the larger costs of the anti-venom. Will depend a lot on the time/distance to nearest larger clinics though.
Thanks for the post—this seems like a really important contribution!
[Caveat: I am not at all an expert on this and just spent some time googling]. Snake antivenom actually requires that you milk venom from a snake to produce, and I wonder how much this is contributing to the high cost ($55–$640) of snake venom [1]. I wonder if R&D would be a better investment, especially given the potentially high storage and transport costs for snake venom (see below). It would be interesting to see someone investigate this more thoroughly.
Storage costs are pretty low in that cost effectiveness estimate you cite [2], but it seems pretty plausible to me that storage and transportation costs would be much higher if you wanted to administer snake venom at smaller clinics that were closer to the victims of snake bites. The cost was based on this previous estimate, in which they say“The cost of shipping from abroad where the antivenoms are manufactured, transportation within Nigeria and freezing of antivenom (including use of supplementary diesel power electric generators in addition to national power grid) is estimated at N3,000 ($18.75) from prior experience and expert opinion. But it was assumed that appropriate storage facilities already exist at the local level through immunization/drug services and that no additional capital investment would be required to adequately store the antivenom in the field” [3].
I’m not sure exactly what facilities are required and how expensive they would be, but this seems like it could be an important consideration.
[1] Brown NI (2012) Consequences of neglect: analysis of the sub-Saharan African snake antivenom market and the global context. PLoS Negl Trop Dis. 6: e1670.
[2] Hamza M, Idris MA, Maiyaki MB, Lamorde M, Chippaux JP, et al. (2016) Cost-Effectiveness of Antivenoms for Snakebite Envenoming in 16 Countries in West Africa. PLOS Neglected Tropical Diseases 10(3): e0004568. https://doi.org/10.1371/journal.pntd.0004568
[3] Habib AG, Lamorde M, Dalhat MM, Habib ZG, Kuznik A (2015) Cost-effectiveness of Antivenoms for Snakebite Envenoming in Nigeria. PLOS Neglected Tropical Diseases 9(1): e3381. https://doi.org/10.1371/journal.pntd.0003381
I was also thinking of the high production costs as a potential area of intervention. A few minutes of browsing turned up some potential advancements in production methods of antivenom, e.g. using synthetic biology, and I would be interested in learning about the potential cost-effectiveness of implementing or scaling up such alternative production methods. It seems like many of them are still in the R&D-stage though, but this could be an area to keep a close eye on.
A recent article on the topic:
https://www.drugdiscoverynews.com/snakebite-antivenoms-step-into-the-future-15378
Since writing this article, this is actually one of the things I’ve been looking into! I think it looks very promising, as many of the issues outlined by WHO seem downstream from people simply being unable to afford high quality antivenom. (ie. why do people choose local healers? Because hospitals cost more and don’t help either!)
It also looks like the marginal cost of high quality antivenom would decrease up to an order of magnitude if you scale up production. I have yet to take an in depth look at synthetic antivenom production, but after briefly looking into it, it seems that we are not going to get synthetic antivenom just yet.
If the lateral-flow test can be cheaply produced, distributed and stored at smaller clinics—then you might be able to then quickly drive patients to larger clinics once positively diagnosed and might not then have to worry as much about the larger costs of the anti-venom. Will depend a lot on the time/distance to nearest larger clinics though.