Wider access to antivenoms in the Brazilian Amazon is a profitable investment, study finds

Making antivenom more widely available in a network of hospitals and community health centers in Brazil’s Amazon region would significantly reduce deaths and disabilities from venomous snake bites, a new study suggests.

The Brazilian state of Amazonas has one of the highest snakebite rates in the world, with between 45 and 235 venomous snake bites per 100,000 inhabitants per year. Prompt treatment with an antivenom is very effective against most bites.

In Brazil, however, antivenoms are generally only available in large urban hospitals, and many people bitten by venomous snakes in remote parts of the state suffer serious complications or even die before they can receive treatment. .

The new study, led by scientists and doctors from Duke University and two Brazilian institutions, evaluated the cost-effectiveness of making antivenom available in more hospitals and community health centers of the region. The results, published in the January 2024 issue of The Lancet Regional Health – Americasshow that such an approach would be a profitable investment.

“We believe our study is the first to evaluate the health and economic benefits of increasing accessibility to snake antivenoms in Latin America,” says João Ricardo Nickenig Vissoci, Ph.D., head of the translational division from the Duke Department of Emergency Medicine. Health Sciences and lead author of the study.

Researchers evaluated three strategies to expand access to snake antivenom in the Amazon. One model made antivenom available in 95% of the state’s hospitals, while a second model tested availability in 95% of community health centers, which are more widely distributed in rural areas. The third model expanded access to hospitals and community health centers.

All three models produced net economic benefits worth millions of US dollars and averted deaths and disabilities, measured by disability-adjusted life years (DALYs), which count the number years of life affected or lost due to illness or injury. . According to the study, expanding access to hospitals and community health centers would produce the greatest benefits, averting up to 3,922 DALYs while generating economic benefits of up to $8.98 million. The cost of expanding access was approximately $328 for each DALY averted.

Despite the high production of antivenom drugs in Brazil, the results show that lack of access to antivenoms can have a significant impact on regions where most snake bites occur. “Policies promoting access to snake antivenom should be a priority in countries where the burden of snakebite envenomation is high,” says Vissoci, who is also with the Duke Global Health Institute.

The next step for researchers is to begin trials making the antivenom available in community health centers in Amazonas. Community healthcare providers can be trained to administer antivenom safely and effectively, researchers say.

The new research is consistent with recommendations from a World Health Organization task force on snakebite envenomation, which emphasized that sustainable strategies for treating snakebites depend on more than therapeutic treatments , notes Charles J. Gerardo, MD, interim chairman of Duke’s Department of Emergency Medicine. and co-senior author of the study. “It depends on the decentralized distribution of treatment, and the infrastructure and knowledge needed to deliver it.”