Herzel Benjamin, Batavia Neev, Gavaza Paul, Phan Tammy, Samones Emmelyn, Ruha Anne-Michelle, Furmaga Jakub, Hoyte Christopher, Wolk Brian J
Department of Emergency Medicine, Loma Linda University School of Medicine, 11234 Anderson St, Room A890 A, Loma Linda, CA, 92354, USA.
Department of Pharmaceutical and Administrative Science, Loma Linda University School of Pharmacy, Loma Linda, CA, USA.
J Med Toxicol. 2025 Jul;21(3):320-326. doi: 10.1007/s13181-025-01072-x. Epub 2025 Apr 14.
Envenomation is a global health issue, with over 9,000 encounters managed in the United States yearly. The introduction of immunoglobulin fragment antivenom has reduced the risk of hypersensitivity. This study compares treatment costs of crotaline envenomation using the Fab and F(ab') antivenoms as reported to the North American Snakebite Registry (NASBR), a nationwide surveillance tool.
This was a retrospective analysis of NASBR data between 2018 and 2020. The following data points were assessed: patient demographics (age, gender, race), snake species, type of antivenom used, and treatment costs. Unit costs were estimated based on United States Centers for Medicare and Medicaid Services data. Average (mean) per patient costs from the payer perspective were calculated by multiplying resources by the unit costs. Sensitivity analyses were performed regarding cost variance and snake species. All costs reported in this study are in U.S. dollars.
The average total cost of treatment was $31,343 per person, with medications contributing 72% of the total. Average total cost among patients who received Fab treatments was $33,347 per person compared to $19,747 among patients who received F(ab'). Antivenom costs accounted for 75% of the total cost in the Fab group and 42% in the F(ab') group. F(ab') required more vials than Fab (median 18 versus 10). Non-antivenom costs such as hospitalizations were higher in the F(ab') group. Using average sale prices increased average total cost to $52,572; Fab remained more expensive.
Antivenom is the primary cost driver in snakebite treatment in North America. Treatment with F(ab') resulted in lower overall costs, driven by lower cost of antivenom. F(ab') did not significantly lower overall resource use except for blood product administration.
蛇咬伤是一个全球性的健康问题，在美国每年有超过9000例病例得到治疗。免疫球蛋白片段抗蛇毒血清的引入降低了过敏反应的风险。本研究使用北美蛇咬伤登记处（NASBR）这一全国性监测工具，比较了使用Fab和F(ab')抗蛇毒血清治疗响尾蛇咬伤的成本。
这是对2018年至2020年NASBR数据的回顾性分析。评估了以下数据点：患者人口统计学特征（年龄、性别、种族）、蛇种、使用的抗蛇毒血清类型和治疗成本。单位成本根据美国医疗保险和医疗补助服务中心的数据估算。从支付方角度计算的每位患者的平均成本是通过将资源乘以单位成本得出的。对成本差异和蛇种进行了敏感性分析。本研究报告的所有成本均以美元为单位。
治疗的平均总成本为每人31343美元，药物占总成本的72%。接受Fab治疗的患者平均总成本为每人33347美元，而接受F(ab')治疗的患者为19747美元。抗蛇毒血清成本在Fab组占总成本的75%，在F(ab')组占42%。F(ab')比Fab需要更多瓶数（中位数分别为18瓶和10瓶）。F(ab')组的住院等非抗蛇毒血清成本更高。使用平均销售价格使平均总成本增加到52572美元；Fab仍然更昂贵。
抗蛇毒血清是北美蛇咬伤治疗中的主要成本驱动因素。使用F(ab')治疗导致总体成本较低，这是由抗蛇毒血清成本较低推动的。除了血液制品管理外，F(ab')并没有显著降低总体资源使用。
