@article{fdi:010066777,
  title = {{C}ost-effectiveness of antivenoms for snakebite envenoming in 16 countries in {W}est {A}frica},
  author = {{H}amza, {M}. and {I}dris, {M}. {A}. and {M}aiyaki, {M}. {B}. and {L}amorde, {M}. and {C}hippaux, {J}ean-{P}hilippe and {W}arrell, {D}. {A}. and {K}uznik, {A}. and {H}abib, {A}. {G}.},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground {S}nakebite poisoning is a significant medical problem in agricultural societies in {S}ub {S}aharan {A}frica. {A}ntivenom ({AV}) is the standard treatment, and we assessed the cost-effectiveness of making it available in 16 countries in {W}est {A}frica. {M}ethods {W}e determined the cost-effectiveness of {AV} based on a decision-tree model from a public payer perspective. {S}pecific {AV}s included in the model were {A}ntivipmyn, {FAV} {A}frique, {E}chi-{T}ab-{G} and {E}chi{T}ab-{P}lus. {W}e derived inputs from the literature which included: type of snakes causing bites (carpet viper ({E}chis species)/non-carpet viper), {AV} effectiveness against death, mortality without {AV}, probability of {E}arly {A}dverse {R}eactions ({EAR}), likelihood of death from {EAR}, average age at envenomation in years, anticipated remaining life span and likelihood of amputation. {C}osts incurred by the victims include: costs of confirming and evaluating envenomation, {AV} acquisition, routine care, {AV} transportation logistics, hospital admission and related transportation costs, management of {AV} {EAR} compared to the alternative of free snakebite care with ineffective or no {AV}. {I}ncremental {C}ost {E}ffectiveness {R}atios ({ICER}s) were assessed as the cost per death averted and the cost per {D}isability-{A}djusted-{L}ife-{Y}ears ({DALY}) averted. {P}robabilistic {S}ensitivity {A}nalyses ({PSA}) using {M}onte {C}arlo simulations were used to obtain 95% {C}onfidence {I}ntervals of {ICER}s. {R}esults {T}he cost/death averted for the 16 countries of interest ranged from $1,997 in {G}uinea {B}issau to $6,205 for {L}iberia and {S}ierra {L}eone. {T}he cost/{DALY} averted ranged from $83 (95% {C}onfidence {I}nterval: $36-$240) for {B}enin {R}epublic to $281 ($159-457) for {S}ierra-{L}eone. {I}n all cases, the base-case cost/{DALY} averted estimate fell below the commonly accepted threshold of one time per capita {GDP}, suggesting that {AV} is highly cost-effective for the treatment of snakebite in all 16 {WA} countries. {T}he findings were consistent even with variations of inputs in 1-way sensitivity analyses. {I}n addition, the {PSA} showed that in the majority of iterations ranging from 97.3% in {L}iberia to 100% in {C}ameroun, {G}uinea {B}issau, {M}ali, {N}igeria and {S}enegal, our model results yielded an {ICER} that fell below the threshold of one time per capita {GDP}, thus, indicating a high degree of confidence in our results. {C}onclusions {T}herapy for {SBE} with {AV} in countries of {WA} is highly cost-effective at commonly accepted thresholds. {B}roadening access to effective {AV}s in rural communities in {W}est {A}frica is a priority.},
  keywords = {{AFRIQUE} {DE} {L}'{OUEST} ; {AFRIQUE} {SUBSAHARIENNE}},
  booktitle = {},
  journal = {{P}los {N}eglected {T}ropical {D}iseases},
  volume = {10},
  numero = {3},
  pages = {e0004568 [16 p.]},
  ISSN = {1935-2735},
  year = {2016},
  DOI = {10.1371/journal.pntd.0004568},
  URL = {https://www.documentation.ird.fr/hor/fdi:010066777},
}