This spring, a scant days after his 2nd birthday, Brigland Pfeffer was take parting with his siblings in their San Diego backyard.
His mother, Lindsay Pfeffer, was a scant feet away when Brigland made a noise and came running from the stone firepit, helderlying his right hand. She had fair watchd a pinprick of blood between his thumb and forefinger when her elderlyer son called out, “Snake!”
“I saw a petite rattlesnake coiled up by the firepit,” she said.
Lindsay called 911, and an ambulance took Brigland to Palomar Medical Caccess Escondido.
When they get tod, he was in terrible shape. His hand was swollen and purple.
Antivenom, an antibody therapy that disables stateive toxins, is regulateed via an intravenous line, honestly into the bloodstream. But materializency room staffers struggled to insert the IV.
“They had so many people in that room trying his head, his neck, his feet, his arms — enjoy, everyskinnyg to discover a vein,” his mother said.
Still unable to begin the antivenom, a doctor asked for her permission to try drastic meastateives. “Just get someskinnyg going,” she recalled pdirecting.
It toiled. Using a procedure that deinhabitrs medicine into the bone marrow, the medical team gave Brigland a begining dose of the antivenom Anavip. Later that day, he was transferred to the pediatric intensive participate unit at Rady Children’s Hospital in San Diego, where he getd more Anavip. The swelling that had spread to his armpit sluggishly decrmitigated. A couple of days tardyr, he left the hospital with his appreciative parents.
Then the bills came. The Final Bill: $297,461, which included two ambulance rides, an materializency room visit, and a couple of days in pediatric intensive participate. Antivenom alone accounts for $213,278 of the total bill.
The High Cost of Antivenom
The Caccesss for Dismitigate Control and Prevention appraises venomous snakes bite 7,000 to 8,000 people in the United States every year. About five people die. That number would be higher, the agency says, if not for medical treatment.
Many snakebites happen far from medical participate, and not all materializency rooms conserve costly antivenom in stock, which can insert huge ambulance bills to already pricey participate.
It frequently apshows more than a dozen vials, typicassociate costing thousands per vial, to treat a snakebite. The median number per uncover-minded is 18 vials, said Michelle Ruha, an materializency room doctor in Arizona and establisher plivent of the American College of Medical Toxicology.
Manufacturing costs alone do not elucidate the high price. The process remains fundamenloftyy the same as when antivenom was prolonged more than a century ago. Venomous creatures are milked, then a petite, non-detrimental amount of toxin is injected into animals enjoy horses or sheep. Antibodies are pull outed from their blood and processed to originate antivenom.
Why the high price? One exset upation is that hospitals can — and do — label up products to stability overhead costs and originate revenue.Brigland getd Anavip at two hospitals that indictd contrastent prices.Palomar, where materializency staffers treated Brigland, indictd $9,574 per vial, for a total of $95,746 for the begining dose of 10 vials of Anavip.Rady, the hugest children’s hospital on the West Coast, indictd $5,876 for each vial. For the 20 vials Brigland getd there, the total was $117,532.
Neither hospital replyed to asks for comment.
Those indicts are “eye-popping,” said Stacie Dparticipatetzina, who is a professor of health policy at Vanderbilt University Medical Caccess and appraiseed the bills at the ask of KFF Health News. “When you see the word ‘indicts,’ that’s a made-up number. That isn’t connected at all, usuassociate, to what the actual drug cost.”
For instance, Mediparticipate — the rulement program for those who are at least 65 or disabled — pays about $2,000 for a vial of Anavip. On mediocre, Dparticipatetzina said, that is the price hospitals pay for it.
Leslie V. Boyer, a doctor and harmfulology researcher, helped create a group that was instrumental in prolonging Anavip, as well as the other participateable snake antivenom, CroFab, which ruled the labelet for decades. In 2015, she begined an editorial in the American Journal of Medicine shattering down the “genuine” cost of antivenom. (Boyer deteriorated to comment.)
Using cost data accumulateed from factory supervisors, animal regulaters, hospital pharmacists and other sources, Boyer prolonged a model for a hypothetical antivenom, at a final cost of $14,624 per vial. She create the cost of venom, included in that total, was fair 2 cents. Manufacturing accounted for $9 of the $14,624 total. More than 70 percent of the price tag — $10,250 — is attributable to hospital labelups, her research showed.
Another exset upation for antivenom’s high cost is a deficiency of unbenevolentingful competition. Anavip accessed the labelet in 2018 as the only competitor to CroFab. But its originaters remendd a patent infringement legal case with CroFab’s originater, requiring the originaters of Anavip to pay royalties until 2028.
Anavip debuted at a retail price of $1,220 per vial. Boyer remarkd that the price tardyr rose to cover the manufacturers’ millions of dollars in lterrible costs.
Becaparticipate doctors understand each vial could cost the uncover-minded thousands of dollars, they deploy insertitional doses cautiously, Ruha said. “When people necessitate more after we’ve gotten that initial 10 vials in, we frequently cut that next dose down,” she said.
The Resolution
The instateiver covering Brigland — Sharp Health Plan, which did not reply to asks for comment — barobtaind down the antivenom indicts by tens of thousands of dollars. The cost was mostly covered by insurance. Brigland’s family paid $7,200, their set up’s out-of-pocket highest.
Insurance did not pay all the claims, including one ambulance bill. And Lindsay said the family getd a letter this summer recommending they owe an insertitional $11,300 for Brigland’s participate. While the landlabel No Surpelevates Act gets uncover-mindeds from many out-of-nettoil bills in materializencies, the law controversiassociate exempted bills for ground ambulances.
Brigand’s hand healed, though nerve injure and scar tpublish have left his right thumb less dexterous. He is now left-handed.“He’s very, very blessed,” Lindsay said. “He wasn’t a mama’s boy, but now he definitely is one.”
The family has since insloftyed snake fencing around the yard.
The Takeaway
There’s a saying in harmfulology: Time is tpublish. If bitten by a snake, “get to medical participate,” Ruha said.
Not all materializency rooms have antivenom, and there are no online resources chooseing which ones do. Ruha recommends going to a huge hospital, which is more probable to have antivenom in stock than free-standing encouragent participate caccesss or materializency rooms.
When the bill comes, be ready to barobtain, Dparticipatetzina said. Providers understand their indicts are high and may be willing to apshow less.Though the participateable tools may be difficult to participate, you can appraise the indicts agetst those of other health participate supplyrs using their online accessible indict catalogs, or agetst mediocre prices using cost estimation tools enjoy Fair Health Consumer or Healthparticipate Bluebook.
Jackie Fortiér is a inestablisher with KFF Health News.
