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Antivenin medication could take a bite out of your wallet

A single snakebite can suck the life out of a person if not treated in time, and the vials of antivenin needed to save a victim's life can suck thousands of dollars from their wallet. 

A student who was bitten by a rattlesnake in California was in shock when the hospital where he received care charged him close to $150,000 for antivenin.

It's hard to put a price tag on saving a human's life, but one call could change that big bill without sacrificing your care.

Thanks to advances in science, the antivenin available today is much safer and more effective than in the past. 

It's called CroFab and only used to treat North American pit viper bites including rattlesnakes, copperheads, cottonmouths or water moccasins.

"It's pure and its more specific to the venom, but all of those things come at a price," said Dr. Michael Beuhler, the medical director of the Carolinas Poison Center in Charlotte, North Carolina.

Each vial of CroFab costs a hospital about $2,000. With only one company holding the patent to produce antivenin, many hospitals only keep a small supply on hand, if any.  

If you are bitten by a snake, the first thing you should do is call your local poison control center because they will know which medical centers in your area have a supply of CroFab.

"Go to a hospital that's well respected so you have people there that will have some experience in treating it, because the less experience they have, the more likely they are to use more of the antivenin," Beuhler warned.

Using more antivenin may not always be medically necessary.

According to CroFab's manufacturer, BTG International, the initial dose is four to six vials and costs hospitals about $8,000 to $12,000. This expense is then usually passed on to the patient.

After an hour, if the snakebite victim is not improving, another four to six vials of antivenin is recommended.

Experts say an extra round of antivenin, however, is not always essential, but is sometimes administered as a precaution.

That's why its important to ask your doctor if they have also contacted your local poison control center. 

Doctors and nurses at poison control centers know which snakes live in your area. Based on the specific species and severity of the bite, they can provide expert advice to ask your doctor whether or not to administer extra vials.

Ultimately, it's your doctor's call to make.

Whether you're paying with insurance or out-of-pocket, if you're in critical condition, life-saving care must come first.

In most cases, snakebite victims will need extra antivenin.

In every case, the time it takes for both you and your doctor to call your poison control center is an important investment in your care.

Creating a team between the two can often lead to better treatment and, perhaps, a more reasonable bill.

Coral snakes are another type of North American venomous snake.

The Carolinas Poison Control Center says coral snakebites are extremely rare and CroFab cannot be used to treat those type of bites.

The company that used to manufacture coral snake antivenin no longer does so, leaving hospitals with a short supply.

If you are bitten by a coral snake, call your poison control center immediately to locate the nearest medical center available to treat you.

Copyright 2012 America Now. All rights reserved.

 Additional Information:

  • Click to read information from the American Association of Poison Control Center regarding snake bites.
  • The National Poison Control Center Hotline's number is 1-800-222-1222.
  • The following information is from Dr. Michael Beuhler who is the medical director of the Carolinas Poison Center in Charlotte, NC:
    • CroFab is currently under patent. When the patent expires, it will likely go generic and market forces will bring down it's cost.
    • Coral snake antivenin is horse derived. Coral snake venom is different than pit viper venom.
    • The snake has different bite characteristics and the decisions surrounding treatment are different.
    • Not all North American pit viper bites require antivenin treatment.
    • The best care is preventative care. Hiking boots and even jeans can prevent or reduce the severity of a bite.
    • Beuhler says coral snake antivenin is no longer made and there are very limited stores. The company that was making it is not the same manufacturer as CroFab. Coral snake bites are very rare.
  • The following information is from Malcolm Stanton, a pharmacy buyer at Carolinas Medical Center located in Charlotte, NC:
    • CMC maintains a sufficient supply of CroFab in case a bite occurs. However, given how infrequent these cases are and the cost of the product, the trick is not having too much on hand where it expires and must be disposed of.
    • Stanton says CroFab has had supply issues in the past. However, current supply levels are adequate.
  • The following information is from BTG International, the manufacturer of CroFab:
    • There are no shortages of CroFab in the US. Any hospital can obtain CroFab from a US wholesaler approved to supply the company's pharmaceutical products.
    • CroFab costs approximately $2,000 per vial. A hospitalization for snake envenomation can be costly because envenomation is a complex, progressive condition, requiring a high level of monitoring and specialized medical care
    • Snake bite victims should be treated with CroFab within 6 hours of bite.
    • CroFab is "ovine" or sheep-derived.
    • Click here to read the package insert for CroFab.
    • A spokesperson for BTG International says the following is used to manufacture CroFab:
      • Snake venom from North American pit vipers is ‘milked' from snakes in the US.
      • The venom is refined for injection at our facility in the UK.
      • The refined venom is then shipped to our facility in Australia where 4 separate flocks of free-range sheep are injected with a different venom type.
      • Over time, the sheep produce antibodies to the venom; a small amount of blood is taken from the sheep periodically.
      • The extracted blood is sent to the UK where the blood is processed for antibodies and where CroFab is manufactured.
      • CroFab is packaged and distributed in the US and distributed to customers.
  • The following information is from the Centers for Disease Control and Prevention in an article entitled How to Prevent or Respond to a Snake Bite.
    • If you are bitten or you see someone bitten, try to remember the shape and color of the snake.
    • Keep the person calm, which can slow down the spread of venom.
  • The following information is from the Centers for Disease Control and Prevention:
    • Venomous snakes found in the United States include rattlesnakes, copperheads, cottonmouths/water moccasins, and coral snakes.
    • It has been estimated that 7,000–8,000 people per year receive venomous bites in the United States, and about 5 of those people die.
    • Rattlesnakes are found across the US.
    • Copperheads are found in the Eastern states, extending as far west as Texas
    • Cottonmouths/Water Moccasins are found in wetland areas, rivers, lakes, etc., in the southeastern states.
    • Coral snakes are found in wooded, sandy, or marshy areas of the Southern United States.
  • The following information is from the website RxList pertaining to CroFab:
    • The recommended initial dose is 4-6 vials.
    • If initial control of the envenomation has not been achieved (as defined by complete arrest of local manifestations, and return of coagulation tests and systemic signs to normal), an additional dose of 4 to 6 vials should be repeated until control is achieved.
    • After initial control, additional 2-vial doses of CroFab every 6 hours for up to 18 hours is recommended.
  • The following information is from a 10News article entitled "$143K Hospital Bill Shocks Snake Bite Victim". Click to read more.
    • A UC San Diego exchange student was charged $143,989 for hospital treatment at Scripps La Jolla Hospital after being bit by a rattlesnake.
    • He was given four doses of antivenin over a 24-hour period.
    • There were two separate charges for antivenin croatalidfab. The first charge is for $102,440 and the second is for $25,610. That is a total of $128,050.
    • The hospital's statement:

      First and most importantly, we are grateful for Mr. Trydal's recovery. We have reviewed our billing practices in this case and find all charges to be accurate and appropriate.

      The largest portion of the charges was for antivenin, a very costly life-saving drug manufactured from snake venom. The patient required 10 units of the antivenin and a night in the Intensive Care Unit, which provides around-the-clock direct nursing supervision.

      Scripps has standardized charges for all of our services and, like other health care organizations, we are reimbursed differently by each insurance provider or government payer based on our contracts.

      It is important to understand that these charges are not reflective of what Scripps will be paid. At this time, the patient's insurance company has not yet paid the bill, and Scripps is in negotiations with the company for the final amount. The patient will not be billed by Scripps.
  • Antivenin's are different around the world, but here is some info about how its made globally much like the "old" way that US antivenin was made (Source: http://www.popularmechanics.com/science/health/med-tech/how-to-make-antivenom-why-the-world-is-running-out#slide-1)
    • The resource-intensive, time consuming process of making antivenin is not much different than when it was first created in the 1890s by Albert Calmette (a protégé of Louis Pasteur).
    • Calmette was living in Vietnam when a flood sent cobras into a village, biting 40 and killing 4.
    • First, snakes must be quarantined for weeks to months to ensure their health.
    • The snake's jaws are opened and the fangs are pushed through a rubber or plastic film while the glands are squeezed to get the venom out.
    • The snake is cooled below minus 20 C and usually freeze-dried for storage and transport.
    • Horses are usually used to create the antibodies because they thrive in many environments, have a large mass and are forgiving from constant injections. Goats, sheep, donkeys, rabbits, cats, chickens, camels, rodents and even sharks can be used.
    • The venom is mixed with some kind of adjuvant–a chemical that causes the horse's immune system to react and produce antibodies that bind to and neutralize the venom.
    • A few milliliters of the solution is put beneath the horse's skin, sometimes in multiple places.
      Antibodies in the horse's bloodstream peak after about 8 to 10 weeks. Then it is bled by drawing 3 to 6 liters of blood from the jugular vein, according to WHO guidelines. Snakes must be "milked" numerous times to get enough venom.