Choosing Value: Antivenom Selection in the Modern Trauma System

BackgroundVenomous snakebites require timely antivenom administration to prevent progression of local and systemic toxicity. In the United States, two FDA-approved crotalid antivenoms, CroFab® and ANAVIP®, are available, both associated with substantial cost. Real-world data comparing antivenom utilization and institutional cost between these agents remain limited.MethodsWe performed an IRB-approved retrospective review of consecutive patients treated with antivenom for venomous snakebite and admitted to a Level I trauma center between March 2017 and August 2023. Demographics, snakebite characteristics, Snakebite Severity Score (SSS), clinical outcomes, complications, hospital length of stay (LOS), and antivenom-associated costs were abstracted.ResultsFifty-four patients were admitted for venomous snakebite and received antivenom; 48 received a single antivenom formulation. CroFab® was administered to 36 patients (75%) and ANAVIP® to 12 patients (25%). There were no significant differences between groups in demographic characteristics or injury severity. Clinical outcomes, including improvement after initial antivenom administration, need for additional dosing, antivenom-related complications, and hospital LOS, were comparable between groups. Median hospital cost was significantly lower in the ANAVIP® group compared with CroFab® ($9665.30 [IQR $9665.30-$9670.00] vs $16,470.57 [IQR $11,775.04-$27,184.72], P = 0.003).DiscussionIn this single-center trauma cohort, ANAVIP® and CroFab® demonstrated comparable clinical effectiveness for the treatment of crotalid snakebites. Use of ANAVIP® was associated with a substantial reduction in hospital cost without detectable compromise in clinical outcomes. These findings support consideration of ANAVIP® as a cost-conscious antivenom strategy in trauma systems.