ArticlePLoS neglected tropical diseases2026
Estimating the distributional impact of improving access to snake antivenom in urban and rural Lao People's Democratic Republic: An extended cost-effectiveness analysis.
Article in PLoS neglected tropical diseases, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionSnakebite is a significant public health issue in the Lao People's Democratic Republic (PDR), with victims often seeking traditional healers due to inadequate antivenom supply and high out-of-pocket (OOP) expenses, contributing to inequities between urban and rural populations.
methodsAn extended cost-effectiveness analysis (ECEA) was conducted to evaluate the distributional impact of improving access to antivenom in urban and rural Lao PDR, where all victims with systemic envenoming clinically indicated for antivenom receive antivenom at conventional hospitals, on disease burdens (deaths and disability-adjusted life years [DALYs]) and economic burden (%household OOP expenditure per monthly income). Sensitivity analyses were performed.
resultsRural areas had higher mortality (3.14 vs. 0.35, +2.79 per 100,000 population), DALYs lost (78.97 vs. 8.86, +70.11 per 100,000 population), and household OOP expenses (39% vs. 38%, +1% of household monthly income) than urban areas. Full access to antivenom reduced health inequities in mortality (from +2.79 to +1.22 per 100,000 population) and DALYs (from +70.11 to +32.14 per 100,000 population) but increased inequities in household OOP expenses (from +1% to +39% of household monthly income). These differences had considerable uncertainties. Sensitivity analyses showed that free snakebite treatment and transportation costs with one caregiver reduced household OOP expenses in both areas (5% rural, 6% urban).
conclusionsWhile improving access to snake antivenom mitigates health inequities in disease burden, it exacerbates financial inequities between urban and rural areas. Policies targeting equitable access to care and financial protection are critical to achieving health equity for snakebites in the Lao PDR.
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