Choosing Value: Antivenom Selection in the Modern Trauma System.

Authors

Jack H Bowdle, Morgan Butler, Justin Pritchett, Drew Hungerford, Sarah A King, Amanda L McKinney, Robert E Heidel, Lou M Smith, Catherine L McKnight

Published in

The American surgeon. Pages 31348261492221. Oct 08, 2026. Epub Oct 08, 2026.

Abstract

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.

PMID:
42848798
Bibliographic data and abstract were imported from PubMed on 09 Oct 2026.

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