A child needed an antidote for a snake bite. It cost more than $200,000

On By Karl

Jackie Fortier
| Washington Post

A few days after her 2nd birthday, Brigland Pfeffer was playing with her siblings in their backyard in San Diego.

Her mother, Lindsay Pfeffer, was a few feet away when Brigland made a noise and ran from the quarry, clutching her right hand. His eldest son shouted “Snake!” When he shouted, he noticed a thin blood between his thumb and index finger.

“I saw a little rattlesnake curled up next to the fire pit,” he said.

Pfeffer called 911 in April and an ambulance took Brigland to Palomar Medical Center Escondido.

medical procedure

When they arrived, Brigland’s hand was swollen and bruised.

Antivenom, an antibody treatment that neutralizes certain toxins, is usually administered directly into the bloodstream through an intravenous line. However, emergency room staff had difficulty inserting the IV.

After many attempts, they finally used a procedure that delivered the drug to the bone marrow and gave Brigland an initial dose of the antidote Anavip.

He was transferred to the pediatric intensive care unit at Rady Children’s Hospital, where he received more Anavip.

The swelling spreading to the armpit gradually decreased. He left the hospital a few days later with his grateful parents.

Then the bills came.

final invoice

It was $297,461, which included two ambulance rides, an emergency room visit and a stay in pediatric intensive care for several days. Antivenom alone accounts for $213,278.80 of the total bill.

Billing issue

The Centers for Disease Control and Prevention estimates that venomous snakes bite 7,000 to 8,000 people in the United States each year. About five people die. The agency says that number would be higher without medical treatment.

Most snake bites occur far from medical care, and not all emergency rooms stock expensive antivenom, which can add large ambulance bills to already expensive care.

More than a dozen vials are usually required to treat a snake bite; this often costs thousands of dollars per bottle. The average number per patient is 18 vials, said Michelle Ruha, an emergency room doctor in Arizona and former president of the American College of Medical Toxicology.

Production, essentially unchanged since the antidote was developed more than a century ago, does not explain the high price. Poisonous creatures are milked, then small, harmless amounts of the toxin are injected into animals such as horses or sheep. Antibodies are removed from their blood and processed to make an antidote.

Why high price?

One explanation for this is that hospitals price products to offset overhead and generate revenue.

Brigland accepted Anavip in two hospitals with different prices.

Palomar, where emergency personnel treated Brigland, charged $9,574.60 per vial, charging a total of $95,746 for an initial dose of 10 vials of Anavip.

Rady, the West Coast’s largest children’s hospital, charged $5,876.64 for each vial. The total of 20 bottles Brigland bought there was $117,532.80.

Neither hospital responded to requests for comment.

Stacie Dusetzina, a professor of health policy at Vanderbilt University Medical Center who reviewed the bills at the request of KFF Health News, said these accusations are “eye-popping.” “When you see the word ‘wages,’ it’s a made-up number. This is often not at all related to the actual cost of the drug.”

For example, Medicare, the government program for people who are at least 65 or disabled, pays about $2,000 for a bottle of Anavip. On average, that’s the price hospitals pay, Dusetzina said.

Another explanation for the high cost of the antidote is the lack of meaningful competition. Anavip entered the market in 2018 as the only competitor to the antidote CroFab. However, its makers filed a patent infringement lawsuit with the maker of CroFab, demanding that the makers of Anavip pay royalties until 2028.

resolution

The insurance company covering Brigland v. Sharp Health Plan, which did not respond to requests for comment, negotiated to reduce antidote costs by tens of thousands of dollars.

Most of the cost was covered by insurance. Brigland’s family paid $7,200, their plan’s out-of-pocket maximum.

Insurance did not pay all claims, including an ambulance bill. Pfeffer said she received a letter this summer saying they owed an additional $11,300 for Brigland’s care. While the landmark No Surprises Act protected patients from out-of-network bills in emergencies, the law exempted bills for ground ambulances.

Brigand’s hand healed, but nerve damage and scar tissue made his right thumb less dexterous. He is now left-handed.

“He’s very, very lucky,” Pfeffer said.

The family has since installed snake fences around the garden.

takeaway

There is a saying in toxicology: Time is tissue. If bitten by a snake, “seek medical attention,” Ruha said.

Not all emergency rooms have antidotes, and there are no online resources to identify which ones do. Ruha suggests going to a large hospital, which is more likely to have antidotes in stock, rather than freestanding emergency rooms.

Dusetzina said be ready to negotiate when the bill comes. Providers know their fees are high and may be willing to take less.

You can compare charges to average prices using cost estimating tools like Fair Healthcare Consumer or Healthcare Bluebook.

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Bill of the Month is a crowdsourced study by KFF Health News that examines and explains medical bills. This series has helped reduce medical bills for many patients and readers since 2018 and has been quoted in statehouses, the U.S. Capitol, and the White House.