A Nationwide Study on the Risks of Complications and Healthcare Costs of Snakebite Envenomation in Taiwan

Jen-Yu Hsu Department of Occupational Medicine and Clinical Toxicology, Taipei Veterans General Hospital, Taipei, Taiwan;
School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan;
Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan;

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Shu-O Chiang ESTAT Statistical Consulting Co., Ltd, Taipei, Taiwan;

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Chen-Chang Yang Department of Occupational Medicine and Clinical Toxicology, Taipei Veterans General Hospital, Taipei, Taiwan;
School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan;
Institute of Environmental and Occupational Health Sciences, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan;

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Yan-Chiao Mao PhD Program in Medical Biotechnology, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan;
School of Medicine, National Defense Medical Center, Taipei, Taiwan;
Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan;
Division of Clinical Toxicology, Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan

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In Taiwan, six medically important venomous snakes, Trimeresurus stejnegeri stejnegeri, Protobothrops mucrosquamatus, Deinagkistrodon acutus, Daboia siamensis, Naja atra, and Bungarus multicinctus, are found. However, comprehensive research on the complications and associated healthcare costs of snakebite envenomation (SBE) is lacking. We retrospectively analyzed pertinent information from the Taiwan National Health Insurance Research Database dated January 2002 to December 2014. We investigated the risk factors for complications and their impact on healthcare costs. Among the 12,542 patients with SBE, those from N. atra or B. multicinctus were more likely to experience wound infections and neurological complications than were those from T. s. stejnegeri or P. mucrosquamatus. In addition, being female, being elderly, and having a Charlson Comorbidity Index equal to or greater than 3 points were associated with an increased likelihood of wound infections and psychological complications. The annual national economic burden averaged US$1,083,624, with an average healthcare cost of US$1,129 per SBE. Snakebite envenomations from N. atra or B. multicinctus, as well as various complications, resulted in significantly higher costs. It is crucial to comprehend the risk factors for complications and their role in increasing expenses to provide insight for tailored healthcare interventions, mitigate complications, and reduce the economic burdens associated with SBEs.

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Author Notes

Financial support: This research was partly funded by the National Science and Technology Council (MOST 110-2320-B-075A-001) and Taichung Veterans General Hospital Research Funding (TCVGH-1067205C; TCVGH-1127201B), with Y.-C. Mao as the grantee. The funders had no involvement in the design of the study, data collection and analysis, decision to publish, or preparation of the manuscript.

Disclosures: Approval for this study was obtained from the Institutional Review Board of the Clinical Ethics Committee, Taichung Veterans General Hospital (CE16258B). Given the study’s retrospective design, the requirement for informed consents was waived. Measures were taken to ensure the confidentiality of medical records, safeguarding the rights and privacy of patients. Informed consent was not applicable. All relevant data are within the manuscript and its supporting information files.

Authors’ contributions: Conceptualization: J.-Y. Hsu, C.-C. Yang, Y.-C. Mao. Methodology: all authors. Investigation: J.-Y. Hsu, S.-O. Chiang. Data analysis: J.-Y. Hsu, S.-O. Chiang. Writing—original draft preparation: J.-Y. Hsu, Y.-C. Mao. Writing—review and editing: J.-Y. Hsu, Y.-C. Mao. All authors read and agreed to the published version of the manuscript.

Authors’ addresses: Jen-Yu Hsu, Department of Occupational Medicine and Clinical Toxicology, Taipei Veterans General Hospital, Taipei, Taiwan, E-mail: b94401012@ntu.edu.tw. Shu-O Chiang, ESTAT Statistical Consulting Co., Ltd, Taipei, Taiwan, E-mail: sophie@estat.com.tw. Chen-Chang Yang, Institute of Environmental and Occupational Health Sciences, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, E-mail: ccyang@vghtpe.gov.tw. Yan-Chiao Mao, Division of Clinical Toxicology, Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, E-mail: doc1385e@gmail.com.

Address correspondence to Yan-Chiao Mao, Division of Clinical Toxicology, Department of Emergency Medicine, Taichung Veterans General Hospital; No. 1650, Sec. 4, Taiwan Blvd., Xitun Dist., Taichung City 407, Taiwan. E-mail: doc1385e@gmail.com
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