Why a Simple, Lifesaving Rabies Shot Can Cost 5000 dollar in Indonesia?

Rabies is a viral infection of the brain that is transmitted by animals and that causes inflammation of the brain and spinal cord.

Once the virus reaches the spinal cord and brain, rabies is almost always fatal. The wound from the bite may be painful or numb. Bat bites typically cause no symptoms. Rabies symptoms appear when the rabies virus reaches the brain or spinal cord, usually 30 to 50 days after a person is bitten. However, this interval can vary from 10 days to more than a year.

The closer the bite to the brain (for example, on the face), the more quickly symptoms appear.

Skunks, raccoons, dogs, cats, coyotes, foxes and other mammals can also transmit the disease. Human rabies is rare in the United States. There have been only 55 cases diagnosed since 1990.

However, between 16,000 and 39,000 people are vaccinated each year as a precaution after animal bites. Also, rabies is far more common in other parts of the world, with about 40,000–70,000 rabies-related deaths worldwide each year. Bites from unvaccinated dogs cause most of these cases.

If you got bitten by these animal, here are some things you can do. Thoroughly clean the wound site with soap and water for 5 minutes. If available, an antiseptic that kills viruses such as povidone-iodine, iodine tincture, aqueous iodine solution or alcohol (ethanol) should be applied after washing.

If exposed, mucous membranes such as eyes, nose or mouth should be flushed well with water. It is important to follow these processes with appropriate treatment with rabies vaccine. If it is possible, call the animal control authorities.

Rabies vaccine is a vaccine used to prevent rabies. There are a number of vaccines available that are both safe and effective. They can be used to prevent rabies before and for a period of time after exposure to the virus such as by a dog or bat bite. The immunity that develops is long lasting after a full course.

Doses are usually given by injection into the skin or muscle. After exposure vaccination is typically used along with rabies immunoglobulin. It is recommended that those who are at high risk of exposure be vaccinated before potential exposure. Vaccines are effective in humans and other animals. Vaccinating dogs is very effective in preventing the spread of rabies to humans. Rabies vaccines may be safely used in all age groups. About 35 to 45 percent of people develop a brief period of redness and pain at the injection site.

About 5 to 15 percent of people may have fever, headaches, or nausea. After exposure to rabies there is no contraindication to its use. Most vaccines do not contain thimerosal. The first rabies vaccine was introduced in 1885, and was followed by an improved version in 1908. Millions of people globally have been vaccinated and it is estimated that this saves more than 250,000 people a year. It is on the World Health Organization’s List of Essential Medicines, the safest and most effective medicines needed in a health system. The wholesale cost in the developing world is between 44 and 78 USD for a course of treatment as of 2014. In the United States a course of rabies vaccine is more than 750 USD.

Rabies treatment is more expensive in Indonesia, as are many medical treatments, because Indonesia don’t have price controls. Emergency rooms, meanwhile, can exacerbate the pricing problem. ERs typically are the only locations where patients can find the lifesaving treatment. And they charge significant “facility fees” to anyone who walks through their doors to seek treatment — including patients seeking a rabies vaccine.

Because rabies treatments include a series of four shots delivered over two weeks — all at separate appointments — those costs can add up quickly. The first step in treatment involves two drugs: a rabies vaccine and something called rabies immunoglobulin. The immunoglobulin essentially kicks the immune system into overdrive, staving off the rabies virus until the vaccine begins to take effect.  The immunoglobulin is what intervenes before the illness can go from the periphery of the body into the central nervous system, and eventually into the brain. That immunoglobulin also buys you time.

Rabies vaccines are safe in all age groups. About 35 to 45 percent of people develop a brief period of redness and pain at the injection site. About 5 to 15 percent of people may have fever, headaches, or nausea. Because rabies is invariably fatal, there is no contraindication to its use after exposure. Most vaccines do not contain thimerosal. Vaccines made from nerve tissue are used in a few countries, mainly in Asia and Latin America, but are less effective and have greater side effects. Their use is thus not recommended by the World Health Organization.

Doctors will give patients an indicated Anti-Rabies Vaccine (VAR) or Anti-Rabies Serum (SAR) as a further treatment for rabies. Anti-Rabies Vaccine (VAR) is a vaccine or active immunization made of a non-active rabies virus. This vaccine can be given prior to exposure (pre-exposure prophylaxis) or after an exposure (post-exposure prophylaxis). This vaccine is injected into the skin or muscles.

If given after exposure, the vaccine is usually given along with Rabies Immunoglobulin (SAR). Anti-Rabies Serum (SAR) is a passive immunization composed of Rabies Immunoglobulin, this vaccine has a function to neutralize the rabies virus caused by an animal bite.

Anti-Rabies Serum is given to those with high-risk wounds, for example, patients with multiple wounds. Moreover, regarding how long does rabies vaccine work in humans, it can give protection for 7 to 10 days before the induced antibodies are formed. Therefore, SAR is not necessary for patients who have already been given the Anti-Rabies Vaccine up to 7 days prior to exposure.

Rabies immunoglobulin costs more than something like a flu shot because it’s derived from human blood, which has to be carefully screened for disease. The cost means the drug is often unavailable in developing countries. By this mean of course the prices in Indonesia are still unexceptionally high. The health data firm Amino combed through 45,000 claims for rabies treatment and found about half of the bills ranged from $280 to $4,500. Five percent of the bills were above $9,912, suggesting that emergency rooms and possibly drug manufacturers have wide leeway on what they charge for the exact same medications. The Amino data represents the actual price paid for the rabies vaccine by patients and insurers, and not the hospital charges.

If this were a flu shot, the variation in prices would be really narrow. But this kind of price variation is typical when you move into the emergency room setting, where patients often have little idea what their treatment will cost until the bill arrives.

High variation in prices for emergency room-type things is something we see a lot of in different types of medical encounters. Sanofi, which manufacturers one of the two brands of rabies immunoglobulin provided Vox with a statement regarding its prices: “Rabies is a serious viral infection that is nearly always fatal. We believe the price of the immunoglobulin is appropriate taking into consideration the life-saving value the product may provide and the complexity of its manufacturing.

Most health care providers in Indonesia do not stock rabies immunoglobulin because the expensive drug has a short shelf life, typically expiring a few years after production. There’s a decent chance the drug would expire on a primary care doctor’s shelf. Emergency rooms, however, do keep this lifesaving medication in stock. The Amino data set shows that 95 percent of post-exposure rabies treatment happens in ERs.

Emergency rooms typically tack on hundreds or thousands of dollars in hospital and doctor fees just for receiving the injections in an ER setting. “Facility fees” are the price emergency rooms charge for walking in the door and seeking care. These fees have risen steeply in recent years: up 89 percent over just six years, according to my recent investigation with the Health Care Cost Institute. The fees also vary significantly from hospital to hospital — and even within the same hospital.

With rabies treatment, it was always different: the medical team was dealing with possible exposure to a disease that is always fatal. The patient needed to seek treatment — and patient did not have a choice about where to do so, essentially requiring her to pay whatever prices the emergency room wanted to charge.

Because the rabies shot also consider as the emergency case which will cost you more than the regular case both on the hospital or on the private clinic in Indonesia.

These are the reason also the rabies shot could take you more than the regular shot. If you still want to learn more about Rabies Vaccine and during your visit in Bali, you can go and contact Hydro Medical Bali. They will provide you the information that you needed for Rabies Vaccine. Also, they will provide you the vaccine when you needed it with the handling of their professional health care and they can assist you to get your insurance covered the vaccine for rabies if you are having health insurance back home.

 

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