The high cost of surviving rabies | Hacker News Reader

The high cost of surviving rabies

webmd.com

29 pointspessimizer33 comments

My wife had contact with a raccoon which tangled with our dog in the middle of the day about a decade ago. Since confirmation from the state lab takes weeks, she was off to the hospital for rabies shots straight away as a precaution. Total cost to us - pretty much nothing minus some trivial co-pays (< $100).

True to the US health care system, today, a decade later, we would likely pay a few thousand dollars or more - if it was covered. If incidental contact (no bite) was not covered, then it would be on my wife to either take the chance that the risk of rabies was insignificant or go ahead and pay thousands for the shots just in case.

About 5 years ago, I was bit by a stray cat we'd been feeding. I am a bit cheap, so going to the doctor is the last thing on my mind unless I'm gushing blood. I did give thought to the risk of rabies, so I did a little research. Seems you can be successfully treated for rabies within 10 days of exposure - depending a bit on the location of the bite (head/neck vs leg) - mine was on my hand. Cats typically die within a week after they become contagious and show clear signs several days prior to that. Lucky me, this cat continued to show up at our door for food every day through the week with no obvious behavioral changes.

So, having rolled the dice on my life for a few thousand dollars, I figured I was fine.

Mate, I wish, cheapskate that I am, that I was never faced with a moment where I pondered the economic worth of my life. I live in the US and my fellow citizens (from what I'm told) do not want the same kind of health care system that the rest of the prosperous nations enjoy. Makes perfect sense, doesn't it?

I wish I could find logic in it, but I can't.

I thought this was going to be about dealing with side effects, yet it's another story about the US healthcare system.

Right! A healthcare system with a 100% cure rate for a 100% fatal disease. Let’s complain about the cost of this miracle.

Start mucking about with the price of this service and the next thing you know, hospitals are not stocking enough doses or the Pharma Corp has trouble recruiting volunteers to make immunoglobulin. Then you get bit by a rabid dog and go to the ER only to find out they gave their last dose to some kid yesterday and the next ration delivery is weeks away.

Miracles cost money. These people are bickering about a $20k bill when their alternative was to get their papers in order and pick out $10k in funeral arrangements.

You can make that argument for basically any amount.

What's your argument for why it isn't priced close to cost when it the treatment is more than 100 years old?

The rabies vaccine is available everywhere and it's probably not this costly anywhere except in US. I got bitten by a stray dog in India a few years back. 4 shots for rabies + one for tetanus cost me less than Rs. 5000 (~$70) in total, including the cost of administering the shots.

I would not have guessed that the Rabies virus is one of the deadliest viruses known to medicine.

It is probably the deadliest.

HIV is also a death sentence without treatment. Slow, painful death. 90%+ mortality if not severe disability and odd complications.

Something like 98.5% fatal.

More like >99.9%. Prior to 2004, nobody was ever known to have survived symptomatic rabies, and there's now about 11 known cases total.

I thought some Marine survived in the 1980s--he had been hunting at Quantico, and got careless with a raccoon.

> Rabies virus is one of the deadliest viruses

Rabies is probably the only virus where a vaccine is given after you get exposed (technically not infected yet, because you need to get it quickly enough).

I was taken in for a post-exposure vaccination as a child, though they didn't give me one after figuring out I wasn't bitten really (I still am very unclear about what happened) and just had thorns all over my legs from jump into some bushes away from the stray dog.

Would've been a painful set of shots in the belly, which some other kids got.

And the dog was left in chains with a giant bowl of water to see if it drank any over the next week.

Rabies and Tetanus seemed to be the "vaccine magic" diseases of my childhood, with very different outcomes with vaccinations after exposure.

> Rabies is probably the only virus where a vaccine is given after you get exposed (technically not infected yet, because you need to get it quickly enough).

Tetanus isn't caused by a virus; it's caused by a bacteria. But getting vaccinated for it after potential exposure is recommended if you aren't up-to-date, and it's recommended even up to 21 days after injury as tetanus can develop slowly: https://www.uptodate.com/contents/image/print?imageKey=PEDS%... https://www.mayoclinic.org/first-aid/first-aid-puncture-woun... I personally once got a tetanus booster shot on doctors advice following a small wound, because I hadn't had one for awhile.

Incidentally, the tetanus vaccine is unusual as it actually primes your immune system to attack the toxin produced by the tetanus bacteria, not the bacteria themselves. The bacteria are especially harmful only because of the toxin they release.

> Rabies is probably the only virus where a vaccine is given after you get exposed

People with high risk of exposure (like vets and zoo workers) take the vaccine periodically as a preventive measure too. At least they do so in India. Maybe in the US they don't because of the cost of the vaccine.

Same in US. The reason its not given to the general population is that it has to be repeated every 3-5 years, and you still need evaluation and possibly PEP after exposure. Its just that the PEP is much less severe.

Very misleading title. It should be 'the high cost of surviving potential Rabies exposure.' Once you get Rabies the chance of survival is approximately zero.

I live in Poland. I just checked the vaccine prices in one of my town's private clinics. It's $57 (Verorab vaccine) or $73 (Rabipur) per shot. So next time when you're bitten by a bat in US, just jump into a plane to Poland ($800 round trip) and stay here for 2 weeks to get all the shots. The entire trip would cost you less than $3000. Still a lot but order of magnitude cheaper than vaccine in US.

17 grand? That doesn't seem high to me for surviving one of the deadliest diseases known to mankind which historically has been almost 100% fatal. And is extremely rare to contract so there aren't any bulk discounts on the treatment.

I paid half of that for braces.

Actually surprised it's not way higher knowing the American medical system.

> The CDC estimates that as many as 50,000 people in the U.S need this regimen to guard against rabies each year.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6613553/

Yeah. Maybe I'm desensitized to US healthcare costs, but $17k for this, when you already know US healthcare is stupid expensive, isn't exactly a shocking figure anymore. Not saying we can't do better, but $17k here actually sounds nice compared to stories I've already come across for the cost of getting a few stitches, or riding in an ambulance, or giving birth, etc.

haha yeah. that's a good point. Its desensitization. If it's not a life crippling bankruptcy inducing, I'm like "only the price of a car? not bad!"

> That doesn't seem high to me for surviving one of the deadliest diseases known to mankind which historically has been almost 100% fatal.

Hm. I don't know about that. Rabipur is about $75 per dose in my country, so depending on the treatment plan (5-6 doses total) $375 to $450 for the vaccines. Add ~$70 per doctor visit and you get $725 to $800 for the treatment. Immunoglobulin is ~$1200 for a typical person (exact dose depends on weight) making for a total treatment cost of ~$2000 in a country with a reasonable medical system.

Granted this estimate doesn't include initial diagnosis and only includes the treatment itself, but still. A far cry from $17k and also included with insurance (no co-pay).

Deadliness of the disease shouldn't factor into the price of the treatment - that'd just be extortion.

Extortion.

That's the perfect word for medical pricing model in America.

Apparently the treatment has been around since the 1800s so it's not like they're recouping money for the development.

It's just extortion.

Not only do we pay extortive costs, by doing so we help subsidize healthcare in other countries:

"Americans also pay some of the highest prices in the world for this treatment. Our high costs offset steep discounts drugmakers give to poorer countries where rabies infections are more common, says Willoughby, the rabies expert at the Children’s Hospital of Wisconsin."

The rabies vaccine was developed in France by Pasteur.

You could take a non-stop flight to China and get a treatment ($50-$300). It will end up so much cheaper.

Obligatory comment from Ontario, Canada: Covered by OHIP.

https://www.ontario.ca/page/rabies-humans

My google-fu is not sufficient to find out what OHIP pays for this, though. But even if it is on the order of $22K, averaged out over the population it's not much.

Covered by Medicare in the US, as well. But, of course, Medicare itself remains age-restricted.

Also covered by Medi-Cal here in California, but that's means-restricted.

What else are you going to do, though? It's essentially guaranteed death otherwise. There's like a dozen people who've ever survived rabies without the vaccine, and they're all at varying degrees of impairment.

I remember the cost of emergency medicine in China:

Even very substantial surgeries are rather cheap, but the trivial appendicitis will cost you $10k-$20k, and they will bill you extra if they believe it is about to burst, and you are untranslortable.

I suppose you could try to get “professionally immunized” each year and get paid for your antibodies and be protected from rabies.

That's weird. I got bit by a dog 5 years or so ago. It was such a light bite that I initially didn't even realize it had broken the skin - when I realized what had happened and went back to talk (realistically maybe strongly talk because the guys dog bit me with no provocation that I was aware of and zero warning. Animal didn't even bark - it was straight to lunge. And the guy was parked right in front of grocery store. ... but I digress)

Anyhow the guy and his dog had vanished. I waited a day or so and then went to the Dr. and the ended up getting the rabies vaccine which was annoying because it's 3 ... or maybe it was 4? shots over a couple of weeks. It didn't cost a lot though. I guess insurance covered it but it's not like I've got wonder insurance.

Who knows though maybe it is incredibly expensive.

Got bit by a dog in Bali while on vacation there in 2013. I got a series of five or six vaccine shots in Indonesia and Thailand. It cost around $10/shot. I remember doing some research and I think it's fabricated differently than here in the USA. There was no difference in efficacy rates between the two types (basically 100% survival).

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