


How much would you pay to be 1% less likely to die in the next month?

I was presented with a very curious dilemma this past weekend: Was I willing to pay $10,000 in order to eliminate a 1% chance that I might die in the next month?

The situation was this... I awoke Sunday morning to find a bat flying circles around my bed. I opened the window and with a little encouragement the bat flew out.  A few hours later I read that according to the Center for Disease Control (CDC) anyone sleeping in a bedroom where a bat is found should receive the rabies post-exposure prophylaxis (RPEP) if the bat is not submitted for testing.  Bats have a documented history of transmitting rabies to people as they slept.  (Had I known this before releasing the bat I would have had a separate moral dilemma, would I be willing to pay $10,000 to avoid causing the death of a bat.)

Rabies is 99.99999999% fatal if not treated long before symptoms occur; treatment is 100% effective. Rabies post-exposure prophylaxis (RPEP) is very expensive, treatment fees (from web-based patient reports) range from $5,000 - $15,000, depending on location, hospital, availability of vaccine, etc. Insurance will likely only cover a portion of my treatment, and as my girlfriend has no insurance I'll be on the hook for the full price of her treatment. I had roughly 72 treatment-effectiveness-limited hours to decide what action, if any, I would take. What would you do?

I find it a fascinating situation to be in, a fascinating problem to wrestle with, because unlike many of the more nebulous philosophical questions relating to morality,  ethics, the nature of existence, etc. this is so elegantly, cruelly simply.

You can't know if you were infected, but you can estimate the likelihood that you were infected. You will absolutely die if you were infected and do not get treatment, but you will not suffer any ill effects if you were infected and get treatment. If it cost $1 almost everyone would get treated (in my situation), but it cost $100,000 almost no one would get treated (in my situation).  Somewhere between $1 and $100,000, somewhere between a 0% chance of infection and a 100% chance of infection exists the divide between getting treated and not getting treated.

I spent the first 24 hours after exposure trying to find where this line of demarcation lay.

Estimating the likelihood of infection was critical.   If it were large the decision would be easy.  I found that various studies put the rate of rabies infection in bat populations at anything from less than 1% to 6%. Bats observed in their natural environment seem to have a lower than 1% rabies infection rate, while bats which have encountered humans, been captured, and sent in for testing have a rate as high as 6%.  Periodic public rabies panics which caused more people to test more bats found inside their homes suggests that the real infected rate related to human-bat encounters is more like 3%. Thus, it seems reasonable to assume my bat had no more than a 3% chance of being rabid.  But of course to become infected I would have needed some contact with the bat.  Surely the likelihood that it bit or scratched me as I slept was low, as my prevailing theory was that I woke up as a result of hearing it somehow wiggle its way through the screen window and then flap against the blinds.  In the end I arbitrarily estimated that there was no more than a 33% chance that I had contact with the bat.  Combining these I estimated my risk as certainly no higher than 1%.

And so it is I spent the evening and the next morning pondering whether I would spend $10,000 to save myself a 1% chance of semi-immediate (and by all accounts agonizing) death.  I was leaning strongly towards not seeking treatment, not wanting the financial devastation over what surely was a small likelihood of grievous harm.

My girlfriend was not so resigned as I to accepting the risk, and as a result I ended up spending more than an hour trying to pin the billing department of the local hospital down to an actual price range for the treatment.

The local hospital's cost for treatment ended up being lower than the average I'd seen online and was roughly $5,100.  That amount broke down to $2,500 for the Human Rabies Immune Globulin (HRIG) drug, $1,800 for four separate Imovax/Rabavert vaccines, and $800 for the administration of those medications across four visits.  With the estimated costs half of what I'd been expecting, and with the anxiety my girlfriend would continue feeling indefinitely had we not sought treatment, getting treated now made sense.

We were treated, and I am enjoying my new found nearly complete immunity to rabies.  I have been volunteering myself and this new super power to friends or family, hoping they may be having a problem with a rabid  or otherwise suspicious animal; thus far I have sadly found no one who needs my help...

Tagged as: , 1 Comment