OBJECTIVES: Anti-venom is the only specific treatment to prevent neurological disorders, amputation and death in snakebite envenoming, categorized as neglected tropical disease by WHO. Majority of victims are young and economically productive. Hence, the economic impact of their disability is considerable. We reviewed the burden and cost of snakebite envenoming: its incidence, morbidity and mortality rates, and the access to anti-venom treatment. METHODS: The information was retrieved from 1985-2009 from MEDLINE, Google Scholar and WHO website with search terms including “snakebite”, “antivenom”, “cost of antivenom” and “ snakebite morbidity and mortality”. RESULTS: Snakebite as a tropical disease causes considerable morbidity and mortality worldwide with global annual estimates for 2007 ranging from 1,200,000-5,500,000 for snakebite incidence to 42,1000-1,841,000 and 20,000–94,000 for envenoming and deaths respectively. South Asia (121,000) has the highest number of envenoming followed by Southeast Asia (111,000) and east-Sub-Saharan Africa (43,000). The price of anti-venom has typically risen by 10 fold over the last 20 years. For example, the costs to Australian hospitals of CSL polyvalent and taipan antivenoms were A$1833 and A$1577 in 2003 as compared to A$300 and A$245 in 1985, respectively. The number of anti-venom vials increases with severity (upto 5, 10 and 20 for mild, moderate and severe cases respectively) thereby increasing cost of treatment. Inadequate anti-venom supply further exaggerates this problem as the current annual need amounts to 10,000,000 vials. Incidence is higher in rural areas, where incomes are generally lower. In Nepal, out-of-pocket expenses (US$69) equal several months of income as most people have a daily incomes of <1-2 US$, besides 15 days of working incapacity period. CONCLUSIONS: The excessive cost and inadequate supply of anti-venom renders it inaccessible to most people in developing countries. Appropriate measures should be taken to prevent the clinical and economic impact of this neglected disease.