Evaluation of cost-effective strategies for rabies post-exposure vaccination in low-income countries

• Published in: PLoS neglected tropical diseases Vol. 5; no. 3; p. e982
• Main Authors: Hampson, Katie, Cleaveland, Sarah, Briggs, Deborah
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 08.03.2011; Public Library of Science (PLoS)
• Subjects: Bats; Budgets; Cost analysis; Cost control; Cost-Benefit Analysis; Developing Countries; Disease prevention; Evidence-Based Healthcare; Evidence-Based Healthcare/Health Services Research and Economics; Health care; Humans; Infectious Diseases/Viral Infections; Injections, Intradermal; Injections, Intramuscular; LDCs; Lifesaving; Low income areas; Patient compliance; Post-Exposure Prophylaxis - economics; Post-Exposure Prophylaxis - methods; Prevention programs; Prophylaxis; Public Health and Epidemiology/Health Policy; Public Health and Epidemiology/Health Services Research and Economics; Public Health and Epidemiology/Immunization; Rabies; Rabies - prevention & control; Rabies Vaccines - administration & dosage; Rabies Vaccines - economics; Tropical diseases; Vaccination - economics; Vaccination - methods; Vaccines; Virology/Vaccines; Cost-Benefit Analysis; Humans; Rabies; Vaccination; Post-Exposure Prophylaxis; Rabies Vaccines; Developing Countries; Injections, Intramuscular; Injections, Intradermal
• ISSN: 1935-2735; 1935-2727; 1935-2735
• DOI: 10.1371/journal.pntd.0000982

Prompt post-exposure prophylaxis (PEP) is essential in preventing the fatal onset of disease in persons exposed to rabies. Unfortunately, life-saving rabies vaccines and biologicals are often neither accessible nor affordable, particularly to the poorest sectors of society who are most at risk and upon whom the largest burden of rabies falls. Increasing accessibility, reducing costs and preventing delays in delivery of PEP should therefore be prioritized. We analyzed different PEP vaccination regimens and evaluated their relative costs and benefits to bite victims and healthcare providers. We found PEP vaccination to be an extremely cost-effective intervention (from $200 to less than $60/death averted). Switching from intramuscular (IM) administration of PEP to equally efficacious intradermal (ID) regimens was shown to result in significant savings in the volume of vaccine required to treat the same number of patients, which could mitigate vaccine shortages, and would dramatically reduce the costs of implementing PEP. We present financing mechanisms that would make PEP more affordable and accessible, could help subsidize the cost for those most in need, and could even support new and existing rabies control and prevention programs. We conclude that a universal switch to ID delivery would improve the affordability and accessibility of PEP for bite victims, leading to a likely reduction in human rabies deaths, as well as being economical for healthcare providers.