Abstract
BackgroundPrompt 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.Methodology/Principal FindingsWe 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.Conclusions/SignificanceWe 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.
Highlights
Rabies is invariably fatal once clinical signs appear but can be readily prevented after exposure with prompt and appropriate post-exposure prophylaxis (PEP) [1]
Rapid delivery of post-exposure vaccination is essential for preventing the fatal onset of rabies in persons bitten by rabid animals
We developed a framework for comparing the cost-effectiveness of different vaccination regimens, including existing approved regimens and new candidates subject to approval, in terms of costs per death averted
Summary
Rabies is invariably fatal once clinical signs appear but can be readily prevented after exposure with prompt and appropriate post-exposure prophylaxis (PEP) [1]. Most of the estimated 7 million people exposed to rabies each year live in resource poor countries where life-saving rabies vaccines are not always available or affordable [3,4,5,6]. Costs of travel and or accommodation accumulate according to the number of clinic visits that a patient and, in many cases, an accompanying family member, makes to complete PEP These considerable indirect costs [7] are affected by vaccine availability, and rise during shortages when patients and families are forced to travel further (often to multiple clinics), wasting time and money [3]. Increasing accessibility, reducing costs and preventing delays in delivery of PEP should be prioritized
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