See also www.rabiescontrol.net
Evaluation of Cost-Effective Strategies for Rabies Post-Exposure Vaccination in Low-Income Countries
Katie Hampson,1* Sarah Cleaveland,1 and Deborah Briggs2
1Boyd Orr Centre for Population and Ecosystem Health, Institute for Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, United Kingdom
2Global Alliance for Rabies Control, Manhattan, Kansas, United States of America
Jakob Zinsstag, Editor
Swiss Tropical Institute, Switzerland
* E-mail: K.Hampson@Bio.gla.ac.uk
Full text & tables, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3050908/?tool=pubmed
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.