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. 2022 Dec 30;11(1):88.
doi: 10.3390/vaccines11010088.

A Cost-Effectiveness Analysis of Pre-Exposure Prophylaxis to Avert Rabies Deaths in School-Aged Children in India

Abhishek Royal  1 , Denny John  2 , Omesh Bharti  3 , Ritesh Tanwar  4 , Deepak Kumar Bhagat  5 , Retna Siwi Padmawati  1 , Vishal Chaudhary  6 , Reddicherla Umapathi  7 , Pradeep Bhadola  8 , Adi Utarini  1
Affiliations

A Cost-Effectiveness Analysis of Pre-Exposure Prophylaxis to Avert Rabies Deaths in School-Aged Children in India

Abhishek Royal et al. Vaccines (Basel). .

Abstract

Children contribute to one-half of the total painful rabies mortalities in India. The state-of-the-art rabies mortality averting strategies need exploration for the effective implementation of pre-exposure prophylaxis (PrEP) in India. This study reports on the economic evaluation of various PrEP and post-exposure prophylaxis (PEP) strategies to avert rabies mortalities in school-aged children in India. A decision tree model has been developed for children in the age group of 5-15 years to evaluate various PrEP + PEP and PEP only regimens. The 2-site intradermal regimen administered on day zero and seven was chosen as the intervention [PrEP (I)]. ICER was calculated from the quasi-societal and quasi-health systems' perspectives for the base case analysis, along with one-way sensitivity, and scenario analyses for each regimen. The incremental DALYs averted per million population with the implementation of PrEP (I) ranged between 451 and 85,069 in 2020. The ICER was reported in the range of USD 384-352/DALY averted (non-dominant) in comparison to PEP regimens from a quasi-societal perspective. PrEP (I) is reported to be 'very cost effective' in comparison with PEP regimens from the quasi-societal and quasi-health systems' perspectives and reduce deaths by up to 89.9%. This study concludes that the PrEP (I) regimen is a cost-effective and life-saving strategy to avert painful mortalities due to rabies in school-aged children in India.

Keywords: India; child health; cost effectiveness; public health; rabies; school-aged children.

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Conflict of interest statement

Omesh Bharti is a rabies expert and is currently affiliated with the State Epidemiologist in State Institute of Health and Family Welfare, Department of Health & Family Welfare, Government of Himachal Pradesh, Shimla, India. He has contributed to the conceptualization of the study, provided an expert opinion, contributed to the development and validation of the decision tree model, and reviewed the final manuscript. The publication of the study results was not contingent on the sponsor’s approval or censorship of the manuscript.

Figures

Scheme A1
Scheme A1
One−way sensitivity of CE analysis of PrEP (I) vs. C1.
Scheme A2
Scheme A2
One−way sensitivity of CE analysis of PrEP (I) vs. C2.
Scheme A3
Scheme A3
One−way sensitivity of CE analysis of PrEP (I) vs. C3.
Scheme A4
Scheme A4
One−way sensitivity of CE analysis of PrEP(I) vs. C4.
Scheme A5
Scheme A5
One−way sensitivity of CE analysis of PrEP (I) vs. C5.
Scheme A6
Scheme A6
One−way sensitivity of CE analysis of PrEP (I) vs. C6.
Scheme A7
Scheme A7
One-way sensitivity of CE analysis of PrEP (I) vs. C7.
Scheme A8
Scheme A8
One−way sensitivity of CE analysis of PrEP (I) vs. C8. Animal bite—Animal bite incidence; Avg death time—Average time a person lives after the onset of rabies; Cat iii—Category of exposure; Compliance—Compliance for full course of PEP; Cost consum—Cost of consumables; Cost RIG—Cost per RIG vial; Cost vac—Cost per vaccine vial; DW—Disability weight; Hospital—Hospital charges; HR—Costs associated with human resources; Meal—Meal cost for the patient/client and one attendant (per visit); PEP seeking—PEP seeking behaviour of the bite victims; Program—Program management costs; Rabid dog—Rabies positivity of the biting animal; Rabies Prob ARV—Probability of developing rabies in Cat II/III exposure in absence of administration or full administration of PEP vaccination; Rabies Prob RIG—Risk probability of rabies in category III exposures in previously unvaccinated children in absence of RIG; RIG seeking—RIG administration in Cat III exposures; RIG utilization—Utilization of calculated dose of RIG; Transport—Travel cost for the patient/client and one attendant (per visit); Treatment—Treatment cost of fatal symptomatic rabies; Wages—Loss of wages of attendant; Wastage ARV—ARV wastage; Wastage RIG—RIG wastage.
Figure 1
Figure 1
Decision Tree Model. Cat 1—Category 1, Cat 2—Category 2, Cat 3—Category 3, PEP—Post-Exposure Prophylaxis, PrEP—Pre-Exposure Prophylaxis, RIG—Rabies Immunoglobin.
Figure 2
Figure 2
One−way sensitivity CE analysis: PrEP (I) vs. C4. Animal bite—Animal bite incidence; Avg death time—Average time a person lives after the onset of rabies; Cat iii—Category of exposure; Compliance—Compliance for full course of PEP; Cost consum—Cost of consumables; Cost RIG—Cost per RIG vial; Cost vac—Cost per vaccine vial; DW—Disability weight; Hospital—Hospital charges; HR—Costs associated with human resources; Meal—Meal cost for the patient/client and one attendant (per visit); PEP seeking—PEP seeking behaviour of the bite victims; Program—Program management costs; Rabid dog—Rabies positivity of the biting animal; Rabies Prob ARV—Probability of developing rabies in Cat II/III exposure in absence of administration or full administration of PEP vaccination; Rabies Prob RIG—Risk probability of rabies in category III exposures in previously unvaccinated children in absence of RIG; RIG seeking—RIG administration in Cat III exposures; RIG utilization—Utilization of calculated dose of RIG; Transport—Travel cost for the patient/client and one attendant (per visit); Treatment—Treatment cost of fatal symptomatic rabies; Wages—Loss of wages of attendant; Wastage ARV—ARV wastage; Wastage RIG—RIG wastage.
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