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Health economic assessment of a rabies pre-exposure prophylaxis program compared with post-exposure prophylaxis alone
Beatriz Quiambao1, Lijoy Varghese2, Nadia Demarteau3
1Research Institute for Tropical Medicine, Filinvest Corporate City, 9002 Research Dr, Alabang, Muntinlupa, 1781 Metro Manila, Philippines.
Insights
A universal pre-exposure prophylaxis (PrEP) program for 5-year-olds in the Philippines is cost-effective. This strategy is projected to prevent hundreds of rabies deaths annually, offering significant public health benefits.
Area of Science:
- Public Health
- Epidemiology
- Health Economics
Background:
- Rabies is nearly always fatal once symptoms appear, causing 200-300 deaths annually in the Philippines.
- Rabies vaccines can be used for pre-exposure prophylaxis (PrEP) or post-exposure prophylaxis (PEP).
- PrEP vaccination reduces the need for PEP doses and rabies immunoglobulin after exposure.
Purpose of the Study:
- To assess the cost-effectiveness of a rabies prevention program combining pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) compared to PEP alone in the Philippines.
- To evaluate the economic impact of a universal PrEP strategy targeting young children.
Main Methods:
- A static decision-tree model was developed to analyze cost-effectiveness.
- Philippines-specific data from July 2015 to June 2016 were utilized.
- Published literature data were incorporated into the model.
Main Results:
- Over 20 years, a cohort of 1 million 5-year-olds receiving PrEP+PEP was projected to prevent 297 deaths compared to PEP alone.
- The incremental cost-effectiveness ratios were PHP 36,035 (payer perspective) and PHP 18,663 (societal perspective) per quality-adjusted life-year gained.
- Both ratios were below the willingness-to-pay threshold of PHP 140,255.
Conclusions:
- A universal PrEP program targeting 5-year-olds is a cost-effective strategy for rabies prevention in the Philippines.
- Implementing PrEP alongside PEP offers significant public health and economic benefits.
Objectives:
Once symptoms appear, rabies is almost always fatal and accounts for 200-300 deaths annually in the Philippines. Available rabies vaccines can be administered either in pre- exposure prophylaxis (PrEP) or post-exposure prophylaxis (PEP). After exposure, PrEP-immunized individuals require fewer doses of PEP and no rabies immunoglobulin.
Methods:
A static decision-tree model was developed to assess cost-effectiveness of a PrEP+PEP program vs PEP alone. Philippines-specific data for people seeking medical advice at the Research Institute for Tropical Medicine between July 2015 and June 2016 were used in the model, together with data from published literature.
Results:
Over a 20-year period, in a cohort of 1 million 5-year-old children in the Philippines, PrEP+PEP was expected to prevent 297 deaths compared with PEP alone. From both payer and societal perspectives, the resulting incremental cost-effectiveness ratios were 36 035 (US$759; 2016 US$ conversion) and 18 663 (US$393) Philippine Pesos (PHP) - quality-adjusted life-years gained - respectively, which are both below the willingness-to-pay threshold of PHP140 255 (US$2 953).
Conclusion:
These data suggest that a universal PrEP program targeting 5-year-olds would be cost-effective in the Philippines.
