Related Experiment Video
Updated: Aug 13, 2025
Author Spotlight: A Cost-Effective Genomic Workflow for Advancing Rabies Control in Resource-Limited Settings
Published on: August 18, 2023
A Cost-Effectiveness Analysis of Pre-Exposure Prophylaxis to Avert Rabies Deaths in School-Aged Children in India
Abhishek Royal1, Denny John2, Omesh Bharti3
1Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia.
Insights
Pre-exposure prophylaxis (PrEP) using the 2-site intradermal regimen is a very cost-effective strategy to prevent painful rabies deaths in Indian children. This life-saving intervention significantly reduces mortality and DALYs averted.
Area of Science:
- Public Health
- Epidemiology
- Health Economics
Background:
- Rabies causes significant mortality in Indian children, with half of all deaths occurring in this demographic.
- Effective strategies for rabies prevention, particularly pre-exposure prophylaxis (PrEP), require further investigation for implementation in India.
Purpose of the Study:
- To conduct an economic evaluation of various pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) strategies for averting rabies mortality in school-aged children in India.
- To compare the cost-effectiveness of different PrEP and PEP regimens using a decision tree model.
Main Methods:
- A decision tree model was developed for children aged 5-15 years to assess PrEP + PEP and PEP-only strategies.
- The 2-site intradermal regimen on days 0 and 7 was selected as the intervention (PrEP [I]).
- Incremental Cost-Effectiveness Ratio (ICER) was calculated from quasi-societal and quasi-health systems' perspectives, including sensitivity and scenario analyses.
Main Results:
- Implementation of PrEP (I) averted between 451 and 85,069 DALYs (Disability-Adjusted Life Years) per million population in 2020.
- The ICER for PrEP (I) ranged from USD 384-352/DALY averted compared to PEP regimens (quasi-societal perspective).
- PrEP (I) was found to be 'very cost effective' and could reduce rabies deaths by up to 89.9%.
Conclusions:
- The PrEP (I) regimen is a highly cost-effective and life-saving strategy for preventing rabies mortality in Indian school-aged children.
- This approach offers a significant public health benefit by reducing painful deaths due to rabies.
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.
