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The potential effect of improved provision of rabies post-exposure prophylaxis in Gavi-eligible countries: a modelling study.

Author(s): WHO Rabies Modelling Consortium; Metcalf, C. Jessica E

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Abstract: BACKGROUND:Tens of thousands of people die from dog-mediated rabies annually. Deaths can be prevented through post-exposure prophylaxis for people who have been bitten, and the disease eliminated through dog vaccination. Current post-exposure prophylaxis use saves many lives, but availability remains poor in many rabies-endemic countries due to high costs, poor access, and supply. METHODS:We developed epidemiological and economic models to investigate the effect of an investment in post-exposure prophylaxis by Gavi, the Vaccine Alliance. We modelled post-exposure prophylaxis use according to the status quo, with improved access using WHO-recommended intradermal vaccination, with and without rabies immunoglobulin, and with and without dog vaccination. We took the health provider perspective, including only direct costs. FINDINGS:We predict more than 1 million deaths will occur in the 67 rabies-endemic countries considered from 2020 to 2035, under the status quo. Current post-exposure prophylaxis use prevents approximately 56 000 deaths annually. Expanded access to, and free provision of, post-exposure prophylaxis would prevent an additional 489 000 deaths between 2020 and 2035. Under this switch to efficient intradermal post-exposure prophylaxis regimens, total projected vaccine needs remain similar (about 73 million vials) yet 17·4 million more people are vaccinated, making this an extremely cost-effective method, with costs of US$635 per death averted and $33 per disability-adjusted life-years averted. Scaling up dog vaccination programmes could eliminate dog-mediated rabies over this time period; improved post-exposure prophylaxis access remains cost-effective under this scenario, especially in combination with patient risk assessments to reduce unnecessary post-exposure prophylaxis use. INTERPRETATION:Investing in post-exposure vaccines would be an extremely cost-effective intervention that could substantially reduce disease burden and catalyse dog vaccination efforts to eliminate dog-mediated rabies. FUNDING:World Health Organization.
Publication Date: Jan-2019
Citation: WHO Rabies Modelling Consortium. (2019). The potential effect of improved provision of rabies post-exposure prophylaxis in Gavi-eligible countries: a modelling study.. The Lancet. Infectious diseases, 19 (1), 102 - 111. doi:10.1016/S1473-3099(18)30512-7
DOI: doi:10.1016/S1473-3099(18)30512-7
ISSN: 1473-3099
EISSN: 1474-4457
Pages: 1 - 10
Language: eng
Type of Material: Journal Article
Journal/Proceeding Title: The Lancet. Infectious diseases
Version: Author's manuscript

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