title: Evaluation of cost-effective strategies for rabies post-exposure vaccination in low-income countries.
abstract: BACKGROUND
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Boyd Orr Centre for Population and Ecosystem Health, Institute for Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, United Kingdom. K.Hampson@Bio.gla.ac.uk
authors.forename: Katie
authors.initials: K
authors.lastname: Hampson
authors.forename: Sarah
authors.initials: S
authors.lastname: Cleaveland
authors.forename: Deborah
authors.initials: D
authors.lastname: Briggs
mesh_terms: D003362:Cost-Benefit Analysis; D003906:Developing Countries; D006801:Humans; D007271:Injections, Intradermal; D007273:Injections, Intramuscular; D056990:Post-Exposure Prophylaxis / Q000191:economics* / Q000379:methods*; D011818:Rabies / Q000517:prevention & control*; D011819:Rabies Vaccines / Q000008:administration & dosage* / Q000191:economics*; D014611:Vaccination / Q000191:economics / Q000379:methods
chemical_list: D011819:Rabies Vaccines