Routine childhood rabies pre-exposure prophylaxis can be cost effective in low- and middle-income countries

This peer-reviewed article in Vaccine presents a cost-effectiveness analysis of routine childhood rabies pre-exposure prophylaxis (PrEP) in low- and middle-income countries. Authors adapted a decision-tree model previously used to inform Gavi’s investment in rabies post-exposure prophylaxis (PEP), alongside a simplified model, to assess whether low-cost PrEP delivered through childhood immunization schedules could be cost-effective compared with PEP-only strategies.

Key findings

• Routine childhood rabies PrEP could be cost-effective across a range of plausible low- and middle-income country settings, especially where rabies exposure risk is high and timely PEP access is limited.
• In the base-case scenario, both the simplified and decision-tree models estimated an ICER of US$354 per QALY gained.
• If PrEP efficacy exceeds 50% over 15 years, ICERs were estimated below US$500 per QALY in settings with rabies incidence of at least 3 per 100,000 per year and vaccination costs of US$5 or less per child.
• The cost-effectiveness of PrEP depends strongly on PrEP cost, rabies exposure risk, PEP access, and the assumed efficacy of PrEP among people who do not access PEP.
• The authors emphasize that PrEP should not replace PEP or dog vaccination, but could serve as an additional interim tool in settings where elimination and universal PEP access remain difficult to achieve.

Thumbnail image credit: Gavi