TY - JOUR
T1 - The potential effect of improved provision of rabies post-exposure prophylaxis in Gavi-eligible countries
T2 - a modelling study
AU - WHO Rabies Modelling Consortium
AU - Hampson, Katie
AU - Ventura, Francesco
AU - Steenson, Rachel
AU - Mancy, Rebecca
AU - Trotter, Caroline
AU - Cooper, Laura
AU - Abela-Ridder, Bernadette
AU - Knopf, Lea
AU - Ringenier, Moniek
AU - Tenzin, Tenzin
AU - Ly, Sowath
AU - Tarantola, Arnaud
AU - Moyengar, Ronelngar
AU - Oussiguéré, Assandi
AU - Bonfoh, Bassirou
AU - Narayana, DH Ashwath
AU - Sudarshan, Mysore Kalappa
AU - Muturi, Matthew
AU - Mwatondo, Athman
AU - Wambura, Gati
AU - Andriamandimby, Soa Fy
AU - Baril, Laurence
AU - Edosoa, Glenn T.
AU - Traoré, Abdallah
AU - Jayme, Sarah
AU - Kotzé, Johann
AU - Gunesekera, Amila
AU - Chitnis, Nakul
AU - Hattendorf, Jan
AU - Laager, Mirjam
AU - Lechenne, Monique
AU - Zinsstag, Jakob
AU - Changalucha, Joel
AU - Mtema, Zac
AU - Lugelo, Ahmed
AU - Lushasi, Kennedy
AU - Yurachai, Onphirul
AU - Metcalf, Charlotte Jessica E.
AU - Rajeev, Malavika
AU - Blanton, Jesse
AU - Costa, Galileu Barbosa
AU - Sreenivasan, Nandini
AU - Wallace, Ryan
AU - Briggs, Deborah
AU - Taylor, Louise
AU - Thumbi, Samuel M.
AU - Huong, Nguyen Thi Thanh
N1 - Funding Information:
This work is supported by a grant from WHO to the Universities of Glasgow and Cambridge. KH and RMa were supported by the Wellcome Trust ( 207569/Z/17/Z ), with additional funding for RMa from Stuart H Leckie. The Wellcome Trust through Afrique One ASPIRE also supported MLe and several unpublished studies and the UBS Optimus Foundation supported LT and SJ. The Gavi learning agenda on rabies supported many of the unpublished studies that contributed data. The Swiss National Science Foundation supported MLa. The Institut Pasteur financed studies in Cambodia.
Publisher Copyright:
© 2019 World Health Organization
PY - 2019/1
Y1 - 2019/1
N2 - 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.
AB - 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.
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U2 - 10.1016/S1473-3099(18)30512-7
DO - 10.1016/S1473-3099(18)30512-7
M3 - Article
C2 - 30472178
AN - SCOPUS:85059241333
SN - 1473-3099
VL - 19
SP - 102
EP - 111
JO - The Lancet Infectious Diseases
JF - The Lancet Infectious Diseases
IS - 1
ER -