{"database":"biostudies-literature","file_versions":[],"scores":null,"additional":{"submitter":["Ritchie AJ"],"funding":["Oregon Department of Agriculture","UK Research and Innovation","Wellcome Trust","Department for Business, Energy and Industrial Strategy, UK Government"],"pagination":["126703"],"full_dataset_link":["https://www.ebi.ac.uk/biostudies/studies/S-EPMC7618176"],"repository":["biostudies-literature"],"omics_type":["Unknown"],"volume":["47"],"pubmed_abstract":["<h4>Background</h4>Pre-exposure prophylactic rabies vaccination (PrEP) is advised for travellers to countries with high rabies incidence, but rarely available for local residents. Some studies suggest poor cost-effectiveness of PrEP in such settings, but have generally focused upon post-exposure prophylaxis (PEP) cost savings as the main benefit of PrEP, without considering lives saved by PrEP efficacy.<h4>Methods</h4>We compared incremental cost-effectiveness ratios (ICERs) of use of rabies PrEP, against an alternative of using only PEP, by adapting a decision-tree model previously used to inform Gavi's investment in rabies PEP. We consider scenarios including: a range of PrEP efficacies in individuals unable to access PEP; PrEP costs significantly below current prices (through single-dose approaches, inclusion in childhood vaccination schedules, increased manufacturing volume and/or new low-cost products); and variable rabies exposure risk and PEP access. We also present results from a simplified model, designed for ease of understanding.<h4>Results</h4>Modelled ICERs were <1000 USD per quality adjusted life year (QALY) across a range of plausible combinations of rabies exposure risk, PEP access, PrEP cost and PrEP efficacy. If PrEP efficacy exceeds 50 % over 15 years, we estimate ICERs <500 USD/QALY where rabies incidence ≥3 per 100,000 per year and cost of vaccination is ≤5 USD/child. Under scenarios with lower rabies incidence of around 0.3 per 100,000 per year, due either to more limited exposure or greater access to PEP, ICERs <3000 USD may still be achieved even if PrEP efficacy is as low as 30 %.<h4>Conclusions</h4>Routine childhood PrEP may be cost-effective in settings with modest willingness-to-pay, and rabies exposure risks plausible across much of Africa and South Asia. Cost-effectiveness requires low-cost PrEP regimes and some efficacy of PrEP in individuals unable to access PEP. Under such conditions, PrEP may be an attractive additional tool in the fight against rabies."],"journal":["Vaccine"],"pubmed_title":["Routine childhood rabies pre-exposure prophylaxis can be cost effective in low- and middle-income countries."],"pmcid":["PMC7618176"],"funding_grant_id":["220679","220679/Z/20/Z"],"pubmed_authors":["Douglas AD","Trotter C","Meeyai A","Ritchie AJ"],"additional_accession":[]},"is_claimable":false,"name":"Routine childhood rabies pre-exposure prophylaxis can be cost effective in low- and middle-income countries.","description":"<h4>Background</h4>Pre-exposure prophylactic rabies vaccination (PrEP) is advised for travellers to countries with high rabies incidence, but rarely available for local residents. Some studies suggest poor cost-effectiveness of PrEP in such settings, but have generally focused upon post-exposure prophylaxis (PEP) cost savings as the main benefit of PrEP, without considering lives saved by PrEP efficacy.<h4>Methods</h4>We compared incremental cost-effectiveness ratios (ICERs) of use of rabies PrEP, against an alternative of using only PEP, by adapting a decision-tree model previously used to inform Gavi's investment in rabies PEP. We consider scenarios including: a range of PrEP efficacies in individuals unable to access PEP; PrEP costs significantly below current prices (through single-dose approaches, inclusion in childhood vaccination schedules, increased manufacturing volume and/or new low-cost products); and variable rabies exposure risk and PEP access. We also present results from a simplified model, designed for ease of understanding.<h4>Results</h4>Modelled ICERs were <1000 USD per quality adjusted life year (QALY) across a range of plausible combinations of rabies exposure risk, PEP access, PrEP cost and PrEP efficacy. If PrEP efficacy exceeds 50 % over 15 years, we estimate ICERs <500 USD/QALY where rabies incidence ≥3 per 100,000 per year and cost of vaccination is ≤5 USD/child. Under scenarios with lower rabies incidence of around 0.3 per 100,000 per year, due either to more limited exposure or greater access to PEP, ICERs <3000 USD may still be achieved even if PrEP efficacy is as low as 30 %.<h4>Conclusions</h4>Routine childhood PrEP may be cost-effective in settings with modest willingness-to-pay, and rabies exposure risks plausible across much of Africa and South Asia. Cost-effectiveness requires low-cost PrEP regimes and some efficacy of PrEP in individuals unable to access PEP. Under such conditions, PrEP may be an attractive additional tool in the fight against rabies.","dates":{"release":"2025-01-01T00:00:00Z","publication":"2025 Feb","modification":"2026-06-03T22:57:26.677Z","creation":"2026-05-02T03:12:12.625Z"},"accession":"S-EPMC7618176","cross_references":{"pubmed":["39799849"],"doi":["10.1016/j.vaccine.2024.126703"]}}