Health economic assessment of a rabies pre-exposure prophylaxis program compared with post-exposure prophylaxis alone in high-risk age groups in the Philippines.

OBJECTIVES: Once symptoms appear, rabies is almost always fatal and accounts for 200-300 deaths annually in the Philippines. Available rabies vaccines can be administered either in pre- exposure prophylaxis (PrEP) or post-exposure prophylaxis (PEP). After exposure, PrEP-immunized individuals require fewer doses of PEP and no rabies immunoglobulin. METHODS: A static decision-tree model was developed to assess cost-effectiveness of a PrEP+PEP program vs PEP alone. Philippines-specific data for people seeking medical advice at the Research Institute for Tropical Medicine between July 2015 and June 2016 were used in the model, together with data from published literature. RESULTS: Over a 20-year period, in a cohort of 1 million 5-year-old children in the Philippines, PrEP+PEP was expected to prevent 297 deaths compared with PEP alone. From both payer and societal perspectives, the resulting incremental cost-effectiveness ratios were 36 035 (US$759; 2016 US$ conversion) and 18 663 (US$393) Philippine Pesos (PHP) - quality-adjusted life-years gained - respectively, which are both below the willingness-to-pay threshold of PHP140 255 (US$2 953). CONCLUSION: These data suggest that a universal PrEP program targeting 5-year-olds would be cost-effective in the Philippines.

Factors affecting compliance to rabies post-exposure prophylaxis among pediatric patients seen at the Research Institute for Tropical Medicine

@#<p style="text-align: justify;">Rabies is a viral disease that produces uniformly fatal encephalitis in humans and most other mammals. It remains one of the most common viral causes of mortality in the developing world.<br /><br /><strong>OBJECTIVE:</strong> The aim of this study was to determine the factors that affect compliance of pediatric patients advised to receive rabies Post-exposure Prophylaxis (PEP).<br /><br /><strong>METHODS:</strong> Pediatric patients zero months to 18 years old who were bitten by animals and thereafter sought consult from January to March 2009. Subjects with Category II and III exposure bites and advised PEP, who have telephone contact numbers, and gave verbal consent to participate were included. Excluded subjects were those who cannot be accessed by telephone or mobile, had previous animal bite and had received prior rabies immunization. Data were gathered through chart review and telephone interviews. Total number of patients who complied and did not comply with PEP and the factors related to compliance were determined. <br /><br /><strong>RESULTS:</strong> One thousand two hundred forty three pediatric patients sought consult and were advised to receive PEP: 757 (61%) were males and 496 (39%) were females. Most common age group was 2-to-5 yrs (41%), followed by 6-to-10 years (32%). A higher proportion of females were noted under Category II exposure while a higher proportion of males were noted under Category III. Most common biting animal was dog. The highest proportion of subjects with multiple body bites were from the very young age group (0 to 1 year old). Most commonly injured body parts were the upper extremities (32.7%), lower extremities (42.7%) and head (16%). The two-site intradermal (ID) rabies vaccine regimen was prescribed on days 0, 3, 7 and 30; however, there was a declining trend in rabies vaccine and rabies immune globulin (RIG) received. Compliance rate of RIG (55%) and rabies vaccine (31%) were low. Factors affecting compliance to rabies PEP were: 1) fear of acquiring rabies and knowledge of the gravity of the disease; 2) vaccine cost and affordability; and 3) knowledge on status of biting animal.<br /><br /><strong>CONCLUSION:</strong> The most salient issue in rabies PEP compliance is the affordability of the vaccine.</p>