Cost Effectiveness of Rabies Post Exposure Prophylaxis

We estimate the cost effectiveness of rabies post exposure prophylaxis (PEP) treatment under different scenarios of risk of rabies transmission. Both direct medical and indirect costs of PEP treatment were included (average $4,042/ PEP: range $1,634 - $8,415). The ranges of probabilities of rabies transmission to a human following possible contact with different species of potentially rabid animals were obtained from a panel of experts. Under all three scenarios (average, most, and least cost effective) it is always cost saving to give PEP if the patient is bitten by an animal that has tested positive for rabies. It is almost always cost saving (range: $573,000/ life saved to cost saving) if a patient is bitten by a reservoir/vector species (e.g. skunk), even if the animal is not available for testing. For all other transmission risk situations, the average net cost effectiveness ratio was always a net cost/ life saved (range: $2.9 million following a bite form an untested cat to $4 billion following a lick from an untested dog). We obtained a wide range of cost effectiveness for most scenarios. The possible bat bite exposure scenario ranged from cost savings (most cost effective scenario) to $8.4 billion (least cost effective scenario). The policy implication of this paper is that improving the economic analysis of current rabies treatment guidelines (Advisory Committee on Immunization Practices) requires more reliable epidemiological data on risk of rabies transmission.