Abstract
Introduction
Rabies is a fatal but preventable infectious disease with a large disease burden in endemic countries. The risk of contracting rabies for travellers from a Western country is low. However, an increasing number of Dutch travellers, potentially exposed to rabies abroad, consult a clinician for post-exposure prophylaxis. In this study, several interventions were examined on how they might influence costs involved in rabies treatment and prevention, including the most recent vaccination guidelines and the use of intradermal vaccination.
Methods
A decision tree based economic model was constructed. Costs of new versus old guidelines, intramuscular versus intradermal vaccination, and post-exposure treatment subsequent to increased vaccination coverage in several risk groups were calculated and compared to each other. Statistical uncertainty with respect to numbers of travellers and vaccination coverage was assessed.
Results
Costs were highest using the old guidelines, estimated at €15.1 million (€405 per vaccinated person). Intradermal vaccinations in combination with the new guidelines led to the lowest costs, estimated at €10.1 million (€270 per vaccinated person). A higher vaccination uptake resulted in higher overall costs. The ratio between the additional vaccinated persons and additional costs in all risk groups was similar, around €104 per person.
Conclusions
The new rabies vaccination guidelines reduced total costs. Strategies with increased vaccination uptake led to fewer rabies immunoglobulin administrations and fewer vaccinations after exposure but at higher total costs. Although intradermal administration of rabies vaccination on a large scale can reduce total costs of pre-exposure prophylaxis and can positively influence vaccination uptake, it remains a costly intervention.
Key messages
The new vaccination guidelines reduce total costs of rabies prevention. Intradermal administration of rabies vaccination on a large scale can further reduce total costs of pre-exposure prophylaxis. Strategies with increased vaccination uptake lead to fewer rabies immunoglobulin administrations and fewer vaccinations after exposure but at higher total costs.
Immunogenicity and Safety of Post-Exposure Rabies Vaccination in Children with Primary Immunodeficiency Disorders
