Beatriz Quiambao1, Lijoy Varghese2, Nadia Demarteau3, Ruth Faye Sengson4, Jenaline Javier5, Piyali Mukherjee6, Leah Cheryl Manio7, Scott Preiss8. 1. Research Institute for Tropical Medicine, Filinvest Corporate City, 9002 Research Dr, Alabang, Muntinlupa, 1781 Metro Manila, Philippines. Electronic address: ado.ritmdoh@gmail.com. 2. GSK, 23 Rochester Park, 139234 Singapore, Singapore. Electronic address: lijoy.varghese@outlook.com. 3. GSK, 20 Fleming Avenue, 1300 Wavre, Belgium. Electronic address: nadiademarteau@gmail.com. 4. GSK, 23 Rochester Park, 139234 Singapore, Singapore. Electronic address: ruth.r.sengson@gsk.com. 5. Research Institute for Tropical Medicine, Filinvest Corporate City, 9002 Research Dr, Alabang, Muntinlupa, 1781 Metro Manila, Philippines. Electronic address: jenaline.javier@gmail.com. 6. GSK, 20 Fleming Avenue, 1300 Wavre, Belgium. Electronic address: piyali.x.mukherjee@gsk.com. 7. GSK, 2266 Chino Roces Ave, Makati, 1231 Metro Manila, Philippines. Electronic address: leahmanio@gmail.com. 8. GSK, 20 Fleming Avenue, 1300 Wavre, Belgium. Electronic address: scott.s.preiss@gsk.com.
Abstract
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.
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.