COST-UTILITY ANALYSIS OF PRE-EXPOSURE PROPHYLAXIS RABIES VACCINATION IN CHILDREN IN THAILAND...
Author(s)
Sutinee Soopairin, PharmD, MSc1, Parnnaphat Luksameesate, PhD2, Nattiya Arthonchaikul, MD3, Suda Punrin, MD, MSc3, Terapong Tantawichien, MD3, Suthira Taychakhoonavudh, BSc, MS, PhD2.
1Student, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand, 2Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand, 3Queen Saovabha Memorial Institute, Thai Red Cross Society, Bangkok, Thailand.
1Student, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand, 2Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand, 3Queen Saovabha Memorial Institute, Thai Red Cross Society, Bangkok, Thailand.
OBJECTIVES: To analyze the cost-utility of the pre-exposure prophyalxis (PrEP) rabies vaccine and post-exposure prophyalxis (PEP) rabies vaccine compared with the PEP rabies vaccine alone in preventing rabies among 5-year-old children.
METHODS: A decision-tree model was used to compare the costs and outcomes of PrEP+PEP rabies vaccines and PrEP rabies vaccine alone. Eight strategies were compared, classified by route of administration (intradermal [ID] or intramuscular [IM]) and vaccine product (purified chick embryo cell vaccine [PCEC], 1 mL/vial or chromatographically purified Vero cell vaccine [CPRV] and purified Vero cell rabies vaccine [PVRV], 0.5 mL/vial), resulting in four PEP alone strategies and four PrEP+PEP strategies. Costs and outcomes were sourced from published literature and were discounted at 3% annually. The analysis was conducted from the societal perspective over a 20-year horizon. Incremental cost-effectiveness ratios (ICERs) were calculated and evaluated against Thailand’s willingness-to-pay threshold of THB 160,000 per QALY.
RESULTS: The results showed that PrEP+PEP ID using PCEC was cost-effective, yielding the ICER of THB 40,977 (USD 1,154) per QALY compared with PEP alone ID using PCEC which was the cheapest strategy. The remaining strategies were dominated. The one-way sensitivity analysis identified annual bite incidence as the most influential parameter, with the ICER ranging from cost-saving to not cost-effective (THB 454,265 [USD 12,796] per QALY). The results were robust to variation in all other parameters.
CONCLUSIONS: PrEP+PEP ID using PCEC is a cost-effective rabies prevention strategy for Thai children, reducing both reliance on equine rabies immunoglobulin, vaccine volume used, and disease-related QALY losses. These findings support integrating PrEP into Thailand's National Immunization Program for children in high rabies-risk areas, advancing the 2030 rabies elimination goal of the World Health Organization.
METHODS: A decision-tree model was used to compare the costs and outcomes of PrEP+PEP rabies vaccines and PrEP rabies vaccine alone. Eight strategies were compared, classified by route of administration (intradermal [ID] or intramuscular [IM]) and vaccine product (purified chick embryo cell vaccine [PCEC], 1 mL/vial or chromatographically purified Vero cell vaccine [CPRV] and purified Vero cell rabies vaccine [PVRV], 0.5 mL/vial), resulting in four PEP alone strategies and four PrEP+PEP strategies. Costs and outcomes were sourced from published literature and were discounted at 3% annually. The analysis was conducted from the societal perspective over a 20-year horizon. Incremental cost-effectiveness ratios (ICERs) were calculated and evaluated against Thailand’s willingness-to-pay threshold of THB 160,000 per QALY.
RESULTS: The results showed that PrEP+PEP ID using PCEC was cost-effective, yielding the ICER of THB 40,977 (USD 1,154) per QALY compared with PEP alone ID using PCEC which was the cheapest strategy. The remaining strategies were dominated. The one-way sensitivity analysis identified annual bite incidence as the most influential parameter, with the ICER ranging from cost-saving to not cost-effective (THB 454,265 [USD 12,796] per QALY). The results were robust to variation in all other parameters.
CONCLUSIONS: PrEP+PEP ID using PCEC is a cost-effective rabies prevention strategy for Thai children, reducing both reliance on equine rabies immunoglobulin, vaccine volume used, and disease-related QALY losses. These findings support integrating PrEP into Thailand's National Immunization Program for children in high rabies-risk areas, advancing the 2030 rabies elimination goal of the World Health Organization.
Conference/Value in Health Info
2026-09, ISPOR Asia Pacific 2026, Bangkok, Thailand
Value in Health, Volume 55, Issue S1
Code
EE35
Topic
Economic Evaluation
Disease
STA: Vaccines