Rabies vaccination strategies in the Netherlands in 2018: a cost evaluation

Abstract

Background: The risk of contracting rabies is low for travellers. However, the number of Dutch travellers potentially exposed abroad following an animal-associated injury and needing post-exposure prophylaxis (PEP) has increased, resulting in increased costs. Aim: Here, we evaluated the costs and the cost-effectiveness of different pre-and post-exposure interventions in the Netherlands, taking into account the 2018 World Health Organization (WHO) recommendations for the prevention of rabies. Methods: A decision tree-based economic model was constructed. We calculated and compared the cost of different WHO pre-exposure prophylaxis (PrEP) recommendations, intramuscular vs intradermal vaccination and PEP subsequent to increased vaccination coverage in risk groups. We estimated cost-effectiveness, expressed as incremental costs per rabies immunoglobulin (RIG) administration averted, using a societal perspective. Statistical uncertainty regarding number of travellers and vaccination coverage was assessed. Results: Total costs at the national level were highest using previous WHO recommendations from 2012, estimated at EUR 15.4 million annually. Intradermal vaccinations in combination with the current recommendations led to the lowest costs, estimated at EUR 10.3 million. Higher vaccination uptake resulted in higher overall costs. The incremental costs per RIG administration averted varied from EUR 21,300-46,800. Conclusions: The change in rabies PrEP and PEP recommendations in 2018 reduced total costs. Strategies with increased pre-travel vaccination uptake led to fewer RIG administrations and fewer vaccinations after exposure but also to higher total costs. Although larger scale intradermal administration of rabies vaccine can reduce total costs of PrEP and can positively influence vaccination uptake, it remains a costly intervention.

The occurrence and extent of anxiety and distress among Dutch travellers after encountering an animal associated injury

“…Health is more than absence of disease, it encompasses a wide range of contexts that cannot be expressed in money [ 36 ], emphasising the importance of health-related QOL (HR-QOL). Suijkerbuijk et al [ 18 ] published a cost–benefit analysis for different rabies vaccination strategies in the Netherlands, but were unable to incorporate the cost implications in terms of HR-QOL. Such cost implications would be a valuable addition to the determination of health in contemporary society.…”

“…Intuitively, a higher PrEP uptake seems a reasonable strategy to reduce risk of infection and consequent anxiety and distress. A recent cost evaluation of different rabies vaccination strategies in the Netherlands by Suijkerbuijk et al [ 18 ] concluded, in contrast, that a higher PrEP uptake would result in higher overall costs. However, only material costs were analysed, while loss of quality of life was not taken into account.…”

Tracking lethal threat: In-depth review of rabies

“…The amount of rabies immunoglobulin used, the type of rabies vaccination administered, and the location of delivery, such as intramuscular or intradermal administration, all affect subsequent treatment expenses ( Haradanhalli et al , 2022 ). The rabies victims are responsible for paying for other expenses including travel, lodging, and hospitalization, but in the veterinary field, the community often pays for dog vaccinations ( Suijkerbuijk et al , 2020 ). The veterinary and medical sectors are equally responsible for the costs of rabies control and prevention ( Subedi et al , 2022 ).…”

Small Volume of Rabies Immunoglobulin (RIG) is Effective for Local Wound Infiltration in Rabies Post-Exposure Prophylaxis whereas Intramuscular RIG is just a Wastage

“…Many other studies show the failure to give protective antibody levels in human serum by RIG injected IM. 13,14 RIG is in limited supply all over the world and only wound infiltration would not only save costs, 15,16 but also spare up to 60% of RIG volume for India 17 and other countries where RIG is not available. 18 Animal model studies have clearly shown that any amount of RIG given IM is of no use as no effective titers of antibodies (i.e.…”