Cost comparison of rabies pre-exposure vaccination with post-exposure treatment in Thai children

Thailand is a canine rabies endemic country with an annual prevalence above 1000 reported animals diagnosed rabid [1]. Over 345,000 humans are treated for possible rabies exposures annually [2]. Lack of perception of the disease burden, social, cultural and traditional beliefs play an important role in the failure of canine rabies control. It is unfortunate that health care budgets are increasingly allocated to human post-exposure treatment rather than to the eradication of rabies in the canine animal vector. Children under the age of 15 years represent up to one-half of dog bite victims and of human rabies deaths, but accurate data of dog bite prevalence are not available [3], [4], [5] and [6]. Large scale pre-exposure immunization of children has been advocated but financial and logistic barriers have hindered implementation. This study analyzes direct medical costs of pre-exposure vaccination (PREP) as a human rabies preventive strategy, against the cost of post-exposure prophylaxis (PEP) in Thai children. Three pre- and post-exposure vaccine regimens are in use and this impacts on cost calculations. It was found that costs of both strategies, PREP of children or PEP of exposed, become equal when the dog bite incidence is 2–30%; depending on which post-exposure treatment regimens (PEP) are used.