Health economic assessment of a rabies pre-exposure prophylaxis program compared with post-exposure prophylaxis alone in high-risk age groups in the Philippines
Health economic assessment of a rabies pre-exposure prophylaxis program compared with post-exposure prophylaxis alone in high-risk age groups in the Philippines
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DOI：
10.1016/j.ijid.2020.05.062
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发表时间：
2020-08-01
影响因子：
8.4
通讯作者：
Preiss, Scott
中科院分区：
文献类型：
--
作者：
Quiambao, Beatriz;Varghese, Lijoy;Preiss, Scott
目的：一旦出现症状，狂犬病几乎总是致命的，在菲律宾每年造成200-300人死亡。现有的狂犬病疫苗可以在暴露前预防(PrEP)或暴露后预防(PEP)中接种。在暴露后，PrEP免疫的个体需要更少的PEP和不需要狂犬病免疫球蛋白。方法：建立静态决策树模型来评估PrEP+PEP方案和单独PEP方案的成本效果。该模型使用了2015年7月至2016年6月期间在热带医学研究所寻求医疗咨询的菲律宾特定数据，以及已发表文献中的数据。结果：在20年的时间里，在菲律宾100万5岁儿童的队列中，与仅使用PEP相比，PrEP+PEP预计可防止297例死亡。从支付者和社会的角度来看，由此产生的增量成本-效果比分别为36 035(759美元；2016年折算为美元)和18 663(393美元)菲律宾比索(PHP)--质量调整后的寿命增加--均低于PHP140 255(2 953美元)的支付意愿阈值。结论：这些数据表明，在菲律宾，针对5岁儿童的全民PrEP计划将是具有成本效益的。(C)由爱思唯尔有限公司代表国际传染病学会出版的2020年葛兰素史克生物制品公司。这是一篇CC BY-NC-ND许可下的开放获取文章(http：//creativeommons.org/les/by-NC-nd/4.0/)。
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 costeffective in the Philippines. (C) 2020 GlaxoSmithKline Biologicals S.A. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/).