Department of Epidemiology & Public Health, Yale University School of Medicine, 60 College Street, New Haven, CT 06510, USA.
Vaccine. 2009 Nov 27;27(51):7167-72. doi: 10.1016/j.vaccine.2009.09.027.
Although fatal if untreated, human rabies can be prevented through post-exposure prophylaxis (PEP), which involves a course of vaccination and immunoglobulin administered immediately after exposure. However, high costs and frequent lack of rabies vaccine and immunoglobulin lead to about 55,000 deaths per year worldwide. Using data from a detailed study of rabies in Tanzania, we calculate a cost-effectiveness ratio for PEP when the WHO-recommended Essen regimen, a 5-dose intramuscular vaccination schedule, is adopted. Our analyses indicate a cost-effectiveness ratio for PEP of $27/quality-adjusted life year (QALY) from a health care perspective and $32/QALY from a societal perspective in Tanzania. From both perspectives, it is "very cost-effective" to administer PEP to patients bitten by an animal suspected to be rabid. Moreover, PEP remains "very cost-effective" provided that at least 1% of doses are administered to people who were actually exposed to rabies.
虽然狂犬病如果不治疗是致命的，但可以通过暴露后预防（PEP）来预防，这包括在暴露后立即接种疫苗和免疫球蛋白。然而，高昂的成本和经常缺乏狂犬病疫苗和免疫球蛋白导致全球每年约有 55000 人死亡。利用坦桑尼亚详细狂犬病研究的数据，我们计算了在采用世界卫生组织推荐的 Essen 方案（一种 5 剂肌内接种方案）时，PEP 的成本效益比。我们的分析表明，从医疗保健的角度来看，PEP 的成本效益比为每质量调整生命年（QALY）27 美元，从社会角度来看为每 QALY32 美元。从这两个角度来看，对疑似患有狂犬病的动物咬伤的患者进行 PEP 治疗是“非常具有成本效益的”。此外，只要至少有 1%的剂量用于实际接触过狂犬病的人，PEP 仍然是“非常具有成本效益的”。
