Department of Family Medicine, Faculty of Medicine, Ramathibodi Hospital, 270 Rama VI Road, Phaya Thai, Ratchathewi, Bangkok 10400, Thailand; Health Intervention and Technology Assessment Program (HITAP), 6(th) Floor, 6(th) Building, Department of Health, Ministry of Public Health, Tiwanon Road, Muang, Nonthaburi 11000, Thailand; Health Technology Assessment Postgraduate Program, Mahidol University, 447 Sri-Ayuthaya Road, Phaya Thai, Ratchathewi, Bangkok 10400, Thailand.
Health Technology Assessment Postgraduate Program, Mahidol University, 447 Sri-Ayuthaya Road, Phaya Thai, Ratchathewi, Bangkok 10400, Thailand.
Vaccine. 2019 Oct 3;37 Suppl 1:A146-A153. doi: 10.1016/j.vaccine.2018.11.071. Epub 2018 Dec 13.
Rabies is one of the most feared infectious diseases worldwide, predominantly occurring in Asia and Africa where rabies is endemic in domestic dog populations. Whereas previous studies have demonstrated mass dog vaccination and post-exposure prophylaxis (PEP) as the most effective control strategies, successful rabies elimination has yet to be realized as these recognized effective interventions continue to face challenges of limited accessibility. In the light of new evidence towards improving programmatic feasibility and clinical practice in rabies control especially among endemic countries, a systematic review was undertaken to identify cost-effectiveness modelling studies of rabies preventive measures and to provide a critical review of published evidence through comparative evaluation and model quality assessment, and a synthesis of key findings based thereon. Our search through MEDLINE and SCOPUS identified a total of 17 studies which mostly focused on estimating the impact of increasing PEP and pre-exposure prophylaxis (PrEP) access, human rabies elimination scenarios using mass dog vaccinations only or complemented with PEP strategy. While no significant methodological inconsistency across studies was identified and the extent of reporting is generally high, we note several points for quality and internal validity improvement. Assessment of modelling approach showed that decision tree models had similar pathways. The results of the studies suggest that interventions would be cost-effective at the cost-effectiveness threshold of 1 to 3 times per capita Gross Domestic Product (GDP) as recommended by the Commission on Macroeconomics and Health's GDP based thresholds, compared with no intervention in rabies endemic countries. When compared across studies which reported incremental cost-effectiveness ratio (ICER) as cost per QALY gained or DALY averted in international dollars adjusted by purchasing power parity conversion rate, PEP vaccination yields less cost per DALY averted or QALY gained due to one year-horizon assessment compared to canine vaccination at 4- or 10-year-time horizon.
狂犬病是全球最令人恐惧的传染病之一，主要发生在亚洲和非洲，这些地区狂犬病在当地犬群中流行。虽然以前的研究表明大规模犬只接种疫苗和接触后预防（PEP）是最有效的控制策略，但由于这些公认的有效干预措施仍面临着可及性有限的挑战，成功消除狂犬病尚未实现。鉴于新的证据表明，在狂犬病控制方面，特别是在流行国家，改善规划可行性和临床实践的必要性，因此进行了系统评价，以确定狂犬病预防措施的成本效益建模研究，并通过比较评估和模型质量评估，对已发表的证据进行批判性评价，并在此基础上综合关键发现。我们通过 MEDLINE 和 SCOPUS 进行的搜索共确定了 17 项研究，这些研究主要集中在评估增加 PEP 和 PrEP （暴露前预防）可及性的影响、仅使用大规模犬只接种疫苗或辅以 PEP 策略消除人类狂犬病的情景。虽然没有发现研究之间存在显著的方法学不一致性，并且报告的程度通常很高，但我们注意到一些需要改进质量和内部有效性的问题。对建模方法的评估表明，决策树模型具有相似的途径。研究结果表明，与狂犬病流行国家不干预相比，在宏观经济学和卫生委员会建议的人均国内生产总值（GDP） 1 至 3 倍的成本效益阈值内，干预措施将具有成本效益。在报告增量成本效益比（ICER）作为每获得一个质量调整生命年（QALY）或避免一个残疾调整生命年（DALY）的成本的研究中进行比较时，与犬只接种疫苗相比，PEP 疫苗接种由于一年的评估，每避免一个 DALY 或 QALY 获得的成本较低，而犬只接种疫苗的时间范围为 4 年或 10 年。
