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 PrEP+PEP program vs. PEP-alone. Philippines-specific data of people seeking medical advice at the Research Institute for Tropical Medicine between July 2015 and June 2016 were used into the model, together with 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-year gained, respectively, both below the willingness-to-pay threshold of PHP 140,255 (US$ 2,953). CONCLUSION These data suggest a universal PrEP program targeting 5-year-olds would be cost-effective in the Philippines.

中文翻译：

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狂犬病暴露前预防计划与菲律宾高危年龄组单独暴露后预防的健康经济评估

目标一旦出现症状，狂犬病几乎总是致命的，在菲律宾每年造成 200-300 人死亡。可用的狂犬病疫苗可用于暴露前预防 (PrEP) 或暴露后预防 (PEP)。暴露后，接受 PrEP 免疫的个体需要更少剂量的 PEP，并且不需要狂犬病免疫球蛋白。方法 开发了一个静态决策树模型来评估 PrEP+PEP 计划与单独 PEP 计划的成本效益。2015 年 7 月至 2016 年 6 月期间在热带医学研究所寻求医疗建议的人的菲律宾特定数据以及已发表的文献被用于该模型。结果 在 20 年的时间里，在菲律宾的 100 万 5 岁儿童队列中，与单独使用 PEP 相比，PrEP+PEP 预计可预防 297 人死亡。从支付者和社会的角度来看，由此产生的增量成本效益比分别为 36,035（759 美元；2016 年美元换算）和 18,663（393 美元）菲律宾比索 (PHP)/质量调整生命年，两者均获得低于 140,255 菲律宾比索（2,953 美元）的支付意愿门槛。结论 这些数据表明，针对 5 岁儿童的通用 PrEP 计划在菲律宾具有成本效益。