ArticleBMJ global health2026
Cost-utility analysis of pre-exposure prophylaxis rabies vaccine in 5-year-old children in Thailand.
Article in BMJ global health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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6 authors.
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Abstract
introductionRabies remains a life-threatening disease affecting children in endemic regions including Thailand. The cost-effectiveness of pre-exposure prophylaxis (PrEP) rabies vaccination in the Thai context is unclear. This study analysed the cost-utility of adding PrEP rabies vaccination to post-exposure prophylaxis (PEP) rabies vaccination compared with PEP alone in 5-year-old children.
methodsA decision tree model compared eight strategies (four PEP alone and four PrEP+PEP), classified by route of administration (intradermal (ID) or intramuscular (IM)) and vaccine product (purified chick embryo cell vaccine (PCEC) or chromatographically purified Vero cell vaccine (CPRV)/purified Vero cell rabies vaccine (PVRV)). Costs and outcomes were derived from published literature and discounted at 3% annually. The analysis was conducted from a societal perspective over a 20-year horizon. Incremental cost-effectiveness ratios (ICERs) were evaluated against Thailand's willingness-to-pay threshold of THB 160 000 per quality-adjusted life year (QALY).
resultsPrEP+PEP ID using PCEC was cost-effective, with an ICER of THB 40 977 (US$1160.8) per QALY versus PEP alone ID using PCEC; the remaining strategies were dominated. The one-way sensitivity analysis identified annual bite incidence as the most influential parameter, with the ICER ranging from cost-saving to not cost-effective (THB 454 265 (US$12 868.7) per QALY). The results were robust to variation in all other parameters.
conclusionPrEP+PEP ID using PCEC is cost-effective for children in Thailand, reducing reliance on equine rabies immunoglobulin and disease-related QALY losses. These findings support integrating PrEP into Thailand's National Immunization Program for children in high-risk areas, prioritising early vaccination in high-risk populations to advance the goal of eliminating rabies by 2030.
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