What does this research mean for the field?

In high-PEP-access settings, routine childhood pre-exposure prophylaxis (PrEP) for rabies is not cost-effective and provides negligible mortality benefit compared to strengthening dog vaccination and post-exposure prophylaxis (PEP) delivery. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To assess the public health and economic impacts of introducing childhood pre-exposure prophylaxis relative to current post-exposure prophylaxis and canine vaccination strategies in Kerala, India.

September 7, 2026The Lancet Regional Health - Southeast AsiaOpen Access

Pre-exposure prophylaxis as a complementary vaccination strategy to reduce rabies in Kerala, India: a cost-effectiveness modelling study

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Authors

MLMartha M. Luka ZNZinia T. Nujum MAMiqdad Asaria

Discussion

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Overview

Decision-tree modelling reveals childhood pre-exposure rabies prophylaxis offers negligible cost-effectiveness over canine immunization, highlighting dog vaccination and abridged regimens as optimal.

Key Points

To assess the public health and economic impacts of introducing childhood pre-exposure prophylaxis relative to current post-exposure prophylaxis and canine vaccination strategies in Kerala, India.
Adapted a probabilistic decision-tree model over a 10-year time horizon (2026–2035) in Kerala, India.
Simulated interactions between canine vaccination, routine childhood pre-exposure prophylaxis (PrEP), and post-exposure prophylaxis (PEP) across multiple willingness-to-pay thresholds to evaluate health provider costs and QALYs gained.
Status quo practice (four-dose intradermal PEP and suboptimal canine vaccination) projected 431 deaths (95% PI 353–523) and costs of US$50.3 million, with canine vaccination accounting for nearly 70% of averted deaths.
Routine childhood PrEP increased costs by US$10.5–36.5 million while cumulatively averting only 10 additional deaths, yielding a probability of optimality ≤12% across India's willingness-to-pay thresholds.
Adopting WHO abridged PEP saved US$6.3 million, while 70% dog vaccination coverage combined with abridged PEP reduced deaths by 83% compared to current practice.

Cite This Study

Luka et al. (2026) studied this question.

synapsesocial.com/papers/6a9e85b3c3034f961570df6c https://doi.org/10.1016/j.lansea.2026.100854

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September 7, 2026The Lancet Regional Health - Southeast AsiaOpen Access

Pre-exposure prophylaxis as a complementary vaccination strategy to reduce rabies in Kerala, India: a cost-effectiveness modelling study

View Full Paper

Ask AI

Bookmark

Authors

MLMartha M. Luka ZNZinia T. Nujum MAMiqdad Asaria

Discussion

Member takes

Overview

Decision-tree modelling reveals childhood pre-exposure rabies prophylaxis offers negligible cost-effectiveness over canine immunization, highlighting dog vaccination and abridged regimens as optimal.

Key Points

To assess the public health and economic impacts of introducing childhood pre-exposure prophylaxis relative to current post-exposure prophylaxis and canine vaccination strategies in Kerala, India.
Adapted a probabilistic decision-tree model over a 10-year time horizon (2026–2035) in Kerala, India.
Simulated interactions between canine vaccination, routine childhood pre-exposure prophylaxis (PrEP), and post-exposure prophylaxis (PEP) across multiple willingness-to-pay thresholds to evaluate health provider costs and QALYs gained.
Status quo practice (four-dose intradermal PEP and suboptimal canine vaccination) projected 431 deaths (95% PI 353–523) and costs of US$50.3 million, with canine vaccination accounting for nearly 70% of averted deaths.
Routine childhood PrEP increased costs by US$10.5–36.5 million while cumulatively averting only 10 additional deaths, yielding a probability of optimality ≤12% across India's willingness-to-pay thresholds.
Adopting WHO abridged PEP saved US$6.3 million, while 70% dog vaccination coverage combined with abridged PEP reduced deaths by 83% compared to current practice.

Cite This Study

Luka et al. (2026) studied this question.

synapsesocial.com/papers/6a9e85b3c3034f961570df6c https://doi.org/10.1016/j.lansea.2026.100854

View Full Paper

Ask AI

Bookmark