Figure 4. Effects of compliance on PEP effectiveness in preventing rabies and cost-effectiveness per death averted.

A) Additive protective efficacy of PEP (defined in Table 3) given 50% compliance is plotted against cost-effectiveness per rabies death averted, calculated from direct medical costs (Table 2). The different regimens are indicated as follows: reduced 4-dose Essen IM regimen in thick black, Zabreb IM in thin black, updated TRC ID in blue, 4-site ID in red and 1 week ID in gray. The dashed lines correspond to complete compliance. Here we assume use of 0.5 mL vials and clinic throughput of 100 new bite patients per month. Assuming use of 1 mL vials results are qualitatively similar but more cost-effective. B) Additive protective efficacy of PEP regimens (Table 3) is plotted against the percentage of rabies deaths averted at high (100%, dotted lines), moderate (75%, dashed lines) and poor (50%, solid lines) levels of compliance. Thick lines correspond to regimens requiring 4 clinic visits (reduced Essen 4-dose IM, updated TRC ID) and thin lines correspond to regimens requiring 3 clinic visits (Zagreb IM, 4-site ID, 1-week ID). C) The costs of PEP regimens for bite victims according to different pricing strategies (Table 5) are plotted against the risk of developing rabies assuming 75% additive protective efficacy for each PEP visit and assuming that patient compliance is affected by PEP costs (as described in Table 3).