Table 2.
Data Inputs for Model.
| Data Inputs | Values | Source | |
|---|---|---|---|
| Epidemiology | |||
| Population cohort | 1,000,000 | Estimates | |
| Population age group | 5–15 years | Objective of the study | |
| Annual bite incidence | 4.40% | N Agarwal 2015 [13] | |
| Probability of bite from a rabid animal | 0.295 | Assumptions from WHO APCRI Survey 2017(Household Survey) [5] | |
| Prevalence of category of exposure | Cat I= 0.53% Cat II= 26.71% Cat III= 72.76% |
Nandimath 2019 [14] | |
| Probability of developing rabies in Cat I exposure from rabid animal | 0.00 | Expert opinion | |
| Probability of developing rabies in Cat II/III exposure in absence of administration or full administration of PEP vaccination | 0.19 | Shim 2009 [15] | |
| Probability of developing rabies in Cat III exposure in absence of administration of RIG in previously unimmunized individuals | 0.30 | Expert opinion | |
| RIG administration in Cat III exposures | 13.6% | WHO APCRI Survey 2017 (Community Survey) [5] |
|
| Practice of seeking PEP after exposure to animal bite | 88.9 % | WHO APCRI Survey 2017 (Community Survey) [5] |
|
| Compliance for full course of ID PEP | Intervention Comparator 1 Comparator 4 Comparator 5 |
= 100% = 94.4% = 90.7% = 85.1% |
Assumptions for regimens from WHO APCRI Survey 2017 [5] |
| Compliance for full course of IM PEP | Comparator 2 Comparator 3 Comparator 6 Comparator 7 Comparator 8 |
= 99.4% = 99.4% = 80.3% = 65.9% = 65.9% |
Assumptions for regimens from WHO APCRI Survey 2017 [5] |
| Duration of protection | 20 years | Suwansrinon 2006 [16] | |
| Average time a person lives after the onset of rabies | 5 days | Expert opinion | |
| Disability weight (rabies) | 0.655 | Ock 2019 [28] | |
| Costs & Resource Utilization | |||
| Amount of eRIG required for children 5–15 years for local + systemic wound infilteration | 4.33 mL | Calculated from Population Projections for India and States 2011–2036 [17] and Khadilkar V 2019 [19] | |
| Amount of eRIG required for children 5–15 years for local wound infilteration only | 2.64 mL | Calculated from Bharti 2016 [29] | |
| Cost per dose of vaccine (1 mL) | INR 250 | Rate Contract 2020, MP Aushadhi [20] | |
| Cost per eRIG vial (5 mL) | INR 313 | WHO APCRI Survey 2017 [5] | |
| Cost per hRIG vial (2 mL, 300 IU) | INR 3700 | WHO APCRI Survey 2017 [5] | |
| Cost per vial of monoclonal antibodies (2.5 mL) | INR 1970 | WHO APCRI Survey 2017 [5] | |
| Hospital charges | INR 3 | WHO APCRI Survey 2017 [5] | |
| Other medicines and consumables for PEP (1st visit only) | INR 169.8 | Calculated from WHO APCRI Survey 2017 [5] | |
| Cost of syringe (per unit) | INR 2.5 | Procurement costs (email communication) | |
| Cost of gloves (per pair) | INR 14 | Procurement costs (email communication) | |
| Cost associated with human resources per patient’s visit | INR 87.39 | Calculated from data from ARV clinic, ShimLa (email communication) National Health System Cost Database of India [21] | |
| Travel cost for the patient/client and one attendant (per visit) | INR 50 | WHO APCRI Survey 2017 [5] | |
| Meal cost for the patient/client and one attendant (per visit) | INR 40 | WHO APCRI Survey 2017 [5] | |
| Loss of wages for one attendant (per visit) | INR 232 | Average state-wise per day wage rate for unskilled manual workers under MGNREGA [24] |
|
| Treatment cost of fatal symptomatic rabies (per day) | INR 3600 | Cost for intensive care services without ventilator as per PMJAY health benefit package 2.0 [22] |
|
| Program management cost (per capita) | INR 0.2 | Calculated from Abbas 2014 [23] | |
| Wastage Factor | |||
| Vaccination | 30% | Abbas 2014 [23] | |
| RIG | 15% | Abbas 2014 [23] | |
| Discount Rates | |||
| Costs | 3% | WHO 2008 [26] | |
| Utilities | 3% | WHO 2008 [26] | |
ID = intradermal; IM = intramuscular; INR = Indian national rupee; PEP = post-exposure prophylaxis; ARV = anti-rabies vaccination; RIG = rabies immunoglobulins.