Table 3.
Results of cost-effectiveness analysis.
| PrEP (I) | Comparator 1 | Comparator 2 | Comparator 3 | Comparator 4 | Comparator 5 | Comparator 6 | Comparator 7 | Comparator 8 | |
|---|---|---|---|---|---|---|---|---|---|
| Regimen | PrEP + PEP | PrEP + PEP | PrEP + PEP | PrEP + PEP | PEP | PEP | PEP | PEP | PEP |
| Route of administration | ID | IM | IM | ID | ID | ID | IM | IM | IM |
| Discounted Costs (in INR) | |||||||||
| ARV (PrEP) | 71,980,000 | 53,990,000 | 359,918,000 | 539,877,000 | - | - | - | - | - |
| ARV (PEP) | 2,800,670 | 1,400,335 | 14,004,049 | 14,004,049 | 4,201,215 | 5,601,729 | 28,008,255 | 28,008,255 | 35,010,318 |
| RIG | - | - | - | - | 754,303 | 754,303 | 754,303 | 754,303 | 754,303 |
| Direct medical costs | 207,766,892 | 254,274,555 | 509,376,347 | 752,765,347 | 15,260,138 | 19,128,523 | 41,535,049 | 39,120,745 | 51,005,110 |
| Direct non-medical costs | 113,421,127 | 170,471,692 | 114,191,833 | 170,475,636 | 6,573,676 | 8,763,085 | 8,763,085 | 6,573,676 | 10,952,494 |
| Indirect costs | 261,918,250 | 395,376,500 | 266,916,500 | 395,376,500 | 14,994,750 | 19,993,001 | 19,993,001 | 14,994,750 | 24,991,251 |
| Treatment costs for fatal rabies | 2,720,882 | 3,936,807 | 2,850,448 | 2,850,448 | 25,155,698 | 25,604,195 | 25,982,926 | 27,139,052 | 27,139,052 |
| Health Outcomes | |||||||||
| Deaths (per million population) | 273 | 395 | 286 | 286 | 2524 | 2569 | 2607 | 2723 | 2723 |
| DALYs (discounted) | 9479.09 | 13,715.17 | 9930.48 | 9930.48 | 87,638.22 | 89,200.71 | 90,520.14 | 94,547.89 | 94,547.89 |
| Base Case Analysis | |||||||||
| Quasi-Societal Perspective | |||||||||
| Incremental costs (INR) | −230,303,107 | −288,236,917 | −716,366,906 | 568,045,594 | 567,897,297 | 567,591,257 | 567,730,161 | 567,367,844 | |
| Incremental costs (USD) | −12,167,324 | −15,228,070 | −37,846,941 | 30,010,862 | 30,003,027 | 29,986,858 | 29,994,197 | 29,975,055 | |
| ICER (INR/death averted) | 1,887,730 | 22,172,071 | 55,105,147 | −252,353 | −247,342 | −243,184 | −231,727 | −231,579 | |
| ICER (USD/death averted) | 99,732 | 1,171,390 | 2,911,303 | −13,332 | −13,068 | −12,848 | −12,243 | −12,235 | |
| ICER (INR/DALYs averted) | 54,367.05 | 638,560.49 | 1,587,040.29 | −7267.81 | −7123.50 | −7003.75 | −6673.78 | −6669.52 | |
| ICER (USD/DALYs averted) | 2872.31 | 33,736.29 | 83,846.17 | −383.97 | −376.35 | −370.02 | −352.59 | −352.36 | |
| Dominant | Dominant | Dominant | Non-dominant | Non-dominant | Non-dominant | Non-dominant | Non-dominant | ||
| Cost-effectiveness | Cost effective | Not cost effective | Not cost effective | Very cost effective | Very cost effective | Very cost effective | Very cost effective | Very cost effective | |
| Quasi-Health Systems’ Perspective | |||||||||
| Incremental costs (INR) | −45,467,834 | −287,131,113 | −531,531,639 | 198,792,933 | 198,743,514 | 198,437,261 | 198,476,552 | 198,312,578 | |
| Incremental costs (USD) | −2,402,147 | −15,169,649 | −28,081,765 | 10,502,585 | 10,499,974 | 10,483,794 | 10,485,870 | 10,477,207 | |
| ICER (INR/death averted) | 372,687.16 | 22,087,008.68 | 40,887,049.15 | −88,313.16 | −86,560.76 | −85,020.25 | −81,010.84 | −80,943.91 | |
| ICER (USD/death averted) | 19,689.73 | 1,166,896.06 | 2,160,135.73 | −4665.74 | −4573.16 | −4491.77 | −4279.95 | −4276.41 | |
| ICER (INR/DALYs averted) | 10,733.47 | 636,110.69 | 1,177,555.97 | −2543.44 | −2492.97 | −2448.60 | −2333.13 | −2331.20 | |
| ICER (USD/DALYs averted) | 567.07 | 33,606.86 | 62,212.38 | −134.37 | −131.71 | −129.36 | −123.26 | −123.16 | |
| Dominant | Dominant | Dominant | Non-dominant | Non-dominant | Non-dominant | Non-dominant | Non-dominant | ||
| Cost-effectiveness | Very cost effective | Not cost effective | Not cost effective | Very cost effective | Very cost effective | Very cost effective | Very cost effective | Very cost effective | |
ARV = anti-rabies vaccine; DALY = disability-adjusted life years; ICER = incremental cost-effectiveness ratio; INR = Indian national rupee; PrEP = pre-exposure prophylaxis; PEP = post-exposure prophylaxis; QALY = quality-adjusted life years; USD = US dollars.