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Swedberg et al. One Health Implement Res 2023;3:77-96 https://dx.doi.org/10.20517/ohir.2023.02 Page 85

Table 2. Cost variables relating to PEP provisioning
PEP cost
Definition Source
variables
Average number of vaccine vials per patient (0.5 mL ~2 Oriental Mindoro PHO bite patient, budget, and financial
Speeda) records [13]
Average cost of 1 vaccine vial (0.5 mL Speeda) $25 USD
Average number of ID injections per patient ~6
Cost of 1 ID injection of vaccine $6.25 USD
Average number of ERIG vials per patient ~2
Cost of vial of ERIG (5 mL EQUIRAB) $45 USD
ERIG dosage per 5 mL vial 1 vial/25 kg
ERIG: Equine rabies immunoglobulin; ID: intradermal; PEP: post-exposure prophylaxis; PHO: Provincial Health Office.

Figure 2. Schematic of decision tree used to estimate the burden of rabies, deaths averted by PEP, and associated costs. This framework
illustrates the steps taken to probabilistically estimate outcomes associated with rabies infections in dogs and resulting human
exposures and deaths. IBCM and hospital record (PHO) data inputs are shown in yellow boxes. Rabies exposures that can lead to rabies
deaths in the absence of PEP are shown in red boxes; rabies exposures where risk is mitigated via PEP are shown in blue boxes; and
healthy dog bites are shown in gray boxes. IBCM: Integrated Bite Case Management; PEP: post-exposure prophylaxis; PHO: Provincial
Health Office.

Annual PEP costs were calculated from the patients who received post-exposure vaccine multiplied by the
cost of the vaccine course, and patients who received ERIG multiplied by the average cost of ERIG, with
cost variables described in Table 2. The average cost per death averted was estimated as total PEP costs
divided by estimated deaths averted. Similarly, the average cost per DALY averted was estimated by dividing
total PEP costs by DALYs averted.

DALYs were calculated from Years of Life Lost (YLL). For rabies, Years of Life lived with Disability are
considered insignificant due to the acute and fatal nature of rabies, and therefore were not included in
[29]
DALY estimates. To estimate YLL, we used expected global life expectancy and subtracted the mean age