A DECISION-ANALYTIC APPROACH TO POSTEXPOSURE RABIES PROPHYLAXIS

The risks and benefits of postex-posure rabies prophylaxis were analyz ed from clinical and economic perspectives. A decision-analytic model was constructed by using probability and outcome data from the literat ure and the state health department. Health outcomes were measured in quality-adjusted life years. In the base case (overweight adult male), treatment is optimal when the probability of animal rabidity is great er than 1 in 2000. Sensitivity analysis showed robustness in the treat ment decision; however, the incremental cost-effectiveness ratio ($140 000/quality-adjusted life year) is sensitive to the rabidity probabili ty. Treatment is optimal from the patient's perspective; however, it m ay not be cost-effective when the probability of rabidity is low.