JRHS 2014; 14(2): 122-127 JRHS Journal of Research in Health Sciences journal homepage: www.umsha.ac.ir/jrhs Original Article Cost-Effectiveness of Rabies Post Exposure Prophylaxis in Iran Nahid Hatam (PhD) a , Firooz Esmaelzade (MSc) b , Ali Reza Mirahmadizadeh (PhD) c* , Khosro Keshavarz (MSc) d , Abdolhalim Rajabi (MSc) e , Parvin Afsar Kazerooni (MD, MPH) f , Marzieh Ataollahi (MSc) f a Department of Health Service Administration , School of Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran b Student Research Committee, School of Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran c Deputy of Health, Shiraz University of Medical Sciences, Shiraz, Iran d Department of Health Economic School of Management and Information Sciences Shiraz University of Medical Sciences, Shiraz, Iran e Student Research Committee, Department of Epidemiology , School of Health and Nutrition, Shiraz University of Medical Sciences, Shiraz, Iran f Center of Diseases Control, Shiraz University of Medical Sciences, Shiraz, Iran ARTICLE INFORMATION ABSTRACT Article history: Received: 12 June 2013 Revised: 08 August 2013 Accepted: 28 September 2013 Available online: 08 October 2013 Background: The rabies is one of the most important officially-known viral zoonotic diseases for its global distribution, outbreak, high human and veterinary costs, and high death rate and caus- es high economic costs in different countries of the world every year. The rabies is the deadliest disease and if the symptoms break out in a person, one will certainly die. However, the deaths resulting from rabies can be prevented by post-exposure prophylaxis. To do so, in Iran and most of the countries in the world, all the people who are exposed to animal bite receive Post- Exposure Prophylaxis (PEP) treatment. The present survey aimed to investigate the cost- effectiveness of PEP in southern Iran. Methods: The present study estimated the PEP costs from the government`s Perspective with step-down method for the people exposed to animal bite, estimated the number of DALYs pre- vented by PEP in the individuals using decision Tree model, and computed the Incremental cost- effectiveness Ratio. The information collected of all reported animal bite cases (n=7111) in Fars Province, who referred rabies registries in urban and rural health centers to receive active care. Performing the PEP program cost estimated 1,052,756.1 USD for one year and the estimated cost for the treatment of each animal bite case and each prevented death was 148.04 and 5945.42 USD, respectively. Likewise 4,509.82 DALYs were prevented in southern Iran in 2011 by PEP program. Results: The incremental cost-effectiveness ratio for each DALY was estimated to be 233.43 USD. In addition to its full effectiveness in prophylaxis from rabies, PEP program saves the fi- nancial resources of the society, as well. Conclusions: This study showed performing PEP to be more cost-effective. Keywords: Cost-effectiveness analysis Rabies post-exposure prophylaxis DALY * Correspondence Ali Reza Mirahmadizadeh (MD, MPH, PhD) Tel: +98 912 5169146 Fax: +98 711 2347315 E-mail: mirahmadia@sums.ac.ir Citation: Hatam N, ESmaelzade F, Mirahmadizadeh AR, Keshavarz K, Rajabi A, Kazerooni P, Ataollahi M. Cost-Effectiveness of Rabies Post Exposure Prophylaxis in Iran. J Res Health Sci. 2014; 14(2): 122-127. Introduction he rabies is one of the most important officially- known viral zoonotic diseases for its global distribu- tion, outbreak, high human and veterinary costs, and high death rate and causes high economic costs in different countries of the world every year 1 . The disease occurs in more than 100 countries and more than 3.3 billion people have been exposed to rabies. Each year, more than 55,000 deaths from rabies occur in Asia and Africa 2 . The highest rate of deaths from rabies occurs in Asia, where incidence rate is more than 3 cases per 100,000 people per year 3 . More than 1.4 billion people are potentially at risk of ra- bies infection in South East Asia. In the areas where rabies is pandemic, 5-15 years-old children comprise about 40% of the people exposed to dog bite 4 . Deaths resulting from rabies in the children below 15 cause about 1.74 million DALYs to be lost in the world. Because of the lack of rabies care advanced system, the real number of the sufferers is probably higher than the reported statistics 5 . Yet, besides the health im- portance in human-beings, disease outbreak among the live- stock causes significant economic losses. Despite the pre- ventability of the rabies by effective and safe vaccines, the disease is still a healthcare problem in many countries, espe- cially in Asia and Africa 6 . Asia nears 96.5% of the burden of the disease in developing countries by spending an annual cost equivalent to 560 million USD 1,7 . In spite of centuries of experience in animal control and effectiveness prophylaxis after being exposed to rabies, human deaths resulting from rabies are still high. Rabies has been existing in Iran for long and is seen as endemic in Iran`s wildlife causing repeated infections in pets 8,9 . During 1994-2003, averagely, 8.4 deaths caused by rabies occurred among human-beings in Iran every year 10 . Moreover, about 130 thousand people annually re- ceive PEP 11 . T