Table 2 Sensitivity analysis: 5-year health and cost effectiveness outcomes for different assumptions of PEP use efficiency.

Outcome	Policy	Number of suspect rabies exposures per true rabies exposure^c
Outcome	Policy	1	2	5 (Baseline)	10
Human deaths^a	No vaccination No PEP^b	5945	5945	5945	5945
	No vaccination Baseline PEP	1383	1383	1383	1383
	Vaccination 2021 Baseline PEP	65	65	65	65
	Vaccination 2022 Baseline PEP	350	350	350	350
PEP^b courses required	No vaccination No PEP	0	0	0	0
	No vaccination Baseline PEP	23,947	47,894	119,735	239,469
	Vaccination 2021 Baseline PEP	1173	2345	5864	11,727
	Vaccination 2022 Baseline PEP	6716	13,431	33,578	67,157
Total costs	No vaccination No PEP	$0	$0	$0	$0
	No vaccination Baseline PEP	$1,779,130	$3,558,260	$8,895,651	$17,791,302
	Vaccination 2021 Baseline PEP	$7,617,856	$7,704,936	$7,966,175	$8,401,574
	Vaccination 2022 Baseline PEP	$6,256,200	$6,754,892	$8,250,969	$10,744,429
Average cost per human death averted	No vaccination No PEP	Ref.	Ref.	Ref.	Ref.
	No vaccination Baseline PEP	$390	$780	$1950	$3900
	Vaccination 2021 Baseline PEP	$1296	$1310	$1355	$1429
	Vaccination 2022 Baseline PEP	$1118	$1207	$1475	$1920

^aTotal human rabies deaths; we assume only 10% of these would be reported.
^bPEP = post-exposure prophylaxis. The baseline PEP assumption is that 80% (outside Ouest Department) or 85% (Ouest Department) of humans exposed to a suspected rabid dog receive PEP, and that 1/5 suspected exposures are true rabies exposures. In people with true rabies exposures, PEP reduces the probability of death. PEP coverage is assumed to remain fixed throughout 2021–2025 in all scenarios.
^cThe number of suspect rabies exposures per true rabies exposure is a measure of PEP use efficiency. A value of 1 indicates that only individuals with exposure to animals that are truly rabid receive PEP. Increasing levels imply decreasing PEP use efficiency.

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