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Posted by bhartiomesh on 20 Apr 2011 at 07:39 GMT

Respected editors,

I am thankful to you for publishing such a great article in PLOS but I differ on one point, that is
" Charging patients for exactly the amount of vaccine administered using the ID route results in a net loss for healthcare providers except in high throughput clinics. Charging patients per ID injection at rates slightly greater than the price of the vaccine used results in net savings in most locations".

I have a different experience in our settings where we pool the patients as well as vaccine vials. On first visit a patient is asked to bring a (1 ml) vial of vaccine and the vial is shared between four to five patients. With this pooling strategy, we not only saved some vaccine vials but also got 100% complience from the patients.

With this pooling technique, There was an increase in the hospital patient load by 2.8 times, and poor patients load by 3.2 times within a month compare to last month. In just less than two year now, $ 200,000 of poor patients have been saved and 5769 patients vaccinated without any failure. Another offshoot of the strategy is saving some drops of vaccine in each vial (0.2ml) that accumulated to become a stock of more than 100 vials that we are able to give free to more than 225 rag pickers, garbage collectors and newspaper hawkers this world rabies day on Sep 28, 2010.
Therefore pooling technique is vital to save costs in low income and high density populations like India and Africa.


No competing interests declared.

RE: Response to bhartiomesh

KHampson replied to bhartiomesh on 28 Apr 2011 at 12:55 GMT

Many thanks for your comment – we are delighted to hear that you have been able to achieve 100% patient compliance by charging patients for a single ampoule on their first clinic visit whilst pooling patients and vials. Presumably using 1mL vials and implementing either the updated-TRC or the 4-site ID, whilst charging patients the price of a single vial recoups both the vial cost-price (with frequent small net-savings even in low throughput clinics due to patient pooling) and saves a small amount of vaccine (see Table 1 in main article). This is in accordance with our predictions and is exactly the type of innovative financing mechanism for implementing ID regimens that we had hypothesized would improve compliance. We are extremely impressed that you have already been demonstrating the value of ID post-exposure vaccination in practice, while implementing this innovative financing mechanism for a pro-poor health intervention that is saving thousands of lives. We hope others will follow your excellent example.

No competing interests declared.