Cost-effectiveness of the national dog rabies prevention and control program in Mexico, 1990–2015

Abstract

Background Rabies is a viral zoonosis that imposes a substantial disease and economic burden in many developing countries. Dogs are the primary source of rabies transmission; eliminating dog rabies reduces the risk of exposure in humans significantly. Through mass annual dog rabies vaccination campaigns, the national program of rabies control in Mexico progressively reduced rabies cases in dogs and humans since 1990. In 2019, the World Health Organization validated Mexico for eliminating rabies as a public health problem. Using a governmental perspective, we retrospectively assessed the economic costs, effectiveness, and cost-effectiveness of the national program of rabies control in Mexico, 1990–2015. Methodology Combining various data sources, including administrative records, national statistics, and scientific literature, we retrospectively compared the current scenario of annual dog vaccination campaigns and post-exposure prophylaxis (PEP) with a counterfactual scenario without an annual dog vaccination campaign but including PEP. The counterfactual scenario was estimated using a mathematical model of dog rabies transmission (RabiesEcon). We performed a thorough sensitivity analysis of the main results. Principal findings Results suggest that in 1990 through 2015, the national dog rabies vaccination program in Mexico prevented about 13,000 human rabies deaths, at an incremental cost (MXN 2015) of $4,700 million (USD 300 million). We estimated an average cost of $360,000 (USD 23,000) per human rabies death averted, $6,500 (USD 410) per additional year-of-life, and $3,000 (USD 190) per dog rabies death averted. Results were robust to several counterfactual scenarios, including high and low rabies transmission scenarios and various assumptions about potential costs without mass dog rabies vaccination campaigns. Conclusions Annual dog rabies vaccination campaigns have eliminated the transmission of dog-to-dog rabies and dog-mediated human rabies deaths in Mexico. According to World Health Organization standards, our results show that the national program of rabies control in Mexico has been highly cost-effective.

Rabies prevention and control practices and associated factors among dog owners in Chiro, West Hararghe, Ethiopia

“…Therefore, controlling rabies in dogs is the first priority for the prevention of human rabies. 6 , 10 Many developing countries have recently faced public health challenges due to rabies, even though some areas have remained free from rabies. 11 Similarly, rabies disease has an economic burden, particularly in developing countries.…”

“… 11 Similarly, rabies disease has an economic burden, particularly in developing countries. 6 Therefore, rabies prevention and control, in general, must be adopted to restrict or eradicate virus transmission by immunizing selected reservoir populations. 12 …”

An increasing public health problem: Suspected rabies exposures

“…WHO reports that mass vaccination of domestic animals, especially dogs is essential for the eradication of rabies [23]. There are also studies that report that such mass animal vaccinations are extremely cost-effective [24].…”

Rabies in the Tropics

“…To date, outcomes are well exemplified by Mexico. Since the 1990s, annual mass canine vaccination programs were highly cost-effective, and significantly, during 2019, the country received validation from the WHO as a country free of canine-mediated rabies [ 41 , 42 ]. No human cases were reported that year, but rabies was detected in 74 rabid animal samples (i.e., primarily livestock mediated by primary wildlife reservoirs) of 22,924 tested [ 40 ].…”