Cost-effectiveness Analysis of Integrated Bite Case Management and Sustained Dog Vaccination for Rabies Control
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Date
2023
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Abstract
The successful prevention, control, and elimination of dog-mediated rabies is challenging due to insuffi cient resource availability and inadequate placement. An integrated dog bite case management (IBCM) system plus dog
vaccination can help address these challenges. Based on data from the IBCM system in Haiti, we conducted a cost effectiveness evaluation of a newly established IBCM system plus sustained vaccination and compared it with 1) a no
bite-case management (NBCM) and 2) a non–risk-based (NRB) program, where bite victims presenting at a health clinic
would receive post-exposure prophylaxis regardless of risk assessment. We also provide cost-effectiveness guidance
for an ongoing IBCM system and for sub-optimal dog vaccination coverages, considering that not all cost-effective inter ventions are affordable. Cost-effectiveness outcomes included average cost per human death averted (USD/death
averted) and per life-year gained (LYG). The analysis used a governmental perspective. Considering a sustained 5-year
implementation with 70% dog vaccination coverage, IBCM had a lower average cost per death averted (IBCM: $7,528,
NBCM: $7,797, NRB: $15,244) and cost per LYG (IBCM: $152, NBCM: $158, NRB: $308) than NBCM and NRB pro grams. As sensitivity analysis, we estimated cost-effectiveness for alternative scenarios with lower dog-vaccination
coverages (30%, 55%) and lower implementation costs. Our results suggest that better health and cost-effectiveness
outcomes are achieved with the continued implementation of an IBCM program ($118 per life-year saved) compared
with a newly established IBCM program ($152 per life-year saved). Our results suggest that IBCM is more cost-effective
than non-integrated programs to eliminate dog-mediated human rabies.