Towards Canine Rabies Elimination in Cebu, Philippines: Assessment of Health Economic Data

Abstract

Rabies is endemic in the Philippines. In 2010, with support from the Bill and Melinda Gates Foundation, a canine rabies elimination project was initiated in the Philippine Archipelago of Visayan. We conducted an analysis of dog vaccination and human PEP costs for dog bite patients in a highly urbanized area and a low-income rural municipality in Cebu Province, Philippines, from 2010 to 2012. Our findings indicated that eliminating rabies in dogs through mass vaccination is more cost-effective than treating rabies exposures in humans. The average costs (in USD) per human life saved through PEP were $1620.28 in Cebu City and $1498 in Carmen. Costs per dog vaccinated ranged from $1.18 to $5.79 in Cebu City and $2.15 to $3.38 in Carmen. Mass dog vaccination campaigns conducted in each village were more cost-effective than fixed-site campaigns. The costs of dog vaccination can be reduced further through bulk vaccine purchase by the national government or large donor agency, for example the BMGF. As communities achieve canine rabies elimination, more judicious use of PEP will result in significant public savings. The study affirms the willingness of local governments to invest and reassure donors of their cooperation and resource contribution to sustain disease elimination efforts.

The Ilocos Norte Communities against Rabies Exposure Elimination Project in the Philippines: Epidemiological and Economic Aspects

“…The cost per patient provided with PEP was consistent with other similar full programmatic cost assessments for Africa (18, 25, 26) and elsewhere in the Philippines (25). Interestingly in Ilocos Norte, the rural health center had lower costs on average than in Laoag City, explained by fewer PEP doses received per patient on average, and a lower programmatic cost per dose in Dingras.…”

“…Even as canine rabies cases fell, bite treatment numbers rose, a trend that has been found elsewhere (8, 9, 25, 26). The impact of educational and other community-based bite prevention activities usually increases the reporting rate of bites (seen here from 2012 to 2014) and could mask any effect of reduced numbers of bites occurring.…”

“…Lower costs per dog vaccinated with higher throughput and higher human density have been observed in other programs (18, 25), and overall costs fell in the middle and toward the higher end of the range of previously documented costs (27). In this project, a very small proportion of the costs of dog vaccination were from external donors, which is expected to be a good model for ensuring rabies control is sustained beyond the end of the project.…”

“…Interestingly in Ilocos Norte, the rural health center had lower costs on average than in Laoag City, explained by fewer PEP doses received per patient on average, and a lower programmatic cost per dose in Dingras. In Ilocos Norte, a large proportion of the costs were borne by the patients, similar to elsewhere in the Philippines, where patients paid around 50% of the total costs (25). This situation will change as the Philippines national government has agreed to pay for full courses of PEP for patients presenting from 2016 onward (28).…”

Toward Elimination of Dog-Mediated Human Rabies: Experiences from Implementing a Large-scale Demonstration Project in Southern Tanzania

“…A study to estimate the cost-effectiveness of the program in Tanzania found that the cost-per-dog vaccinated ranged from USD 2.5 to 22.49 across districts and phases with the average cost per phase falling from USD 11.27 in the first phase to USD 7.3 in the third phase (13). In comparison to other rabies elimination demonstration sites of KwaZulu-Natal and Cebu in the Philippines (17, 18), Tanzania had the highest cost-per-dog vaccinated mainly because of the over purchase of the vaccine in the early phases of the program and purchasing equipment for a program starting from scratch.…”