Abstract
The study aimed to determine costs to the state government of implementing different interventions for controlling rabies among the entire human and animal populations of Tamil Nadu. This built upon an earlier assessment of Tamil Nadu's efforts to control rabies. Anti-rabies vaccines were made available at all health facilities. Costs were estimated for five different combinations of animal and human interventions using an activity-based costing approach from the provider perspective. Disease and population data were sourced from the state surveillance data, human census and livestock census. Program costs were extrapolated from official documents. All capital costs were depreciated to estimate annualized costs. All costs were inflated to 2012 Rupees. Sensitivity analysis was conducted across all major cost centres to assess their relative impact on program costs. It was found that the annual costs of providing Anti-rabies vaccine alone and in combination with Immunoglobulins was $0.7 million (Rs 36 million) and $2.2 million (Rs 119 million), respectively. For animal sector interventions, the annualised costs of rolling out surgical sterilisation-immunization, injectable immunization and oral immunizations were estimated to be $ 44 million (Rs 2,350 million), $23 million (Rs 1,230 million) and $ 11 million (Rs 590 million), respectively. Dog bite incidence, health systems coverage and cost of rabies biologicals were found to be important drivers of costs for human interventions. For the animal sector interventions, the size of dog catching team, dog population and vaccine costs were found to be driving the costs. Rabies control in Tamil Nadu seems a costly proposition the way it is currently structured. Policy makers in Tamil Nadu and other similar settings should consider the long-term financial sustainability before embarking upon a state or nation-wide rabies control programme.
Highlights
Background & objective While rabies has been identified as a priority zoonoses that needs to be addressed globally [1], it has a special relevance in South Asia
Rabies control efforts in Tamil Nadu seem a costly proposition as they are currently structured in the state
This would necessarily require high levels of technical, political and financial commitments before the government chooses to embark upon a long-term rabies control strategy
Summary
Background & objective While rabies has been identified as a priority zoonoses that needs to be addressed globally [1], it has a special relevance in South Asia. Knowledge gaps Evidence from India and elsewhere demonstrates the efficacy of principle rabies intervention strategies. Indian researchers have studied the application of different post-exposure prophylaxis (PEP) regimens among humans [6]. Economic assessments have been conducted in different parts of the world which study the economic impact of rabies [2], economics of rabies control [10] and cost effectiveness of different post-exposure prophylaxis regimens [11]. This body of work has been instrumental in development of national strategic plans for rabies control [12]
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