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

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. Author summary: Rabies is a virus that affects wild and domestic animals that can affect humans. Rabies infection is almost certainly fatal once clinical symptoms appear but can be prevented with timely post-exposure prophylaxis administration. Dogs are the primary source of rabies transmission; eliminating dog rabies reduces the risk of exposure in humans significantly. In Mexico, the national program of dog rabies vaccination has accomplished a progressive reduction of rabies episodes since 1990. The impact of these campaigns has not been systematically assessed, and that evaluation is critical to inform public health decisions. Using a mathematical model of rabies transmission, we estimated the costs and effectiveness of the dog rabies vaccination program in Mexico, compared to a scenario with no vaccination. Our results suggest that from 1990 through 2015, the national dog rabies vaccination program in Mexico prevented about 13,000 human rabies deaths, at an additional 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. According to World Health Organization standards, the annual dog vaccination campaign in Mexico is highly cost-effective.