Meltzer M I, Rupprecht C E
National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Pharmacoeconomics. 1998 Nov;14(5):481-98. doi: 10.2165/00019053-199814050-00003.
Although rabies in domestic and wild animals represents a significant threat to public health and can cause economic losses among livestock, there are very few studies that examine the economics of rabies in animals. The literature that does exist can be characterised as poorly documented estimates of costs, with insufficient information to allow replication of the analyses. Most papers have numerous 'violations' of the standard recommended procedures for assessing burden of disease and the cost and benefits of interventions. For example, most studies do not distinguish between financial charges and true economic costs. Further, despite the fact that controlling rabies in animal populations is often a multi-year task, only a few papers contain a multi-year framework, complete with discounting of future costs and benefits. Globally, dog-transmitted rabies represents the largest threat to human health. In order to prevent the transmission of rabies in a dog population, it is theoretically necessary to vaccinate a minimum of 60 to 70% of the dogs. Even countries with potentially sufficient resources, however, do not often meet and sustain these rates. One reason for such failure might be that individual dog owners might feel that it is too expensive to vaccinate their pets. Recent estimates in the US of the cost of vaccinating dogs range from $US16 to $US24 per dog. In developing countries, estimates range from $US0.52 in Thailand, to $US1.19 in the Philippines, to $US2.70 in Malawi. None of these estimates include indirect costs accured by the pet owners. Lethal methods of dog population control are even more expensive, and attempting to control rabies by reducing dog populations has not worked for any extended period. Rabies in livestock is often reported, but the impact in the US and most developed countries appears relatively small. Vampire bat-transmitted rabies in Latin America appears to be the most serious rabies problem in livestock. The largest cost due to wildlife rabies is the cost of vaccinating domestic animals, both large and small. In the US, domestic animals face multiple sources of wildlife rabies. Attributing the entire cost of vaccinating domestic animals to 1 species can result in the over estimation of the benefits of immunising a given wildlife population via vaccine-laden baits. For example, despite a definite decline in the number of rabid foxes, it has been difficult to obtain the promised benefits of using oral vaccines in Europe to control fox rabies. Other authors maintain that the use of oral vaccines to control fox rabies is cost beneficial, but there are no convincing data supporting that claim. Additionally, vaccinating raccoons with an oral vaccine requires approximately 4 times more vaccine-laden baits vaccinating foxes, which makes it highly questionable if it would be cost beneficial to use oral vaccine to attempt raccoon rabies elimination in areas where it is already enzootic. The economics of using oral vaccines to prevent raccoon rabies invading uninfected areas has yet to be examined.
尽管家畜和野生动物身上的狂犬病对公众健康构成重大威胁,并可能给畜牧业带来经济损失,但很少有研究探讨动物狂犬病的经济学问题。现有文献的特点是成本估算记录不佳,信息不足,无法重复分析。大多数论文在评估疾病负担以及干预措施的成本和效益时,都存在许多违反标准推荐程序的情况。例如,大多数研究没有区分财务费用和真正的经济成本。此外,尽管控制动物群体中的狂犬病通常是一项多年任务,但只有少数论文包含多年框架,并对未来成本和效益进行了贴现。在全球范围内,犬传狂犬病对人类健康构成的威胁最大。为了预防犬类群体中狂犬病的传播,理论上至少需要给60%至70%的犬只接种疫苗。然而,即使是资源可能充足的国家,也常常无法达到并维持这些接种率。这种失败的一个原因可能是,个别犬主可能觉得给宠物接种疫苗太贵。美国最近对犬只接种疫苗成本的估计为每只犬16美元至24美元。在发展中国家,估计范围从泰国的0.52美元到菲律宾的1.19美元,再到马拉维的2.70美元。这些估计都没有包括宠物主人产生的间接成本。控制犬类数量的致死方法成本更高,而且试图通过减少犬类数量来控制狂犬病在任何较长时期内都没有效果。家畜中的狂犬病经常被报道,但在美国和大多数发达国家,其影响似乎相对较小。拉丁美洲吸血蝙蝠传播的狂犬病似乎是家畜中最严重的狂犬病问题。野生动物狂犬病造成的最大成本是给大小家畜接种疫苗的成本。在美国,家畜面临多种野生动物狂犬病传染源。将给家畜接种疫苗的全部成本归因于某一个物种,可能会高估通过投放含疫苗诱饵来免疫特定野生动物群体的益处。例如,尽管狂犬病狐狸的数量确实有所下降,但在欧洲很难获得使用口服疫苗控制狐狸狂犬病所承诺的益处。其他作者认为使用口服疫苗控制狐狸狂犬病在成本上是有益的,但没有令人信服的数据支持这一说法。此外,给浣熊接种口服疫苗所需的含疫苗诱饵大约是给狐狸接种的4倍,因此在狂犬病已经地方性流行的地区,使用口服疫苗试图消除浣熊狂犬病是否在成本上有益,这是非常值得怀疑的。使用口服疫苗预防浣熊狂犬病侵入未感染地区的经济学问题尚未得到研究。