Gordon E R, Krebs J W, Rupprecht C R, Real L A, Childs J E
Department of Biology, Emory University, 1510 Clifton Road, Atlanta, GA 30322, USA.
Prev Vet Med. 2005 May 10;68(2-4):195-222. doi: 10.1016/j.prevetmed.2004.12.007.
Determining the benefits to cost relationships among different approaches to rabies control and prevention has been hindered by the inherent temporal variability in the dynamics of disease among wildlife reservoir hosts and a tangible and objective measure of the cost of rabies prevention. A major and unavoidable component of rabies prevention programs involves diagnostic testing of animals and the subsequent initiation of appropriate public health responses. The unit cost per negative and positive diagnostic test outcome can be reasonably estimated. This metric when linked to methodologies subdividing the epizootic process into distinct temporal stages provided the requisite detail to estimate benefits derived from rabies control strategies. Oral rabies vaccine (ORV), for prevention of the raccoon-associated variant of rabies, has been distributed in Ohio and adjoining states in an effort to develop an immune barrier to the westward spread of epizootic raccoon rabies. The costs of ORV delivery have been quantified. Herein, the cost structures required to assess the benefits accrued by prevention were developed. A regression model was developed effectively predicting (r2=0.70) the total number of rabies diagnostic tests performed by 53 counties in five northeastern (NE) states from 1992 to 2001. Five temporal stages sufficed to capture the range of variability in the raccoon rabies epizootic process. Unit costs, dollars per diagnostic test outcome, were calculated for negative and positive results from published reports. Ohio counties were matched to NE counties based on similar socioeconomic characters. A "pseudo-epizootic" of raccoon rabies was introduced into Ohio and the costs savings from ORV were derived as the excess costs imposed by epizootic spread throughout the state. At 46 km/year (range modeled, 30-60 km/year), the pseudo epizootic spread, and reached the enzootic stage, in all Ohio counties by year 13 (range modeled, 11-17 years). Cumulative excess costs for Ohio ranged between $11 and $21 million; counties of low socioeconomic status experienced the greatest relative excess costs. The costs for rabies prevention activities reached apices during the epizootic stage of raccoon rabies (2.7-10.8 times baseline) an unforeseen finding indicated elevated costs persisted (1.7-7.2 times baseline) into the enzootic stage.
确定狂犬病控制与预防的不同方法之间的效益成本关系，受到野生动物储存宿主中疾病动态固有的时间变异性以及狂犬病预防成本的切实客观衡量标准的阻碍。狂犬病预防计划的一个主要且不可避免的组成部分涉及对动物的诊断检测以及随后启动适当的公共卫生应对措施。阴性和阳性诊断检测结果的单位成本可以合理估算。当这个指标与将动物流行病过程细分为不同时间阶段的方法相关联时，就能提供估算狂犬病控制策略所带来效益所需的详细信息。口服狂犬病疫苗（ORV）用于预防与浣熊相关的狂犬病变种，已在俄亥俄州及周边各州分发，旨在建立一道免疫屏障，阻止动物流行病浣熊狂犬病向西传播。ORV投放的成本已得到量化。在此，开发了评估预防所产生效益所需的成本结构。建立了一个回归模型，有效预测（r2 = 0.70）了1992年至2001年五个东北部（NE）州53个县进行的狂犬病诊断检测总数。五个时间阶段足以捕捉浣熊狂犬病动物流行病过程中的变异性范围。根据已发表报告，计算了阴性和阳性结果的单位成本（每次诊断检测结果的美元数）。根据相似的社会经济特征，将俄亥俄州的县与NE州的县进行匹配。将浣熊狂犬病的“假流行病”引入俄亥俄州，ORV节省的成本被推导为整个州动物流行病传播所带来的额外成本。以每年46公里（建模范围为30 - 60公里/年）的速度，假流行病传播，并在第13年（建模范围为11 - 17年）在俄亥俄州所有县达到地方流行阶段。俄亥俄州的累计额外成本在1100万至2100万美元之间；社会经济地位较低的县经历的相对额外成本最高。狂犬病预防活动的成本在浣熊狂犬病的动物流行阶段达到顶点（是基线的2.7 - 10.8倍），一个意外发现表明，在地方流行阶段成本仍然居高不下（是基线的1.7 - 7.2倍）。
