Animal Health Study Program, Kupang State Agricultural Polytechnic (Politeknik Pertanian Negeri Kupang), Jl. Prof. Dr. Herman Yohanes, Penfui Kupang, 85011 West Timor, Indonesia; Business Economics Group, Wageningen University, Hollandseweg 1, 6706 KN Wageningen, The Netherlands.
Business Economics Group, Wageningen University, Hollandseweg 1, 6706 KN Wageningen, The Netherlands.
Vaccine. 2017 Dec 4;35(48 Pt B):6727-6736. doi: 10.1016/j.vaccine.2017.10.009. Epub 2017 Oct 25.
The cost-effectiveness of different mass dog rabies vaccination strategies, defined as the costs per year of life lost (YLL) averted was evaluated for a period of 10 years by means of a dynamic simulation study for a typical village on Flores Island. In the base strategy (no dog vaccination and no post-exposure treatment (PET) of human bite cases), the model showed that the introduction of the virus by one infectious dog into an isolated village with 1500 inhabitants and 400 dogs resulted in 881 YLLs during a 10-year simulation period, which is equivalent to 30 human rabies cases. An annual dog vaccination campaign with a coverage of 70% using a short-acting vaccine saved 832 YLLs, while the cumulative costs for the public sector were US$3646 or US$4.38 per YLL averted. Switching to a long-acting vaccine, the annual vaccination strategies with a coverage of 50% (AV_156_50) or 70% (AV_156_70) reduced the baseline YLLs from 881 to respectively 78 and 26 YLLs with cumulative costs of US$3716 and US$2264 or US$4.63 and US$2.65 per YLL averted, respectively. In general, dog vaccination was more cost-effective than PET alone (US$2.65-4.63 per YLL averted versus US$23.29 per YLL averted). Although a combination of PET with AV_156_70 was less cost-effective compared to AV_156_70 alone, this strategy was able to prevent all human deaths due to rabies. A combination of PET with annual vaccination using a short-acting vaccine at a coverage of 50% was far from being cost-effective, suggesting that the currently applied rabies control in Flores Island is not an efficient investment in reducing human rabies burden. An increased investment in either an increase in the current coverage or in a switch from the short-acting vaccine to the long-acting vaccine type would certainly pay off.
对弗洛雷斯岛上一个典型村庄进行了为期 10 年的动态模拟研究，评估了不同大规模犬狂犬病疫苗接种策略的成本效益，定义为每年避免的生命损失（YLL）成本。在基础策略（无犬接种疫苗和无人类咬伤病例的暴露后治疗（PET））中，该模型显示，在一个有 1500 名居民和 400 只狗的隔离村庄中，一只感染病毒的狗的引入导致在 10 年模拟期间发生了 881 例 YLL，相当于 30 例人类狂犬病病例。使用短效疫苗进行的每年 70%犬接种疫苗运动挽救了 832 例 YLL，而公共部门的累计成本为 3646 美元或每避免 1 例 YLL 成本为 4.38 美元。改用长效疫苗后，每年接种疫苗的策略，覆盖率为 50%（AV_156_50）或 70%（AV_156_70），将基础 YLL 从 881 例分别减少到 78 例和 26 例，累计成本分别为 3716 美元和 2264 美元，或每避免 1 例 YLL 成本分别为 4.63 美元和 2.65 美元。一般来说，犬接种疫苗比单独进行 PET 更具成本效益（每避免 1 例 YLL 的成本分别为 2.65-4.63 美元和 23.29 美元）。尽管 PET 与 AV_156_70 联合使用的成本效益低于 AV_156_70 单独使用，但这种策略能够预防所有因狂犬病导致的人类死亡。将 PET 与每年 50%覆盖率的短效疫苗接种相结合远非具有成本效益，这表明目前在弗洛雷斯岛实施的狂犬病控制措施并非减少人类狂犬病负担的有效投资。无论是增加当前覆盖率还是从短效疫苗转为长效疫苗类型，增加投资肯定会得到回报。
