title: Cost-effectiveness of canine vaccination to prevent human rabies in rural Tanzania.
abstract: BACKGROUND
  The annual mortality rate of human rabies in rural Africa is 3.6 deaths per 100 000 persons. Rabies can be prevented with prompt postexposure prophylaxis, but this is costly and often inaccessible in rural Africa. Because 99% of human exposures occur through rabid dogs, canine vaccination also prevents transmission of rabies to humans.
  
  
  OBJECTIVE
  To evaluate the cost-effectiveness of rabies control through annual canine vaccination campaigns in rural sub-Saharan Africa.
  
  
  METHODS
  We model transmission dynamics in dogs and wildlife and assess empirical uncertainty in the biological variables to make probability-based evaluations of cost-effectiveness.
  
  
  METHODS
  Epidemiologic variables from a contact-tracing study and literature and cost data from ongoing vaccination campaigns.
  
  
  METHODS
  Two districts of rural Tanzania: Ngorongoro and Serengeti.
  
  
  METHODS
  10 years.
  
  
  CONCLUSIONS
  Health policymaker.
  
  
  METHODS
  Vaccination coverage ranging from 0% to 95% in increments of 5%.
  
  
  METHODS
  Life-years for health outcomes and 2010 U.S. dollars for economic outcomes.
  
  
  RESULTS
  Annual canine vaccination campaigns were very cost-effective in both districts compared with no canine vaccination. In Serengeti, annual campaigns with as much as 70% coverage were cost-saving.
  
  
  RESULTS
  Across a wide range of variable assumptions and levels of societal willingness to pay for life-years, the optimal vaccination coverage for Serengeti was 70%. In Ngorongoro, although optimal coverage depended on willingness to pay, vaccination campaigns were always cost-effective and lifesaving and therefore preferred.
  
  
  CONCLUSIONS
  Canine vaccination was very cost-effective in both districts, but there was greater uncertainty about the optimal coverage in Ngorongoro.
  
  
  CONCLUSIONS
  Annual canine rabies vaccination campaigns conferred extraordinary value and dramatically reduced the health burden of rabies.
  
  
  BACKGROUND
  National Institutes of Health.
authors.forename: Meagan C
authors.initials: MC
authors.lastname: Fitzpatrick
authors.forename: Katie
authors.initials: K
authors.lastname: Hampson
authors.forename: Sarah
authors.initials: S
authors.lastname: Cleaveland
authors.forename: Imam
authors.initials: I
authors.lastname: Mzimbiri
authors.forename: Felix
authors.initials: F
authors.lastname: Lankester
authors.forename: Tiziana
authors.initials: T
authors.lastname: Lembo
authors.forename: Lauren A
authors.initials: LA
authors.lastname: Meyers
authors.forename: A David
authors.initials: AD
authors.lastname: Paltiel
authors.forename: Alison P
authors.initials: AP
authors.lastname: Galvani
mesh_terms: D000818:Animals; D001733:Bites and Stings / Q000150:complications; D003362:Cost-Benefit Analysis; D004283:Dog Diseases / Q000517:prevention & control* / Q000635:transmission*; D004285:Dogs; D006801:Humans; D015233:Models, Statistical; D011818:Rabies / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission / Q000662:veterinary; D011819:Rabies Vaccines / Q000191:economics*; D012424:Rural Population; D013636:Tanzania / Q000453:epidemiology; D014611:Vaccination / Q000191:economics*
chemical_list: D011819:Rabies Vaccines