Costs Analysis of a Population Level Rabies Control Programme in Tamil Nadu, India

The study aimed to determine costs to the state government of implementing different interventions for controlling rabies among the entire human and animal populations of Tamil Nadu. This built upon an earlier assessment of Tamil Nadu's efforts to control rabies. Anti-rabies vaccines were made available at all health facilities. Costs were estimated for five different combinations of animal and human interventions using an activity-based costing approach from the provider perspective. Disease and population data were sourced from the state surveillance data, human census and livestock census. Program costs were extrapolated from official documents. All capital costs were depreciated to estimate annualized costs. All costs were inflated to 2012 Rupees. Sensitivity analysis was conducted across all major cost centres to assess their relative impact on program costs. It was found that the annual costs of providing Anti-rabies vaccine alone and in combination with Immunoglobulins was $0.7 million (Rs 36 million) and $2.2 million (Rs 119 million), respectively. For animal sector interventions, the annualised costs of rolling out surgical sterilisation-immunization, injectable immunization and oral immunizations were estimated to be $ 44 million (Rs 2,350 million), $23 million (Rs 1,230 million) and $ 11 million (Rs 590 million), respectively. Dog bite incidence, health systems coverage and cost of rabies biologicals were found to be important drivers of costs for human interventions. For the animal sector interventions, the size of dog catching team, dog population and vaccine costs were found to be driving the costs. Rabies control in Tamil Nadu seems a costly proposition the way it is currently structured. Policy makers in Tamil Nadu and other similar settings should consider the long-term financial sustainability before embarking upon a state or nation-wide rabies control programme.本研究旨在测算泰米尔纳德邦针对全体人类与动物群体实施狂犬病防控各项干预措施所需的邦政府成本，该研究基于此前对泰米尔纳德邦狂犬病防控工作的评估展开。研究人员为所有医疗卫生机构配备了抗狂犬病疫苗（Anti-rabies vaccines），并从服务提供方视角出发，采用基于活动的成本核算（activity-based costing）方法，针对5种不同的动物与人类干预措施组合开展成本估算。疾病与人口数据来源于该邦的监测数据、人口普查及家畜普查。项目成本通过官方文件进行外推，所有资本成本均经折旧处理以估算年度化成本，且所有成本均按2012年卢比计价标准进行通胀调整。研究针对所有主要成本中心开展了敏感性分析，以评估其对项目成本的相对影响。研究发现，仅提供抗狂犬病疫苗，以及联合免疫球蛋白（Immunoglobulins）的年度成本分别为70万美元（约合3600万卢比）与220万美元（约合1.19亿卢比）。在动物领域干预措施方面，推广手术绝育-免疫接种、注射式免疫及口服免疫的年度化成本分别为4400万美元（约合23.5亿卢比）、2300万美元（约合12.3亿卢比）与1100万美元（约合5.9亿卢比）。研究表明，犬咬伤发生率、医疗保障覆盖范围及狂犬病生物制剂成本是人类干预措施成本的重要影响因素；而在动物领域干预措施中，捕犬团队规模、犬只种群数量及疫苗成本则主导了项目成本。从当前架构来看，泰米尔纳德邦的狂犬病防控工作成本高昂。泰米尔纳德邦及其他类似地区的政策制定者在启动邦级或全国性狂犬病防控项目前，应考量其长期财务可持续性。