{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T10:47:57Z","timestamp":1788691677205,"version":"build-2803163510"},"update-to":[{"DOI":"10.1371\/journal.pntd.0009130","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2021,3,16]],"date-time":"2021-03-16T00:00:00Z","timestamp":1615852800000}}],"reference-count":53,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2021,3,4]],"date-time":"2021-03-04T00:00:00Z","timestamp":1614816000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"funder":[{"name":"ANID Millennium Science Initiative","award":["NCN17_081"],"award-info":[{"award-number":["NCN17_081"]}]}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:sec id=\"sec001\"><jats:title>Background<\/jats:title><jats:p>Rabies is a viral zoonosis that imposes a substantial disease and economic burden in many developing countries. Dogs are the primary source of rabies transmission; eliminating dog rabies reduces the risk of exposure in humans significantly. Through mass annual dog rabies vaccination campaigns, the national program of rabies control in Mexico progressively reduced rabies cases in dogs and humans since 1990. In 2019, the World Health Organization validated Mexico for eliminating rabies as a public health problem. Using a governmental perspective, we retrospectively assessed the economic costs, effectiveness, and cost-effectiveness of the national program of rabies control in Mexico, 1990\u20132015.<\/jats:p><\/jats:sec><jats:sec id=\"sec002\"><jats:title>Methodology<\/jats:title><jats:p>Combining various data sources, including administrative records, national statistics, and scientific literature, we retrospectively compared the current scenario of annual dog vaccination campaigns and post-exposure prophylaxis (PEP) with a counterfactual scenario without an annual dog vaccination campaign but including PEP. The counterfactual scenario was estimated using a mathematical model of dog rabies transmission (<jats:italic>RabiesEcon<\/jats:italic>). We performed a thorough sensitivity analysis of the main results.<\/jats:p><\/jats:sec><jats:sec id=\"sec003\"><jats:title>Principal findings<\/jats:title><jats:p>Results suggest that in 1990 through 2015, the national dog rabies vaccination program in Mexico prevented about 13,000 human rabies deaths, at an incremental cost (MXN 2015) of $4,700 million (USD 300 million). We estimated an average cost of $360,000 (USD 23,000) per human rabies death averted, $6,500 (USD 410) per additional year-of-life, and $3,000 (USD 190) per dog rabies death averted. Results were robust to several counterfactual scenarios, including high and low rabies transmission scenarios and various assumptions about potential costs without mass dog rabies vaccination campaigns.<\/jats:p><\/jats:sec><jats:sec id=\"sec004\"><jats:title>Conclusions<\/jats:title><jats:p>Annual dog rabies vaccination campaigns have eliminated the transmission of dog-to-dog rabies and dog-mediated human rabies deaths in Mexico. According to World Health Organization standards, our results show that the national program of rabies control in Mexico has been highly cost-effective.<\/jats:p><\/jats:sec>","DOI":"10.1371\/journal.pntd.0009130","type":"journal-article","created":{"date-parts":[[2021,3,4]],"date-time":"2021-03-04T19:07:22Z","timestamp":1614884842000},"page":"e0009130","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":42,"title":["Cost-effectiveness of the national dog rabies prevention and control program in Mexico, 1990\u20132015"],"prefix":"10.1371","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2320-0593","authenticated-orcid":true,"given":"Jes\u00fas Felipe","family":"Gonz\u00e1lez-Rold\u00e1n","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4425-1253","authenticated-orcid":true,"given":"Eduardo A.","family":"Undurraga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7250-0472","authenticated-orcid":true,"given":"Martin I.","family":"Meltzer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charisma","family":"Atkins","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3817-9651","authenticated-orcid":true,"given":"Fernando","family":"Vargas-Pino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8429-6341","authenticated-orcid":true,"given":"Ver\u00f3nica","family":"Guti\u00e9rrez-Cedillo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0518-6487","authenticated-orcid":true,"given":"Jos\u00e9 Ram\u00f3n","family":"Hern\u00e1ndez-P\u00e9rez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,3,4]]},"reference":[{"issue":"32","key":"pntd.0009130.ref001","first-page":"309","article-title":"Rabies vaccines: WHO position paper.","volume":"85","author":"World Health Organization.","year":"2010","journal-title":"Wkly Epidemiol Rec"},{"key":"pntd.0009130.ref002","volume-title":"WHO Expert Consultation on Rabies.","author":"World Health Organization","year":"2018"},{"issue":"6","key":"pntd.0009130.ref003","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1016\/S1473-3099(02)00287-6","article-title":"Rabies re-examined.","volume":"2","author":"CE Rupprecht","year":"2002","journal-title":"Lancet Infect Dis"},{"key":"pntd.0009130.ref004","article-title":"Overview, prevention, and treatment of rabies","author":"DG Hankins","year":"2004","journal-title":"Mayo Clin Proc"},{"issue":"4","key":"pntd.0009130.ref005","doi-asserted-by":"crossref","first-page":"e0003709","DOI":"10.1371\/journal.pntd.0003709","article-title":"Estimating the global burden of endemic canine rabies.","volume":"9","author":"K Hampson","year":"2015","journal-title":"PLoS Negl Trop Dis"},{"issue":"10159","key":"pntd.0009130.ref006","doi-asserted-by":"crossref","first-page":"1736","DOI":"10.1016\/S0140-6736(18)32203-7","article-title":"Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980\u20132017: a systematic analysis for the Global Burden of Disease Study 2017","volume":"392","author":"GA Roth","year":"2018","journal-title":"Lancet"},{"issue":"9","key":"pntd.0009130.ref007","article-title":"Elimination of Dog-Mediated Human Rabies Deaths by 2030: Needs Assessment and Alternatives for Progress Based on Dog Vaccination.","volume":"4","author":"RM Wallace","year":"2017","journal-title":"Front Vet Sci"},{"key":"pntd.0009130.ref008","volume-title":"Eliminaci\u00f3n de la rabia humana transmitida por perros en Am\u00e9rica Latina. An\u00e1lisis de la situaci\u00f3n.","author":"Pan American Health Organization","year":"2005"},{"key":"pntd.0009130.ref009","volume-title":"Rabies.","author":"Pan American Health Organization","year":"2015"},{"key":"pntd.0009130.ref010","doi-asserted-by":"crossref","first-page":"e247","DOI":"10.1017\/S0950268819001158","article-title":"Estimating the effectiveness of vaccine programs in dog populations","volume":"147","author":"RM Wallace","year":"2019","journal-title":"Epidemiol Infect"},{"key":"pntd.0009130.ref011","doi-asserted-by":"crossref","first-page":"6162","DOI":"10.1016\/j.vaccine.2020.06.006","article-title":"Costs and effectiveness of alternative dog vaccination strategies to improve dog population coverage in rural and urban settings during a rabies outbreak","volume":"38","author":"EA Undurraga","year":"2020","journal-title":"Vaccine"},{"issue":"4","key":"pntd.0009130.ref012","doi-asserted-by":"crossref","first-page":"678","DOI":"10.3201\/eid1904.121482","article-title":"Rabies update for Latin America and the Caribbean","volume":"19","author":"MA Vigilato","year":"2013","journal-title":"Emerg Infect Dis"},{"issue":"1623","key":"pntd.0009130.ref013","doi-asserted-by":"crossref","first-page":"20120143","DOI":"10.1098\/rstb.2012.0143","article-title":"Progress towards eliminating canine rabies: policies and perspectives from Latin America and the Caribbean","volume":"368","author":"MAN Vigilato","year":"2013","journal-title":"Philosophical Transactions of the Royal Society of London B. Biological Sciences"},{"key":"pntd.0009130.ref014","unstructured":"World Health Organization. Mexico is free from human rabies transmitted by dogs Geneva: Pan American Health Organization, World Health Organization,; 2020 [cited 2020 November 1]. Available from: https:\/\/bit.ly\/2J9ZkrY."},{"key":"pntd.0009130.ref015","unstructured":"Secretar\u00eda de Salud M\u00e9xico. Lineamientos generales primera semana nacional de vacunaci\u00f3n antirr\u00e1bica canina y felina 2015. Del 22 al 28 de Marzo. Mexico DF: Centro Nacional de Programas Preventivos y Control de Enfermedades, Subsecretar\u00eda de Prevenci\u00f3n y Promoci\u00f3n de la Salud, 2015 August 26. Report No."},{"key":"pntd.0009130.ref016","volume-title":"Pan American Health Organization Reuni\u00f3n de los directores del programa de control de la rabia en Las Am\u00e9ricas(REDIPRA).","year":"2010"},{"issue":"1","key":"pntd.0009130.ref017","doi-asserted-by":"crossref","first-page":"e1000223","DOI":"10.1371\/journal.pmed.1000223","article-title":"Meeting the demand for results and accountability: A call for action on health data from eight global health agencies.","volume":"7","author":"M Chan","year":"2010","journal-title":"PLoS Med."},{"issue":"18","key":"pntd.0009130.ref018","doi-asserted-by":"crossref","first-page":"1748","DOI":"10.1056\/NEJMsa1511248","article-title":"The future of public health","volume":"373","author":"TR Frieden","year":"2015","journal-title":"N Engl J Med"},{"issue":"2","key":"pntd.0009130.ref019","doi-asserted-by":"crossref","first-page":"e626","DOI":"10.1371\/journal.pntd.0000626","article-title":"The feasibility of canine rabies elimination in Africa: dispelling doubts with data.","volume":"4","author":"T Lembo","year":"2010","journal-title":"PLoS Negl Trop Dis"},{"issue":"5","key":"pntd.0009130.ref020","doi-asserted-by":"crossref","first-page":"e0006490","DOI":"10.1371\/journal.pntd.0006490","article-title":"Cost-effectiveness of dog rabies vaccination programs in East Africa.","volume":"12","author":"RH Borse","year":"2018","journal-title":"PLoS Negl Trop Dis"},{"issue":"12","key":"pntd.0009130.ref021","doi-asserted-by":"crossref","first-page":"e0007869","DOI":"10.1371\/journal.pntd.0007869","article-title":"Determining the post-elimination level of vaccination needed to prevent re-establishment of dog rabies.","volume":"13","author":"S Jeon","year":"2019","journal-title":"PLoS Negl Trop Dis"},{"issue":"35","key":"pntd.0009130.ref022","doi-asserted-by":"crossref","first-page":"14996","DOI":"10.1073\/pnas.0904740106","article-title":"Transmission dynamics and economics of rabies control in dogs and humans in an African city","volume":"106","author":"J Zinsstag","year":"2009","journal-title":"Proc Natl Acad Sci"},{"key":"pntd.0009130.ref023","first-page":"1","article-title":"Human Rabies Prevention\u2014United States.","volume":"57","author":"SE Manning","year":"2008","journal-title":"2008 MMWR Recomm Rep."},{"issue":"51","key":"pntd.0009130.ref024","doi-asserted-by":"crossref","first-page":"7167","DOI":"10.1016\/j.vaccine.2009.09.027","article-title":"Evaluating the cost-effectiveness of rabies post-exposure prophylaxis: a case study in Tanzania","volume":"27","author":"E Shim","year":"2009","journal-title":"Vaccine"},{"key":"pntd.0009130.ref025","unstructured":"Instituto Nacional de Estad\u00edstica y Geograf\u00eda. Anuario Estad\u00edstico y Geogr\u00e1fico por Entidad Federativa 2015 Mexico City: Instituto Nacional de Estad\u00edstica y Geograf\u00eda(INEGI),; 2015 [cited 2016 May 18]. Available from: http:\/\/internet.contenidos.inegi.org.mx\/contenidos\/productos\/prod_serv\/contenidos\/espanol\/bvinegi\/productos\/nueva_estruc\/AEGPEF_2015\/702825077297.pdf."},{"key":"pntd.0009130.ref026","unstructured":"Secretar\u00eda de Salud M\u00e9xico. Sistema nacional de informaci\u00f3n en salud Mexico DF: Secretar\u00eda de Salud; 2016 [cited 2016 May 18]. Available from: http:\/\/www.sinais.salud.gob.mx."},{"issue":"5","key":"pntd.0009130.ref027","first-page":"615","article-title":"Urban epizootic of rabies in Mexico: epidemiology and impact of animal bite injuries","volume":"71","author":"T Eng","year":"1993","journal-title":"Bull World Health Organ"},{"issue":"3","key":"pntd.0009130.ref028","doi-asserted-by":"crossref","first-page":"e1000053","DOI":"10.1371\/journal.pbio.1000053","article-title":"Transmission dynamics and prospects for the elimination of canine rabies","volume":"7","author":"K Hampson","year":"2009","journal-title":"PLoS Biol"},{"issue":"4","key":"pntd.0009130.ref029","doi-asserted-by":"crossref","first-page":"365","DOI":"10.2165\/00019053-199814040-00004","article-title":"Rupprecht CE. A review of the economics of the prevention and control of rabies","volume":"14","author":"MI Meltzer","year":"1998","journal-title":"PharmacoEconomics"},{"key":"pntd.0009130.ref030","doi-asserted-by":"crossref","DOI":"10.1093\/oso\/9780198529446.001.0001","volume-title":"Methods for the Economic Evaluation of Health Care Programmes","author":"MF Drummond","year":"2005","edition":"3"},{"issue":"6","key":"pntd.0009130.ref031","doi-asserted-by":"crossref","first-page":"1307","DOI":"10.4269\/ajtmh.16-0785","article-title":"Cost-Effectiveness Evaluation of a Novel Integrated Bite Case Management Program for the Control of Human Rabies, Haiti 2014\u20132015","volume":"96","author":"EA Undurraga","year":"2017","journal-title":"Am J Trop Med Hyg"},{"key":"pntd.0009130.ref032","unstructured":"World Bank. GDP per capita 2020 [cited 2020 10 november]. Available from: https:\/\/data.worldbank.org\/."},{"key":"pntd.0009130.ref033","unstructured":"Secretar\u00eda de Salud M\u00e9xico. Prevenci\u00f3n y Control de la Rabia Humana 2013\u20132018. Programa de Acci\u00f3n Espec\u00edfico. Mexico DF: D.R. Secretar\u00eda de Salud; 2015. Available from: https:\/\/www.gob.mx\/cms\/uploads\/attachment\/file\/38496\/PAE_PrevencionControlRabiaHumana2013_2018.pdf."},{"key":"pntd.0009130.ref034","unstructured":"World Health Organization. Choosing interventions that are cost effective(WHO\u2014CHOICE). Cost effectiveness and strategic planning Geneva2017 [cited 2020 March]. Available from: http:\/\/www.who.int\/choice\/costs\/en\/."},{"issue":"1","key":"pntd.0009130.ref035","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1186\/1478-7547-1-8","article-title":"Generalized cost-effectiveness analysis for national-level priority-setting in the health sector.","volume":"1","author":"R Hutubessy","year":"2003","journal-title":"Cost Eff Resour Alloc"},{"issue":"11","key":"pntd.0009130.ref036","doi-asserted-by":"crossref","first-page":"903","DOI":"10.2165\/10899580-000000000-00000","article-title":"Cost effectiveness in low-and middle-income countries.","volume":"27","author":"SD Shillcutt","year":"2009","journal-title":"PharmacoEconomics."},{"issue":"6","key":"pntd.0009130.ref037","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1007\/s40273-014-0162-x","article-title":"Are current cost-effectiveness thresholds for low-and middle-income countries useful? Examples from the world of vaccines.","volume":"32","author":"A Newall","year":"2014","journal-title":"PharmacoEconomics."},{"key":"pntd.0009130.ref038","first-page":"38","article-title":"Cost description and comparative cost efficiency of post-exposure prophylaxis and canine mass vaccination against rabies in N\u2019Djamena.","volume":"4","author":"R Mindekem","year":"2017","journal-title":"Chad Front Vet Sci"},{"issue":"3","key":"pntd.0009130.ref039","first-page":"281","article-title":"Economics of human and canine rabies elimination: guidelines for programme orientation","volume":"68","author":"K B\u00f6gel","year":"1990","journal-title":"Bull World Health Organ"},{"issue":"1","key":"pntd.0009130.ref040","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1111\/tbed.12637","article-title":"Towards canine rabies elimination: Economic comparisons of three project sites.","volume":"65","author":"J Elser","year":"2018","journal-title":"Transbound Emerg Dis"},{"issue":"4","key":"pntd.0009130.ref041","first-page":"304","article-title":"Estimating human rabies mortality in the United Republic of Tanzania from dog bite injuries","volume":"80","author":"S Cleaveland","year":"2002","journal-title":"Bull World Health Organ"},{"issue":"5","key":"pntd.0009130.ref042","first-page":"360","article-title":"Re-evaluating the burden of rabies in Africa and Asia","volume":"83","author":"DL Knobel","year":"2005","journal-title":"Bull World Health Organ"},{"issue":"11","key":"pntd.0009130.ref043","doi-asserted-by":"crossref","first-page":"e339","DOI":"10.1371\/journal.pntd.0000339","article-title":"Rabies exposures, post-exposure prophylaxis and deaths in a region of endemic canine rabies.","volume":"2","author":"K Hampson","year":"2008","journal-title":"PLoS Negl Trop Dis"},{"issue":"3","key":"pntd.0009130.ref044","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1111\/tbed.12463","article-title":"Towards Canine Rabies Elimination in South-Eastern Tanzania: Assessment of Health Economic Data.","volume":"64","author":"B Hatch","year":"2017","journal-title":"Transbound Emerg Dis."},{"key":"pntd.0009130.ref045","first-page":"167","article-title":"Rabies control in Mexico.","volume":"131","author":"C Lucas","year":"2008","journal-title":"Dev Biol"},{"issue":"23","key":"pntd.0009130.ref046","doi-asserted-by":"crossref","first-page":"524","DOI":"10.15585\/mmwr.mm6823e1","article-title":"Vital signs: trends in human rabies deaths and exposures\u2014United States, 1938\u20132018.","volume":"68","author":"EG Pieracci","year":"2019","journal-title":"Morb Mortal Wkly Rep"},{"issue":"7","key":"pntd.0009130.ref047","first-page":"77","article-title":"Human rabies: 2016 updates and call for data.","volume":"92","author":"World Health Organization","year":"2017","journal-title":"Wkly Epidemiol Rec"},{"issue":"10","key":"pntd.0009130.ref048","doi-asserted-by":"crossref","first-page":"e107539","DOI":"10.1371\/journal.pone.0107539","article-title":"Right Place, Wrong Species: A 20-Year Review of Rabies Virus Cross Species Transmission among Terrestrial Mammals in the United States.","volume":"9","author":"RM Wallace","year":"2014","journal-title":"PLoS One."},{"issue":"3","key":"pntd.0009130.ref049","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1016\/j.cimid.2012.10.008","article-title":"Surveillance guidelines for disease elimination: a case study of canine rabies","volume":"36","author":"SE Townsend","year":"2013","journal-title":"Comp Immunol Microbiol Infect Dis"},{"issue":"3","key":"pntd.0009130.ref050","doi-asserted-by":"crossref","first-page":"38","DOI":"10.3390\/tropicalmed2030038","article-title":"Spatial Association of Canine Rabies Outbreak and Ecological Urban Corridors, Arequipa, Peru.","volume":"2","author":"R Castillo-Neyra","year":"2017","journal-title":"Tropical Medicine and Infectious Disease"},{"issue":"4","key":"pntd.0009130.ref051","article-title":"How to determine if a model is right for neglected tropical disease decision making.","volume":"11","author":"BY Lee","year":"2017","journal-title":"PLoS Negl Trop Dis."},{"key":"pntd.0009130.ref052","volume-title":"Modeling canine rabies virus transmission dynamics.","author":"M Rajeev","year":"2020","edition":"4"},{"issue":"50","key":"pntd.0009130.ref053","doi-asserted-by":"crossref","first-page":"1247","DOI":"10.1098\/rsif.2010.0142","article-title":"Modelling the influence of human behaviour on the spread of infectious diseases: a review","volume":"7","author":"S Funk","year":"2010","journal-title":"J R Soc Interface"}],"updated-by":[{"DOI":"10.1371\/journal.pntd.0009130","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2021,3,16]],"date-time":"2021-03-16T00:00:00Z","timestamp":1615852800000}}],"container-title":["PLOS Neglected Tropical Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0009130","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,25]],"date-time":"2024-08-25T10:53:40Z","timestamp":1724583220000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0009130"}},"subtitle":[],"editor":[{"given":"Sirikachorn","family":"Tangkawattana","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2021,3,4]]},"references-count":53,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2021,3,4]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pntd.0009130","relation":{"new_version":[{"id-type":"doi","id":"10.1371\/journal.pntd.0009130","asserted-by":"object"}]},"ISSN":["1935-2735"],"issn-type":[{"value":"1935-2735","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,3,4]]}}}