Evaluating delivery models for mass dog vaccination: a cost-effectiveness analysis of community-led and team-led vaccination strategies for rabies control in resource-limited settings

Abstract

Introduction Rabies is a fatal but preventable zoonotic disease that is still endemic in many low- and middle-income countries. Mass dog vaccination is central to rabies control, but identifying delivery strategies that are both effective and economically feasible continues to be a challenge in low-resource settings. Methods We assessed the cost-effectiveness of a community-led hybrid MDV strategy compared to the standard team-led approach in northern Tanzania. We estimate three key economic metrics from both the provider and the societal perspective: cost per dog vaccinated, marginal cost per dog vaccinated, and the incremental cost-effectiveness ratio (ICER). Results The community-led strategy incurred higher annual costs at the ward level ($1,729, 95% CI: $1,641–$1,816) compared to the team-led approach ($884, 95% CI: $729–$937, p< 0.001), but twice as many dogs were vaccinated (768 vs. 350 annual average). The difference in average cost per dog vaccinated (team-led: $2.851 (95% CI: 2.705–2.996) vs community-led: $2.703 (95% CI: 2.404–3.001)) was not significant (p = 0.380), but the median cost was significantly higher for the team-led ($2.297 vs $2.608; Wilcoxon p< 0.001). The cost per dog varied by location, with team-led delivery being cheaper in urban settings (mean $2.942 vs. $5.267: p = 0.016) whilst community-led delivery performed better in rural settings (mean $2.275 vs. $2.820: p< 0.001). The adjusted ICER for community-led delivery over team-led delivery was $2.072 (95% CI: $1.954–$2.217) per additional dog vaccinated, while the regression model indicated that both strategies exhibited economies of scale with costs decreasing as the number of dogs vaccinated increased. Conclusion Both delivery strategies are viable to increase dog rabies vaccination, but their cost-effectiveness is context-specific. Community-led vaccination emerges as a more efficient option in rural areas, while team-led delivery may be preferable in densely populated environments. These results provide policymakers with practical insights to guide strategic investment and national implementation of rabies vaccination programmes.