The evaluation of operating Animal Bite Treatment Centers in the Philippines from a health provider perspective

作者：Anna Charinna Amparo, Sarah I. Jayme, Maria Concepcion Roces, Maria Consorcia L. Quizon, Ernesto E. S. Villalon, Beatriz P. Quiambao, Mario Baquilod, Leda Hernandez, Louise Taylor, Louis H. Nel · 发表于：PLoS ONE · 年份：2018 · DOI：10.1371/journal.pone.0199186 · 被引用次数：22 · 研究领域：Rabies epidemiology and control、Zoonotic diseases and public health、Venomous Animal Envenomation and Studies

BACKGROUND: The Philippine government has an extensive network of 513 Animal Bite Treatment Centers (ABTCs) to supply rabies post exposure prophylaxis (PEP), reaching over 1 million bite victims in 2016. The network was evaluated using a review of existing national and provincial data, key informant interviews and surveys in sample ABTCs to determine the cost-effectiveness of this network in preventing human rabies deaths. METHODOLOGY AND PRINCIPAL FINDINGS: One urban and one rural ABTC in each of three selected provinces were studied in more detail. PEP delivery generally followed national guidance based on best practices, but there was evidence of operational challenges in supplying all ABTCs with adequate biologics and recently trained staff. Funding was contributed by different levels of government and in some clinics, patients paid for a significant fraction of the total cost. From a health provider perspective including both fixed and variable costs, the average PEP course delivered cost USD 32.91 /patient across urban ABTCs (with higher patient throughput) and USD 57.21 /patient across rural ABTCs. These costs suggests that PEP provision in the Philippines cost USD 37.6 million in 2016, with a cost per life saved of USD 8,290. An analysis of the 2,239 suspected rabies deaths from 2008 to 2016 showed no significant decline, and from 2014-16 an average of 8,534 years of life were lost annually. The incidence of rabies deaths from 2014-16 was not clearly related to the pr...