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Swedberg et al. One Health Implement Res 2023;3:77-96 https://dx.doi.org/10.20517/ohir.2023.02 Page 91

Figure 4. Model sensitivity to uncertainty. Variation in model estimates (x-axis) of (A) annual human rabies deaths; (B) human rabies
deaths averted; (C) the percentage of rabid animals confirmed; and (D) probability of rabies exposures obtaining PEP. Model parameters
[Table 1] and data inputs that were varied in the sensitivity analysis are shown on the y-axis. Variations in estimates are not symmetrical
around the baseline estimate (vertical gray line) because the range of uncertainty examined was not symmetric distributions centered
on the baseline parameters. HDR: Human:dog ratio; PEP: post-exposure prophylaxis.

vaccine (> $41.2 million) and ERIG (> $15.3 million, assuming 15.5% of bite patients receive ERIG) each
year. Assuming 2%-3% of bites presenting to ABTCs are probable rabies exposures and utilizing DOH
national records reporting 200-300 deaths/year, we estimate that PEP prevents roughly 3,520 to 5,570 deaths
each year in the Philippines, at an average cost of $12,460 and $325 USD per death/DALY averted,
respectively. However, these estimations are conservative, considering increasing PEP-seeking behaviors
and the likelihood of underreported human deaths.

DISCUSSION
Key findings
The findings from our analysis reveal that despite an overall bite patient incidence exceeding 1,240/100,000
persons per year, the majority (> 97%) of patients who sought PEP in Oriental Mindoro had encountered
non-exposures from healthy animals. The Philippines’ national policy mandating free PEP provision and
widespread establishment of ABTCs has substantially improved PEP access, preventing an estimated
average of 29 deaths annually throughout the province. Nevertheless, even with increased availability and
accessibility, only around 73.8% of people exposed to rabies were estimated to seek PEP provincewide.
Consequently, dog-mediated rabies still precipitated 7 to 9 reported human deaths (0.77 to 0.99 per 100,000
persons/year) in Oriental Mindoro Province each year of the study.

The distribution of the human rabies burden was not uniform across the province, as evidenced by three
municipalities accounting for 16 out of 25 deaths over the 3-year duration of the study. This spatial