Cost effectiveness of the Texas wildlife rabies Border Maintenance Zone

Rabies prevention in the United States (US) relies on a robust public health infrastructure that includes pet vaccination, post-exposure prophylaxis (PEP), and wildlife surveillance, costing $245-$510 million annually but saving over $1 billion in avoided healthcare expenditures. While canine rabies has been eliminated from the US, wildlife reservoirs continue to pose a zoonotic threat, particularly bats, skunks, raccoons, and foxes. Oral rabies vaccination (ORV) programs targeting coyotes, foxes, and raccoons have demonstrated significant public health and economic benefits across multiple states, with benefit-cost ratios consistently above 1.0. In 2023, the Texas Oral Rabies Vaccination Program (TX-ORVP) reduced bait density within its ORV program's barrier maintenance zone (BMZ) to lower fixed costs. This study applies cost-effectiveness analysis (CEA) to assess whether these reductions remain economically viable under scenarios involving increased variable costs. Three scenarios were modeled: (1) enhanced surveillance without contingency actions, (2) rural incursions requiring contingency actions, and (3) comprehensive breaches involving surveillance, contingency actions, and increased PEP. Results indicate that surveillance costs could increase by up to 155% before negating savings, but any scenario requiring contingency actions renders the BMZ2023 cost-inefficient compared to pre-2023 practices. These findings underscore that while reduced bait density may appear cost-saving, heightened risk of rabies incursions can quickly erode economic sustainability. Sustained investment in wildlife rabies ORV programs is necessary for effective and efficient long-term rabies control and public health protection.