Objective: To determine the hospital cost of caring for newborn infants with congenital syphilis.
Study Population: All live-born singleton neonates with birth weight greater than 500 gm at an inner-city municipal hospital in New York City in 1989.
Methods: We compared the characteristics of 114 infants with case-compatible congenital syphilis with those of 2906 infants without syphilis. Cost estimates were based on New York State newborn diagnosis-related groups (DRG) reimbursements adjusted for length of stay, birth weight, preterm delivery, and selected maternal risk factors, including infection with the human immunodeficiency virus, cocaine use during pregnancy, and history of injected drug use.
Results: For infants with congenital syphilis, the unadjusted mean cost ($11,031) and the median cost ($4961) were more than three times larger than those for infants without syphilis (p 0.01). After adjustment, congenital syphilis was associated with an additional length of hospitalization of 7 1/2 days and an additional cost of $4690 (both p 0.01) above mean study population values (7.13 days, $3473).
Conclusions: Based on the number of reported cases (1991 to 1994), the average annual national cost of treating infants with congenital syphilis is approximately $18.4 million (1995 dollars). This estimate provides a benchmark to assess the cost-effectiveness of strategies to prevent, diagnose, and treat the disease.
The renewed American debate over ballistic missile defenses (BMD) echoes loudly in NATO, in Europe, and in France. This issue will be decisive for the future of European political organization and its security and defense. The issue will also be important for the future of relations between Europe, the United States, and Russia.
Faced with the potential threat of ballistic missiles equipped with nuclear warheads (or biological and chemical payloads) that could strike French and European territories, deterrence is sufficient and offers the greatest cost-effectiveness. In this analysis, the question of the broadening of the French and British deterrent and the political organization of a possible European anti-missile defense system will be discussed. Then, a new transatlantic strategic partnership, the robustness of which lies in counterbalancing the vulnerabilities of its members, will be described.
Evidence-Based Medicine 1996 Jul-Aug;1:158. Comment on Javitt JC, Aiello LP. Cost-effectiveness of detecting and treating diabetic retinopathy
A unique, in-depth discussion of the uses and conduct of cost-effectiveness analyses (CEAs) as decision-making aids in the health and medical fields, Cost-Effectiveness in Health and Medicine is the product of over two years of comprehensive research and deliberation by a multi-disciplinary panel of economists, ethicists, psychometricians, and clinicians. Exploring cost-effectiveness in the context of societal decision-making for resource allocation purposes, this volume proposes that analysts include a "reference-case" analysis in all CEAs designed to inform resource allocation and puts forth the most explicit set of guidelines (together with their rationale) ever defined on the conduct of CEAs. Important theoretical and practical issues encountered in measuring costs and effectiveness, evaluating outcomes, discounting, and dealing with uncertainty are examined in separate chapters. Additional chapters on framing and reporting of CEAs elucidate the purpose of the analysis and the effective communication of its findings.
Cost-Effectiveness in Health and Medicine differs from the available literature in several important aspects. Most importantly, it represents a consensus on standard methods. Standardization is particularly important for CEA, since its principal goal, only partly realized to date, is to permit comparisons of the costs and health outcomes of alternative ways of improving health. The second major contribution of this book is the detailed level at which the discussion is offered. Guidelines in journal literature and in CEA-related books tend to be rather general, to the extent that the analyst is left with little guidance on specific matters. Thirdly, this volume is differentiated by a detailed discussion of the theoretical background underlying areas of controversy and the implications of methodological alternatives. Finally, the study is written with a wider audience in mind, since it is not limited , for instance, to pharmaceutical analysts, physicians or any other interest subgroup. Intended primarily for analysts in medicine and public health who wish to improve practice and comparability of CEAs, this book will also be of interest to decision-makers in government, managed care, and industry who wish to consider the roles and limitations of CEA and become familiar with the criteria for evaluating these studies.