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WORLD HEALTH. 1993 Jul-Aug; 46(4):30-1.The cost to eradicate the small pox virus was US$300 million. Smallpox eradication saved millions of lives. The US spent $100 million in a few months to make sure there would be no more cyanide poisonings from pain relievers in the Chicago area, but few if any lives were saved by this effort. Many public health needs force officials to determine which health interventions are the most cost effective. The World Bank and WHO have developed a common standard with which to make health care comparisons call the disability-adjusted life year (DALY). Officials relate the costs of preventing or treating a disease to the number of healthy years of life gained by an intervention to determine cost effectiveness. The formula is more involved for infectious diseases, since treating them prevents further infections, e,g., tuberculosis (TB). The 1993 World Development Report reveals TB is among the most cost-effective diseases to control in adults older than 15 year olds. Studies in sub-Saharan Africa show that the cost of treating a TB-infected patient can be as low as $20 and never higher than $100, equalling as little as $.90 for each year of life saved. The 6-month chemotherapy regimen is the most cost-effective intervention of TB control programs. Other cost-effective interventions are the 12-month treatment and hospitalizing patients throughout treatment. As much as 40% of public health expenditures are for interventions with low cost effectiveness, e.g., heart surgery and intensive care for premature babies. Yet, critical and very cost-effective interventions, such as TB treatment, receive little funding. The Report contends that if funding of higher cost-effective health interventions increases, governments could save millions of lives and billions of dollars. TB prevention will stem the development of multidrug resistant strains of TB. If the $100 million spent in 1992 to prevent cyanide deaths could have been spent to address the emerging disease, AIDS, perhaps many people would have not been infected with HIV.
TROPICAL AND GEOGRAPHICAL MEDICINE. 1991 Jul; 43(3):S13-21.Tuberculosis (TB) has long been recognized as a complication of immune suppression. It poses a particularly major public health threat to developing countries. Many developing countries suffer high prevalence and incidence of TB infection. By suppressing host cell-mediated immunity, HIV exacerbates TB infection by helping to facilitate the transition of latent TB into active disease. Higher prevalence of active disease in population then leads to increasing rates of TB transmission. The World Bank estimates an annual incidence of greater than 7.1 million TB cases in the developing world. Cost-effective interventions have, however, been incorporated as components of national programs in Tanzania and other developing countries. The World Health Organization and World Bank are also working on new strategies to revitalize global efforts against tuberculosis. Finding TB cases early and treating them with chemotherapy are specifically recommended.
Lancet. 1992 May 9; 339(8802):1162-3.HIV infection was detected in India in 1986 in 6 female prostitutes. Current estimates are that 1 million people in India are HIV positive. The official number of AIDS cases to date is 112. In Bombay, Pune, and Madras, 33% of the prostitutes and 50% of the IV drug users have become HIV positive. There have been reports of HIV positive blood donors and new born infants with HIV. To complicate matters, India is currently experiencing a tuberculosis epidemic with 9 million cases and 500,000 deaths annually. India is receiving US$84 million from the World Bank over the next 5 years plus special WHO funding for a national AIDS prevention and control campaign.