Cost effectiveness analysis of clinically driven versus routine laboratory monitoring of antiretroviral therapy in Uganda and Zimbabwe.

BACKGROUND: Despite funding constraints for treatment programmes in Africa, the costs and economic consequences of routine laboratory monitoring for efficacy and toxicity of antiretroviral therapy (ART) have rarely been evaluated. METHODS: Cost-effectiveness analysis was conducted in the DART trial (ISRCTN13968779). Adults in Uganda/Zimbabwe starting ART were randomised to clinically-driven monitoring (CDM) or laboratory and clinical monitoring (LCM); individual patient data on healthcare resource utilisation and outcomes were valued with primary economic costs and utilities. Total costs of first/second-line ART, routine 12-weekly CD4 and biochemistry/haematology tests, additional diagnostic investigations, clinic visits, concomitant medications and hospitalisations were considered from the public healthcare sector perspective. A Markov model was used to extrapolate costs and benefits 20 years beyond the trial. RESULTS: 3316 (1660LCM;1656CDM) symptomatic, immunosuppressed ART-naive adults (median (IQR) age 37 (32,42); CD4 86 (31,139) cells/mm(3)) were followed for median 4.9 years. LCM had a mean 0.112 year (41 days) survival benefit at an additional mean cost of $765 [95$7386 [3277,dominated] per life-year gained and $7793 [4442,39179] per quality-adjusted life year gained. Routine toxicity tests were prominent cost-drivers and had no benefit. With 12-weekly CD4 monitoring from year 2 on ART, low-cost second-line ART, but without toxicity monitoring, CD4 test costs need to fall below$3.78 to become cost-effective (<3xper-capita GDP, following WHO benchmarks). CD4 monitoring at current costs as undertaken in DART was not cost-effective in the long-term. CONCLUSIONS: There is no rationale for routine toxicity monitoring, which did not affect outcomes and was costly. Even though beneficial, there is little justification for routine 12-weekly CD4 monitoring of ART at current test costs in low-income African countries. CD4 monitoring, restricted to the second year on ART onwards, could be cost-effective with lower cost second-line therapy and development of a cheaper, ideally point-of-care, CD4 test

A-D-E Quivers and Baryonic Operators

We study baryonic operators of the gauge theory on multiple D3-branes at the tip of the conifold orbifolded by a discrete subgroup Gamma of SU(2). The string theory analysis predicts that the number and the order of the fixed points of Gamma acting on S^2 are directly reflected in the spectrum of baryonic operators on the corresponding quiver gauge theory constructed from two Dynkin diagrams of the corresponding type. We confirm the prediction by developing techniques to enumerate baryonic operators of the quiver gauge theory which includes the gauge groups with different ranks. We also find that the Seiberg dualities act on the baryonic operators in a non-Abelian fashion.Comment: 46 pages, 17 figures; v2: minor corrections, note added in section 1, references adde

Interrogating race: color, racial categories, and class across the Americas

We address long-standing debates on the utility of racial categories and color scales for understanding inequality in the United States and Latin America, using novel data that enable comparisons of these measures across both broad regions. In particular, we attend to the degree to which color and racial category inequality operate independently of parental socioeconomic status. We find a variety of patterns of racial category and color inequality, but that in most countries accounting for maternal education changes our coefficients by 5% or less. Overall, we argue that several posited divergences in ethnoracial stratification processes in the United States, compared with Latin America, might be overstated. We conclude that the comparison of the effects of multiple ethnoracial markers, such as color and racial categories, for the analysis of social stratification holds substantial promise for untangling the complexities of “race” across the Americas

Minimum target prices for production of direct acting antivirals and associated diagnostics to combat Hepatitis C Virus

Combinations of direct-acting antivirals (DAAs) can cure hepatitis C virus (HCV) in the majority of treatment-naïve patients. Mass treatment programs to cure HCV in developing countries are only feasible if the costs of treatment and laboratory diagnostics are very low. This analysis aimed to estimate minimum costs of DAA treatment and associated diagnostic monitoring. Clinical trials of HCV DAAs were reviewed to identify combinations with consistently high rates of sustained virological response across hepatitis C genotypes. For each DAA, molecular structures, doses, treatment duration, and components of retrosynthesis were used to estimate costs of large-scale, generic production. Manufacturing costs per gram of DAA were based upon treating at least 5 million patients per year and a 40% margin for formulation. Costs of diagnostic support were estimated based on published minimum prices of genotyping, HCV antigen tests plus full blood count/clinical chemistry tests. Predicted minimum costs for 12-week courses of combination DAAs with the most consistent efficacy results were: US$122 per person for sofosbuvir+daclatasvir; US$152 for sofosbuvir+ribavirin; US$192 for sofosbuvir+ledipasvir; and US$115 for MK-8742+MK-5172. Diagnostic testing costs were estimated at US$90 for genotyping US$34 for two HCV antigen tests and US$22 for two full blood count/clinical chemistry tests. Conclusions: Minimum costs of treatment and diagnostics to cure hepatitis C virus infection were estimated at US$171-360 per person without genotyping or US$261-450 per person with genotyping. These cost estimates assume that existing large-scale treatment programs can be established. (Hepatology 2015;61:1174–1182

Are sciences essential and humanities elective? Disentangling competing claims for humanities research public value

[EN] Recent policy discourse suggests that arts and humanities research is seen as being less useful to society than other disciplines, notably in science, technology, engineering and mathematics. The paper explores how this assumption s construction has been built and whether it is based upon an unfair prejudice: we argue for a prima facie case to answer in assuming that arts and humanities research s lower societal value. We identify a set of claims circulating in policy circles regarding science, technology, engineering and math- ematics research and arts and humanities research s differences. We find two groups: arts and humanities research is less useful than science, technology, engineering and mathematics, and arts and humanities research is merely differently useful. We argue that empirical analysis is necessary to disentangle which ones are true to assess whether policy-making is being based on rational and evidence-based claims. We argue that debates about public research value should recognise that humanities have different (but equally valid) kinds of societal value.This work was supported by the Spanish Ministry of Education, which funded the PhD research fellowship of Julia Olmos Peñuela through the F.P.U program [AP2007- 01850]. The research fellowship took place in the framework of the HERAVALUE project, Measuring the public value of arts and humanities research, financially supported by the HERA Joint Research Programme, cofunded by AHRC, AKA, DASTI, ETF, FNR, FWF, HAZU, IRCHSS, MHEST, NWO, RANNIS, RCN, VR and The European Community FP7 2007-2013, under the Socio-economic Sciences and Humanities programme. The authors would like to thank the editors and two anonymous referees for their invaluable comments. Any errors or omissions remain the authors’ responsibilitieOlmos-Peñuela, J.; Benneworth, P.; Castro-Martínez, E. (2015). Are sciences essential and humanities elective? Disentangling competing claims for humanities research public value. Arts and Humanities in Higher Education. 14(1):61-78. https://doi.org/10.1177/1474022214534081S617814

Families and Children Strategic Analysis Programme (FACSAP): Reviewing approaches to understanding the link between childcare use and mothers' employment

This report was commissioned through the Department for Work and Pensions' Families and Children Strategic Analysis Programme (FACSAP). It examines methods that could potentially be used to explore the link between mothers' demand for childcare and their employment. Several approaches are examined, including: learning from evaluations of existing programmes; the scope for natural experiments and the potential for reduced form and structural modelling of key relationships. The report focuses on methodology but in doing so presents findings from existing studies in the area, most of which are from the United States

Taxonomic review of the chironomid genus Cricotopus v.d. Wulp (Diptera: Chironomidae) from Australia: keys to males, females, pupae and larvae, description of ten new species and comments on Paratrichocladius Santos Abreu

The Australian species of the Orthocladiinae genus Cricotopus Wulp (Diptera: Chironomidae) are revised for larval, pupal, adult male and female life stages. Eleven species, ten of which are new, are recognised and keyed, namely Cricotopus acornis Drayson &amp; Cranston sp. nov., Cricotopus albitarsis Hergstrom sp. nov., Cricotopus annuliventris (Skuse), Cricotopus brevicornis Drayson &amp; Cranston sp. nov., Cricotopus conicornis Drayson &amp; Cranston sp. nov., Cricotopus hillmani Drayson &amp; Cranston, sp. nov., Cricotopus howensis Cranston sp. nov., Cricotopus parbicinctus Hergstrom sp. nov., Cricotopus tasmania Drayson &amp; Cranston sp. nov., Cricotopus varicornis Drayson &amp; Cranston sp. nov. and Cricotopus wangi Cranston &amp; Krosch sp. nov. Using data from this study, we consider the wider utility of morphological and molecular diagnostic tools in untangling species diversity in the Chironomidae. Morphological support for distinguishing Cricotopus from Paratrichocladius Santo-Abreu in larval and pupal stages appears lacking for Australian taxa and brief notes are provided concerning this matter