Cost effectiveness analysis of school based Mantoux screening for TB in Central Sydney, CHERE Discussion Paper No 37

A cost effectiveness analysis of differing school based TB infection screening regimes was conducted for 1996 populations of Year 1 and Year 8 students who attended schools in the areas of Central Sydney Area Health Service and South Western Sydney Area Health Service. The costs of screening would be partially offset by savings in future costs of treating adult cases of TB disease. Screening the high risk group of Year 8 students was found to be the most cost effective screening option. The cost per case prevented and the cost per death prevented were comparable with other health programs which are judged to be ?value for money?. Screening Year 1 students was found to be not as effective nor as cost effective. Universal screening would prevent more cases of adult TB disease than targeted screening but at a relatively high cost per case.TB, cost effectiveness, school based screening

INF2 promotes the formation of detyrosinated microtubules necessary for centrosome reorientation in T cells

T cell antigen receptor-proximal signaling components, Rho-family GTPases, and formin proteins DIA1 and FMNL1 have been implicated in centrosome reorientation to the immunological synapse of T lymphocytes. However, the role of these molecules in the reorientation process is not yet defined. Here we find that a subset of microtubules became rapidly stabilized and that their α-tubulin subunit posttranslationally detyrosinated after engagement of the T cell receptor. Formation of stabilized, detyrosinated microtubules required the formin INF2, which was also found to be essential for centrosome reorientation, but it occurred independently of T cell receptor-induced massive tyrosine phosphorylation. The FH2 domain, which was mapped as the INF2 region involved in centrosome repositioning, was able to mediate the formation of stable, detyrosinated microtubules and to restore centrosome translocation in DIA1-, FMNL1-, Rac1-, and Cdc42-deficient cells. Further experiments indicated that microtubule stabilization was required for centrosome polarization. Our work identifies INF2 and stable, detyrosinated microtubules as central players in centrosome reorientation in T cellsThis work was supported by grants BFU2009-07886 and CONSOLIDER COAT CSD2009-00016 to M.A. Alonso, and BFU2011-22859 to I. Correas (all of them from the Ministerio de Economía y Competitividad, Spain), and grant S2010/BMD-2305 from the Comunidad de Madrid to I. Correa

Child care outcomes: economic perspectives and issues

Economics starts with the observation of widespread scarcity and the consequent need for choices about resource allocation. Common criteria for such choices are economy, effectiveness, efficiency and equity. This paper defines these criteria and locates them within a conceptual framework (the 'production of welfare'). It also examines some of the reasons for the growth in interest in them. The main modes of evaluation - cost-benefit, cost-effectiveness, cost-utility and cost-consequences analyses - are described and illustrated. Few such evaluations have been conducted in child care, and the paper ends with speculation as to why this is so

Mental health care in London: costs

The costing element of this study set out to establish the cost implications of existing mental health service provision in London, and to compare these derived costs to the costs associated with predicted service requirements. Rather than attempting to break down the budgetary allocations of mental health purchasers and providers, we employed a 'bottom-up' approach to service costing. The methodology that we employed was to use the best available estimates of service activity in each locality, to which we applied unit costs. For inpatient and residential mental health services, we used the PRiSM survey of London boroughs to estimate current service activity and the Mental Illness Needs Index (MM) to estimate predicted service requirements (both described in detail in Chapter 7 of this report). For day and community mental health services, estimates of locality-specific levels of (current and predicted) provision were unavailable. We therefore attached unit cost estimates to an indicative range of alternative service configurations. With respect to inpatient hospital and residential care, we find: total costs associated with current service activity (as measured by the PRiSM survey) across all London boroughsamounts to £315 million. A further £20 million is estimated for some missing service activity data for medium secure beds and residential places, giving an adjusted total of £335 million. By comparison, total costs associated with predicted service requirements (as measured by MM) reach an estimated £391 million. Consequently, the costs associated with current inpatient and residential provision are £56 million less than those associated with predicted service requirements. This negative differential indicates large-scale underprovision, and is particularly apparent in inner London boroughs (nine out of 13 boroughs are estimated on this basis to have negative differentials, seven in excess of £2.5 million per annum). Over and above inpatient hospital and residential care, there are additional elements of a comprehensive mental healthservice (including day hospital and day care services, sheltered employment/work schemes and community mental health teanis). The total costs of these day and community inental health care services are not known, due to lack of data. This means we cannot establish any possible differential in these areas. However, the potential costs of these services are estimated to be between £136-267 million. These are unsubstantiated (and therefore uncertain) range estimates, but demonstrate the very considerable cost implications of providing a comprehensive range of inental health services throughout the capital

Uses of old long-stay hospital buildings

Closing old psychiatric and learning disability hospitals was promoted in the interest of patients' quality of life and normalisation. However, it was also hoped that re-using (or selling) the sites could help the development of a span of good mental health services in the community, which could ease the pressure on acute hospital beds. We identified the 206 largepsychiatric and learning disability hospitals with over 100 beds in 1962 and 1986 respectively. In August 1996 National Health Service regional executives were sent questionnaires, one per site, asking for summary information on closure dates, current use of hospital sites and difficulties relating to the sale of sites. Half of the land on sites no longer in use was vacant. Each vacant site generates maintenance costs, but these pale in comparison to the likely opportunity costs measured in terms of the health and community care services that could be provided with the resources released by selling or reusing vacant sites. If the future development of community mental health care is even partly dependent on the release of resources from asylum sites, we could be in for a long wait

Costs of Bipolar Disorder

Bipolar disorder is a chronic affective disorder that causes significant economic burden to patients, families and society. It has a lifetime prevalence of approximately 1.3%. Bipolar disorder is characterised by recurrent mania or hypomania and depressive episodes that cause impairments in functioning and health-related quality of life. Patients require acute and maintenance therapy delivered via inpatient and outpatient treatment. Patients with bipolar disorder often have contact with the social welfare and legal systems; bipolar disorder impairs occupational functioning and may lead to premature mortality through suicide. This review examines the symptomatology of bipolar disorder and identifies those features that make it difficult and costly to treat. Methods for assessing direct and indirect costs are reviewed. We report on comprehensive cost studies as well as administrative claims data and program evaluations. The majority of data is drawn from studies conducted in the US; however, we discuss European studies when appropriate. Only two comprehensive cost-of-illness studies on bipolar disorder, one prevalence-based and one incidence-based, have been reported. There are, however, several comprehensive cost-of-illness studies measuring economic burden of affective disorders including bipolar disorder. Estimates of total costs of affective disorders in the US range from $US30.4-43.7 billion (1990 values). In the prevalence-based cost-of-illness study on bipolar disorder, total annual costs were estimated at$US45.2 billion (1991 values). In the incidence-based study, lifetime costs were estimated at $US24 billion. Although there have been recent advances in pharmacotherapy and outpatient therapy, hospitalisation still accounts for a substantial portion of the direct costs. A variety of outpatient services are increasingly important for the care of patients with bipolar disorder and costs in this area continue to grow. Indirect costs due to morbidity and premature mortality comprise a large portion of the cost of illness. Lost workdays or inability to work due to the disease cause high morbidity costs. Intangible costs such as family burden and impaired health-related quality of life are common, although it has proved difficult to attach monetary values to these costs.Affective-disorders, Antipsychotics, Bipolar-disorders, Cost-of-illness, Mood-stabilisers, Pharmacoeconomics