The Value of Cost Benefit Analysis of Road Projects. Quarterly Economic Commentary Special Article, April 1985

The Government announced in the National Plan, and is now implementing, a major increase in road expenditure. One reason why this has happened is because cost benefit studies have suggested that such an increase could be justified in economic terms. The argument that cost benefit studies in some sense "justify" additional road investment has been accepted rather uncritically in recent years, and in view of its practical consequences requires closer examination. In discussing this argument I shall refer to Sean D. Barrett and David Mooney's recent cost benefit analysis of the Naas bypass, as a good recent example of such studies. There are two basic grounds for concern at the use of cost benefit analysis to support increases in road expenditure now. First, the type of justification for road investment which cost benefit analysis is able to provide is a rather specialised one. The fact that a project shows a high rate of return on a cost benefit study does not mean that our debt problems are unlikely to be made more acute by carrying out the project, or that the effect on permanent employment will necessarily be favourable, or that many other forms of public expenditure might not perform as well or better on both counts. It is doubtful whether an expansion of road investment represents an appropriate use of the very limited funds which can be assembled for expanding publicly funded activities, and we are only going to find out whether it is or not if we can develop techniques which will indicate what the likely effects of particular types of public expenditure on employment and the public finances are going to be

Perinatal HIV transmission and the cost-effectiveness of screening at 14 weeks gestation, at the onset of labour and the rapid testing of infants

<p>Abstract</p> <p>Background</p> <p>Preventing HIV transmission is a worldwide public health issue. Vertical transmission of HIV from a mother can be prevented with diagnosis and treatment, but screening incurs cost. The U.S. Virgin Islands follows the mainland policy on antenatal screening for HIV even though HIV prevalence is higher and rates of antenatal care are lower. This leads to many cases of vertically transmitted HIV. A better policy is required for the U.S. Virgin Islands.</p> <p>Methods</p> <p>The objective of this research was to estimate the cost-effectiveness of relevant HIV screening strategies for the antenatal population in the U.S. Virgin Islands. An economic model was used to evaluate the incremental costs and incremental health benefits of nine different combinations of perinatal HIV screening strategies as compared to existing practice from a societal perspective. Three opportunities for screening were considered in isolation and in combination: by 14 weeks gestation, at the onset of labor, or of the infant after birth. The main outcome measure was the cost per life year gained (LYG).</p> <p>Results</p> <p>Results indicate that all strategies would produce benefits and save costs. Universal screening by 14 weeks gestation and screening the infant after birth is the recommended strategy, with cost savings of $1,122,787 and health benefits of 310 LYG. Limitations include the limited research on the variations in screening acceptance of screening based on specimen sample, race and economic status. The benefits of screening after 14 weeks gestation but before the onset of labor were also not addressed.</p> <p>Conclusion</p> <p>This study highlights the benefits of offering screening at different opportunities and repeat screening and raises the question of generalizing these results to other countries with similar characteristics.</p

The integration of the princely state of Hyderabad and the making of the postcolonial state in India, 1948-56

This article explores the impact of the police action and the anti-communist struggle in Hyderabad on the formation of the Indian state in the first years after independence. Because of its central location and diverse cultural heritage, the absorption of the princely state of Hyderabad into the Indian Union was an important goal for Nehru's government. However, the task of bringing Hyderabad into the Union was not an easy one. As it entered Hyderabad, the government of independent India had to come to terms with the limitations of the police, military and bureaucracy, which it had inherited from the colonial state; and as it took over the governance of the state, it had to find ways to manage relations between Hindus and Muslims, even as the social order was being transformed. It also had to fight communism in the Telangana region of the state, whilst trying to ensure the loyalty of its new citizens. This article examines the ways in which India's first government confronted these complex problems. The following pages argue that these early years must be seen as a time of great dynamism, rather than as a period of stability inherited from the colonial state