Cost effectiveness analysis of antenatal HIV screening in United Kingdom

ObjectiveTo assess the cost effectiveness of universal antenatal HIV screening compared with selective screening in the United Kingdom.DesignIncremental cost effectiveness analysis relating additional costs of screening to life years gained. Maternal and paediatric costs and life years were combined.SettingUnited Kingdom.ResultsOn base case assumptions, a new diagnosis of a pregnant woman with HIV results in a gain of 6.392 life years and additional expenditure of £14 833. If decision makers are prepared to pay up to £10 000 for an additional life year, this would imply a net benefit of £49 090 (range £12 300-£59 000), which would be available to detect each additional infected woman in an antenatal screening programme. In London, universal antenatal screening would be cost effective compared with a selective screening under any reasonable assumptions about screening costs. Outside London, universal screening with uptake above 90% would be cost effective with a £0.60 HIV antibody test cost and up to 3.5 minutes for pretest discussion. Cost effectiveness of universal testing is lower if selective testing can achieve high uptake among those at higher risk. A universal strategy with only 50% uptake may not be less cost effective in low prevalence districts and may cost more and be less effective than a well run selective strategy.ConclusionsUniversal screening with pretest discussion should be adopted throughout the United Kingdom as part of routine antenatal care as long as test costs can be kept low and uptake high.

Key messages

• In 1997 only 13% of undiagnosed HIV infection in pregnant women was picked up on antenatal testing, resulting in many preventable paediatric infections
• Assuming NHS willingness to pay £10 000 per life year gained, universal testing would be much more cost effective than selective testing throughout London on any reasonable assumptions on costs, prevalence, and uptake of testing
• Outside London, universal testing would also be cost effective, even allowing 2-4 minutes for pretest discussion, provided that test costs were no more than £0.60 and uptake exceeded 90%
• Low cost tests could be achieved by pooling antenatal sera or centralisation of testing
• Universal testing with uptake of 50% may be less cost effective than a well run selective programme

     

Economic Cost of Campylobacter,Norovirus and Rotavirus Disease in the United Kingdom

Objectives

To estimate the annual cost to patients, the health service and society of infectious intestinal disease (IID) from Campylobacter, norovirus and rotavirus.

Design

Secondary data analysis.

Setting

The United Kingdom population, 2008–9.

Main outcome measures

Cases and frequency of health services usage due to these three pathogens; associated healthcare costs; direct, out-of-pocket expenses; indirect costs to patients and caregivers.

Results

The median estimated costs to patients and the health service at 2008–9 prices were: Campylobacter £50 million (95% CI: £33m–£75m), norovirus £81 million (95% CI: £63m–£106m), rotavirus £25m (95% CI: £18m–£35m). The costs per case were approximately £30 for norovirus and rotavirus, and £85 for Campylobacter. This was mostly borne by patients and caregivers through lost income or out-of-pocket expenditure. The cost of Campylobacter-related Guillain-Barré syndrome hospitalisation was £1.26 million (95% CI: £0.4m–£4.2m).

Conclusions

Norovirus causes greater economic burden than Campylobacter and rotavirus combined. Efforts to control IID must prioritise norovirus. For Campylobacter, estimated costs should be considered in the context of expenditure to control this pathogen in agriculture, food production and retail. Our estimates, prior to routine rotavirus immunisation in the UK, provide a baseline vaccine cost-effectiveness analyses.     

A model of kin-migration in plants

Summary Migrants between plant populations may represent a random sample of the donor population or may be related, being identical in the extreme. There is considerable potential for kin-structured migration in many plant species through the co-dispersal of seeds from single individuals. Through simulation experiments we have shown that the greater the level of relatedness of migrants, the less a given level of migration counterbalances the effect of genetic drift among populations.     

The Cost of Being Bright

Male ornaments are predicted to be a signal of the genetic quality of a male but often the relationship between ornaments and the physiological performances of males is unclear. Males of Metichnogaster cillipennis, a hover-wasp, during their courtship flights send luminous signals to females by using two abdominal reflectors. Malpighian tubules, an essential organ in the physiology of insects, participate in the building of the larger of these reflectors but at a physiological cost. By evaluating the capacity of light reflection from males during their courtship, females can assess directly the physiological quality of males.     

Presymptomatic testing for Huntington's disease in the United Kingdom. The United Kingdom Huntington's Disease Prediction Consortium.

OBJECTIVE--To evaluate the United Kingdom Huntington''s disease presymptomatic testing programme. DESIGN--Postal questionnaire survey to collect data on all tests performed by clinical genetics centres between 1987 and 1990. SETTING--Genetic centres providing presymptomatic testing in the United Kingdom. SUBJECTS--248 subjects at risk of Huntington''s disease who had presymptomatic testing at their request. MAIN OUTCOME MEASURES--Sex, age, prior risk, and risk after testing. RESULTS--The risk of carrying the Huntington disease gene was reduced for 151 (61%) of the applicants and raised for 97 (39%). 158 (64%) of the subjects were female and 90 (36%) male. The median age at which the results were given was 32.5 years. CONCLUSIONS--The demand for testing was lower than expected and may have reached its peak in 1990. The excess of low risk results was not fully explained by the age effect. All the genetics centres concerned have agreed a common service protocol which requires extensive pre-test counselling and post-test follow up. The worth of the procedure remains to be decided. The availability of a large body of pooled data from all the United Kingdom testing centres, which individually are likely to have only a few results, will form a valuable resource for monitoring the long term psychosocial impact of testing.     

The early Aptian transgression event in the United Kingdom

In the United Kingdom the base of the Aptian transgression is located at the base of the Perna Beds (on the Isle of Wight), although recent work on the magnetostratigraphy has indicated that this dating may be in error. Micropalaeontological work on the Isle of Wight sections has shown that the Perna Beds represent a complex event at the transition from a non‐marine to a marine succession. Foraminiferal and palynological data agree on this transition, although no biostratigraphically diagnostic taxa are present. The base of the Aptian is tentatively moved downwards to the level of the Barnes, High Sandstone Member (Vectis Formation). If correct, this realignment of the boundary would necessitate a revision of many stratigraphic ranges and diversity calculations.     

Economic and greenhouse gas costs of Miscanthus supply chains in the United Kingdom

Miscanthus has been identified as one of the most promising perennial grasses for renewable energy generation in Europe and the United States [Mitigation and Adaptation Strategies for Global Change 9 (2004) 433]. However, the decision to use Miscanthus depends to a considerable degree on its economic and environmental performance [Soil Use and Management 24 (2008) 235; Renewable and Sustainable Energy Reviews 13 (2009) 1230]. This article assessed the spatial distribution of the economic and greenhouse gas (GHG) costs of producing and supplying Miscanthus in the UK. The average farm‐gate production cost of Miscanthus in the UK is estimated to be 40 £ per oven‐dried tonne (£ odt^?1), and the average GHG emissions from the production of Miscanthus are 1.72 kg carbon equivalent per oven‐dried tonnes per year (kg CE odt^?1 yr^?1). The production cost of Miscanthus varies from 35 to 55 £ odt^?1 with the lowest production costs in England, Wales and Northern Ireland, and the highest costs in Scotland. Sensitivity analysis shows that yield of Miscanthus is the most influential factor in its production cost, with precipitation the most crucial input in determining yield. GHG emissions from the production of Miscanthus range from 1.24 to 2.11 kg CE odt^?1 yr^?1. To maximize the GHG benefit, Miscanthus should be established preferentially on croplands, though other considerations obviously arise concerning suitability and value of the land for food production.     

The Black Rat Rattus rattus in the United Kingdom in 1989

The loss of ground by the Black Rat in the late 1950s continued through the next decade. Since then the number of site records has fluctuated and there has been less constancy in the places recording the presence of the rat. This impermanence of populations together with their small size suggests that introductions are short lived and that the species has only a tenuous foothold in the United Kingdom today. Port records show that rats are still arriving regularly by ship and it is suggested that future developments in climate and trade might further assist entry and make the environment more favourable for the Black Rat.     

Surveillance of AIDS in the United Kingdom.

The surveillance of cases of the acquired immune deficiency syndrome (AIDS) in the United Kingdom is described and a preliminary analysis made of the 1012 cases that were reported to the end of August 1987. Homosexuals were the largest risk group. For the first time it is possible to present cases by the date of diagnosis and by the regional health authority of residence. The rate of increase of new cases shows no sign of slowing down. One third of patients with AIDS lived in a different regional health authority from that in which their disease had been diagnosed. The geographical distribution varied with the risk group. The commonest presenting clinical feature at diagnosis was Pneumocystis carinii pneumonia. Kaposi''s sarcoma was considerably more common among homosexuals than among people in other groups at risk.     

The process of ethnogenesis among Haitian and Israeli immigrants in the United States

This article examines the process of ethnic identity formation among two different groups of recent immigrants to the United States: secular kibbutz‐born Israelis and middle‐class Haitians. While the two groups are different in a number of ways, they share an ambivalence with the identities that American society would assign to them ‐ as Jews and blacks respectively. By contrasting these two case studies we identify the role of the ‘proximal host’, the category to which the immigrants would be assigned following immigration. The determination of the ultimate definition of the ethnic identities of these immigrants is a result of the interaction of the conception of identity the immigrants bring with them from their countries of origin, the definitions and reactions of the proximal host group, and the overall ordering and definitions of American society. The ambivalence of both groups of immigrants towards their post‐immigration identities is a result of both macro‐forces determining the definition of categories and micro‐forces of individual choice. In conclusion we show that because of the primacy of race in American society, Israelis are likely to face many more options in the determination of their identities, than are Haitians, although they both face a similar structural dilemma.     

The development of butterfly indicators in the United Kingdom and assessments in 2010

The United Kingdom (UK) Government has national and international commitments to tackle the rate of biodiversity loss by 2010. Biodiversity indicators are used to measure and communicate progress in meeting these commitments. From 2005 onwards, butterflies have been adopted as Governmental biodiversity indicators in England, Scotland and for the UK as a whole. The indicators are compiled using butterfly abundance data collected through the UK Butterfly Monitoring Scheme, at a network of site established from 1976 onwards. The indicators show that butterfly numbers have fluctuated considerably from year-to-year, though analysis of the underlying smoothed multi-species trends for (habitat) ??specialist?? species show significant long-term declines in each country since the 1970s. Trends in wider countryside ??generalist?? species vary at the country-level from little or no overall change in Scotland and across the UK, to declines over selected years in England. Comparisons of changes in butterfly abundance before and after the 2010 target was set in 2002 suggest that the rate of decline at the UK-level is increasing for specialist species. In spite of large amounts of investment since 2000 to improve the habitat condition of protected areas, the trend for butterfly populations is no different in protected areas compared to elsewhere. Analysis by policy sector in England, shows that butterflies are declining rapidly in both forestry land and farmland, although in the latter habitat type, improvements are being seen on land entered into agri-environment schemes. We conclude by assessing the extent to which butterflies may represent broader biodiversity and help inform and evaluate conservation policy.