One study which examined the immunization of persons 25 to 65 years of age-found benefit-cost ratios ranging from 2:1 to 5:1 for two types of workers over a five-year period. A study by the Congressional Office of Technology Assessment found that vaccination of persons at high risk was more cost effective than vaccination of the general populations. Hepatitis B: Cost-effectiveness analyses for hepatitis B vaccine which only became available in June 1982-have been undertaken for different vaccination strategies in different population groups. The results are quite speculative, however, because the vaccine is so new. One study found that for a "medium-risk" population--surgical residents in hospitals-the least costly approach was to vaccinate the entire target group. Vaccines in Developing Countries In Report 3, John G. Haaga of Cornell University reviewed the literature of some 20 cost-effectiveness studies of immunization programs in developing countries and concluded that the programs substantially improved public health and economic welfare. One study showed that benefits were 33 times costs for measles immunization in Yaounde, Cameroon (a benefit-cost ratio of 33:1). Other results found benefit-cost ratios of 2:1 for tuberculosis in India, 3.3:1 for tuberculosis and DPT prevention in Indonesia and 9:1 for tetanus in Haiti. The cost of vaccines, Haaga emphasized, constituted only a small part of total costs. Delivery costs were the largest. The cost per immunization ranged from a few cents to more than $20, with much of the variation attributable to differences in the number of persons immunized and in health-care infrastructures. Generally, the studies were limited by lack of complete data showing the extent to which immunization programs succeeded in reducing the incidence of disease and mortality. As Haaga reported, however, the available data demonstrate that immunization programs substantially improved the health of people in developing countries. REVIEW OF LITERATURE ON COST-EFFECTIVENESS OF PHARMACEUTICALS (Report 4) In Report 4, Judith L. Wagner, Director of Technology Research Associates, reviewed the literature on the cost-effectiveness of major classes of drugs for which such analyses had been done. A summary of her findings follows. Anti-Microbial Therapy Two kinds of studies were reviewed in this drug class: (1) studies evaluating the prophylactic use of antibiotic therapy in higher-risk groups, and (2) those considering the cost-effectiveness of alternative settings for antibiotic therapy. Antibiotics in Prophylaxis: The prophylactic use of antibiotics shortly before or after surgery is a particularly appropriate subject for cost-effectiveness evaluation. That is because of the potential for savings in hospital costs and physician office visits, and because of the potential for reducing a patient's pain and possibly saving the patient's life. Clinical evidence clearly demonstrated that there is a significant reduction in surgery-related infections with the prophylactic use of antibiotics, but more economic evaluations are needed. The limited economic data also suggested that post-surgery antibiotics saved costs in some situations. For patients with uncomplicated but recurrent urinary tract infections, the prophylactic use of antibiotics may well save more than the costs of such use. In one study of the prophylactic use of antibiotics, for example, the average annual cost of preventing urinary tract infections was found to be $85 per patient, compared to $126 for treating infections-a saving of 33 percent. Alternative Settings of Care: Some serious bacterial infections require extended antibiotic therapy administered intravenously. Because of the difficulty of administration, the therapy often is given in a hospital and may be the only reason a patient is hospitalized. Two small uncontrolled studies of home antibiotic programs suggested that third-party reimbursement for such programs would be cost-effective. These small programs, moreover, probably understated the potential savings from home intravenous therapy because savings likely would increase as the number of participating patients rises. Anti-Tuberculosis Drugs Pulmonary tuberculosis--once a major killer in the United States is a relatively rare and curable infectious disease in this country. As late as 1950, the death rate from tuberculosis in the United States was 22.5 per 100,000 people. By 1980, the rate had declined to less than 1 per 100,000. This dramatic improvement is due at least in part to the development of effective preventive and therapeutic drugs. A succession of chemotherapeutic agents has proven effective against tuberculosis since 1948, when the efficacy of combined anti-microbial chemotherapy was demonstrated in Great Britain. This success provides strong evidence that tuberculosis chemotherapy in patients with the disease is well worth its costs. Drug therapy is an undisputed bargain when the low cost of most anti-microbial drugs is compared to the cost of other therapeutic approaches, such as long-term hospitalization. Anti-Ulcer Drugs The introduction of a new medicine to treat peptic ulcer diseaserelatively common illness-shows dramatically how health-care costs can be reduced by the development of a single drug. In 1976, peptic ulcers accounted for the hospitalization of 620,000 Americans which is about 175 such cases per 100,000 people. More than 25 percent of the patients who were hospitalized required surgery, the treatment of last resort for ulcer disease. In 1975, the total cost of this disease in the United States was about $2 billion. In August 1977, a new drug-cimetidine was approved for use in the United States for the short-term treatment of duodenal ulcers. Clinical evidence has demonstrated that cimetidine helps heal ulcers. The major |