A cost-benefit analysis of programmatic use of CVD 103-HgR live oral cholera vaccine in a high-risk population.

BACKGROUND: Cholera spread to Latin America in 1991; subsequently, cholera vaccination was considered as an interim intervention until long-term solutions involving improved water supplies and sanitation could be introduced. Three successive summer cholera outbreaks in northern Argentina and the licensing of the new single-dose oral cholera vaccine, CVD 103-HgR, raised questions of the cost and benefit of using this new vaccine. METHODS: This study explored the potential benefits to the Argentine Ministry of Health of treatment costs averted, versus the costs of vaccination with CVD 103-HgR in the relatively confined population of northern Argentina affected by the cholera outbreaks. Water supplies and sanitation in this area are poor but a credible infrastructure for vaccine delivery exists. RESULTS: In our cost-benefit model of a 3-year period (1992-1994) with an annual incidence of 2.5 case-patients per 1000 population and assumptions of vaccine efficacy of 75% and coverage of 75%, vaccination of targeted high risk groups would prevent 1265 cases. CONCLUSION: Assuming a cost of US$602 per treated case and of US$1.50 per dose of vaccine, the total discounted savings from use of vaccine in the targeted groups would be US$132,100. The projected savings would be altered less by vaccine coverage (range 75-90%) or efficacy (60-85%) changes than by disease incidence changes. Our analysis underestimated the true costs of cholera in Argentina because we included only medical expenditures; Indirect losses to trade and tourism had the greatest economic impact. However, vaccination with CVD 103-HgR was still cost-beneficial in the base case.

Statistical molecular model for hydrated peptides. Application to angiotensin II analogs.

A statistical molecular model for hydrated peptides is used to stimulate the behaviour of various peptide chains in aqueous solution. The reliability of the model is ascertained by the evolution of the characteristic ratio, Cn, for hydrophobic and hydrophilic polypeptide chains, such as, respectively, poly-Ala and poly-Ser. The comparison of computed and experimental properties related to non radiative energy transfer of angiotensin II analogs, assuming that an ensemble of conformers is a satisfactory representation of the state of these molecules in water, provides further support for the model.

Theoretical conformational analysis of enkephalin analogues related to fluorescence and n.m.r. measurements in aqueous solution.

The properties related to non-radiative energy transfer of a number of enkephalin analogues with tryptophan substituted for phenylalanine in position 4 and n.m.r. 3JNH-C alpha H coupling constants of corresponding [Phe4]-enkephalin analogues are being derived from semi-empirical conformational energy. The molecules considered contain a glycyl, a D-alanyl or an L-alanyl as second residue; two of the compounds are N-methylated at position 4 or 5. The [Trp4]-enkephalin analogues and the corresponding [Phe4]-enkephalin analogues display nearly parallel affinities in the opiate receptor binding assay (Schiller et al. (1). The comparison of computed and experimental properties shows that an ensemble of conformers is a satisfactory representation of the state of these molecules in water.