Phase-out of onchocerciasis eradication begins

THE LANCET

POLICY AND PEOPLE

osts of health care are rising faster than most western economies are growing. And costs of cancer treatments are growing faster than the average costs of health care. With the ageing of populations, the continued development of new treatments, and the substantial variations in outcome of current treatment practices, the value of cancer care has been questioned. Safety and efficacy are not the only arguments to justify the introduction of new treatments. Economically, they can be justified only if the additional benefits outweigh the additional costs, or if they decrease the costs of treatment with a benefit equal to the standard therapy. That economic evaluations are of interest to a broad audience with various scientific backgrounds was demonstrated during the first European Conference of the Economics of Cancer, held in Brussels, Belgium, on Nov 19–21. Almost 300 clinicians, academic researchers, and employees of health services and the pharmaceutical industry throughout Europe and North America attended this conference, which was initiated by the Health Economics Unit of the European Organisation for Research and Treatment of Cancer (EORTC). The aim was to increase awareness and knowledge of this relatively new area of research by means of tutorial lectures, to discuss completed studies, and to exchange views. The tremendous pressure to make new treatments seem cost-effective fortunately does not hinder a critical reflection on the strengths and weaknesses of this type of research by its practitioners. The demand for good study design, with the collection and analysis of data in a consistent and scientifically rigorous fashion, cautious interpretation of results, and unbiased reporting, was emphasised repeatedly. Not only is this good scientific practice, but it is also vital since, in the words of Linda Davies of the Centre for Health Economics at York University, UK, “ . . . the consequences of biases in this type of research may lead to substantial effects in terms of resource allocation and patient and family outcomes”.

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Gwendoline Kiebert, John Hutton

Vol 350 • December 6, 1997

“Last chance” to control tuberculosis in India are infected. 2·2 million new cases of edical experts from nearly 60 tuberculosis occur each year in India medical colleges in India have —the total annual number of people called for phased and effective expanwith tuberculosis is 14 million; of sion of India’s Revised National these, 3·5 million are highly infecTuberculosis Control Programme tious. Two people become sputum (RNTCP), calling it “perhaps the positive every minute, and one only chance of controlling the emergpatient dies of tubering TB epidemic in culosis almost every India during this minute, killing more generation”. than 1000 each day. The RNTCP— Given the spread based on the of HIV in India, WHO-recommended tuberculosis—espeDirectly Observed cially multidrugTreatment, Short resistant tuberculosis Course—was initi(MDRTB)—is causated in 1993 and was ing serious concern. pilot tested in 20 sites “The current situafor 4 years. In this Time to focus on DOTS in India tion of MDRTB is pilot, eight out of ten not known because no good surveilpatients were cured compared with lance exists”, says Frieden. WHO has three out of ten in previous designed a strategy to get reliable programmes. It is now targeted to information about it. The only effeccover the entire 300 million populative way to confront MDRTB is to tion in the next 3 years. “The prevent its emergence, says Frieden. RNTCP could save more lives in “A poor TB control programme will India than any other public-health create MDRTB at a faster rate intervention in the next decade”, says than such cases can be cured, even Thomas Frieden, Medical Officer if unlimited resources are available”, (TB) of WHO in Delhi. he adds. Almost two out of every five tuberculosis cases worldwide are found in India and half of all adults Sanjay Kumar

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Panos

First European Conference counts the cost of cancer

Hepatitis-C-virus risk from Italian fertility centre t an infertility clinic and sperm bank in Florence, Italy, two gynaecologists and a biologist have been arrested, while their anaesthetist has been put under home arrest. They are charged with potentially initiating an epidemic—the sentence for which is life imprisonment—and forging medical notes. They are alleged to have used in their own centre—and sold to many other infertility-treatment centres—1000 sperm doses prepared from samples

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obtained from a donor whose sperm they apparently knew tested positive for hepatitis-C-virus (HCV) antibodies, in addition to herpes simplex and cytomegalovirus. Investigators discovered counterfeit test results for this donor’s serological status. Medical consultants for the prosecution have estimated that the risk of transmitting HCV by infertility treatment is at least 25%. Bruno Simini

Phase-out of onchocerciasis eradication begins t the African onchocerciasiseradication meeting in Liverpool, UK, Dec 1–5, Clare Short, UK Secretary of State for International Development, praised the campaign, saying, “The partnerships involved here, which bring together development donors, governments, private enterprise, and the non-governmental organisations, set a standard which others can do well to emulate”.

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Short was one of 14 donor-country ministers who signed a funding agreement for the “phasing-out” of the 11-country programme, which starts on Jan 1, 1998, and will run for 5 years. Other signatories included the World Bank, the European Union, and the Organisation of Petroleum Exporting Countries. Paul Ress

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