Selenium (Se) deficiency among populations in Ethiopia is consistent with low concentrations of Se in soil and crops that could be addressed partly by Se-enriched fertilisers. This study examines the disease burden of Se deficiency in Ethiopia and evaluates the cost-effectiveness of Se agronomic biofortification. A disability-adjusted life years (DALY) framework was used, considering goiter, anaemia, and cognitive dysfunction among children and women. The potential efficiency of Se agronomic biofortification was calculated from baseline crop composition and response to Se fertilisers based on an application of 10 g/ha Se fertiliser under optimistic and pessimistic scenarios. The calculated cost per DALY was compared against gross domestic product (GDP; below 1–3 times national GDP) to consider as a cost-effective intervention. The existing national food basket supplies a total of 28·2 µg of Se for adults and 11·3 µg of Se for children, where the risk of inadequate dietary Se reaches 99·1 %–100 %. Cereals account for 61 % of the dietary Se supply. Human Se deficiency contributes to 0·164 million DALYs among children and women. Hence, 52 %, 43 %, and 5 % of the DALYs lost are attributed to anaemia, goiter, and cognitive dysfunction, respectively. Application of Se fertilisers to soils could avert an estimated 21·2–67·1 %, 26·6–67·5 % and 19·9–66·1 % of DALY via maize, teff and wheat at a cost of US$129·6–226·0, US$149·6–209·1 and US$99·3–181·6, respectively. Soil Se fertilisation of cereals could therefore be a cost-effective strategy to help alleviate Se deficiency in Ethiopia, with precedents in Finland.

In a rational world, scientific effort would reflect society's needs. We tested this hypothesis using the area of infectious diseases, where the research response to emerging threats has obvious potential to save lives through informing interventions such as vaccination and prevention policies. Pathogens continue to evolve, emerge and re-emerge and infectious diseases that were once common become less so or their global distribution changes. A question remains as to whether scientific endeavours can adapt. Here, we identified papers on infectious diseases published in the four highest ranking, health-related journals over the 118 years from 1900. Focussing on outbreak-related and burden of disease-related metrics over the two time periods, 1990 to 2017 and 1900 to 2017, our analyses suggest that there is little underrepresentation of important infectious diseases among top ranked journals. Encouragingly our results suggest the scientific process is largely self-correcting.

Many economic measures are structured to reflect ethical values. I describe three attitudes towards this: maximalism, according to which we should aim to build all relevant values into measures; minimalism, according to which we should aim to keep values out of measures; and an intermediate view. I argue the intermediate view is likely correct, but existing versions are inadequate. In particular, economists have strong reason to structure measures to reflect fixed, as opposed to user-assessable, values. This implies that, despite disagreement about precisely how to do so, economists should standardly adjust QALYs and DALYs to reflect egalitarian values.

Psittacosis (infection with Chlamydia psittaci) can have diverse presentations in humans, ranging from asymptomatic infection to severe systemic disease. Awareness of psittacosis and its presentations are low among clinicians and the general public. Therefore, underdiagnosis and thereby underestimation of the incidence and public health importance of psittacosis is very likely. We used the methodology developed for the Burden of communicable diseases in Europe toolkit of the European Centre for Disease Prevention and Control, to construct a model to estimate disease burden in disability-adjusted life years (DALYs) attributable to psittacosis. Using this model, we estimated the disease burden caused by psittacosis in the Netherlands to have been 222 DALY per year (95% CI 172–280) over the period 2012–2014. This is comparable with the amount of DALYs estimated to be due to rubella or shigellosis in the same period in the Netherlands. Our results highlight the public health importance of psittacosis and identify evidence gaps pertaining to the clinical presentations and prognosis of this disease.

Canteen Takeaway is a novel concept, which entails workplace canteens to utilise existing production capacity to supply packaged meals for employees to bring home. The concept has a potential to raise the average nutritional quality of employees’ diets. The purpose of the study is to assess the economic net gains for users, and for society as a whole, of promoting healthy canteen takeaway meals, using Danish workplaces as an example. The analytical framework for the study combines direct cost analyses, users’ willingness to pay estimated through a choice experiment and cost-of-illness methods to assess the net society costs and benefits associated with an extended use of canteen takeaway meals as a health promotion strategy. The results show that employees have a positive willingness to pay for health attributes in canteen takeaway meals, but with a minority having a highly negative willingness to pay for the canteen takeaway concept. The potential health effects of a healthy canteen takeaway programme are estimated to be positive, but modest in magnitude. The estimated costs of providing healthy canteen takeaway meals exceed the sum of average direct and indirect benefits. In conclusion, healthy CTA programmes seems to be an economically sustainable intervention at some workplaces, though the analysis does not fully support a full-scale implementation of healthy CTA programmes at Danish workplaces from a welfare economic perspective.

International health care providers have flocked to Haiti and other disaster-affected countries in record numbers. Anecdotal articles often give “body counts” to describe what was accomplished, followed months later by articles suggesting outcomes could have been better. Mention will be made that various interventions were “expensive,” or not the best use of limited funds. But there is very little science to post-intervention evaluations, especially with regard to the value for the money spent. This is surprising, because a large body of literature exists with regard to the Cost Utility Analysis (CUA) of health care interventions. Applying reproducible metrics to disaster interventions will help improve performance.

This study will: (1) introduce and explain basic CUA; (2) review why the application of CUA is difficult in disaster settings; (3) consider how disasters may be unique with regard to CUA; (4) demonstrate past and theoretical utilization of CUA in disaster settings; and (5) suggest future utilization of CUA by healthcare providers in Disaster Response.

Zoraster R. Cost utility analyses in international disaster responses—where are they? Prehosp Disaster Med. 2012;27(2):1-6.

This study examines the parameters crucial to cost-effectiveness of universal hepatitis B immunization in India. An incremental cost-effectiveness analysis was done using a decision tree (Markov model) to follow up a hypothetical cohort of 100,000 newborns for the effects of hepatitis B acquired vertically at birth. The measure of effectiveness was disability-adjusted life-years gained. Uncertainty analysis and Scenario analysis were done using Latin hypercube sampling. Hepatitis B endemicity is the most important factor, followed by the cost of vaccine. Other factors of some influence are vaccination coverage, vaccine efficacy, HBeAg positivity, and vaccine wastage.