The cost-effectiveness of chemotherapy for pulmonary sputum smear-positive tuberculosis was examined in the national tuberculosis control programmes of Malawi, Mozambique and Tanzania. In these three programmes, routine cure rates have exceeded 80 per cent. Average, average incremental and marginal unit costs for standard, short-course and retreatment regimens with and without hospitalization have been measured. The average incremental cost per year of life saved through chemotherapy ranged from US $0.90-3.10. In all conditions, short-course chemotherapy is preferable to standard 12-month chemotherapy. When hospitalization during the intensive phase of chemotherapy increases the cure rate by 10-15 percentage points, it can be relatively cost-effective. Analysing the cost-effectiveness of short-course and standard chemotherapy, where the depth of the margin of benefit is different, illustrates some of the dangers of simplistic use of cost-effectiveness ratios.

Porcine Reproductive and Respiratory Syndrome (PRRS) infections play an important role in Porcine Respiratory Disease Complex (PRDC). The aim of this study was to evaluate the effect of implementing a PRRS MLV vaccine, as an aid to control PRDC, on the antibiotic use in piglets and fatteners. The study was performed in a wean-to-finish farm. Piglets were vaccinated upon arrival. In 2012, piglets were only vaccinated against Mycoplasma hyopneumoniae (M. hyo) with Ingelvac MycoFLEX®. As from 2013, Ingelvac® PRRS MLV was applied at the same time as the Mycoplasma hyopneumoniae (M. hyo) vaccine, at the other side of the neck. The reason for implementing the PRRS MLV vaccine were PRDC problems occurring at the end of 2012, including cough and poor performance in the nursery and fattening period. Presence of the PRRS virus was confirmed by serology. A retrospective analysis of the antibiotic use and costs was performed over a 1-year-period before implementation of PRRS vaccination, an intermediate period of 6 months (PRRS vaccinated and non-vaccinated pigs were present) and a period of 1 year in which only PRRS vaccinated pigs were present on the farm. In the period before PRRS vaccination, 18.56 g active substance/pig place/year was used, equal to an average of 29.3 daily doses/animal year. In the transition period, the antibiotic consumption equalled 20.82 g active substance/pig place/year or 33.6 daily doses/animal year. In the period after the PRRS vaccine implementation, 12.04 g active substance/pig place/year or 13.5 daily doses/animal year was used. The antibiotic costs equalled respectively 3.40€, 4.35€, 1.85€ per pig place per year in the 3 subsequent periods. Antibiotic use expressed in daily doses/animal year was reduced by 53.9% and antibiotic costs by 45.6% after implementation of PRRS vaccination compared to the period before PRRS vaccination. Furthermore, the use of antibiotics considered as highly important for human medicine (red class) was reduced with 97.4%. Besides the reduction in antibiotic use, an improvement of the technical performance of the pigs was also observed.