is at the forefront of global mangrove conservation. It is the first country to officially protect all its remaining mangrove forests and has embarked on an ambitious plan to restore 10,000 ha of wetland during the United Nations Decade of Ecosystem Restoration. One incentive for this conservation effort is a recognition, based on research mostly done elsewhere, of the importance of mangroves for carbon sequestration and storage. However, a lack of data on Sri Lankan mangrove carbon pools, especially on soil organic carbon, has been recognized as a major impediment to national climate change mitigation strategies. The current work examined both above and below-ground carbon stocks of five important mangrove forests in Sri Lanka (Rekawa, Puttalam-Kalpitiya, Pambala-Chilaw, Batticaloa and Negombo) which are situated in the three major climate zones (dry, intermediate and wet) and therefore sample the main climatic drivers of spatial variability. Above-ground carbon, below-ground root carbon and soil carbon stocks of mangroves in Sri Lanka ranged from 75.5 to 189.1 Mg C ha − 1 , 7.9 to 14.3 Mg C ha − 1 and 643.6 to 1253.6 Mg C ha − 1 , respectively. The highest total mangrove carbon stock was recorded from the Rekawa lagoon which is in the intermediate climate zone (1455.4 Mg C ha − 1 ) while the lowest was found in the Batticaloa lagoon in the dry zone (734.7 Mg C ha − 1 ). Soil carbon stocks were substantially higher in the places where vegetation biomass and stand densities are high. Soil comprised 83-90% of the total mangrove carbon stocks at all sites, highlighting the large potential for release into the atmosphere as carbon dioxide if these habitats are disturbed. Overall, our study contributes important data that broadens our current understanding of how mangrove organic carbon pools vary spatially and with climatic zone.

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estimated cost and effectiveness for four treatment strategies: 1) Standard dual therapy pegylated interferon alfa and ribavirin (PR); 2) BOCϩPR triple therapy; 3) TELϩPR triple therapy; and 4) no treatment. RESULTS: In our model, patients received 1) PR for 48 weeks; 2) TEL for 12 weeks with PR for 34-36 weeks; or 3) BOC for 29 weeks with PR for 34-36 weeks. Estimated treatment cost associated with PR alone, BOCϩPR, and TELϩPR are about $8,300, $31,000 and $45,000 per average patient, respectively. Total system-wide costs to adopt BOCϩPR or TELϩPR would be $673 million and $971 million, respectively. Assuming continuation of the current 21% VHA treatment rates and optimal SVR results, the long term reduction in liver related death from treatment PR, BocϩPR, and TelϩPR are 7.9%, 13.1%, and 14.5%, respectively. CONCLUSIONS: Our model indicates upfront investments with BOCϩPR, and TELϩPR are high, with the benefits of extending quality of life and lower costs due to liver-related morbidity. Though model projected potential cost under these assumptions, a clinical trial of comparative effectiveness would be needed to evaluate both costs and benefits of DAAs in veterans. OBJECTIVES:In Brazil, switching to a protease inhibitor (PI) based ARV regimen is recommended as second line therapy for experienced patients failing non-nucleoside reverse transcriptase inhibitors. The BMS-045 study compared ATVϩRTV and LPV/r regimens in ARV-experienced patients. Similar viral load (VL) suppression rates Ͻ400 copies were reported, but LPV/r provided greater suppression rate Ͻ50 copies. Total cholesterol (TC) levels improved to guideline levels in 23% of ATVϩRTV patients and became elevated in 7% of LPV/r patients at 48 weeks. The long term clinical and cost impact of this difference is not yet clear. The objective of this study was to examine the long term HRQL and economic implications in Brazil for LPV/r versus ATVϩRTV treatment of ARV-experienced patients. METHODS: A previously published HIV Markov model was adapted. Baseline assumptions: TC profile and CD4 cell distribution matching the BMS-045 population. HRQL and survival outcomes were measured in quality adjusted life years (QALYs). Costs in Brazilian Reale were indexed to 2011. ARV costs and HIV treatment patterns were based on Brazilian references. Lifetime costs/outcomes were discounted at 3% per annum. A national health services perspective was adopted. RESULTS: VL suppression differences favored LPV/r, driving a net improvement in survival (0.31 QALYs, 106 days). Five and 10 year cost savings (BRL1,816, BRL1,496 per patient) were projected for LPV/r. Lifetime costs were slightly higher for LPV/r due to improved survival. An incremental cost effectiveness ratio (ICER) of BRL2319 per QALY gained was estimated for the LPV/r regimen, which is highly acceptable by Brazilian threshold . CONCLUSIONS: Compared to ATVϩRTV, an LPV/r based regimen is cost saving through the first 10 years of survival and is a cost effective use of public resources for ARV-experienced Brazilian pati...

estimated cost and effectiveness for four treatment strategies: 1) Standard dual therapy pegylated interferon alfa and ribavirin (PR); 2) BOCϩPR triple therapy; 3) TELϩPR triple therapy; and 4) no treatment. RESULTS: In our model, patients received 1) PR for 48 weeks; 2) TEL for 12 weeks with PR for 34-36 weeks; or 3) BOC for 29 weeks with PR for 34-36 weeks. Estimated treatment cost associated with PR alone, BOCϩPR, and TELϩPR are about $8,300, $31,000 and $45,000 per average patient, respectively. Total system-wide costs to adopt BOCϩPR or TELϩPR would be $673 million and $971 million, respectively. Assuming continuation of the current 21% VHA treatment rates and optimal SVR results, the long term reduction in liver related death from treatment PR, BocϩPR, and TelϩPR are 7.9%, 13.1%, and 14.5%, respectively. CONCLUSIONS: Our model indicates upfront investments with BOCϩPR, and TELϩPR are high, with the benefits of extending quality of life and lower costs due to liver-related morbidity. Though model projected potential cost under these assumptions, a clinical trial of comparative effectiveness would be needed to evaluate both costs and benefits of DAAs in veterans. OBJECTIVES:In Brazil, switching to a protease inhibitor (PI) based ARV regimen is recommended as second line therapy for experienced patients failing non-nucleoside reverse transcriptase inhibitors. The BMS-045 study compared ATVϩRTV and LPV/r regimens in ARV-experienced patients. Similar viral load (VL) suppression rates Ͻ400 copies were reported, but LPV/r provided greater suppression rate Ͻ50 copies. Total cholesterol (TC) levels improved to guideline levels in 23% of ATVϩRTV patients and became elevated in 7% of LPV/r patients at 48 weeks. The long term clinical and cost impact of this difference is not yet clear. The objective of this study was to examine the long term HRQL and economic implications in Brazil for LPV/r versus ATVϩRTV treatment of ARV-experienced patients. METHODS: A previously published HIV Markov model was adapted. Baseline assumptions: TC profile and CD4 cell distribution matching the BMS-045 population. HRQL and survival outcomes were measured in quality adjusted life years (QALYs). Costs in Brazilian Reale were indexed to 2011. ARV costs and HIV treatment patterns were based on Brazilian references. Lifetime costs/outcomes were discounted at 3% per annum. A national health services perspective was adopted. RESULTS: VL suppression differences favored LPV/r, driving a net improvement in survival (0.31 QALYs, 106 days). Five and 10 year cost savings (BRL1,816, BRL1,496 per patient) were projected for LPV/r. Lifetime costs were slightly higher for LPV/r due to improved survival. An incremental cost effectiveness ratio (ICER) of BRL2319 per QALY gained was estimated for the LPV/r regimen, which is highly acceptable by Brazilian threshold . CONCLUSIONS: Compared to ATVϩRTV, an LPV/r based regimen is cost saving through the first 10 years of survival and is a cost effective use of public resources for ARV-experienced Brazilian pati...