relative risk in survival and case-control analysis avoiding an arbitrary reference group. Stat Med 1991;lO:1025-35. 5 Jarvis J. A profile oftobacco smoking. Addiction 1994;89:1371-6. 6 MacMahon S, Peto R, Cutler J, Collins R, Sorlie P, Neaton J, et al. Blood pressure, stroke, and coronary heart disease. I. Prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias. Design-Retrospective analysis of national epidemiological and economic data.Main outcome measures-Incidence of travel associated infections in susceptible United Kingdom residents per visit; costs of prophylaxis provision from historical data; benefits to the health sector, community, and individuals in terms of avoided morbidity and mortality based on hospital and community costs ofdisease.Results-The high incidence of imported malaria (070°/6) and the low costs of providing chemoprophylaxis resulted in a cost-benefit ratio of0 19 for chloroquine and proguanil and 057 for a regimen containing mefloquine. Hepatitis A infection occurred in 005% of visits and the cost of prophylaxis invariably exceeded the benefits for immunoglobulin (cost-benefit ratio 5 8) and inactivated hepatitis A vaccine (cost-benefit ratio 15.8). Similarly, low incidence of typhoid (002%/) and its high cost gave whole cell killed, polysaccharide Vi, and oral Ty 21a typhoid vaccines cost-benefit ratios of 18*1, 18*0, and 22-0 respectively.Conclusions-Fewer than one third of travellers receive vaccines but the total cost of providing typhoid and hepatitis A prophylaxis of £25 8m is significantly higher than the treatment costs to the NHS (C1.03m) of cases avoided by prophylaxis.Neither hepatitis A prophylaxis nor typhoid prophylaxis is cost effective, but costs of treating malaria greatly exceed costs of chemoprophylaxis, which is therefore highly cost effective.