Showing papers by "Christopher J L Murray published in 1991"
TL;DR: Because the greatest benefit of chemotherapy is reduced transmission of the bacillus, treating HIV-seropositive, tuberculosis smear-positive patients would be only slightly less cost-effective than treatingAIDS-seronegative, tuberculosis-smear- positive patients.
188 citations
TL;DR: Therapy with low-dose rIL-2 can be given safely in an uninterrupted fashion for prolonged periods of time in an outpatient setting and results in selective expansion of NK cells in vivo with minimal toxicity.
Abstract: In previous clinical trials, recombinant interleukin-2 (rIL-2) has been infused at high doses over short periods of time to generate lymphokine-activated killer (LAK) cells in vivo. These trials have been limited by severe toxicities, and the immunologic effects of rIL-2 have been transient. The present study was designed to assess the toxicity and immunologic effects of prolonged administration of low doses of rIL-2. In this phase I study, patients with advanced cancer were scheduled to receive intravenous (IV) infusion of rIL-2 without interruption for 3 months in an outpatient setting. Twenty-one patients received rIL-2 at doses ranging from 0.5 x 10(5) to 6.0 x 10(5) U/m2/d. Treatment was extremely well tolerated, and no patient experienced grade 3 or grade 4 toxicity. The lowest dose level (0.5 x 10(5) U/m2/d) did not have demonstrable immunologic activity. At doses of 1.5 x 10(5) and 4.5 x 10(5) U/m2/d, rIL-2 infusion resulted in the specific expansion of natural-killer (NK) cells (sixfold and ninef...
110 citations
Journal Article•
TL;DR: The author examines the costs and effectiveness of the national tuberculosis programmes in Malawi, Mozambique and Tanzania and finds short-course chemotherapy is found to be more cost-effective than standard 12-month chemotherapy.
Abstract: Social, economic and operational research has already contributed to the growing global awareness of the neglected burden of tuberculosis on individuals, families and communities. These studies have also illustrated that short-course chemotherapy for smear-positive pulmonary tuberculosis is a highly cost-effective tool for combatting tuberculosis. In the present work, the author examines the costs and effectiveness of the national tuberculosis programmes in Malawi, Mozambique and Tanzania. Chemotherapy for smear-positive tuberculosis is found to be among the most cost-effective health interventions known, costing 1-4 US dollars per year of life saved. In all situations, short-course chemotherapy is found to be more cost-effective than standard 12-month chemotherapy. General conclusions about the role of hospitalization are difficult to make; its cost-effectiveness depends on local patterns of compliance and the cost of hospitalization. Because more than three-quarters of the benefits of chemotherapy for smear-positive tuberculosis are due to transmission reduction, treating HIV sero-positives, smear-positives is probably cost-effective.
38 citations