Hyperbaric oxygen therapy in necrotising soft tissue infections: a study of patients in the United States Nationwide Inpatient Sample.

PURPOSE: Necrotising soft tissue infection (NSTI) is a deadly disease associated with a significant risk of mortality and long-term disability from limb and tissue loss. The aim of this study was to determine the effect of hyperbaric oxygen (HBO(2)) therapy on mortality, complication rate, discharge status/location, hospital length of stay and inflation-adjusted hospitalisation cost in patients with NSTI. METHODS: This was a retrospective study of 45,913 patients in the Nationwide Inpatient Sample (NIS) from 1988 to 2009. RESULTS: A total of 405 patients received HBO(2) therapy. The patients with NSTI who received HBO(2) therapy had a lower mortality (4.5 vs. 9.4 %, p = 0.001). After adjusting for predictors and confounders, patients who received HBO(2) therapy had a statistically significantly lower risk of dying (odds ratio (OR) 0.49, 95 % confidence interval (CI) 0.29-0.83), higher hospitalisation cost (US$52,205 vs. US$45,464, p = 0.02) and longer length of stay (LOS) (14.3 days vs. 10.7 days, p < 0.001). CONCLUSIONS: This retrospective analysis of HBO(2) therapy in NSTI showed that despite the higher hospitalisation cost and longer length of stay, the statistically significant reduction in mortality supports the use of HBO(2) therapy in NSTI.

Private demand for a HIV/AIDS vaccine: evidence from Guadalajara, Mexico.

The private demand for a hypothetical vaccine that would provide lifetime protection against HIV/AIDS to an uninfected adult was measured in Guadalajara, Mexico, using the concept of willingness to pay (WTP). A 91-question survey instrument was administered by trained enumerators employing contingent valuation techniques to 234 adults, aged 18-60. Our estimates of private demand indicate that individuals anticipate sizable personal benefits from such a vaccine, and that they would be willing to allocate a substantial portion of their income to be protected in this way from HIV infection. A conservative estimate of the mean WTP of adults in the Guadalajara sample is 6358 pesos (669 US dollars) and the median is 3000 pesos (316 US dollars). A multivariate statistical analysis of the determinants of individuals' WTP shows that individuals with higher incomes, with spouses or partners, and with higher perceived risks of becoming infected with HIV are willing to pay more for the vaccine. Older respondents are willing to pay less. These results suggest that there is likely to be a potentially large private market for a HIV/AIDS vaccine in the middle-income developing countries such as Mexico. These findings have important implications both for the level of R&D effort that is devoted to a vaccine and, assuming these efforts are successful, for future policies to make the vaccine available to the public.