Margaret L. Brandeau

Are Organic Foods Safer or Healthier Than Conventional Alternatives?: A Systematic Review

BACKGROUND The health benefits of organic foods are unclear. PURPOSE To review evidence comparing the health effects of organic and conventional foods. DATA SOURCES MEDLINE (January 1966 to May 2011), EMBASE, CAB Direct, Agricola, TOXNET, Cochrane Library (January 1966 to May 2009), and bibliographies of retrieved articles. STUDY SELECTION English-language reports of comparisons of organically and conventionally grown food or of populations consuming these foods. DATA EXTRACTION 2 independent investigators extracted data on methods, health outcomes, and nutrient and contaminant levels. DATA SYNTHESIS 17 studies in humans and 223 studies of nutrient and contaminant levels in foods met inclusion criteria. Only 3 of the human studies examined clinical outcomes, finding no significant differences between populations by food type for allergic outcomes (eczema, wheeze, atopic sensitization) or symptomatic Campylobacter infection. Two studies reported significantly lower urinary pesticide levels among children consuming organic versus conventional diets, but studies of biomarker and nutrient levels in serum, urine, breast milk, and semen in adults did not identify clinically meaningful differences. All estimates of differences in nutrient and contaminant levels in foods were highly heterogeneous except for the estimate for phosphorus; phosphorus levels were significantly higher than in conventional produce, although this difference is not clinically significant. The risk for contamination with detectable pesticide residues was lower among organic than conventional produce (risk difference, 30% [CI, -37% to -23%]), but differences in risk for exceeding maximum allowed limits were small. Escherichia coli contamination risk did not differ between organic and conventional produce. Bacterial contamination of retail chicken and pork was common but unrelated to farming method. However, the risk for isolating bacteria resistant to 3 or more antibiotics was higher in conventional than in organic chicken and pork (risk difference, 33% [CI, 21% to 45%]). LIMITATION Studies were heterogeneous and limited in number, and publication bias may be present. CONCLUSION The published literature lacks strong evidence that organic foods are significantly more nutritious than conventional foods. Consumption of organic foods may reduce exposure to pesticide residues and antibiotic-resistant bacteria. PRIMARY FUNDING SOURCE None.

The Cost-Effectiveness of Preexposure Prophylaxis for HIV Prevention in the United States in Men Who Have Sex With Men

BACKGROUND A recent randomized, controlled trial showed that daily oral preexposure chemoprophylaxis (PrEP) was effective for HIV prevention in men who have sex with men (MSM). The Centers for Disease Control and Prevention recently provided interim guidance for PrEP in MSM at high risk for HIV. Previous studies did not reach a consistent estimate of its cost-effectiveness. OBJECTIVE To estimate the effectiveness and cost-effectiveness of PrEP in MSM in the United States. DESIGN Dynamic model of HIV transmission and progression combined with a detailed economic analysis. DATA SOURCES Published literature. TARGET POPULATION MSM aged 13 to 64 years in the United States. TIME HORIZON Lifetime. PERSPECTIVE Societal. INTERVENTION PrEP was evaluated in both the general MSM population and in high-risk MSM and was assumed to reduce infection risk by 44% on the basis of clinical trial results. OUTCOME MEASURES New HIV infections, discounted quality-adjusted life-years (QALYs) and costs, and incremental cost-effectiveness ratios. RESULTS OF BASE-CASE ANALYSIS Initiating PrEP in 20% of MSM in the United States would reduce new HIV infections by an estimated 13% and result in a gain of 550,166 QALYs over 20 years at a cost of

The Cost-Effectiveness and Population Outcomes of Expanded HIV Screening and Antiretroviral Treatment in the United States

172,091 per QALY gained. Initiating PrEP in a larger proportion of MSM would prevent more infections but at an increasing cost per QALY gained (up to

Cost-effectiveness of screening and vaccinating Asian and Pacific Islander adults for hepatitis B.

216,480 if all MSM receive PrEP). Preexposure chemoprophylaxis in only high-risk MSM can improve cost-effectiveness. For MSM with an average of 5 partners per year, PrEP costs approximately

Optimal Commonality in Component Design

50,000 per QALY gained. Providing PrEP to all high-risk MSM for 20 years would cost

Effectiveness and Cost Effectiveness of Expanding Harm Reduction and Antiretroviral Therapy in a Mixed HIV Epidemic: A Modeling Analysis for Ukraine

75 billion more in health care-related costs than the status quo and

Resource allocation for control of infectious diseases in multiple independent populations: beyond cost-effectiveness analysis.

600,000 per HIV infection prevented, compared with incremental costs of

Optimal Investment in a Portfolio of HIV Prevention Programs

95 billion and

Effectiveness and cost-effectiveness of strategies to expand antiretroviral therapy in St. Petersburg, Russia.

2 million per infection prevented for 20% coverage of all MSM. RESULTS OF SENSITIVITY ANALYSIS PrEP in the general MSM population would cost less than

Comparative Effectiveness of HIV Testing and Treatment in Highly Endemic Regions

100,000 per QALY gained if the daily cost of antiretroviral drugs for PrEP was less than