A study of the cost and effect of newborn screening for Congenital Adrenal Hyperplasia in Texas

Congenital Adrenal Hyperplasia (CAH), due to 21-Hydroxylase deficiency, has an estimated incidence of 1:15,000 births and can result in death, salt-wasting crisis or impaired growth. It has been proposed that early diagnosis and treatment of infants detected from newborn screening for CAH will decrease the incidence of mortality and morbidity in the affected population. The Texas Department of Health (TDH) began mandatory screening for CAH in June, 1989 and Texas is one of fourteen states to provide neonatal screening for the disorder.^ The purpose of this study was to describe the cost and effect of screening for CAH in Texas during 1994 and to compare cases first detected by screen and first detected clinically between January 1, 1990 and December 31, 1994. This study used a longitudinal descriptive research design. The data was secondary and previously collected by the Texas Department of Health. Along with the descriptive study, an economic analysis was done. The cost of the program was defined, measured and valued for four phases of screening: specimen collection, specimen testing, follow-up and diagnostic evaluation.^ There were 103 infants with Classical CAH diagnosed during the study and 71 of the cases had the more serious Salt-Wasting form of the disease. Of the infants diagnosed with Classical CAH, 60% of the cases were first detected by screen and 40% were first detected because of clinical findings before the screening results were returned. The base case cost of adding newborn screening to an existing program (excluding the cost of specimen collection) was $357,989 for 100,000 infants. The cost per case of Classical CAH diagnosed, based on the number of infants first detected by screen in 1994, was \$126,892. There were 42 infants diagnosed with the more benign Nonclassical form of the disease. When these cases were included in the total, the cost per infant to diagnose Congenital Adrenal/Hyperplasia was $87,848. ^

Family budgets of American wage-earners: a critical analysis

National Industrial Conference Board.

An account of my quarter bills, charges &c from July 11th 1743 to July 13th 1748 at Harvard College

Handwritten account book kept while Storer was a student at Harvard College. The well-organized volume is arranged by expense type and then date and was updated periodically, usually quarterly. The information offers a glimpse at the expenses of a Harvard student and provides information about the larger community that supported student life. The precise entries indicate the lifelong habits of Storer as a careful and methodical financial manager that would prove so valuable when he served as Harvard's treasurer more than thirty years later. Storer documents accounts with the steward, butler, sweeper, glazier, barber, and lists these individuals by name. The volume also includes notes on expenses for boarding, transportation, wood, and pocket expenses. While most entries do not list specific purchases, Storer provides details on the cost of a Harvard Commencement in 1747 (including the cost of a diploma, money to the President, hiring a house, a boat, a woman, and "2 Negroes"), and a specific accounting of the different food purchased for the event; Storer also lists expenses for an 1748 "supper for the graduates."

Bill of disbursments [for the] sch[oone]r Lydia : manuscript, 1790

List of ship's expenses between Feb. 7 and May 25; dated at Aux Cayes, (Haiti) May 27, 1790; includes money paid to an interpreter at Tobago, workers for ship maintenance, and various harbor officials; and notation of purchases for goods such as sugar, coffee, rice, tar, food, and rum.