The question of culturing "sore throats" of staff in community hospitals is an important one. 1 Obviously the protocol will impact on the well being of both staff and hospital. E.P. Bradley Hospital is a children's p s y c h i a t r i c h o s p i t a l w i t h 3 0 0 employees and a census averaging 56 patients. For many years employees have been cultured for the complaint of sore throat. The techniques are similar to that of Watanakunakom with the addition of microbiological confirmation. Between J u n e 1981 and April 1985, 1,377 cultures of staff were taken and 234 were positive for beta hemolytic streptococcus group A representing an incidence rate of 17%. This is a much larger recovery rate than that found in the previously mentioned study. The explanation of the difference may be the fact that our findings are from a child and adolescent hospital rather than a general hospital. We feel t h a t t h e c o n c l u s i o n s recorded in the Watanakunakom article are probably not generalizable.

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Main outcomes were quality adjusted life years (QALY) and incremental cost-effectiveness ratios (ICER) for the different treatment options. Transition probabilities were obtained from primary studies comparing these drugs and costs from local databases and studies. We used a threshold of 3 times the Colombian per capita GDP to assess cost-effectiveness (equivalent to USD= 23 337 for 2014; USD 1= COP 2000). Results: Total costs related to dulaglutide, liraglutide and glargine were USD 12 798, USD 15 135 and USD 7 826 and yielded 3.311 QALY, 3.227 QALY and 3.156 QALY, respectively. The comparison between dulaglutide and liraglutide results in the former dominating, given the lower total costs and higher QALYs produced. When comparing dulaglutide with glargine, the estimated ICER is USD 32 081, which is greater than the threshold. Discount rate or time horizon variations do not change the result significantly. Sensibility analysis shows that decreased duglutide cost, increased utility for weight loss, value attached to non-daily injection, and number and cost of glucometry could lower the ICER below the threshold. ConClusions: Our cost-effectiveness estimation indicates that dulaglutide dominates liraglutide. However, its ICER is greater than the accepted threshold for Colombia when compared to glargine. Lowering its cost would make it a more appealing alternative for Colombian healthcare system given the benefits in weight loss and weekly administration. EN4 EstimatiNg thE sociEtal costs associatEd With glp-1ras iN thE UNitEd statEs For thE trEatmENt oF typE 2 diabEtEs