3. Two alternative mosquito control programs have been proposed to reduce the health risks of West Nile disease in a state over the next five years.The costs and effectiveness of each program in each of the next five years are displayed below:

	Alternative A	Alternative B
	QALYs Saved	Incremental Cost (Millions of Dollars)	QALYs Saved	Incremental Cost (Millions of Dollars)
Year 0
Year 1	2	3.8	1	1
Year 2	1.5	0	1	1
Year 3	1	0	1	1
Year 4	0.5	0	1	1

1. Calculate CE ratios for each program without discounting.

• Alternative A = 3.8/(1+.5+.3+.1) = 2
• Alternative B = (1+1+1+1)/( 1+1+1+1) = 1

1. Calculate CE ratios discounting cost but not effectiveness assuming a discount rate of 4 percent.

• Alt A = 2 because the cost is up front
• Alt B =

1. Calculate CE ratios discounting both costs and effectiveness at 4 percent

1. Which project do you prefer and why?