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:

a. Calculate CE ratios for each program without discounting.
b. Calculate CE ratios discounting cost but not effectiveness assuming a discount rate of 4 percent.
c. Calculate CE ratios discounting both costs and effectiveness at 4 percent.
d. Assume that the uncertainty range for each of the yearly effectiveness estimates is plus or minus 20 percent, and the uncertainty in each of the yearly cost estimates is 10 percent. Assuming uniform distributions of errors, produce Monte Carlo distributions of CE ratios for each program and compare them.

Alternative A Alternative B QALYs SavedI IncrementQALYs Saved Cost Millions of Dollars) 3.8 Incremental Cost Millions of Dollars) 1.0 0.5 0.3 0.1 Year l 0.5 0.5 0.5 0.5 Year Year 3 Year