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Background: International funding for global health research is not systematically documented. We have assessed the level of research funding awarded by UK funders of international research to low- and middle-income countries or research institutions in these countries., Methods: We analysed 6165 studies; from these we selected 522 that matched our criteria and used them to evaluate research funding by pathogen, disease, research and development value chain, funding organisation and country., Results: Investment in infectious disease research in the countries studied totalled £264 million. Distribution of research investments closely mirrored that of the UK's former colonial territories; the top five countries, and eight of the top 10, have historical links with the UK, being current or former members of the Commonwealth of Nations. HIV, malaria and neglected tropical diseases attracted the greatest investment (£219 million; 82.8%), with most studies focussing on operational and epidemiological research (£109 million; 41.3%)., Conclusions: International financing of infectious disease research by UK funding organisations follows former colonial ties. Funding institutions should review their funding policies to ensure that they also assist low- and middle-income countries without colonial ties to address their disease burden. A global investment surveillance system is needed to map and monitor funding for international research and guide the allocation of scarce resources to reduce the global disease burden.

Pharmacotherapeutic interventions and drug acquisition costs in HIV-positive and HIV-negative patients on a hospital medical service were studied. In November and December 1995, HIV-positive and HIV-negative patients were randomly selected and matched on the basis of admission date. Pharmacotherapeutic interventions were recorded by a pharmacist until the time of discharge. Drug acquisition costs were obtained through records of medications ordered. The two patient groups were compared with respect to length of stay (LOS), number and cost of medications, and number of interventions. HIV-positive patients had significantly more medication orders and required more interventions than HIV-negative patients. Mean LOS was not significantly different. HIV status and number of medications were significantly associated with requiring five or more interventions. Drug acquisition costs were significantly higher in the HIV-positive group. The mean pharmacist-attributed cost saving per patient was $134 for HIV-positive patients and $27 for HIV-negative patients. HIV-positive patients required more interventions and consumed more medication resources than HIV-negative patients. Pharmacist interventions produced drug acquisition cost savings for both groups, with more savings being realized for positive patients.

People are more vulnerable to infection at the extremes of age for a variety of reasons, the most important being that they are more likely to be in hospital in a crowded ward environment and to be at risk from hospital acquired infection. Recognition of this increased vulnerability to infection should be accompanied by equal emphasis on their increased susceptibility to nosocomial disease arising from the diagnosis or treatment of infection. An economic evaluation of infection at the extremes of age should include an assessment of need made in terms of the capacity of patients to benefit from investigation or treatment. Benefits should not be confused with treatment effects such as reduction in pyrexia or correction of other physiological abnormalities. Ideally benefits should be quantified in a manner which allows comparison with the cost-effectiveness of other uses of health care resources. In order to achieve this aim clinicians must understand the economic terms opportunity cost and marginal cost-effectiveness. These terms are defined in general terms and then applied to examples of investigation, prevention and treatment of infection at the extremes of age.