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Cost-effectiveness analysis compared four treatments of end-stage renal disease in Brazil: continuous ambulatory peritoneal dialysis (CAPD), in-center hemodialysis (HD), cadaver donor transplantation (CD-Tx), and living related donor transplantation (LR-Tx). After 2 years, the costs per year of survival were CAPD, $12,134; HD, $10,065; CD-Tx, $6,978; and LR-Tx, $3,022. The HD cost was lower than CAPD partially because of the reuse of hemodialyzers in Brazil. Although less cost-effective, both dialysis treatments yielded more years of survival after 2 years. This analysis reveals a trade-off between cost per year of survival and years of survival.

Primitive groups of people, living in complete isolation, are rarely encountered these days. In fact, the process of 'approximation', or contact, depends upon decisions made on both sides--that representing the civilized world and that representing the group called by us 'primitive'. The isolated group, however, can never perceive the tremendous risks its members will inevitably encounter one the barrier of isolation, by which they are protected, has been broken. Civilized man has the means of persuasion and attraction at his disposal and also knows the risks involved. It must therefore be his responsibility to protect and preserve the group right from the initial contact. In spite of the medical resources available, primitive man has paid heavily in human lives through contact with the civilized world. This raises two equally important question: (a) have medical resources been thoroughly applied to protect these groups? And (b) are the existing medical resources sufficient to ensure the survival of primitive man once his state of isolation has been broken? Without any definite answers to these questions, we are limited to describing our experiences with the Kren-Akorore Indians, recently contacted in Central Brazil. We also present data on the biological characteristics of these Indians, collected two years after the first contact.