ORCID Profile
0000-0002-6445-7486
Current Organisations
University of Sydney
,
Deakin University
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Publisher: Wiley
Date: 10-04-2014
DOI: 10.1111/BJU.12051
Abstract: To compare the costs of photoselective vaporisation (PVP) and transurethral resection of the prostate (TURP) for management of symptomatic benign prostatic hyperplasia (BPH) from the perspective of a Queensland public hospital provider. A decision-analytic model was used to compare the costs of PVP and TURP. Cost inputs were sourced from an audit of patients undergoing PVP or TURP across three hospitals. The probability of re-intervention was obtained from secondary literature sources. Probabilistic and multi-way sensitivity analyses were used to account for uncertainty and test the impact of varying key assumptions. In the base case analysis, which included equipment, training and re-intervention costs, PVP was AU$ 739 (95% credible interval [CrI] -12 187 to 14 516) more costly per patient than TURP. The estimate was most sensitive to changes in procedural costs, fibre costs and the probability of re-intervention. Sensitivity analyses based on data from the most favourable site or excluding equipment and training costs reduced the point estimate to favour PVP (incremental cost AU$ -684, 95% CrI -8319 to 5796 and AU$ -100, 95% CrI -13 026 to 13 678, respectively). However, CrIs were wide for all analyses. In this cost minimisation analysis, there was no significant cost difference between PVP and TURP, after accounting for equipment, training and re-intervention costs. However, PVP was associated with a shorter length of stay and lower procedural costs during audit, indicating PVP potentially provides comparatively good value for money once the technology is established.
Publisher: Public Library of Science (PLoS)
Date: 21-09-2022
DOI: 10.1371/JOURNAL.PONE.0274917
Abstract: The Western Australian LiveLighter® program has implemented a series of mass media advertising c aigns that aim to encourage adults to achieve and maintain a healthy weight through healthy behaviours. This study aimed to assess the cost-effectiveness of the LiveLighter® c aign in preventing obesity-related ill health in the Western Australian population from the health sector perspective. C aign effectiveness (delivered over 12 months) was estimated from a meta-analysis of two cohort studies that surveyed a representative s le of the Western Australian population aged 25–49 years on discretionary food consumption one month pre- and one month post-c aign. C aign costs were derived from c aign invoices and interviews with c aign staff. Long-term health (measured in health-adjusted life years (HALYs)) and healthcare cost-savings resulting from reduced obesity-related diseases were modelled over the lifetime of the population using a validated multi-state lifetable Markov model (ACE-Obesity Policy model). All cost and health outcomes were discounted at 7% and presented in 2017 values. Uncertainty analyses were undertaken using Monte-Carlo simulations. The 12-month intervention was estimated to cost approximately A$2.46 million (M) (95% uncertainty interval (UI): 2.26M 2.67M). The meta-analysis indicated post-c aign weekly reduction in sugary drinks consumption of 0.78 serves (95% UI: 0.57 1.0) and sweet food of 0.28 serves (95% UI: 0.07 0.48), which was modelled to result in average weight reduction of 0.58 kilograms (95%UI: 0.31 0.92), 204 HALYs gained (95%UI: 103 334), and healthcare cost-savings of A$3.17M (95%UI: A$1.66M A$5.03M). The mean incremental cost-effectiveness ratio showed that LiveLighter® was dominant (cost-saving and health promoting 95%UI: dominant A$7 703 per HALY gained). The intervention remained cost-effective in all sensitivity analyses conducted. The LiveLighter® c aign is likely to represent very good value-for-money as an obesity prevention intervention in Western Australia and should be included as part of an evidence-based obesity prevention strategy.
Publisher: MDPI AG
Date: 28-07-2023
Abstract: Australia’s mental health system is failing young people. Calls for accountability, strategic long-term policy planning, and regional leadership have been identified as solutions to guide mental health reform. Developing system dynamics models using a participatory approach (participatory systems modelling (PSM)) is recognized as a useful method that can support decision-making for strategic reform. This paper reports evaluation findings of a youth mental health PSM process conducted in the Australian Capital Territory (ACT). Baseline and follow-up mixed-methods evaluation data were collected in 2022 across erse stakeholder groups to investigate the feasibility, value, impact, and sustainability of PSM. Although youth mental health system reform was viewed as desirable and a necessity across all stakeholder groups, shared perceptions of disabling powerless was observed regarding their ability to influence current decision-making processes to improve the youth mental health system. This suggests greater accountability is required to support systemic reform in youth mental health. PSM offers promise in improving transparency and accountability of decision-making for youth mental health, as exemplified in the ACT. However, more support and time are required to facilitate transformational change. Future research should investigate empowerment strategies to complement the implementation of findings from dynamic models developed through PSM, as well as the effectiveness of regional youth mental health policy decision-making supported by systems modelling.
Publisher: BMJ
Date: 04-03-2015
DOI: 10.1136/BMJ.H824
Publisher: Elsevier BV
Date: 04-2019
Abstract: A systematic review was conducted to determine the health burden of preventable disease in Australia. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement guidelines were followed to identify, screen and describe the protocols used in the systematic review. Eleven studies were included in the review. Data on the health burden associated with lifestyle-related risk factors were extracted by disease with outcomes reported in attributable number and proportion of deaths, years of life lost, years lived with disability and disability-adjusted life years (DALYs). Around one-third of DALYs was attributed to all modifiable risk factors. The range of estimates of DALYs attributable to each prioritised risk factor was: combined dietary risk factors, 7.2% to 9.7% tobacco, 7.9% to 9.0% alcohol, 5.1% to 12.2% high body mass, 5.5% to 8.3% and physical inactivity, 1.2% to 5.5%. Although the methods used to estimate preventable health burden varied greatly between studies, all found that a substantial amount of death and disability was attributable to lifestyle-related risk factors. Implications for public health: There is a large health burden in Australia caused by modifiable risk factors and further action is warranted to address this burden.
Publisher: BMJ
Date: 25-02-2015
DOI: 10.1136/BMJ.H701
Publisher: Informa Healthcare
Date: 05-12-2014
DOI: 10.3111/13696998.2013.867271
Abstract: Treatment uptake amongst patients with chronic Hepatitis C virus (HCV) in Australia is relatively low. New approaches to assessment have the potential to reduce public waiting lists, improve access to treatment, and to reduce healthcare costs. To describe the costs to the public hospital system and waiting time associated with a novel integrated rapid access to assessment and treatment (RAAT) model of care that utilizes Transient Elastography (TE) as a specialist outpatient-based approach for a streamlined assessment of patients with chronic HCV, compared to conventional outpatient management with liver biopsy (LB). Time from first medical review to treatment plan and costs associated with detection of fibrosis were recorded for patients receiving RAAT during a 3-month period, and for a similar historical cohort managed conventionally with LB. Costs related to medical and multidisciplinary team reviews and the TE/LB test itself were included. Patients receiving RAAT had lower costs (n = 27, median AU$2716) and shorter time to treatment (median = 194 days) than for conventional management (n = 13, median $5005, 420 days p < 0.01). Differences related to the lower TE test costs and the lower cost of consults between first medical review and establishment of a treatment plan. Based on real world audit data, this evaluation suggests TE, used as part of a new RAAT model of care, is cost saving to the health system in the short-term and reduces waiting times. The analysis reported here was intended to assess the costs related to detection of fibrosis, and is limited by the small s le size and potential selection bias. Future research should undertake a full economic evaluation at a whole of service level, to consider a more comprehensive and longer-term assessment of the costs and benefits associated with HCV management.
Publisher: BMJ
Date: 18-01-2016
DOI: 10.1136/BJSPORTS-2015-H824REP
Abstract: This is one of a series of BMJ summaries of new guidelines based on the best available evidence they highlight important recommendations for clinical practice, especially where uncertainty or controversy exists.
Publisher: The Sax Institute
Date: 2023
Publisher: Wiley
Date: 25-11-2022
DOI: 10.1002/HPJA.552
Abstract: Since the inception of PHNs in Australia, their role in implementing chronic disease prevention activities in general practice has been unclear. This study aimed to qualitatively explore the views of PHN staff on the role of PHNs in promoting prevention, with a focus on cardiovascular disease (CVD) prevention. Content analysis of PHN Needs Assessments was conducted to inform interview questions. Twenty-nine semi-structured interviews were conducted with 32 PHN staff, between June and December 2020, in varied roles across 18 PHNs in all Australian states and territories. Transcribed audio recordings were thematically coded, using the Framework Analysis method to ensure rigour. We identified three main themes: (a) Informal prevention: All respondents agreed the role of PHNs in prevention was indirect and, for the most part, outside the formal remit of PHN Key Performance Indicators (KPIs.) Prevention activities were conducted in partnership with external stakeholders, professional development and quality improvement programs, and PHN-funded data extraction and analysis software for general practice. (b) Constrained by financial incentives: Most interviewees felt the role of PHNs in prevention was contingent on the financial drivers provided by the Commonwealth government, such as Medicare funding and national quality improvement programs. (c) Shaped through competing priorities: The role of PHNs in prevention is a function of competing priorities. There was strong agreement amongst participants that the myriad competing priorities from government and local needs assessments impeded prevention activities. PHNs are well-positioned to foster prevention activities in general practice. However, we found that PHNs role in prevention activities was informal, constrained by financial incentives and shaped through competing priorities. Prevention can be improved through a more explicit prevention focus at the Commonwealth government level. To optimise the role of PHNs, therefore, requires prioritising prevention, aligning it with KPIs and supporting stakeholders like general practice.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 25-08-2021
DOI: 10.1097/AUD.0000000000001112
Abstract: The aim of this study was to conduct an economic evaluation for the treatment of subjective tinnitus using different modalities of cognitive behavioral therapy (CBT) in Australia. A decision tree model was used to conduct a cost-utility analysis for CBT to determine the cost effectiveness for tinnitus treatments, in terms of cost per responder and cost per quality-adjusted life-year (QALY), from a health system perspective using a 2-year time horizon. Meta-analysis was used to differentiate the levels of effectiveness between three delivery methods for CBT: in idual face-to-face care (fCBT), group sessions (gCBT), and a supported internet program (iCBT). One-way sensitivity analysis and probabilistic sensitivity analysis (PSA) explored the uncertainty surrounding model inputs and outcomes. Results were presented as incremental cost-effectiveness ratios compared with no treatment, and as net monetary benefit at a $50,000 willingness-to-pay threshold. Compared with no treatment, the incremental cost per responder was $700 for gCBT, $871 for iCBT, and $1380 for fCBT. The base case incremental cost-effectiveness ratio was $35,363 per QALY for fCBT, $17,935 per QALY for gCBT, and $22,321 per QALY for iCBT compared with no treatment, although there was substantial uncertainty around the QALY gain for responders. Net monetary benefit was $356 (fCBT), $555 (gCBT), and $487 (iCBT), indicating the treatments were cost effective compared with no treatment. One-way sensitivity analysis revealed the results were most sensitive to the probability of a positive response to treatment and treatment length. The PSA found the probability of being cost effective compared with no treatment for gCBT was 99.8%, iCBT 98.4%, and fCBT 71.5% at a willingness-to-pay of $50,000 per QALY, although QALY gain remained at a fixed value in the PSA. CBT for tinnitus was likely to be cost effective compared with no treatment regardless of treatment modality, assuming they are not mutually exclusive. Of the interventions, gCBT was the lowest cost per responder and lowest cost per QALY. Internet CBT obtained comparable economic outcomes due to similar treatment effectiveness and cost. Group CBT and iCBT warrant greater adoption in clinical practice for the treatment of subjective tinnitus. Further research on preference-based utility measures for varying levels of tinnitus severity and the durability of treatment effect is required to enhance the quality of economic evaluation in this field.
Publisher: Informa UK Limited
Date: 22-02-2022
DOI: 10.1080/14992027.2022.2039965
Abstract: To examine willingness to consider and to pay for various one-to-one telehealth appointments and online group training/information sessions amongst hearing service clients interested in future telehealth. Online survey exploring telehealth usage and attitudes more broadly. One-hundred-and-sixty-eight (39.8%) of the 422 survey respondents who answered the question were interested in future hearing-related telehealth. Data were analysed for the 148 providing demographic information. At least some respondents were interested in each type of one-to-one appointment (∼30-60% for most types) and group training/information session (∼30-50% for most types). Some inconsistent associations were found between willingness to consider in idual appointment types and a metropolitan location, younger age, and female gender. Associations with having a hearing device fitted may have been influenced by the different needs of those without devices. Younger respondents were more likely to consider a wide range of appointment types. Being younger was associated with an interest in 7 of the 9 different group session types. The acceptable price range was AUD$30-$86 (USD$22-$62) ( Despite additional communication needs, hearing service clients have a strong interest in a range of in idual and group telehealth services.
Publisher: Elsevier BV
Date: 10-2019
Abstract: The aim of this literature review was to establish the economic burden of preventable disease in Australia in terms of attributable health care costs, other costs to government and reduced productivity. A systematic review was conducted to establish the economic cost of preventable disease in Australia and ascertain the methods used to derive these estimates. Nine databases and the grey literature were searched, limited to the past 10 years, and the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines were followed to identify, screen and report on eligible studies. Eighteen studies were included. There were at least three studies examining the attributable costs and economic impact for each risk factor. The greatest costs were related to the productivity impacts of preventable risk factors. Estimates of the annual productivity loss that could be attributed to in idual risk factors were between $840 million and $14.9 billion for obesity up to $10.5 billion due to tobacco between $1.1 billion and $6.8 billion for excess alcohol consumption up to $15.6 billion due to physical inactivity and $561 million for in idual dietary risk factors. Productivity impacts were included in 15 studies and the human capital approach was the method most often employed (14 studies) to calculate this. Substantial economic burden is caused by lifestyle-related risk factors. Implications for public health: The significant economic burden associated with preventable disease provides an economic rationale for action to reduce the prevalence of lifestyle-related risk factors. New analysis of the economic burden of multiple risk factors concurrently is needed.
Publisher: Springer Science and Business Media LLC
Date: 19-03-2022
DOI: 10.1186/S12966-022-01276-2
Abstract: Strong evidence indicates that excessive time spent sitting (sedentary behaviour) is detrimentally associated with multiple chronic diseases. Sedentary behaviour is prevalent among adults in Australia and has increased during the COVID-19 pandemic. Estimating the potential health benefits and healthcare cost saving associated with reductions in population sitting time could be useful for the development of public health initiatives. A sedentary behaviour model was developed and incorporated into an existing proportional, multi-state, life table Markov model (ACE-Obesity Policy model). This model simulates the 2019 Australian population (age 18 years and above) and estimates the incidence, prevalence and mortality of five diseases associated with sedentary behaviour (type 2 diabetes, stroke, endometrial, breast and colorectal cancer). Key model inputs included population sitting time estimates from the Australian National Health Survey 2014–2015, healthcare cost data from the Australian Institute of Health and Welfare (2015) and relative risk estimates assessed by conducting literature reviews and meta-analyses. Scenario analyses estimated the potential change in disease incidence as a result of changes in population sitting time. This, in turn, resulted in estimated improvements in long term health outcomes (Health-adjusted life years (HALYs)) and healthcare cost-savings. According to the model, if all Australian adults sat no more than 4 h per day, the total HALYs gained would be approximately 17,211 with health care cost savings of approximately A$185 million over one year. Under a more feasible scenario, where sitting time was reduced in adults who sit 4 or more hours per day by approximately 36 min per person per day (based on the results of the Stand Up Victoria randomised controlled trial), potential HALYs gained were estimated to be 3,670 and healthcare cost saving could reach A$39 million over one year. Excessive sedentary time results in considerable population health burden in Australia. This paper describes the development of the first Australian sedentary behaviour model that can be used to predict the long term consequences of interventions targeted at reducing sedentary behaviour through reductions in sitting time. These estimates may be used by decision makers when prioritising healthcare resources and investing in preventative public health initiatives.
Publisher: Wiley
Date: 04-02-2023
DOI: 10.5694/MJA2.51844
Abstract: To identify the financing and policy challenges for Medicare and universal health care in Australia, as well as opportunities for whole‐of‐system strengthening. Review of publications on Medicare, the Pharmaceutical Benefits Scheme, and the universal health care system in Australia published 1 January 2000 – 14 August 2021 that reported quantitative or qualitative research or data analyses, and of opinion articles, debates, commentaries, editorials, perspectives, and news reports on the Australian health care system published 1 January 2015 – 14 August 2021. Program‐, intervention‐ or provider‐specific articles, and publications regarding groups not fully covered by Medicare (eg, asylum seekers, prisoners) were excluded. MEDLINE Complete, the Health Policy Reference Centre, and Global Health databases (all via EBSCO) the Analysis & Policy Observatory, the Australian Indigenous HealthInfoNet, the Australian Public Affairs Information Service, Google, Google Scholar, and the Organisation for Economic Co‐operation and Development (OECD) websites. The problems covered by the 76 articles included in our review could be grouped under seven major themes: fragmentation of health care and lack of integrated health financing, access of Aboriginal and Torres Strait Islander people to health services and essential medications, reform proposals for the Pharmaceutical Benefits Scheme, the burden of out‐of‐pocket costs, inequity, public subsidies for private health insurance, and other challenges for the Australian universal health care system. A number of challenges threaten the sustainability and equity of the universal health care system in Australia. As the piecemeal reforms of the past twenty years have been inadequate for meeting these challenges, more effective, coordinated approaches are needed to improve and secure the universality of public health care in Australia.
Publisher: Elsevier BV
Date: 08-2018
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Paul Crosland.