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The IDEAL Trial - Initiating Dialysis Early And Late
Funder
National Health and Medical Research Council
Funding Amount
$752,500.00
Summary
Kidney replacement therapy by dialysis has in the past been provided for patients with endstage renal failure once their remaining kidney function has deterioriated to less than 5-10% of normal. There has been an increasing trend in recent years to offer dialysis therapy at an earlier stage of kidney failure, such that more than 20% of dialysis patients in Australia (and up to 35% in some subgroups) now commence that therapy when their remaining kidney function is greater than 10%. This change h ....Kidney replacement therapy by dialysis has in the past been provided for patients with endstage renal failure once their remaining kidney function has deterioriated to less than 5-10% of normal. There has been an increasing trend in recent years to offer dialysis therapy at an earlier stage of kidney failure, such that more than 20% of dialysis patients in Australia (and up to 35% in some subgroups) now commence that therapy when their remaining kidney function is greater than 10%. This change has occurred because of the unproven belief that earlier dialysis may be associated with a better health outcome. However, dialysis treatment is associated with complications and it is very expensive. Therefore, it is important to determine the health and economic consequences of commencing dialysis early rather than late. The IDEAL trial (Initiating Dialysis Early And Late) is a large multi-centre study being conducted in many renal units in Australia and New Zealand, which will determine whether it is better, in terms of health outcomes and total cost of treatment, to commence dialysis at a time when remaining kidney function is between 10 and 14% or between 5 and 7% of normal.Read moreRead less
Development And Valuation Of Cancer-specific Multi-attribute Health States For Use In Economic Evaluation
Funder
National Health and Medical Research Council
Funding Amount
$707,671.00
Summary
Economic evaluation is used by the Australian government in deciding which medical services and pharmaceuticals should be funded. This study will develop quality of life utility measures for use in economic evaluation of cancer interventions in Australia and internationally. This represents a significant methodological contribution to the assessment of quality of life, effectiveness and efficiency in cancer, in one of Australia's national health priority areas.
Improving The Surgical Outcomes For Barretts-derived Oesophageal Adenocarcinoma Through Early Detection.
Funder
National Health and Medical Research Council
Funding Amount
$796,144.00
Summary
Some people with severe reflux develop Barrett's oesophagus, which puts them at high risk of developing cancer. Patients with Barrett's can be monitored by regular endoscopy to detect cancer early enough so that they can be treated successfully with surgery. The aim of this work is to identify patients who are at highest risk of cancer using molecular biomarkers. We will then determine the cost effectiveness of using biomarkers for surveillance of patients with Barrett's oesophagus.
Application Of Discrete Choice Experiments To Value Multi-attribute Health States For Use In Economic Evaluation
Funder
National Health and Medical Research Council
Funding Amount
$450,369.00
Summary
Economic evaluation is used increasingly by health care decision makers to decide which health care programs provide the best value for money, in terms of improving health and quality of life outcomes for the population. It is used by the Australian government in deciding which medical services and pharmaceuticals should be funded. This requires measurement of quality of life in a way that allows comparison across treatments, and a means of quantifying community preferences for different health ....Economic evaluation is used increasingly by health care decision makers to decide which health care programs provide the best value for money, in terms of improving health and quality of life outcomes for the population. It is used by the Australian government in deciding which medical services and pharmaceuticals should be funded. This requires measurement of quality of life in a way that allows comparison across treatments, and a means of quantifying community preferences for different health states (that is, how we value health outcomes). Health outcomes are often valued using the quality adjusted life year (QALY) which combines length and quality of life in a single measure. To compare across diseases and treatments, quality of life must be measured in the same way. This can be done by using a standard set of questions that cover the different aspects of quality of life (eg pain, mobility, emotional state). In this way, a single survey instrument can be used for any disease or outcome of treatment. We can also use the same instrument to ask members of the public to provide information about their preferences for different health states (that is how they value health outcomes). However, obtaining this information from respondents is complex, and there is debate about which are the best instruments, and the best methods to value health outcomes. In this research, we propose a new approach to valuing health states, which is easier to administer and which allows for more detailed and rigorous analysis of the responses people give, to provide better models of how the different aspects of quality of life are combined in valuing health outcomes. We will compare the new method with the main existing methods. We will compare these methods for two standard quality of life instruments that are widely used in health care research. The research will also provide valuations of health states from the Australian population that can then be used in economic evaluation.Read moreRead less
Developing A Common Outcome Measure For Priority Setting In Health: Validation Of The 'Transfer To Utility' Technique
Funder
National Health and Medical Research Council
Funding Amount
$314,100.00
Summary
The economic evaluation of health programs is a common requirement of funders and purchasers seeking to get the best value from the health dollar. But researchers employ a wide range of disease specific and generic health status instruments to describe trial outcomes, making comparison between diverse interventions difficult. In response to this problem a 'Transfer to Utility' or TTU technique was developed by Dr Segal and colleagues, to translate diverse outcomes reported in clinical trials, in ....The economic evaluation of health programs is a common requirement of funders and purchasers seeking to get the best value from the health dollar. But researchers employ a wide range of disease specific and generic health status instruments to describe trial outcomes, making comparison between diverse interventions difficult. In response to this problem a 'Transfer to Utility' or TTU technique was developed by Dr Segal and colleagues, to translate diverse outcomes reported in clinical trials, into a utility score, so the performance of diverse health interventions can be expressed in cost-QALY and compared. The technique establishes a statistical transformation between instruments commonly used in clinical trials and a utility value. While the technique appears highly useful, based on a priority setting exercise in osteoarthritis enabling 20 disparate interventions to be compared its validity and applicability in other contexts is not established. The purpose of the grant is to explore the TTU technique to i) establish the best method for estimating the regression equation between common health outcome measures and a utility score and validating that method; ii) test generalisability to other disease areas, for which quality of life is the primary objective of management (in stroke, drug dependence and depression), iii) develop and validate a method for translating the most commonly used measure of general health status, the SF-36, into a utility score and iv) illustrate the application of the TTU in comparing intervensions for the prevention and management of depression. The results of the research will be of value to i) decision makers who must compare the performance of medical-health care interventions across a range of diseases and modalities and ii) to clinicians who want to practice evidenced based health care. The potential health gains for the community are substantial, in supporting the redirection of resources to more effective and cost-effectiveRead moreRead less
Improving Outcomes Of Preschool Language Delay In The Community: Randomised Trial
Funder
National Health and Medical Research Council
Funding Amount
$927,327.00
Summary
7-15% of preschool children have language delay, so are vulnerable to poor lifelong academic, social and economic outcomes. Small trials suggest that intervention helps. This randomized trial aims to find out the population costs and benefits of optimized intervention for 4 year olds following systematic identification of language delay. Because we have studied the 1500 participants since infancy, the trial could also shed light on why some children respond better than others to treatment.
Randomised Controlled Trial Of Multimedia Patient Education Approaches To Preventing In-hospital Falls
Funder
National Health and Medical Research Council
Funding Amount
$524,137.00
Summary
In hospital falls are one of the most frequently occurring adverse events in Australian hospitals. They are the cause of considerable patient morbidity, stress to family members and care givers, and health care resource use. However, there are many potential causes of in-hospital falls which has made minimising them a difficult task for hospitals around the country. Recent evidence has indicated that a patient intervention strategy is useful for preventing in-hospital falls as a part of a multi- ....In hospital falls are one of the most frequently occurring adverse events in Australian hospitals. They are the cause of considerable patient morbidity, stress to family members and care givers, and health care resource use. However, there are many potential causes of in-hospital falls which has made minimising them a difficult task for hospitals around the country. Recent evidence has indicated that a patient intervention strategy is useful for preventing in-hospital falls as a part of a multi-factorial falls prevention program. This research aims to investigate the effectiveness and economic benefit of two approaches to providing patient education for the prevention of in-hospital falls. Patients at high risk for falls will be recruited from the Princess Alexandra Hospital and be randomly allocated to either a DVD + 4 sessions of face-to-face education with an occupational therapist program, to a DVD alone education program, or to a usual care with no additional education control condition. Patients will be followed up until their discharge from hospital and the number of in-hospital falls they incur will be compared between groups. It is expected that both the DVD + 4 sessions of face-to-face education with an occupational therapist program, to a DVD alone education program will be effective in reducing falls and that the DVD alone education program will demonstrate the greater cost-effectiveness in reducing falls. Stemming from this research, it is anticipated that a cost-effective resource for preventing in-hospital falls will be developed and evaluated such that it can be used in hospitals Australia wide.Read moreRead less
Population Outcomes And Cost-effectiveness Of Universal Newborn Hearing Vs Risk Factor Screening At Age 5 Years.
Funder
National Health and Medical Research Council
Funding Amount
$540,423.00
Summary
Universal newborn hearing screening (UNHS) is being widely implemented because it is thought to greatly improve outcomes for children with congenital deafness. However, it is also very costly. Between 2003-5, all New South Wales babies were offered UNHS, while Victorian babies were offered a risk-factor screening and referral program. This two-year 'natural experiment' paves the way for a unique population effectiveness and cost-effectiveness study of UNHS as the children reach 5 years of age.
Defining And Optimising The Economic And Social Return On Investment Of Telephone Cancer Information And Support Services For All Australians
Funder
National Health and Medical Research Council
Funding Amount
$936,787.00
Summary
The economic and social value of telephone cancer information and support services (CISS) for Australia is undefined thus hindering decisions about the future direction of services and levels of funding. This research will identify and compare the broad monetised, social benefits of CISS with the costs of providing the service. We will identify different strategies to deliver, promote and target services to improve cancer outcomes for all Australians and maximise the return on investment.