Health Care Priorities: The Community's Preferences For Using Community Preferences
Funder
National Health and Medical Research Council
Funding Amount
$52,355.00
Summary
Determining how health care resources should be allocated - often termed rationing or priority setting - has traditionally been carried out by health care personnel, usually doctors but increasingly managers. More recently there has been a move to involve the general public in this process. Much of the research in this area has focussed on the methods used to elicit community preferences. While this is an important area of investigation, a prior issue of how community members feel about the use ....Determining how health care resources should be allocated - often termed rationing or priority setting - has traditionally been carried out by health care personnel, usually doctors but increasingly managers. More recently there has been a move to involve the general public in this process. Much of the research in this area has focussed on the methods used to elicit community preferences. While this is an important area of investigation, a prior issue of how community members feel about the use of their preferences in informing health care priorities needs to be investigated. Four specific questions will be addressed in this study: (i) do members of the general public feel that, as individuals, they have a legitimate role to play in informing priority decisions in health care? if so why? if not, why not? (ii) does the nature-level-setting of the decisions for which priorities are to be set affect whether individual members of the public would wish to participate in the priority setting process? (e.g. different health services, medical procedures-treatments, diseases) (iii) whose preferences should be used if not the community's? (iv) faced ex post with the preferences of the community and the preferences (possibly different) of health service decision makers (i.e. Oexperts'), does this knowledge affect preferences for having community preferences count? A number of health authorities are currently looking for ways of engaging local communities in health care decision making. This study will indicate the appropriate levels at which community preferences are to be elicited and the type of decisions and settings in which they are most relevant.Read moreRead less
Empirical Ethics: Quantification Of Social Preferences For Economic Evaluation In The Health Sector
Funder
National Health and Medical Research Council
Funding Amount
$329,450.00
Summary
Recent studies indicate that there are significant differences between the social 'preferences'-priorities of the population and the priorities implied by health policy and embodied in health economic evaluations of the health sector. For example, members of the public give higher priority to the severely ill even when little can be done for them. The studies suggest that the public would also take into account, inter alia, a number of other factors, including prognosis, health potential and the ....Recent studies indicate that there are significant differences between the social 'preferences'-priorities of the population and the priorities implied by health policy and embodied in health economic evaluations of the health sector. For example, members of the public give higher priority to the severely ill even when little can be done for them. The studies suggest that the public would also take into account, inter alia, a number of other factors, including prognosis, health potential and the social context of the problem. They would not treat program costs in the way economic theory and practice recommends. These issues have been dramatised in the WHO's Evaluation of Health Systems (World Health Report 2000). This assigns a weight of only 0.25 to health improvement and 0.75 to issues of fairness. The proposed study will carry out three tasks. The first is to measure the importance of Australian health-related social preferences which should, potentially, be included in economic evaluation studies. Key values - parameters - including the rate of time preference and the social willingness to pay for an additional year of life will be measured precisely for immediate use. Secondly, the importance of other issues including illness severity, adaptation and prognosis will be tested to determine how these factors should be included in the economic evaluation of health programs. Finally, some general issues related to public versus private funding, egalitarianism and choice will be investigated. Results from interviews and surveys will be integrated in the Assessment of Quality of Life (AQoL) instrument and its user manual.Read moreRead less
Economic Evaluation Of Interventions To Reduce The Burden Of Harm From Alcohol Misuse In Indigenous Australians
Funder
National Health and Medical Research Council
Funding Amount
$609,571.00
Summary
Indigenous people live considerably less than non-Indigenous Australians. Governments spend millions each year trying to close this health gap but there is little evidence to demonstrate that this money is being spent appropriately. This project aims to evaluate the return on investment on funds spent on addressing the harm caused by alcohol misuse in Indigenous Australians. These results will strengthen the evidence-base required to develop appropriate Indigenous health policy in Australia.
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
Economic Evaluation Of The Costs And Benefits Of Options For Publicly Funded Dental Care Provision In Australia
Funder
National Health and Medical Research Council
Funding Amount
$219,135.00
Summary
Governments and administrators of public dental services (PDS) currently address resource allocation problems with little guidance from the public. This project will provide evidence of population priorities that can underpin planning for public dental care and provide direction for priorities in PDS A cost-benefit analysis of dental care, to guide future decisions, will be conducted by comparing the community's willingness to pay for dental services and the cost of providing those services.
Using Evidence To Set Priorities In Health: An Analysis Of Decisions Of The Pharmaceutical Benefits Advisory Committee
Funder
National Health and Medical Research Council
Funding Amount
$174,575.00
Summary
Australia has pioneered the use of rigorous clinical and economic evidence in the evaluation of drugs prior to funding on our nationally subsidised Pharmaceutical Benefits Scheme. In the ten years since the introduction of the requirement that drugs demonstrate cost effectiveness prior to subsidy being granted there has been no formal independent evaluation of the system to assess its performance. This project will examine the recommendations of the Pharmaceutical Benefits Advisory Committee in ....Australia has pioneered the use of rigorous clinical and economic evidence in the evaluation of drugs prior to funding on our nationally subsidised Pharmaceutical Benefits Scheme. In the ten years since the introduction of the requirement that drugs demonstrate cost effectiveness prior to subsidy being granted there has been no formal independent evaluation of the system to assess its performance. This project will examine the recommendations of the Pharmaceutical Benefits Advisory Committee in the last decade and consider the factors that explain those decisions. At times it has been asserted that those decisions have been arbitrary or based on inappropriate considerations such as the financial cost to government or politics of the day rather than the value for money of the drug in question. We will examine the reasons behind the decisions against the objectives of providing access to life enhancing medicines in a cost effective manner. We will look at what are the key determinants of whether a drug is recommended for listing on the PBS or is rejected. A key focus will be on whether those determinants could be described as legitimate in terms of their consistency with the objectives of the scheme. For example whether the main cause of rejection is a lack of high quality evidence on effectiveness- cost effectiveness or simply because of factors such as the high financial cost to government. The project will create a database of all submissions to the PBAC 1992-2004 that will allow us to explore a number of questions about the effectiveness of the decision making process in using evidence on effectiveness and costs in health more broadly as well as those specific to the PBS. In highlighting some of the problems with the evidence and its interpretation the overall aim is to improve the quality of the decision making process in the future.Read moreRead less
Efficacy Of Exercise Physiologist Counselling In Primary Care Patients: A RCT Of Two Pragmatic Approaches
Funder
National Health and Medical Research Council
Funding Amount
$940,925.00
Summary
Physical activity is one of the most powerful contributors to health, but population levels of activity are low. General practitioners (GPs) are well placed to provide physical activity counselling, but many are too busy. This project examines the effectiveness of referral of insufficiently active adults to an exercise physiologist (EP), using step counts from a pedometer as the outcome. We compare usual care from the GP with: (1) 5 EP visits, and (2) a single visit and telephone follow up.