Louisa Gordon

TRACEBACK: Testing of Historical Tubo-Ovarian Cancer Patients for Hereditary Risk Genes as a Cancer Prevention Strategy in Family Members

Publisher: American Society of Clinical Oncology (ASCO)

Date: 20-06-2022

DOI: 10.1200/JCO.21.02108

Abstract: Tubo-ovarian cancer (TOC) is a sentinel cancer for BRCA1 and BRCA2 pathogenic variants (PVs). Identification of a PV in the first member of a family at increased genetic risk (the proband) provides opportunities for cancer prevention in other at-risk family members. Although Australian testing rates are now high, PVs in patients with TOC whose diagnosis predated revised testing guidelines might have been missed. We assessed the feasibility of detecting PVs in this population to enable genetic risk reduction in relatives. In this pilot study, deceased probands were ascertained from research cohort studies, identification by a relative, and gynecologic oncology clinics. DNA was extracted from archival tissue or stored blood for panel sequencing of 10 risk-associated genes. Testing of deceased probands ascertained through clinic records was performed with a consent waiver. We identified 85 PVs in 84 of 787 (11%) probands. Familial contacts of 39 of 60 (65%) deceased probands with an identified recipient (60 of 84 71%) have received a written notification of results, with follow-up verbal contact made in 85% (33 of 39). A minority of families (n = 4) were already aware of the PV. For many (29 of 33 88%), the genetic result provided new information and referral to a genetic service was accepted in most cases (66% 19 of 29). Those who declined referral (4 of 29) were all male next of kin whose family member had died more than 10 years before. We overcame ethical and logistic challenges to demonstrate that retrospective genetic testing to identify PVs in previously untested deceased probands with TOC is feasible. Understanding reasons for a family member's decision to accept or decline a referral will be important for guiding future TRACEBACK projects.

Juggling cancer and life in survivorship

Publisher: The Royal Australian College of General Practitioners

Date: 08-2021

DOI: 10.31128/AJGP-04-21-5938

Patient out-of-pocket medical expenses over 2 years among Queenslanders with and without a major cancer

Publisher: CSIRO Publishing

Date: 2018

DOI: 10.1071/PY18003

Abstract: Medical out-of-pocket costs paid by patients can be problematic when it adversely affects access to care. Survey research involving patients with out-of-pocket expenses may have selection biases, so accurate estimates are unknown. During 2010–11, 419 participants from the QSkin Sun and Health Study (n=43794) had a confirmed diagnosis of either melanoma, prostate, breast, colorectal or lung cancer. These were matched to a general population group (n=421) and a group of high users of GP services (n=419). Medical fees charged and out-of-pocket medical expenses for Medicare services were analysed. Over 2 years, three-quarters of in iduals with cancer paid up-front provider fees of up to A$20551 compared with A$10995 for the high GP user group and A$6394 for the general population group. Out-of-pocket expenses were significantly higher for those with cancer (mean A$3514) compared with the high GP-user group (mean A$1837) and general population group (A$1245). Highest expenses were for therapeutic procedures (mean A$2062). Older in iduals, those with poor perceived health or private health insurance had the highest costs. Regardless of private insurance status, patients with one of the main five cancers pay significantly higher out-of-pocket costs for health care compared with those without cancer.

Evidence on the economic value of psychosocial interventions to alleviate anxiety and depression among cancer survivors: A systematic review

Publisher: Wiley

Date: 18-05-2011

DOI: 10.1111/J.1743-7563.2011.01395.X

Abstract: With cancer cases expected to rise in the coming decades, increased demands will be placed on our health system to address the psychosocial care of patients affected by cancer. The objective of this study was to review the evidence on the cost effectiveness of psychological interventions for in iduals with cancer. A systematic review was undertaken to assess the cost effectiveness of psychosocial approaches specifically treating depression or anxiety, or both, in patients with cancer. Major medical databases were searched together with reference lists from eligible articles. A narrative approach was used to synthesise the findings and quality assessment was guided by recommendations by Drummond's 10-point checklist for reporting health economic evaluations. The review yielded five cost-effectiveness studies. Most interventions showed improvements in some psychological outcomes. Three studies reported slightly but not significantly higher health-care costs for their intervention than their comparison groups. Costs of the interventions ranged from US$47 to $629 per patient. One study of patients with mixed cancer diagnoses used the preferred outcome "quality-adjusted life years" (QALY) and found a cost-effective investment for an intensive nurse-led program with reported incremental costs of £5278 per QALY gained. No study undertook a comprehensive sensitivity analysis although two studies performed simple one-way sensitivity analyses. Current results are inconclusive due to study heterogeneity and inadequate analyses but suggest that psychosocial interventions are inexpensive on a per patient basis. Future studies should routinely include preference-based utility instruments to capture psychological distress in economic evaluation.

Modeling the Cost-effectiveness of Strategies for Treating Esophageal Adenocarcinoma and High-grade Dysplasia

Publisher: Springer Science and Business Media LLC

Date: 30-05-2012

DOI: 10.1007/S11605-012-1911-9

Abstract: This study aims to synthesize cost and health outcomes for current treatment pathways for esophageal adenocarcinoma and high-grade dysplasia (HGD) and to model comparative net clinical and economic benefits of alternative management scenarios. A decision-analytic model of real-world practices for esophageal adenocarcinoma treatment by tumor stage was constructed and validated. The model synthesized treatment probabilities, survival, quality of life, and resource use extracted from epidemiological datasets, published literature, and expert opinion. Comparative analyses between current practice and five hypothetical scenarios for modified treatment were undertaken. Over 5 years, outcomes across T stage ranged from 4.06 quality-adjusted life-years and costs of $3,179 for HGD to 1.62 quality-adjusted life-years and costs of $50,226 for stage T4. Greater use of endoscopic mucosal resection for stage T1 and measures to reduce esophagectomy mortality to 0-3 % produced modest gains, whereas a 20 % reduction in the proportion of patients presenting at stage T3 produced large incremental net benefits of $4,971 (95 % interval, $1,560-8,368). These findings support measures that promote earlier diagnosis, such as developing risk assessment processes or endoscopic surveillance of Barrett's esophagus. Incremental net monetary benefits for other strategies are relatively small in comparison to predicted gains from early detection strategies.

What does it cost Medicare to diagnose and treat men with localized prostate cancer in the first year?

Publisher: Wiley

Date: 16-03-2017

DOI: 10.1111/AJCO.12663

Abstract: To estimate costs on the Medicare Benefits Schedule (MBS) and the Pharmaceutical Benefits Scheme (PBS) attributable to the diagnosis and treatment of prostate cancer. We used data from a cohort study of 1064 men with localized prostate cancer recruited between 2005 and 2007 by 24 urologists across 10 sites in Queensland, Australia (ProsCan). We estimated the MBS and PBS costs attributable to prostate cancer from the date of initial appointment to 12 months after diagnosis in 2013 Australian dollars using a comparison group without prostate cancer. We used generalized linear modeling to identify key determinants of higher treatment-related costs. From the date of initial appointment to 12 months postdiagnosis, the average MBS costs attributable to prostate cancer were $9,357 (SD $191) per patient. These MBS costs were most sensitive to having private health insurance and the type of primary treatment received. The PBS costs were higher in the control group than in the ProsCan group ($5,641 vs $1,924). The costs of treating and managing prostate cancer are high and these result in a substantial financial burden for the Australian MBS. Costs attributable to prostate cancer appear to vary widely based on initial treatment and these are likely to increase with the introduction of more expensive services and pharmaceuticals. There is a pressing need for better prognostic tools to distinguish between indolent and aggressive prostate tumors to reduce potential over treatment and help ease the burden of prostate cancer.

Within a smoking-cessation program, what impact does genetic information on lung cancer need to have to demonstrate cost-effectiveness?

Publisher: Springer Science and Business Media LLC

Date: 2010

DOI: 10.1186/1478-7547-8-18

Cost-effectiveness of a policy-based intervention to reduce melanoma and other skin cancers associated with indoor tanning.

Publisher: Oxford University Press (OUP)

Date: 18-05-2022

DOI: 10.1111/BJD.21046

Abstract: The use of indoor tanning devices causes melanoma and other skin cancers with resulting morbidity, mortality and increased healthcare costs. Policymakers require robust economic evidence to inform decisions about a possible ban of such devices to mitigate these burdens. To assess the health costs and consequences of introducing a policy-based intervention across England to ban commercial indoor tanning with an accompanying public information c aign. A cost-effectiveness analysis, adopting a healthcare system perspective, was conducted using a decision model to track a national cohort of 18-year-olds over a lifetime time horizon. A nationwide ban on commercial indoor tanning combined with a public information c aign (the policy-based intervention) was compared with the status quo of availability of commercial indoor tanning. The expected costs (currency, GBP price year, 2019) and quality-adjusted life-years (QALYs) were calculated. Net monetary benefit (NMB) (net benefit measured in cost compared with an accepted threshold) and net health benefit (NHB) (net gain in QALYs compared with an accepted threshold) of implementation were calculated. A probabilistic sensitivity analysis was used to calculate the probability that the intervention was cost-effective. Compared with the current situation, a ban on commercial indoor tanning combined with a public information c aign would result in 1206 avoided cases of melanoma, 207 fewer melanoma deaths and 3987 averted cases of keratinocyte cancers over the lifetime of all 18-year-olds (n = 618 873) living in England in 2019. An additional 497 QALYs would be realized along with healthcare cost-savings of £697 858. This intervention would result in an NMB of £10.6m and an NHB of 530 QALYS. Multiple sensitivity analyses confirmed the robustness of the findings. At a cost-effectiveness threshold of £20 000, there is a 99% likelihood of this policy-based intervention being cost-effective. The implementation of a ban on commercial indoor tanning across England with an accompanying public information c aign would be an effective use of healthcare resources.

Healthcare resource use and medical costs for the management of oesophageal cancer

Publisher: Oxford University Press (OUP)

Date: 17-08-2011

DOI: 10.1002/BJS.7599

Abstract: This study examined the interaction between natural history, current practice patterns in diagnosis, monitoring and treatment of oesophageal cancer, and associated health resource utilization and costs. A cost analysis of a prospective population-based cohort of 1100 patients with a primary diagnosis of oesophageal cancer was performed using chart review from the Australian Cancer Study Clinical Follow-Up Study. The analysis enabled estimation of healthcare resources and associated costs in 2009 euros by stage of disease and treatment pathway. Most patients (88·5 per cent) presented with stage II, III or IV cancer 61·1 per cent (672 of 1100) were treated surgically. Overall mean costs were €37 195 (median €29 114) for patients undergoing surgery and €17 281 (median €13 066) for those treated without surgery. Surgery contributed 66·4 per cent of the total costs (mean €24 697 per patient) in the surgical group. In the non-surgical group, use of chemotherapy was more prevalent (81·9 per cent of patients) and contributed 61·1 per cent of the total costs. Other important cost determinants were gastro-oesophageal junction tumours, treatment location and tumour stage. Mean costs of those monitored for Barrett's oesophagus (7·3 per cent of patients) were lower, although about one-third still presented with advanced-stage cancer. Overall costs for managing oesophageal cancer were high and dominated by surgery costs in patients treated surgically and by chemotherapy costs in patients treated without surgery. Radiotherapy, treatment location and cancer subtype were also important. Monitoring for Barrett's oesophagus and earlier-stage detection were associated with lower management costs, but the potential net benefit from surveillance strategies needs further investigation.

A reconstruction of a medical history from administrative data: with an application to the cost of skin cancer

Publisher: Springer Science and Business Media LLC

Date: 11-02-2015

DOI: 10.1186/S13561-015-0042-X

Exercise during CHemotherapy for Ovarian cancer (ECHO) trial: design and implementation of a randomised controlled trial

Publisher: BMJ

Date: 04-2023

DOI: 10.1136/BMJOPEN-2022-067925

Abstract: Epidemiological evidence supports an association between higher levels of physical activity and improved cancer survival. Trial evidence is now needed to demonstrate the effect of exercise in a clinical setting. The E xercise during CH emotherapy for O varian cancer (ECHO) trial is a phase III, randomised controlled trial, designed to determine the effect of exercise on progression-free survival and physical well-being for patients receiving first-line chemotherapy for ovarian cancer. Participants (target s le size: n=500) include women with newly diagnosed primary ovarian cancer, scheduled to receive first-line chemotherapy. Consenting participants are randomly allocated (1:1) to either the exercise intervention (plus usual care) or usual care alone, with stratification for recruitment site, age, stage of disease and chemotherapy delivery (neoadjuvant vs adjuvant). The exercise intervention involves in idualised exercise prescription with a weekly target of 150 minutes of moderate-intensity, mixed-mode exercise (equivalent to 450 metabolic equivalent minutes per week), delivered for the duration of first-line chemotherapy through weekly telephone sessions with a trial-trained exercise professional. The primary outcomes are progression-free survival and physical well-being. Secondary outcomes include overall survival, physical function, body composition, quality of life, fatigue, sleep, lymphoedema, anxiety, depression, chemotherapy completion rate, chemotherapy-related adverse events, physical activity levels and healthcare usage. Ethics approval for the ECHO trial (2019/ETH08923) was granted by the Sydney Local Health District Ethics Review Committee (Royal Prince Alfred Zone) on 21 November 2014. Subsequent approvals were granted for an additional 11 sites across Queensland, New South Wales, Victoria and the Australian Capital Territory. Findings from the ECHO trial are planned to be disseminated via peer-reviewed publications and international exercise and oncology conferences. Australian New Zealand Clinical Trial Registry (ANZCTRN12614001311640 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=367123& isReview=true ).

Value of Information Analysis in Oncology: The Value of Evidence and Evidence of Value

Publisher: American Society of Clinical Oncology (ASCO)

Date: 03-2014

DOI: 10.1200/JOP.2013.001108

Abstract: Benefits in oncology research and practice will potentially be optimized with increased application of VOI methods to inform decision making, optimal trial design, and research prioritization.

Translating research into practice: outcomes from the Healthy Living after Cancer partnership project.

Publisher: Springer Science and Business Media LLC

Date: 06-10-2020

DOI: 10.1186/S12885-020-07454-4

Abstract: Healthy Living after Cancer (HLaC) was a national dissemination and implementation study of an evidence-based lifestyle intervention for cancer survivors. The program was imbedded into existing telephone cancer information and support services delivered by Australian state-based Cancer Councils (CC). We report here the reach, effectiveness, adoption, implementation, and maintenance of the program. In this phase IV study (single-group, pre-post design) participants - survivors of any type of cancer, following treatment with curative intent - received up to 12 nurse/allied health professional-led telephone health coaching calls over 6 months. Intervention delivery was grounded in motivational interviewing, with emphasis on evidence-based behaviour change strategies. Using the RE-AIM evaluation framework, primary outcomes were reach, indicators of program adoption, implementation, costs and maintenance. Secondary (effectiveness) outcomes were participant-reported anthropometric, behavioural and psychosocial variables including: weight physical activity dietary intake quality-of-life treatment side-effects distress and fear of cancer recurrence and participant satisfaction. Changes were evaluated using linear mixed models, including terms for timepoint (0/6 months), strata (Cancer Council), and timepoint x strata. Four of 5 CCs approached participated in the study. In total, 1183 cancer survivors were referred (mostly via calls to the Cancer Council telephone information service). Of these, 90.4% were eligible and 88.7% ( n = 791) of those eligible consented to participate. Retention rate was 63.4%. Participants were mostly female (88%), aged 57 years and were overweight (BMI = 28.8 ± 6.5 kg/m2). Improvements in all participant-reported outcomes (standardised effect sizes of 0.1 to 0.6) were observed ( p 0.001). The program delivery costs were on average AU$427 (US$296) per referred cancer survivor. This telephone-delivered lifestyle intervention, which was feasibly implemented by Cancer Councils, led to meaningful and statistically significant improvements in cancer survivors’ health and quality-of-life at a relatively low cost. Australian and New Zealand Clinical Trials Registry (ANZCTR) - ACTRN12615000882527 (registered on 24/08/2015).

EndoScreen Chip: Serum Complement C9 Immunoassays Improve Risk Prediction and Early Diagnosis of Esophageal Adenocarcinoma

Publisher: MDPI AG

Date: 12-03-2021

DOI: 10.20944/PREPRINTS202103.0330.V1

Abstract: Esophageal adenocarcinoma (EAC) detection relies on endoscopy-biopsy diagnosis, with routine endoscopic surveillance recommended for Barrett& rsquo s esophagus (BE) patients. Here, we examine the utility of blood biomarkers in patient risk stratification by translating the EAC blood biomarker Jacalin lectin binding complement C9 (JAC-C9) into a novel microfluidic immunoassay, the EndoScreen Chip. Cohort evaluation (n=46) showed elevated serum total C9 and JAC-C9 in EAC. Logistic regression modeling demonstrated that addition of C9 and JAC-C9 to patient risk factors (age, body mass index and heartburn/reflux history) improved EAC prediction from AUROC of 0.838 to 0.931. Serum JAC-C9 strongly predicted EAC (vs BE OR= 4.6, 95% CI: 1.6-15.6, p = 0.014 vs Healthy OR=4.1, 95% CI:1.2-13.7, p = 0.024) while total C9 was moderately predictive for BE (vs EAC OR=1.4 95% CI: 1.0-1.8, p = 0.032 vs Healthy OR=0.8 95% CI: 0.6-1.0, p = 0.039). This translational study demonstrates the potential utility of blood biomarkers in improving triaging for diagnostic endoscopy.

Advanced practice profiles and work activities of nurse navigators: An early-stage evaluation

Publisher: Elsevier BV

Date: 02-2019

DOI: 10.1016/J.COLEGN.2018.05.003

Qualitative insights of patients and carers under the care of nurse navigators

Publisher: Elsevier BV

Date: 02-2019

DOI: 10.1016/J.COLEGN.2018.05.002

Accounting for Intergenerational Cascade Testing in Economic Evaluations of Clinical Genomics—A Scoping Review

Publisher: Elsevier BV

Date: 06-2021

DOI: 10.1016/J.JVAL.2021.11.1353

Abstract: Clinical genomics is emerging as a diagnostic tool in the identification of blood relatives at risk of developing heritable diseases. Our objective was to identify how genetic cascade screening has been incorporated into health economic evaluations. A scoping review was conducted to identify how multiple generations of a family were included in economic evaluations of clinical genomic sequencing, how many and which relatives were included, and uptake rates. Databases were searched for full economic evaluations of genetic interventions that screened multiple generations of families and were in English language, and no restrictions were made for disease or publication type. Data were synthesized using a narrative approach. Twenty-five studies were included covering a range of diseases in various countries. Markov cohort models were mostly used with hypothetical populations and unsupported by clinical evidence. Cascade testing was either the primary intervention or secondary to the index cases. The number and type of relatives were based on assumptions or identified through population or family records, clinical registry data, or clinical literature. Studies included only immediate family members and the uptake of testing ranged between 20% and 100%. All interventions were reported as cost-effective, and a higher number of relatives was a key driver. Several economic evaluations have considered the impacts of cascade testing interventions within clinical genomics. Ideally, models supported with high-quality clinical data are needed and, in their absence, transparent and justifiable assumptions of uptake rates and choices about including relatives. Consideration of more appropriate modeling types is required.

Cost-Effectiveness of a Serum Biomarker Test for Risk-Stratified Liver Ultrasound Screening for Hepatocellular Carcinoma

Publisher: Elsevier BV

Date: 10-2021

DOI: 10.1016/J.JVAL.2021.04.1286

Abstract: Risk-stratified ultrasound screening for hepatocellular carcinoma (HCC), informed by a serum biomarker test, enables resources to be targeted to patients at the highest risk of developing cancer. We aimed to investigate the cost-effectiveness of risk-stratified screening for HCC in the Australian healthcare system. A Markov cohort model was constructed to test 3 scenarios for patients with compensated cirrhosis: (1) risk-stratified screening for high-risk patients, (2) all-inclusive screening, and (3) no formal screening. Probabilistic sensitivity analyses were undertaken to determine the impact of uncertainty. Scenario analyses were used to assess cost-effectiveness in Australia's Aboriginal and Torres Strait Islander peoples and to determine the impact of including productivity-related costs of mortality. Both risk-stratified screening and all-inclusive screening programs were cost-effective compared with no formal screening, with incremental cost-effectiveness ratios of A$39 045 and A$23 090 per quality-adjusted life-year (QALY), respectively. All-inclusive screening had an incremental cost-effectiveness ratio of A$4453 compared with risk-stratified screening and had the highest probability of being cost-effective at a willingness-to-pay (WTP) threshold of A$50 000 per QALY. Risk-stratified screening had the highest likelihood of cost-effectiveness when the WTP was between A$25 000 and A$35 000 per QALY. Cost-effectiveness results were further strengthened when applied to an Aboriginal and Torres Strait Islander cohort and when productivity costs were included. Cirrhosis population-wide screening for HCC is likely to be cost-effective in Australia. Risk-stratified screening using a serum biomarker test may be cost-effective at lower WTP thresholds.

Medical cost-offsets from psychosocial care in breast cancer

Publisher: Springer Science and Business Media LLC

Date: 20-09-2007

DOI: 10.1007/S10549-007-9750-1

Cost analysis of gym-based versus home-based cardiac rehabilitation programs.

Publisher: CSIRO Publishing

Date: 2001

DOI: 10.1071/AH010051

Abstract: A cost-analysis of an existing gym-based program was compared with a proposed home-based program for deliveringcardiac rehabilitation services in West Moreton, Queensland. Cost and baseline data were collected on 95 cardiacrehabilitation patients living in Ipswich and West Moreton. Cost data included costs to the program funders andpatients. The average cost per patient rehabilitated was $1,933 in the gym-based program and $1,169 in the home-basedprogram. Adopting the lower cost home-based program would allow the services to be provided to many morepatients. The relevance of home-based rehabilitation programs for rural patients facing barriers accessing traditionalhospital- or gym-based programs is significant.

Estimated Healthcare Costs of Melanoma in Australia Over 3 Years Post-Diagnosis

Publisher: Springer Science and Business Media LLC

Date: 29-07-2017

DOI: 10.1007/S40258-017-0341-Y

Abstract: Skin cancer exerts a large and growing burden on health systems. With new pharmacotherapies for metastatic melanoma now available, a contemporary understanding of the cost burden of melanoma control is warranted. To comprehensively assess the healthcare costs of malignant melanoma diagnosis and treatment in Australia, over 3 years after diagnosis. We developed a decision-analytic model and micro-costing method to estimate the mean cost per patient for melanoma, incorporating all diagnostic and treatment modalities used in Australia (2017 AU$). By using the de-identified 10% s le of Medicare Benefits Scheme, we analysed health service use and supplemented our analyses with published estimates. We took a health system cost perspective, and addressed input uncertainty with sensitivity analyses. The mean annual cost per patient for melanoma stage 0/I/II was AU$1681 (US$1175) rising to AU$37,729 (US$26,365) for stage III resectable, and AU$115,109 (US$80,440) for stage III unresectable/IV. Three-year costs for stage III unresectable/IV were AU$187,720. Nationally, the annual estimated cost for treatment of all new cases of in situ and invasive melanomas was AU$201 million (95% CI: AU$187 to AU$216 million). When we included treatments for presumptive melanoma later found to be benign lesions, the estimated annual cost burden reached AU$272 million. With rapidly rising treatment costs, there is a need to consider a comprehensive melanoma control strategy that includes primary prevention of skin cancers and cost-effective sun protection initiatives.

On the potential beneficial effects of indoor tanning: reply from the authors

Publisher: Oxford University Press (OUP)

Date: 12-2022

DOI: 10.1111/BJD.21854

A cost-effectiveness analysis of a telephone-linked care intervention for individuals with Type 2 diabetes

Publisher: Elsevier BV

Date: 04-2014

DOI: 10.1016/J.DIABRES.2013.12.032

Abstract: To assess the cost-effectiveness of an automated telephone-linked care intervention, Australian TLC Diabetes, delivered over 6 months to patients with established Type 2 diabetes mellitus and high glycated haemoglobin level, compared to usual care. A Markov model was designed to synthesize data from a randomized controlled trial of TLC Diabetes (n=120) and other published evidence. The 5-year model consisted of three health states related to glycaemic control: 'sub-optimal' HbA1c ≥58mmol/mol (7.5%) 'average' ≥48-57mmol/mol (6.5-7.4%) and 'optimal' <48mmol/mol (6.5%) and a fourth state 'all-cause death'. Key outcomes of the model include discounted health system costs and quality-adjusted life years (QALYS) using SF-6D utility weights. Univariate and probabilistic sensitivity analyses were undertaken. Annual medication costs for the intervention group were lower than usual care [ £1076 (95%CI: £947, £1206) versus usual care £1271 (95%CI: £1115, £1428) p=0.052]. The estimated mean cost for intervention group participants over five years, including the intervention cost, was £17,152 versus £17,835 for the usual care group. The corresponding mean QALYs were 3.381 (SD 0.40) for the intervention group and 3.377 (SD 0.41) for the usual care group. Results were sensitive to the model duration, utility values and medication costs. The Australian TLC Diabetes intervention was a low-cost investment for in iduals with established diabetes and may result in medication cost-savings to the health system. Although QALYs were similar between groups, other benefits arising from the intervention should also be considered when determining the overall value of this strategy.

Hepatocellular carcinoma surveillance in Australia: time to improve the diagnosis of cirrhosis and use liver ultrasound

Publisher: AMPCo

Date: 24-02-2020

DOI: 10.5694/MJA2.50521

Health utilities and health‐related quality of life of patients with keratinocyte skin cancers

Publisher: Wiley

Date: 07-08-2023

DOI: 10.1002/JVC2.227

Abstract: Health utilities and health‐related quality of life (HRQoL) have not been adequately examined in patients with basal and squamous cell carcinomas (or keratinocyte skin cancers KCs) repeatedly treated for multiple skin cancers and who require ongoing medical surveillance. Our aim was to assess whether health utilities and HRQoL in an Australian population‐based s le of patients recently treated for multiple KCs were poorer compared to patients with single or no KCs. Selected from the QSkin Study, a cross‐sectional analysis of 680 patients was undertaken involving data linkage of survey and administrative claims data. Health utility was measured using the EuroQol‐5D 5‐level (EQ‐5D‐5L) while HRQoL was assessed using the Basal and Squamous Cell Carcinoma Quality of Life (BaSQoL) instrument. Scores were summarised by sociodemographic and skin cancer profiles and stratified by skin cancer group (i.e., naïve or zero, single, multiple KCs). Generalised linear models with Poisson family and log link functions were used for multivariate analyses. The mean EQ‐5D‐5L score was slightly worse for people with multiple KCs (mean: 0.88, SD: 0.14) versus single KCs (mean: 0.90, SD: 0.16) versus none (mean: 0.91, SD: 0.11). Mean scores were not significantly different across skin cancer group after adjustment for number of comorbidities and self‐reported health. BaSQoL domain scores indicated having KCs had little impact on quality of life with mean total scores ranging from 0.27 for the ‘appearance’ domain to 1.15 for the ‘other people’ domain out of a maximum (worst) score of 3. Even among persons chronically afflicted with multiple KCs and ongoing surgical and nonsurgical treatments, health utility and HRQoL losses were minimal and similar to those people without KCs.

Development of EndoScreen Chip, a Microfluidic Pre-Endoscopy Triage Test for Esophageal Adenocarcinoma

Publisher: MDPI AG

Date: 08-06-2021

DOI: 10.3390/CANCERS13122865

Abstract: The current endoscopy and biopsy diagnosis of esophageal adenocarcinoma (EAC) and its premalignant condition Barrett’s esophagus (BE) is not cost-effective. To enable EAC screening and patient triaging for endoscopy, we developed a microfluidic lectin immunoassay, the EndoScreen Chip, which allows sensitive multiplex serum biomarker measurements. Here, we report the proof-of-concept deployment for the EAC biomarker Jacalin lectin binding complement C9 (JAC-C9), which we previously discovered and validated by mass spectrometry. A monoclonal C9 antibody (m26 3C9) was generated and validated in microplate ELISA, and then deployed for JAC-C9 measurement on EndoScreen Chip. Cohort evaluation (n = 46) confirmed the expected elevation of serum JAC-C9 in EAC, along with elevated total serum C9 level. Next, we asked if the small panel of serum biomarkers improves detection of EAC in this cohort when used in conjunction with patient risk factors (age, body mass index and heartburn history). Using logistic regression modeling, we found that serum C9 and JAC-C9 significantly improved EAC prediction from AUROC of 0.838 to 0.931, with JAC-C9 strongly predictive of EAC (vs. BE OR = 4.6, 95% CI: 1.6–15.6, p = 0.014 vs. Healthy OR = 4.1, 95% CI: 1.2–13.7, p = 0.024). This proof-of-concept study confirms the microfluidic EndoScreen Chip technology and supports the potential utility of blood biomarkers in improving triaging for diagnostic endoscopy. Future work will expand the number of markers on EndoScreen Chip from our list of validated EAC biomarkers.

Management of organ transplant recipients attending a high-throughput skin cancer surgery and surveillance clinic in Queensland

Publisher: Oxford University Press (OUP)

Date: 27-09-2019

DOI: 10.1111/BJD.17001

Abstract: The incidence of skin cancer in organ transplant recipients (OTRs) is very high, due mainly to long-term immunosuppressive therapy. The problem is particularly severe for OTRs living in Queensland, Australia, and results in significant mortality. To describe the experience of the first dedicated outpatient high-throughput transplant skin clinic in Queensland. This prospective evaluation study was conducted at a newly established, outpatient transplant skin cancer surgery and surveillance clinic. Participants (89 OTRs and 12 non-OTRs) were referred to the Princess Alexandra Hospital Transplant Skin Clinic during December 2016 to May 2017, and were each followed for 3 months. Self-completed questionnaires were administered at baseline and the end of follow-up (n = 94), and details of any skin cancers occurring in that period were extracted from hospital records. In the 3-month follow-up of 101 participants, a total of 615 skin lesions were detected in the 3-month follow-up of 101 participants, of which 478 (78%) were treated in the clinic and 55 (9%) were referred to another specialist. Of the 478 treated lesions, 268 were histopathologically confirmed skin cancers, equivalent to 2·7 (95% confidence interval 2·5-2·8) skin cancers per participant per 3 months. The overall number needed to treat for any skin cancer was 1·4 (95% confidence interval 1·3-1·5). Three-quarters (374) of in-clinic treatments were surgical, and most (90%) were complete excisions. The median time from detection of skin cancer to excision was 7 days. This high-volume surgical outpatient transplant skin clinic enables efficient treatment of skin cancers in very-high-risk OTRs.

Hospitalization costs for patients colonized with carbapenemase-producing Enterobacterales during an Australian outbreak

Publisher: Elsevier BV

Date: 06-2020

DOI: 10.1016/J.JHIN.2020.03.009

Sun Protection Among Organ Transplant Recipients After Participation in a Skin Cancer Research Study

Publisher: American Medical Association (AMA)

Date: 07-2018

DOI: 10.1001/JAMADERMATOL.2018.1164

Navigate: a study protocol for a randomised controlled trial of an online treatment decision aid for men with low-risk prostate cancer and their partners

Publisher: Springer Science and Business Media LLC

Date: 11-01-2021

DOI: 10.1186/S13063-020-04986-9

Abstract: Active surveillance (AS) is the disease management option of choice for low-risk prostate cancer. Despite this, men with low-risk prostate cancer (LRPC) find management decisions distressing and confusing. We developed Navigate , an online decision aid to help men and their partners make management decisions consistent with their values. The aims are to evaluate the impact of Navigate on uptake of AS decision-making preparedness decisional conflict, regret and satisfaction quality of illness communication and prostate cancer-specific quality of life and anxiety. In addition, the healthcare cost impact, cost-effectiveness and patterns of use of Navigate will be assessed. This paper describes the study protocol. Three hundred four men and their partners are randomly assigned one-to-one to Navigate or to the control arm. Randomisation is electronically generated and stratified by site. Navigate is an online decision aid that presents up-to-date, unbiased information on LRPC tailored to Australian men and their partners including each management option and potential side-effects, and an interactive values clarification exercise. Participants in the control arm will be directed to the website of Australia’s peak national body for prostate cancer. Eligible patients will be men within 3 months of being diagnosed with LRPC, aged 18 years or older, and who are yet to make a treatment decision, who are deemed eligible for AS by their treating clinician and who have Internet access and sufficient English to participate. The primary outcome is self-reported uptake of AS as the first-line management option. Secondary outcomes include self-reported preparedness for decision-making decisional conflict, regret and satisfaction quality of illness communication and prostate cancer-specific quality of life. Uptake of AS 1 month after consent will be determined through patient self-report. Men and their partners will complete study outcome measures before randomisation and 1, 3 and 6 months after study consent. The Navigate online decision aid has the potential to increase the choice of AS in LRPC, avoiding or delaying unnecessary radical treatments and associated side effects. In addition, Navigate is likely to reduce patients’ and partners’ confusion and distress in management decision-making and increase their quality of life. Australian and New Zealand Clinical Trial Registry ACTRN12616001665426 . Registered on 2 December 2016. All items from the WHO Trial Registration Data set can be found in this manuscript.

Do nurse navigators bring about fewer patient hospitalisations?

Publisher: Emerald

Date: 18-03-2019

DOI: 10.1108/JHOM-02-2018-0063

Abstract: Nurse navigators (NNs) coordinate patient care, improve care quality and potentially reduce healthcare resource use. The purpose of this paper is to undertake an evaluation of hospitalisation outcomes in a new NN programme in Queensland, Australia. A matched case-control study was performed. Patients under the care of the NNs were randomly selected ( n =100) and were matched to historical ( n =300) and concurrent ( n =300) comparison groups. The key outcomes of interest were the number and types of hospitalisations, length of hospital stay and number of intensive care unit days. Generalised linear and two-part models were used to determine significant differences in resources across groups. The control and NN groups were well matched on socio-economic characteristics, however, groups differed by major disease type and number/type of comorbidities. NN patients had high healthcare needs with 53 per cent having two comorbidities. In adjusted analyses, compared with the control groups, NN patients showed higher proportions of preventable hospitalisations over 12 months, similar days in intensive care and a smaller proportion had overnight stays in hospital. However, the NN patients had significantly more hospitalisations (mean: 6.0 for NN cases, 3.4 for historical group and 3.2 for concurrent group) and emergency visits. As many factors will affect hospitalisation rates beyond whether patients receive NN care, further research and longer follow-up is required. A matched case-control study provides a reasonable but insufficient design to compare the NN and non-NN exposed patient outcomes.

Is endoscopic surveillance for non-dysplastic Barrett's esophagus cost-effective? Review of economic evaluations

Publisher: Wiley

Date: 25-01-2011

DOI: 10.1111/J.1440-1746.2010.06506.X

Abstract: Several health economic evaluations have explored the cost-effectiveness of endoscopic surveillance for patients with non-dysplastic Barrett's esophagus, with conflicting results. By comparing results across studies and highlighting key methodological and data limitations a platform for future, more rigorous analyses, can be developed. A systematic literature review was undertaken of studies evaluating cost-effectiveness of surveillance for non-dysplastic Barrett's esophagus. Articles were included if they assessed both cost and health outcomes for surveillance versus no surveillance. A descriptive review was undertaken and the quality of the studies appraised against best-practice recommendations for economic evaluations and modeling studies. Seven publications met the inclusion criteria. All used decision-analytic Markov models. Half of the evaluations found surveillance was not cost-effective. At best, surveillance produced improved outcomes at a cost of US$16 640 per quality-adjusted life-year, and at worst it did more harm than good and at a greater cost. The quality of the evaluations and generalizability to the Asia-Pacific region was diminished as a result of inadequate or inconsistent evidence supporting parameter estimates, such as quality of life, endoscopic sensitivity and specificity and cancer recurrence rates. Unless newly emerging technologies improve the quality-adjusted survival benefit conferred by endoscopic surveillance, this strategy is unlikely to be cost-effective. Obsolete assumptions and incomplete analyses reduce the quality of published evaluations. For these reasons new evaluations are required that encompass the growing evidence base for new technologies, such as new endoscopic therapies for high-grade dysplasia and intramucosal cancer.

Cost-effectiveness analysis of clinically indicated versus routine replacement of peripheral intravenous catheters

Publisher: Springer Science and Business Media LLC

Date: 10-01-2014

DOI: 10.1007/S40258-013-0077-2

Abstract: Millions of peripheral intravenous catheters are used worldwide. The current guidelines recommend routine catheter replacement every 72-96 h. This practice requires increasing healthcare resource use. The clinically indicated catheter replacement strategy is proposed as an alternative. To assess the cost effectiveness of clinically indicated versus routine replacement of peripheral intravenous catheters. A cost-effectiveness analysis from the perspective of Queensland Health, Australia, was conducted alongside a randomized controlled trial. Adult patients with an intravenous catheter of expected use for longer than 4 days were randomly assigned to receive either clinically indicated replacement or third-day routine replacement. The primary outcome was phlebitis during catheterization or within 48 h after catheter removal. Resource use data were prospectively collected and valued (2010 prices). The incremental net monetary benefit was calculated with uncertainty characterized using bootstrap simulations. Additionally, value of information (VOI) and value of implementation analyses were performed. The clinically indicated replacement strategy was associated with a cost saving per patient of AU$7.60 (95% confidence interval [CI] 4.96-10.62) and a non-significant difference in the phlebitis rate of 0.41% (95% CI -1.33 to 2.15). The incremental net monetary benefit was AU$7.60 (95% CI 4.96-10.62). The expected VOI was zero, whereas the expected value of perfect implementation of the clinically indicated replacement strategy was approximately AU$5 million over 5 years. The clinically indicated catheter replacement strategy is cost saving compared with routine replacement. It is recommended that healthcare organizations consider changing to a policy whereby catheters are changed only if clinically indicated.

Intracellular ribonucleotide pools as a tool for monitoring the physiological state of plant cell suspension culture of Vitis vinifera in response to temperature change

Publisher: Elsevier BV

Date: 11-2009

DOI: 10.1016/J.JBIOSC.2009.08.496

Consequences of banning commercial solaria in 2016 in Australia

Publisher: Elsevier BV

Date: 06-2020

DOI: 10.1016/J.HEALTHPOL.2020.04.010

Safety, feasibility and effects of an individualised walking intervention for women undergoing chemotherapy for ovarian cancer: a pilot study

Publisher: Springer Science and Business Media LLC

Date: 08-09-2011

DOI: 10.1186/1471-2407-11-389

Relationships Between Financial Toxicity and Symptom Burden in Cancer Survivors: A Systematic Review

Publisher: Elsevier BV

Date: 03-2019

DOI: 10.1016/J.JPAINSYMMAN.2018.12.003

Abstract: Financial toxicity (FT) is used to describe the financial distress/hardship associated with cancer and its treatment. The aim of this review was to explore the relationship between FT and symptom burden. A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE, EMBASE, and CINAHL (from January 2000 to January 2018) and accepted quantitative, mixed-methods and qualitative studies. Data were extracted and appraised by two reviewers. Owing to significant heterogeneity in the included studies, a narrative synthesis was performed. Nine studies involving 11,544 cancer survivors were included. Of these nine studies, eight were of high quality. The relationships between FT and psychological symptoms and physical symptoms were examined in eight and three studies, respectively. Six studies reported a positive relationship between FT and depression. Three studies found a positive association between FT and anxiety. Limited evidence was found for an association between FT and stress, fear of recurrence, spiritual suffering, pain, and overall symptom burden. A relatively clear association exists between FT and psychological symptoms. Clinicians should regularly screen for, assess, and manage emotional distress that may be attributed to FT. Although the causal pathway is not known, future intervention studies aimed at minimizing or preventing FT should evaluate psychological symptoms as secondary outcomes. Little is known about the relationships between FT and physical symptoms. Future research should overcome methodological limitations by incorporating longitudinal data collection, use of mixed-methods approaches, and homogeneity of s les.

Cancer put my life on hold

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 03-2017

DOI: 10.1097/NCC.0000000000000359

Letter to the Editor in response to “When to apply sunscreen: a consensus statement for Australia and New Zealand”

Publisher: Elsevier BV

Date: 10-2019

DOI: 10.1111/1753-6405.12904

Cost savings for elective laparoscopic resection compared with open resection for colorectal cancer in a region of high uptake

Publisher: Springer Science and Business Media LLC

Date: 14-12-2014

DOI: 10.1007/S00464-013-3345-1

Abstract: Previous cost analyses of laparoscopic resection for colorectal cancer (CRC) reported slightly higher or similar costs to those of open resection. These analyses were based on randomised controlled trials when the laparoscopic approach was newly adopted. This study compared costs for laparoscopic versus open resection in a region of high uptake where adoption is mature. Hospital cost data were obtained for elective resections for CRC that occurred between June 2009 and June 2011 in public hospitals in Queensland, Australia. The primary outcome was total cost and secondary outcomes were length-of-stay, operating time, and ICU admission. Multivariate least-squares regression was used to adjust for potential confounders: age, sex, comorbidities, procedure, and hospital volume. The crude mean cost for laparoscopic resection was euro 20,036 compared with that for open resection of euro 22,780 (difference = euro 2,744). Patients who underwent laparoscopic resection (744/1,397 53 %) were slightly younger and had fewer comorbidities (decreasing costs) but more had rectal surgery (increasing costs). The adjusted mean cost for laparoscopic resection was euro 20,396 compared with euro 22,442 for open resection (difference = euro 2,054). Compared with open resection, when adjusted for potential confounders, laparoscopic resection resulted in similar operating time (216 vs. 214 min), shorter length-of-stay (difference = -1.1 days, 95 % CI -1.9, -0.3), and shorter admission to ICU (difference = -7.3 h, 95 % CI -11.9, -2.7). This non-randomised study in a region of high uptake found a similar operating time and lower cost for laparoscopic resection for CRC compared with those of open resection due to a shorter length-of-stay and shorter time in ICU. Laparoscopic resection for CRC saves money when the procedure is widely adopted and surgeons are experienced in the technique.

Cost-effectiveness of endoscopic surveillance of non-dysplastic Barrett's esophagus

Publisher: Elsevier BV

Date: 02-2014

DOI: 10.1016/J.GIE.2013.07.046

Abstract: Endoscopic surveillance for non-dysplastic Barrett's esophagus (BE) is contentious and its cost effectiveness unclear. To perform an economic analysis of endoscopic surveillance strategies. Cost-utility analysis by using a simulation Markov model to synthesize evidence from large epidemiologic studies and clinical data for surveillance, based on international guidelines, applied in a coordinator-managed surveillance program. Tertiary care hospital, South Australia. A total of 2040 patient-years of follow-up. (1) No surveillance, (2) 2-yearly endoscopic surveillance of patients with non-dysplastic BE and 6-monthly surveillance of patients with low-grade dysplasia, (3) a hypothetical strategy of biomarker-modified surveillance. U.S. cost per quality-adjusted life year (QALY) ratios. Compared with no surveillance, surveillance produced an estimated incremental cost per QALY ratio of $60,858. This was reduced to $38,307 when surveillance practice was modified by a hypothetical biomarker-based strategy. Sensitivity analyses indicated that the likelihood that surveillance alone was cost-effective compared with no surveillance was 16.0% and 60.6% if a hypothetical biomarker-based strategy was added to surveillance, at an acceptability threshold of $100,000 per QALY gained. Treatment options for BE that overlap those for symptomatic GERD were omitted. By using best available estimates of the malignant potential of BE, endoscopic surveillance of patients with non-dysplastic BE is unlikely to be cost-effective for the majority of patients and depends heavily on progression rates between dysplasia grades. However, strategies that modify surveillance according to cancer risk might be cost-effective, provided that high-risk in iduals can be identified and prioritized for surveillance.

The Epidemiology of Women's Cancers

Publisher: Wiley

Date: 05-04-2013

DOI: 10.1002/9781118786635.CH2

Liquid Biopsies for Hepatocellular Cancer and Their Potential in Clinical Practice

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 30-05-2020

DOI: 10.1002/HEP.31168

Cost-effectiveness analysis of whole-genome sequencing during an outbreak of carbapenem-resistant Acinetobacter baumannii

Publisher: Cambridge University Press (CUP)

Date: 2021

DOI: 10.1017/ASH.2021.233

Abstract: Whole-genome sequencing (WGS) shotgun metagenomics (metagenomics) attempts to sequence the entire genetic content straight from the s le. Diagnostic advantages lie in the ability to detect unsuspected, uncultivatable, or very slow-growing organisms. To evaluate the clinical and economic effects of using WGS and metagenomics for outbreak management in a large metropolitan hospital. Cost-effectiveness study. Intensive care unit and burn unit of large metropolitan hospital. Simulated intensive care unit and burn unit patients. We built a complex simulation model to estimate pathogen transmission, associated hospital costs, and quality-adjusted life years (QALYs) during a 32-month outbreak of carbapenem-resistant Acinetobacter baumannii (CRAB). Model parameters were determined using microbiology surveillance data, genome sequencing results, hospital admission databases, and local clinical knowledge. The model was calibrated to the actual pathogen spread within the intensive care unit and burn unit (scenario 1) and compared with early use of WGS (scenario 2) and early use of WGS and metagenomics (scenario 3) to determine their respective cost-effectiveness. Sensitivity analyses were performed to address model uncertainty. On average compared with scenario 1, scenario 2 resulted in 14 fewer patients with CRAB, 59 additional QALYs, and $75,099 cost savings. Scenario 3, compared with scenario 1, resulted in 18 fewer patients with CRAB, 74 additional QALYs, and $93,822 in hospital cost savings. The likelihoods that scenario 2 and scenario 3 were cost-effective were 57% and 60%, respectively. The use of WGS and metagenomics in infection control processes were predicted to produce favorable economic and clinical outcomes.

Financial toxicity: a potential side effect of prostate cancer treatment among Australian men

Publisher: Hindawi Limited

Date: 10-2017

DOI: 10.1111/ECC.12392

Financial Toxicity Among Patients With Cancer - Where to From Here?

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 07-2017

DOI: 10.1097/NCC.0000000000000510

Financial Toxicity and Out-of-Pocket Costs for Patients with Head and Neck Cancer

Publisher: MDPI AG

Date: 10-05-2023

DOI: 10.3390/CURRONCOL30050371

Abstract: Aim: To quantify financial toxicity and out-of-pocket costs for patients with HNC in Australia and explore their relationship with health-related quality of life (HRQoL). Methods: A cross-sectional survey was administered to patients with HNC 1–3 years after radiotherapy at a regional hospital in Australia. The survey included questions on sociodemographics, out-of-pocket expenses, HRQoL, and the Financial Index of Toxicity (FIT) tool. The relationship between high financial toxicity scores (top quartile) and HRQoL was explored. Results: Of the 57 participants included in the study, 41 (72%) reported out-of-pocket expenses at a median of AUD 1796 (IQR AUD 2700) and a maximum of AUD 25,050. The median FIT score was 13.9 (IQR 19.5) and patients with high financial toxicity (n = 14) reported poorer HRQoL (76.5 vs. 114.5, p 0.001). Patients who were not married had higher FIT scores (23.1 vs. 11.1, p = 0.01), as did those with lower education (19.3 vs. 11.1, p = 0.06). Participants with private health insurance had lower financial toxicity scores (8.3 vs. 17.6, p = 0.01). Medications (41%, median AUD 400), dietary supplements (41%, median AUD 600), travel (36%, median AUD 525), and dental (29%, AUD 388) were the most common out-of-pocket expenses. Participants living in rural locations (≥100 km from the hospital) had higher out-of-pocket expenses (AUD 2655 vs. AUD 730, p = 0.01). Conclusion: Financial toxicity is associated with poorer HRQoL for many patients with HNC following treatment. Further research is needed to investigate interventions aimed at reducing financial toxicity and how these can best be incorporated into routine clinical care.

Cost-utility analysis comparing radioactive iodine, anti-Thyroid drugs and total thyroidectomy for primary treatment of Graves' disease

Publisher: Oxford University Press (OUP)

Date: 12-2016

DOI: 10.1530/EJE-16-0527

Abstract: Little data is in existence about the most cost-effective primary treatment for Graves’ disease. We performed a cost–utility analysis comparing radioactive iodine (RAI), anti-thyroid drugs (ATD) and total thyroidectomy (TT) as first-line therapy for Graves’ disease in England and Australia. We used a Markov model to compare lifetime costs and benefits (quality-adjusted life-years (QALYs)). The model included efficacy, rates of relapse and major complications associated with each treatment, and alternative second-line therapies. Model parameters were obtained from published literature. One-way sensitivity analyses were conducted. Costs were presented in 2015£ or Australian Dollars (AUD). RAI was the least expensive therapy in both England (£5425 QALYs 34.73) and Australia (AUD5601 30.97 QALYs). In base case results, in both countries, ATD was a cost-effective alternative to RAI (£16 866 35.17 QALYs incremental cost-effectiveness ratio (ICER) £26 279 per QALY gained England AUD8924 31.37 QALYs ICER AUD9687 per QALY gained Australia), while RAI dominated TT (£7115 QALYs 33.93 England AUD15 668 30.25 QALYs Australia). In sensitivity analysis, base case results were stable to changes in most cost, transition probabilities and health-relative quality-of-life (HRQoL) weights however, in England, the results were sensitive to changes in the HRQoL weights of hypothyroidism and euthyroidism on ATD. In this analysis, RAI is the least expensive choice for first-line treatment strategy for Graves’ disease. In England and Australia, ATD is likely to be a cost-effective alternative, while TT is unlikely to be cost-effective. Further research into HRQoL in Graves’ disease could improve the quality of future studies.

Higher levels of supportive care needs are linked to higher health service use and cost, poor quality of life, and high distress in patients with cirrhosis in Queensland, Australia

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 27-02-2023

DOI: 10.1097/HC9.0000000000000066

Abstract: Australians with cirrhosis have significant practical and psychosocial needs. This longitudinal study examined the association between supportive care needs and health service use and costs, and patient outcomes from June 2017 to December 2018. The Supportive Needs Assessment tool for Cirrhosis (SNAC), quality of life (Chronic Liver Disease Questionnaire and Short Form 36), and distress (distress thermometer) were self-reported through an interview at recruitment (n=433). Clinical data were obtained from medical records and through linkage, and health service use and costs through linkage. Patients were grouped as by needs status. Rates of hospital admissions (per person days at risk) and costs were assessed by needs status [incidence rate ratios (IRR), Poisson regression]. Multivariable linear regression was used to assess the differences in SNAC scores by quality of life and distress. Multivariable models included Child-Pugh class, age, sex, recruitment hospital, living arrangements, place of residence, comorbidity burden, and primary liver disease etiology. In adjusted analyses, compared with patients with low/no needs, patients with unmet needs had more cirrhosis-related admissions (adjusted IRR=2.11, 95% CI=1.48–3.13 p .001), admissions through the emergency department (IRR=2.99, 95% CI=1.80–4.97, p .001), and emergency presentations (IRR=3.57, 95% CI=1.41–9.02 p .001). Total hospitalization costs for cirrhosis admissions were higher for those with unmet needs ($431,242 per person days at risk) compared with those with met needs ($87,363 per person days at risk, adjusted cost ratio=3.52, 95%CI=3.49–3.54 p .001). In multivariable analysis, increasing overall mean SNAC scores (higher needs) were correlated with poorer quality of life and higher level of distress ( p .001 for all comparisons). Patients with cirrhosis and high unmet psychosocial needs and practical and physical needs have poor quality of life, high distress, and very high service use and costs, highlighting the importance of urgently addressing unmet needs.

Value of information analysis in healthcare: a review of principles and applications

Publisher: Informa Healthcare

Date: 27-03-2014

DOI: 10.3111/13696998.2014.907170

Abstract: Economic evaluations are increasingly utilized to inform decisions in healthcare however, decisions remain uncertain when they are not based on adequate evidence. Value of information (VOI) analysis has been proposed as a systematic approach to measure decision uncertainty and assess whether there is sufficient evidence to support new technologies. The objective of this paper is to review the principles and applications of VOI analysis in healthcare. Relevant databases were systematically searched to identify VOI articles. The findings from the selected articles were summarized and narratively presented. Various VOI methods have been developed and applied to inform decision-making, optimally designing research studies and setting research priorities. However, the application of this approach in healthcare remains limited due to technical and policy challenges. There is a need to create more awareness about VOI analysis, simplify its current methods, and align them with the needs of decision-making organizations.

Health care service use by people diagnosed with invasive melanoma in Queensland: a benefit incidence analysis

Publisher: Wiley

Date: 09-10-2023

DOI: 10.5694/MJA2.52122

Prevention versus early detection for long-term control of melanoma and keratinocyte carcinomas: a cost-effectiveness modelling study

Publisher: BMJ

Date: 02-2020

DOI: 10.1136/BMJOPEN-2019-034388

Abstract: To compare the long-term economic impact of melanoma prevention by sun protection, with the corresponding impact of early detection of melanoma to decrease melanoma deaths. Cost-effectiveness analysis using Markov cohort model. Data were primarily from two population-based randomised controlled trials, epidemiological and costing reports, and included flow-on effects for keratinocyte cancers (previously non-melanoma skin cancers) and actinic keratoses. Queensland, Australia. Men and women with a mean age 50 years modelled for 30 years. Daily sunscreen use (prevention) compared with annual clinical skin examinations (early detection) and comparing these in turn with the status quo. Costs, counts of melanoma, melanoma deaths, keratinocyte cancers, life years and quality-adjusted life years. Per 100 000 in iduals, for early detection, primary prevention and without intervention, there were 2446, 1364 and 2419 new melanomas, 556, 341 and 567 melanoma deaths, 64 452, 47 682 and 64 659 keratinocyte cancers and £493.5, £386.4 and £406.1 million in economic costs, respectively. There were small differences between prevention and early detection in life years saved (0.09%) and quality-adjusted life years gained (0.10%). Compared with early detection of melanoma, systematic sunscreen use at a population level will prevent substantial numbers of new skin tumours, melanoma deaths and save healthcare costs. Primary prevention through daily use of sunscreen is a priority for investment in the control of melanoma.

The vitamin D testing rate is again rising, despite new MBS testing criteria

Publisher: AMPCo

Date: 20-05-2020

DOI: 10.5694/MJA2.50619

The epic3 recommendation that clinically indicated replacement of peripheral venous catheters is safe and cost-saving: How much would the NHS save?

Publisher: Elsevier BV

Date: 07-2014

DOI: 10.1016/J.JHIN.2014.04.004

Out-of-pocket medical expenses for Queenslanders with a major cancer

Publisher: AMPCo

Date: 06-2018

DOI: 10.5694/MJA17.00815

When to apply sunscreen: a consensus statement for Australia and New Zealand

Publisher: Elsevier BV

Date: 04-2019

DOI: 10.1111/1753-6405.12873

Abstract: Cancers of the skin are the most common cancers in humans, with Australia and New Zealand having the world's highest incidence. Primary prevention c aigns advise people to apply sunscreen to exposed body sites when outdoors. However, despite growing evidence that cumulative sub-erythemal exposures cause mutational damage, and trial data demonstrating benefit from daily sunscreen use, current policies do not consider the hazards of incidental (everyday) sun exposure. Thus, a Sunscreen Summit was convened to review the evidence and update the policies for people living in Australia and New Zealand. After reviewing the benefits and risks of sunscreen application, the policy group concluded that people living in Australia and New Zealand should be advised to apply sunscreen to the face/head/neck and all parts of the body not covered by clothing on all days when the ultraviolet index is forecast to reach three or greater, irrespective of their anticipated activities. For planned outdoors activities, sunscreen should be used alongside other sun protection measures. People living in Australia and New Zealand are now advised to apply sunscreen every day when the UV index is predicted to reach 3 or above. Implications for public health: Increased use of sunscreen as part of the daily routine to reduce incidental sun exposure will lead to decreased incidence of skin cancer in the future.

Clinical skin examination outcomes after a video-based behavioral intervention analysis from a randomized clinical trial

Publisher: American Medical Association (AMA)

Date: 04-2014

DOI: 10.1001/JAMADERMATOL.2013.9313

Abstract: Older men are at risk of dying of melanoma. To assess attendance at and clinical outcomes of clinical skin examinations (CSEs) in older men exposed to a video-based behavioral intervention. This was a behavioral randomized clinical trial of a video-based intervention in men aged at least 50 years. Between June 1 and August 31, 2008, men were recruited, completed baseline telephone interviews, and were than randomized to receive either a video-based intervention (n = 469) or brochures only (n = 461 overall response rate, 37.1%) and were again interviewed 7 months later (n = 870 93.5% retention). Video on skin self-examination and skin awareness and written informational materials. The control group received written materials only. Participants who reported a CSE were asked for the type of CSE (skin spot, partial body, or whole body), who initiated it, whether the physician noted any suspicious lesions, and, if so, how lesions were managed. Physicians completed a case report form that included the type of CSE, who initiated it, the number of suspicious lesions detected, how lesions were managed (excision, nonsurgical treatment, monitoring, or referral), and pathology reports after lesion excision or biopsy. Overall, 540 of 870 men (62.1%) self-reported a CSE since receiving intervention materials, and 321 of 540 (59.4%) consented for their physician to provide medical information (received for 266 of 321 [82.9%]). Attendance of any CSE was similar between groups (intervention group, 246 of 436 [56.4%] control group, 229 of 434 [52.8%]), but men in the intervention group were more likely to self-report a whole-body CSE (154 of 436 [35.3%] vs 118 of 434 [27.2%] for control group P = .01). Two melanomas, 29 squamous cell carcinomas, and 38 basal cell carcinomas were diagnosed, with a higher proportion of malignant lesions in the intervention group (60.0% vs 40.0% for controls P = .03). Baseline attitudes, behaviors, and skin cancer history were associated with higher odds of CSE and skin cancer diagnosis. A video-based intervention may increase whole-body CSE and skin cancer diagnosis in older men. anzctr.org.au Identifier: ACTRN12608000384358.

Supporting patients and carers affected by pancreatic cancer: A feasibility study of a counselling intervention

Publisher: Elsevier BV

Date: 06-2020

DOI: 10.1016/J.EJON.2020.101729

Cost-effectiveness of Barrett's oesophagus screening and surveillance

Publisher: Elsevier BV

Date: 12-2013

DOI: 10.1016/J.BPG.2013.08.019

Abstract: Endoscopic screening and surveillance of patients with Barrett's oesophagus to detect oesophageal cancer at earlier stages is contentious. As a consequence, their cost-effectiveness is also debatable. Current health economic evidence shows mixed results for demonstrating their value, mainly due to varied assumptions around progression rates to cancer, quality of life and treatment pathways. No randomized controlled trial exists to definitively support the efficacy of surveillance programs and one is unlikely to be undertaken. Contemporary treatment, cost and epidemiological data to contribute to cost-effectiveness analyses are needed. Risk assessment to stratify patients at low- or high-risk of developing cancer should improve cost-effectiveness outcomes as higher gains will be seen for those at higher risk, and medical resource use will be avoided in those at lower risk. Rapidly changing technologies for imaging, biomarker testing and less-invasive endoscopic treatments also promise to lower health system costs and avoid adverse events in patients.

The COVID-19 Incarceration Model: a tool for corrections staff to analyze outbreaks of COVID-19

Publisher: Cold Spring Harbor Laboratory

Date: 21-02-2021

DOI: 10.1101/2021.02.18.21252032

Abstract: Correctional facilities are at high risk of COVID-19 outbreaks due to the inevitable close contacts in the environment. Such facilities are a high priority in the public health response to the epidemic. We developed a user-friendly Excel spreadsheet model (building on the previously developed Reci iz model) to analyze COVID-19 outbreaks in correctional facilities and the potential impact of prevention strategies - the COVID-19 Incarceration Model. The model requires limited inputs and can be used by non-modelers. The impact of a COVID-19 outbreak and mitigation strategies is illustrated for an ex le prison setting.

RETRACTED ARTICLE: Cost-effectiveness of dual energy X-ray absorptiometry (DXA) plus anti-resorptive treatment in Australian women with breast cancer who receive aromatase inhibitors

Publisher: Springer Science and Business Media LLC

Date: 03-04-2016

DOI: 10.1007/S00774-015-0663-5

Cost-effectiveness analysis of multiparametric MRI with increased active surveillance for low-risk prostate cancer in Australia

Publisher: Wiley

Date: 11-10-2017

DOI: 10.1002/JMRI.25504

Abstract: To evaluate the cost‐effectiveness of multiparametric magnetic resonance imaging (mpMRI) to diagnose prostate cancer and direct all low‐risk patients into active surveillance (AS). A Markov cohort model was developed to assess three scenarios: 1) no mpMRI and current AS 2) mpMRI and current AS and 3) mpMRI and increased AS. Men were tracked from diagnosis to end‐of‐life. Estimates to populate the model were derived from systematic reviews, meta‐analyses, epidemiological publications, and national cost reports. An Australian Government perspective was used. Outcomes included healthcare costs, survival, quality‐adjusted life years (QALYs), number of biopsies, and significant and insignificant cancers. Extensive sensitivity analyses were undertaken to address possible variation in the modeled inputs. Mean lifetime costs per patient were AU$23,191 for Scenario 1, AU$23,387 for Scenario 2 and AU$21,064 for Scenario 3. Corresponding QALYs were 7.81, 7.77, 7.83 for Scenarios 1, 2, and 3, respectively. At the current uptake of AS in Australia, mpMRI alone does not appear cost‐effective (16.9% likelihood). However, mpMRI with AS for all men with low‐risk disease is strongly cost‐effective (86.9% likelihood) at a willingness‐to‐pay AU$50,000 per QALY gained. For the mpMRI options, for every 1000 men suspected of prostate cancer, using mpMRI would avoid 340 biopsies, detect an additional 20 significant cancers, and detect 10 fewer insignificant cancers. Diagnosis of prostate cancer through mpMRI technology would be cost‐effective if it leads to increased uptake of AS for men with confirmed very‐low‐ or low‐risk prostate cancer. Level of Evidence : 2 J. MAGN. RESON. IMAGING 2017 :1304–1315

Evolution of skin cancer numbers in solid organ transplant recipients: a pilot study

Publisher: Wiley

Date: 16-08-2021

DOI: 10.1111/AJD.13685

Erratum to: Estimated Healthcare Costs of Melanoma in Australia Over 3 Years Post-Diagnosis

Publisher: Springer Science and Business Media LLC

Date: 12-09-2017

DOI: 10.1007/S40258-017-0347-5

Abstract: The last word in the first paragraph which previously read AU$25 million should read 25 million as this relates to population size.

Estimating the costs of genomic sequencing in cancer control

Publisher: Springer Science and Business Media LLC

Date: 03-06-2020

DOI: 10.1186/S12913-020-05318-Y

Abstract: Despite the rapid uptake of genomic technologies within cancer care, few studies provide detailed information on the costs of sequencing across different applications. The objective of the study was to examine and categorise the complete costs involved in genomic sequencing for a range of applications within cancer settings. We performed a cost-analysis using gross and micro-costing approaches for genomic sequencing performed during 2017/2018 across different settings in Brisbane, Australia. Sequencing was undertaken for patients with lung, breast, oesophageal cancers, melanoma or mesothelioma. Aggregated resource data were captured for a total of 1433 patients and point estimates of per patient costs were generated. Deterministic sensitivity analyses addressed the uncertainty in the estimates. Estimated costs to the public health system for resources were categorised into seven distinct activities in the sequencing process: s ling, extraction, library preparation, sequencing, analysis, data storage and clinical reporting. Costs were also aggregated according to labour, consumables, testing, equipment and ‘other’ categories. The per person costs were AU$347–429 (2018 US$240–297) for targeted panels, AU$871–$2788 (2018 US$604–1932) for exome sequencing, and AU$2895–4830 (2018 US$2006-3347) for whole genome sequencing. Cost proportions were highest for library preparation/sequencing materials (average 76.8% of total costs), s le extraction (8.1%), data analysis (9.2%) and data storage (2.6%). Capital costs for the sequencers were an additional AU$34–197 (2018 US$24–67) per person. Total costs were most sensitive to consumables and sequencing activities driven by commercial prices. Per person sequencing costs for cancer are high when tumour/blood pairs require testing. Using the natural steps involved in sequencing and categorising resources accordingly, future evaluations of costs or cost-effectiveness of clinical genomics across cancer projects could be more standardised and facilitate easier comparison of cost drivers.

Evaluation of the telehealth making sense of brain tumor psychological support intervention for people with primary brain tumor and their caregivers: A randomized controlled trial

Publisher: Wiley

Date: 06-07-2023

DOI: 10.1002/PON.6189

Abstract: This pragmatic randomized control trial aimed to evaluate clinical efficacy of the Making Sense of Brain Tumour program delivered via videoconferencing (Tele‐MAST) for improving mental health and quality of life (QoL) relative to standard care in in iduals with primary brain tumor (PBT). Adults with PBT experiencing at least mild distress (Distress Thermometer ≥4) and caregivers were randomly allocated to the 10‐session Tele‐MAST program or standard care. Mental health and QoL were assessed pre‐intervention, post‐intervention (primary endpoint), and 6‐weeks and 6‐months follow‐up. The primary outcome was clinician‐rated depressive symptoms on the Montgomery‐Asberg Depression Rating Scale. 82 participants with PBT (34% benign, 20% lower‐grade glioma, 46% high‐grade glioma) and 36 caregivers were recruited (2018–2021). Controlling for baseline functioning, Tele‐MAST participants with PBT had lower depressive symptoms at post‐intervention (95% CI: 10.2–14.6, vs. 15.2–19.6, p = 0.002) and 6‐weeks post‐intervention (95% CI: 11.5–15.8 vs. 15.6–19.9, p = 0.010) than standard care, and were almost 4 times more likely to experience clinically reduced depression (OR, 3.89 95% CI: 1.5–9.9). Tele‐MAST participants with PBT also reported significantly better global QoL, emotional QoL and lower anxiety at post‐intervention and 6‐weeks post‐intervention than standard care. There were no significant intervention effects for caregivers. At 6‐months follow‐up participants with PBT who received Tele‐MAST reported significantly better mental health and QoL relative to pre‐intervention. Tele‐MAST was found to be more effective for reducing depressive symptoms at post‐intervention than standard care for people with PBT but not caregivers. Tailored and extended psychological support may be beneficial for people with PBT.

Cost-effectiveness of a pragmatic exercise intervention for women with breast cancer: results from a randomized controlled trial

Publisher: Wiley

Date: 02-08-2017

DOI: 10.1002/PON.4201

Abstract: To report on the cost-effectiveness of the Exercise for Health trial, comparing an exercise intervention with usual care during and following treatment for women with breast cancer. Women with breast cancer were randomized to an 8-month exercise intervention (involving regular contact with an exercise physiologist over the phone, n = 67, or home delivered face to face, n = 67) or usual care (n = 60) group and were assessed pre-intervention (5 weeks post-surgery), mid-intervention (6 months post-surgery), and 10 weeks post-intervention (12 months post-surgery). The benefit measures were "number of improvers" in quality of life (FACT-B+4) and quality-adjusted life years (QALYs). Data on provider, patient, and government costs were used to consider 2 cost scenarios: (1) a service provider model and (2) a private model. There were 69 improvers in the intervention group compared with 21 in the usual care group (odds ratio 2.09, 95% confidence interval 1.08, 4.01 P = .033). The incremental cost per improver was A$2282 to A$2644. Quality-adjusted life years gain for the intervention group versus the usual care group was 0.009, with incremental cost per QALY gain for models 1 and 2 being A$105 231 and A$90 842, respectively. However, sensitivity analyses indicate that incremental cost per QALY gained was volatile to EuroQol-5D-3L weights. Findings suggest that a pragmatic exercise intervention yields more women with markedly improved quality of life after breast cancer than usual care and may be cost-effective. The results are less certain in terms of incremental cost per quality-adjusted life years however, this may be an inappropriate measure for reflecting exercise benefit for women with breast cancer.

Partnering with general practitioners to optimize survivorship for patients with lymphoma: a phase II randomized controlled trial (the GOSPEL I trial).

Publisher: Springer Science and Business Media LLC

Date: 06-01-2021

DOI: 10.1186/S13063-020-04945-4

Abstract: Survival rates for lymphoma are highest amongst hematological malignancies. In 2019, it was estimated that over 6400 Australians were diagnosed with lymphoma, a group of hematological malignancies with a high 5-year survival rate of ~ 76%. There is an increased focus on the promotion of wellness in survivorship and active approaches to reducing morbidity related to treatment however, current models of follow-up care heavily rely on hospital-based specialist-led care. Maximizing the potential of general practitioners (GPs) in the ongoing management of cancer is consistent with the national health reform principles and the Cancer Council Australia’s Optimal Care Pathways. GPs are well positioned to provide guideline-based follow-up care and are more likely to address comorbidities and psychosocial issues and promote healthy lifestyle behaviors. This study aims to test the feasibility of the GOSPEL I intervention for implementing an integrated, shared care model in which cancer center specialists and community-based GPs collaborate to provide survivorship care for patients with lymphoma. We describe a protocol for a phase II, randomized controlled trial with two parallel arms and a 1:1 allocation. Sixty patients with Hodgkin’s and non-Hodgkin’s lymphoma will be randomized to usual specialist-led follow-up care (as determined by the treating hematologists) or a shared follow-up care intervention (i.e., GOSPEL I). GOSPEL I is a nurse-enabled, pre-specified shared care pathway with follow-up responsibilities shared between cancer center specialists (i.e., hematologists and specialist cancer nurses) and GPs. Outcome measures assess feasibility as well as a range of patient-reported outcomes including health-related quality of life as measured by the Functional Assessment of Cancer Therapy—Lymphoma, patient experience of care, symptom distress, comorbidity burden, dietary intake, physical activity behaviors, financial distress/interference, and satisfaction of care. Safety indicators including hospital admission and unscheduled lymphoma clinic visits as well as process outcomes such as intervention fidelity and economic indicators will be analyzed. This trial is designed to explore the feasibility and acceptability of a new model of shared care for lymphoma survivors. Patient-reported outcomes as well as potential barriers to implementation will be analyzed to inform a larger definitive clinical trial testing the effects and implementation of a shared care model on health-related quality of life of lymphoma survivors. Australia and New Zealand Clinical Trials Registry ACTRN12620000594921 . Registered on 22 May 2020.

A cost-consequences analysis of the SAFE trial: a comparative, effectiveness trial evaluating high- versus low-supervision of an exercise intervention for women with breast cancer

Publisher: Springer Science and Business Media LLC

Date: 03-12-2022

DOI: 10.1007/S12282-022-01418-1

Medical Costs and Outcomes for Australian Women With Ovarian Cancer: A Patient-Level Analysis Over 2.5 Years

Publisher: BMJ

Date: 06-2010

DOI: 10.1111/IGC.0B013E3181DBD13F

Abstract: As treatment costs for gynecological cancer escalate, real-world data on use of resources and costs becomes increasingly important. This study investigated medical costs, quality of life, and survival end points for women with ovarian cancer in Australia. Women with primary epithelial ovarian cancer referred for chemotherapy (n = 85) were recruited through 7 hospitals in Australia. Overall survival, progression-free interval, and quality-adjusted life years were assessed by stage using the Cox proportional hazards models. Direct medical costs, including those for surgeries, hospitalizations, supportive care, chemotherapy, and adverse effects (while on chemotherapy), were calculated over 2.5 years and assessed by nonparametric bootstrapping. Quality-adjusted life years decreased with increased disease stage at diagnosis and ranged from 2.3 for women with stage I or II disease to 1.3 for those with stage IV disease. A total of AU $4.1 million (2008) were spent on direct medical costs for 85 women over approximately 2.5 years. Medical costs were significantly higher for women with stage III or IV disease compared with that for women with stage I or II disease ($50,945 vs $31,958, P 0.01) and/or women who experienced surgical complications and/or adverse effects requiring hospitalization while on chemotherapy ($57,821 vs $34,781, P 0.01). Costs after first-line chemotherapy were significantly higher for women with advanced disease (mean, $20,744) compared with those for women with early disease (mean, $5525 P 0.01). Whereas for women with early-stage ovarian cancer, costs are concentrated in the period of primary treatment, cumulated costs are especially high for women with recurrent disease rising rapidly after first-line therapy.

Correction to: Exercise following breast cancer: exploratory survival analyses of two randomised, controlled trials

Publisher: Springer Science and Business Media LLC

Date: 10-11-2017

DOI: 10.1007/S10549-017-4569-X

Abstract: In the original publication of the article, under the heading Discussion, 1st paragraph, the sentence that reads as, "Nonetheless, our observed improvements of over 50% for OS and over 30% for DFS (HRs: 0.45 and 0.66, respectively) are consistent with results from other available studies" should read as "Nonetheless, our observed improvements of over 50% for OS and DFS (HRs: 0.45 and 0.66, respectively) are consistent with results from other available studies." Under the heading Discussion, 3rd paragraph, the sentence that reads as "We cannot discount the possibility …such as education, income and access to care [1, 7]" should read as "We cannot discount the possibility…such as education, income and access to care, which ultimately have on survival outcomes [1, 7]."

Prospective cohort study: Causes of stillbirth in Australia 2013–2018

Publisher: Wiley

Date: 19-04-2021

DOI: 10.1111/AJO.13334

Abstract: Stillbirth is a major public health problem that is slow to improve in Australia. Understanding the causes of stillbirth through appropriate investigation is the cornerstone of prevention and important for parents to understand why their baby died. The aim of this study is to assess compliance with the Perinatal Society of Australia and New Zealand (PSANZ) Perinatal Mortality Clinical Practice Guidelines (2009) for stillbirths. This is a prospective multi‐centred cohort study of stillbirths at participating hospitals (2013–2018). Data were recorded into a purpose‐built database. The frequency of the recommended core investigations was calculated, and χ 2 test was performed for subgroup analyses by gestational age groups and timing of fetal death. A 70% compliance threshold was defined for investigations. The cause of death categories was provided according to PSANZ Perinatal Death Classification. Among 697 reported total stillbirths, 562 (81%) were antepartum, and 101 (15%) were intrapartum. The most common cause of death categories were ‘congenital abnormality’ (12.5%), ‘specific perinatal conditions’ (12.2%) and ‘unexplained antepartum death’ (29%). According to 2009 guidelines, there were no stillbirths where all recommended investigations were performed (including or excluding autopsy). A compliance of 70% was observed for comprehensive history (82%), full blood count (94%), cytomegalovirus (71%), toxoplasmosis (70%), renal function (75%), liver function (79%), external examination (86%), post‐mortem examination (84%) and placental histopathology (92%). The overall autopsy rate was 52%. Compliance with recommended investigations for stillbirth was suboptimal, and many stillbirths remain unexplained. Education on the value of investigations for stillbirth is needed. Future studies should focus on understanding the yield and value of investigations and service delivery gaps that impact compliance.

Clinical and economic outcomes of nurse-led services in the ambulatory care setting: a systematic review

Publisher: Elsevier BV

Date: 05-2018

DOI: 10.1016/J.IJNURSTU.2018.02.002

Abstract: With the increasing burden of chronic and age-related diseases, and the rapidly increasing number of patients receiving ambulatory or outpatient-based care, nurse-led services have been suggested as one solution to manage increasing demand on the health system as they aim to reduce waiting times, resources, and costs while maintaining patient safety and enhancing satisfaction. The aims of this review were to assess the clinical effectiveness, economic outcomes and key implementation characteristics of nurse-led services in the ambulatory care setting. A systematic review was conducted using the standard Cochrane Collaboration methodology and was prepared in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochrane Library, MEDLINE EBSCO, CINAHL EBSCO, and PsycINFO Ovid (from inception to April 2016). Data were extracted and appraisal undertaken. We included randomised controlled trials quasi-randomised controlled trials controlled and non-controlled before-and-after studies that compared the effects of nurse-led services in the ambulatory or community care setting with an alternative model of care or standard care. Twenty-five studies of 180,308 participants were included in this review. Of the 16 studies that measured and reported on health-related quality of life outcomes, the majority of studies (n = 13) reported equivocal outcomes with three studies demonstrating superior outcomes and one demonstrating inferior outcomes in comparison with physician-led and standard care. Nurse-led care demonstrated either equivalent or better outcomes for a number of outcomes including symptom burden, self-management and behavioural outcomes, disease-specific indicators, satisfaction and perception of quality of life, and health service use. Benefits of nurse-led services remain inconclusive in terms of economic outcomes. Nurse-led care is a safe and feasible model of care for consideration across a number of ambulatory care settings. With appropriate training and support provided, nurse-led care is able to produce at least equivocal outcomes or at times better outcomes in terms of health-related quality of life compared to physician-led care or standard care for managing chronic conditions. There is a lack of high quality economic evaluations for nurse-led services, which is essential for guiding the decision making of health policy makers. Key factors such as education and qualification of the nurse self-management support resources available for the nurse prescribing capabilities and evaluation using appropriate outcome should be carefully considered for future planning of nurse-led services.

The effects of a multidisciplinary high-throughput skin clinic on healthcare costs of organ transplant recipients

Publisher: Wiley

Date: 02-05-2019

DOI: 10.1111/JDV.15458

Abstract: A long-term complication among organ transplant recipients (OTRs) is skin malignancies which are associated with level and duration of immunosuppressive treatment, sun exposure and age. Dermatological surveillance is recommended for OTRs at high risk of skin malignancies, but evidence is lacking on the benefits of such services. To examine the economic impact on patients and on the hospital service of a multidisciplinary high-throughput skin cancer clinic in Brisbane, Australia, dedicated to dermatological and surgical care of high-risk OTRs. In a pre ostdesign, hospital admission and cost data were obtained for 101 consecutively enrolled study participants from 12 months prior to the introduction of the clinic (to February 2016), the 3-month 'run-in' period (March to May 2016) and 12 months subsequent (to June 2017). Differences between pre- and post-clinic hospital costs were tested using non-parametric bootstrapping and interrupted time series analysis. A survey of patient out-of-pocket costs and perceived financial burden was also undertaken during the clinic. Overall hospital costs were higher after the clinic but 3-monthly hospital costs for skin procedures trended downwards. Despite 3-monthly mean, hospital visits increasing from 85 to 314, mean 3-monthly costs reduced by AU$1491 (P < 0.001) indicating greater cost efficiency. Total patient out-of-pocket costs were AU$18 377 over 3 months. Clinical costing data revealed higher, more rapid throughput and significantly lower per patient costs pre- and postestablishment of a multidisciplinary skin cancer clinic for OTRs.

The Economic Impact on Australian Patients with Neuroendocrine Tumours

Publisher: Springer Science and Business Media LLC

Date: 19-02-2020

DOI: 10.1007/S40271-020-00412-Z

Developing a gene panel for pharmacoresistant epilepsy: a review of epilepsy pharmacogenetics

Publisher: Future Medicine Ltd

Date: 03-2021

DOI: 10.2217/PGS-2020-0145

Abstract: Evaluating genes involved in the pharmacodynamics and pharmacokinetics of epilepsy drugs is critical to better understand pharmacoresistant epilepsy. We reviewed the pharmacogenetics literature on six antiseizure medicines (carbamazepine, per anel, lamotrigine, levetiracetam, sodium valproate and zonisamide) and compared the genes found with those present on epilepsy gene panels using a functional annotation pathway analysis. Little overlap was found between the two gene lists pharmacogenetic genes are mainly involved in detoxification processes, while epilepsy panel genes are involved in cell signaling and gene expression. Our work provides support for a specific pharmacoresistant epilepsy gene panel to assist antiseizure medicine selection, enabling personalized approaches to treatment. Future efforts will seek to include this panel in genomic analyses of pharmacoresistant patients, to determine clinical utility and patient treatment responses.

Electronic finance-related outcome measures (eFROMs): a new approach to screen for cancer-related financial toxicity in clinical practice

Publisher: Springer Science and Business Media LLC

Date: 06-04-2021

DOI: 10.1007/S00520-021-06191-Z

Cancer Survivors’ Long-Term Health Service Costs in Queensland, Australia: Results of a Population-Level Data Linkage Study (Cos-Q)

Publisher: MDPI AG

Date: 02-08-2022

DOI: 10.3390/IJERPH19159473

Abstract: Worldwide, the number of cancer survivors is rapidly increasing. The aim of this study was to quantify long-term health service costs of cancer survivorship on a population level. The study cohort comprised residents of Queensland, Australia, diagnosed with a first primary malignancy between 1997 and 2015. Administrative databases were linked with cancer registry records to capture all health service utilization. Health service costs between 2013–2016 were analyzed using a bottom-up costing approach. The cumulative mean annual healthcare expenditure (2013–2016) for the cohort of N = 230,380 in iduals was AU$3.66 billion. The highest costs were incurred by patients with a history of prostate (AU$538 m), breast (AU$496 m) or colorectal (AU$476 m) cancers. Costs by time since diagnosis were typically highest in the first year after diagnosis and decreased over time. Overall mean annual healthcare costs per person (2013–2016) were AU$15,889 (SD: AU$25,065) and highest costs per in idual were for myeloma (AU$45,951), brain (AU$30,264) or liver cancer (AU$29,619) patients. Our results inform policy makers in Australia of the long-term health service costs of cancer survivors, provide data for economic evaluations and reinforce the benefits of investing in cancer prevention.

ProsCan for Couples: Randomised controlled trial of a couples-based sexuality intervention for men with localised prostate cancer who receive radical prostatectomy

Publisher: Springer Science and Business Media LLC

Date: 08-08-2008

DOI: 10.1186/1471-2407-8-226

Distinct employment interference profiles in patients with breast cancer prior to and for 12 months following surgery

Publisher: Springer Science and Business Media LLC

Date: 02-08-2021

DOI: 10.1186/S12885-021-08583-0

Abstract: To identify subgroups of female breast cancer patients with distinct self-reported employment interference (EI) profiles and determine which demographic, clinical, and symptom characteristics, and quality of life outcomes were associated with subgroup membership. Women with breast cancer ( n = 385) were assessed for changes in EI over ten times, from prior to, through 12 months after breast cancer surgery. Latent profile analysis (LPA) was used to identify subgroups of patients with distinct EI profiles. Three distinct EI profiles (i.e., None – 26.2% ( n = 101), Low – 42.6% ( n = 164), High – 31.2% ( n = 120)) were identified. Compared to the None and Low groups, patients in the High group were more likely to be younger. Higher proportions in the High group were non-White, pre-menopausal prior to surgery, had more advanced stage disease, had received an axillary lymph node dissection, had received neoadjuvant chemotherapy, had received adjuvant chemotherapy, and had a re-excision or mastectomy on the affected breast within 6 months after surgery. In addition, these patients had lower quality of life scores. Compared to the None group, the High group had higher levels of trait and state anxiety, depressive symptoms, fatigue and sleep disturbance and lower levels of cognitive function. This study provides new knowledge regarding EI profiles among women in the year following breast cancer surgery. The non-modifiable risk factors (e.g., younger age, being non-White, having more advanced stage disease) can inform current screening procedures. The potentially modifiable risk factors can be used to develop interventions to improve employment outcomes of breast cancer patients.

Hospital costs associated with adverse events in gynecological oncology

Publisher: Elsevier BV

Date: 04-2011

DOI: 10.1016/J.YGYNO.2010.11.030

Abstract: Treatment for gynecological malignancies is complex and may cause unintended or accidental adverse events (AE). We evaluated the costs of hospitalization associated with those AEs among patients who had an abdominal or laparoscopic procedure for proven or suspected gynecological cancer at a tertiary gynecological cancer center in Australia. Data on AEs were prospectively collected and matched with cost data (AU$ 2008) from the hospital's clinical costing unit and linked to demographical, clinical and histopathological data. Total costs were adjusted for various clinical factors and estimated using log-transformed ordinary least squared regression. Back-transformation was achieved using smearing factors. From epidemiological data, we also estimated the costs of AEs Australia-wide and undertook scenario and probabilistic sensitivity analyses to investigate the potential cost impact of reducing AEs. A total of 369 patients had surgical procedures of which 95 patients (26%) had at least one AE. Patients with AEs incurred an extra AU$12,780 on average, adjusted for age, co-morbidities, ovarian cancer, major or minor complications, surgical complexity, presence of malignancy and abdominal surgery. Mean adjusted costs (95% CI) for patients with intra-operative, minor post-operative and major post-operative AEs were AU$40,746 (11,582-71,859) AU$18,459 (17,270-19,713) and AU$67,656 (5324-131,761), respectively. Up to an estimated AU$20.6 million/year could be saved if the AEs were reduced by 40%. Adverse events are associated with significantly increased hospitalization costs and appropriate evidence-based interventions are justified to minimize AEs.

Yes, The Government Should Tax Soft Drinks: Findings from a Citizens' Jury in Australia

Publisher: MDPI AG

Date: 27-02-2014

DOI: 10.3390/IJERPH110302456

Diverse e‐cigarette regulations in the Asia Pacific: A health economic perspective

Publisher: Wiley

Date: 14-06-2023

DOI: 10.1111/RESP.14535

UVR emissions from Solaria in Australia and implications for the regulation process

Publisher: Wiley

Date: 19-11-2011

DOI: 10.1111/J.1751-1097.2010.00835.X

Abstract: To assist in the development of the 2008 Australian/New Zealand standard on solaria and related regulations, Australian Radiation Protection and Nuclear Safety Agency scientists visited a number of tanning establishments during 2008 to measure the intensity and spectral distribution of the ultraviolet radiation (UVR) emissions from a range of solaria. The 2002 Australian/New Zealand Standard "Solaria for cosmetic purposes" (AS/NZS 2635) allowed a maximum UVR output from solaria of UV Index 60, a compromise between the solarium industry who wanted no upper limit and the health agencies who wanted to limit intensity. Of the 20 solaria examined in detail, only one had emissions of intensity less than UV Index 12, typical of mid-latitude summer sunlight, 15 units emitted more than UV Index 20, while three units emitted at intensities above UV Index 36, the maximum allowed by the new standard, AS/NZS 2635 (2008) and would thus not comply. UVA emissions ranged from 98W·m(-2) up to a maximum of 438W·m(-2) , more than six times the UVA content of mid-latitude summer sunshine. The results indicate that solaria users in Australia have access to solaria that are high intensity units with both significantly higher UVB and UVA emissions than sunlight, with implications for resultant adverse health effects.

Differences in the pattern and cost of hospital care between Indigenous and non-Indigenous Australians with cirrhosis: an exploratory study

Publisher: Wiley

Date: 15-09-2022

DOI: 10.1111/IMJ.15854

Abstract: Liver diseases are important contributors to the mortality gap between Indigenous and non‐Indigenous Australians. This cohort study examined factors associated with hospital admissions and healthcare outcomes among Indigenous Australians with cirrhosis. Patient‐reported outcomes were obtained by face‐to‐face interview (Chronic Liver Disease Questionnaire and Short Form 36 (SF‐36)). Clinical data were extracted from medical records and through data linkage for 534 patients (25 indigenous). Cumulative overall survival (Kaplan–Meier), rates of hospital admissions and emergency presentations, and costs were assessed by indigenous status. Incidence rate ratios (IRR Poisson regression) were reported. Indigenous Australians admitted to hospital with cirrhosis had lower educational status compared with non‐indigenous patients (79.2% vs 43.4% P 0.001). The two groups had, in general, similar clinical characteristics including disease severity ( P = 0.78), presence of cirrhosis complications ( P = 0.67), comorbidities ( P = 0.62), rates of cirrhosis‐related admissions ( P = 0.86) and 5‐year survival ( P = 0.30). However, indigenous patients had a lower score in the SF‐36 domain related to bodily pain ( P = 0.037), more cirrhosis admissions via the emergency department (IRR = 1.42, 95% confidence interval (CI) 1.10–1.83) and fewer planned cirrhosis admissions (IRR = 0.32, 95% CI 0.14–0.72). The total cost for cirrhosis‐related hospital admissions for 534 patients over 6 years (July 2012 to June 2018) was A$13.7 million. The cost of cirrhosis‐related hospital admissions was double for indigenous patients (cost ratio = 2.04, 95% CI 2.04–2.05). Our data highlight the disparities in health service use and patient‐reported outcomes, despite having similar clinical profiles. Integration between primary care, Aboriginal Community Controlled Health Organisations and liver specialists is critical for appropriate health service delivery and effective use of resources. Chronic liver disease costs the community dearly.

Views from senior Australian cancer researchers on evaluating the impact of their research: Results from a brief survey

Publisher: Springer Science and Business Media LLC

Date: 12-2016

DOI: 10.1186/S12961-015-0073-0

Characteristics of men aged 50 years or older who do not take up skin self-examination following an educational intervention

Publisher: Elsevier BV

Date: 07-2012

DOI: 10.1016/J.JAAD.2011.10.019

Economic evaluation of an exercise-counselling intervention to enhance smoking cessation outcomes: The Fit2Quit trial

Publisher: E.U. European Publishing

Date: 29-03-2017

DOI: 10.1186/S12971-017-0126-Y

Out-of-pocket medical expenses compared across five years for patients with one of five common cancers in Australia

Publisher: Springer Science and Business Media LLC

Date: 25-09-2021

DOI: 10.1186/S12885-021-08756-X

Abstract: Patient medical out-of-pocket expenses are thought to be rising worldwide yet data describing trends over time is scant. We evaluated trends of out-of-pocket expenses for patients in Australia with one of five major cancers in the first-year after diagnosis. Participants from the QSKIN Sun and Health prospective cohort Study with a histologically confirmed breast, colorectal, lung, melanoma, or prostate cancer diagnosed between 2011 and 2015 were included ( n = 1965). Medicare claims data on out-of-pocket expenses were analysed using a two-part model adjusted for year of diagnosis, health insurance status, age and education level. Fisher price and quantity indexes were also calculated to assess prices and volumes separately. On average, patients with cancer diagnosed in 2015 spent 70% more out-of-pocket on direct medical expenses than those diagnosed in 2011. Out-of-pocket expenses increased significantly for patients with breast cancer (mean AU$2513 in 2011 to AU$6802 in 2015). Out-of-pocket expenses were higher overall for in iduals with private health insurance. For prostate cancer, expenses increased for those without private health insurance over time (mean AU$1586 in 2011 to AU$4748 in 2014) and remained stable for those with private health insurance (AU$4397 in 2011 to AU$5623 in 2015). There were progressive increases in prices and quantities of medical services for patients with melanoma, breast and lung cancer. For all cancers, prices increased for medicines and doctor attendances but fluctuated for other medical services. Out-of-pocket expenses for patients with cancer have increased substantially over time. Such increases were more pronounced for women with breast cancer and those without private health insurance. Increased out-of-pocket expenses arose from both higher prices and higher volumes of health services but differ by cancer type. Further efforts to monitor patient out-of-pocket costs and prevent health inequities are required.

Estimated Healthcare Costs of Melanoma and Keratinocyte Skin Cancers in Australia and Aotearoa New Zealand in 2021

Publisher: MDPI AG

Date: 08-03-2022

DOI: 10.3390/IJERPH19063178

Abstract: Australia and Aotearoa New Zealand have the highest incidence of melanoma and KC in the world. We undertook a cost-of-illness analysis using Markov decision–analytic models separately for melanoma and keratinocyte skin cancer (KC) for each country. Using clinical pathways, the probabilities and unit costs of each health service and medicine for skin cancer management were applied. We estimated mean costs and 95% uncertainty intervals (95% UI) using Monte Carlo simulation. In Australia, the mean first-year costs of melanoma per patient ranged from AU$644 (95%UI: $642, $647) for melanoma in situ to AU$100,725 (95%UI: $84,288, $119,070) for unresectable stage III/IV disease. Australian-wide direct costs to the Government for newly diagnosed patients with melanoma were AU$397.9 m and AU$426.2 m for KCs, a total of AU$824.0 m. The mean costs per patient for melanoma ranged from NZ$1450 (95%UI: $1445, $1456) for melanoma in situ to NZ$77,828 (95%UI $62,525, $94,718) for unresectable stage III/IV disease. The estimated total cost to New Zealand in 2021 for new patients with melanoma was NZ$51.2 m, and for KCs, was NZ$129.4 m, with a total combined cost of NZ$180.5 m. These up-to-date national healthcare costs of melanoma and KC in Australia and New Zealand accentuate the savings potential of successful prevention strategies for skin cancer.

Cost-Effectiveness and Value of Information Analysis of Nutritional Support for Preventing Pressure Ulcers in High-risk Patients: Implement Now, Research Later

Publisher: Springer Science and Business Media LLC

Date: 04-02-2015

DOI: 10.1007/S40258-015-0152-Y

Abstract: Pressure ulcers are a major cause of mortality, morbidity, and increased healthcare cost. Nutritional support may reduce the incidence of pressure ulcers in hospitalised patients who are at risk of pressure ulcer and malnutrition. To evaluate the cost-effectiveness of nutritional support in preventing pressure ulcers in high-risk hospitalised patients, and to assess the value of further research to inform the decision to implement this intervention using value of information analysis (VOI). The analysis was from the perspective of Queensland Health, Australia using a decision model with evidence derived from a systematic review and meta-analysis. Resources were valued using 2014 prices and the time horizon of the analysis was one year. Monte Carlo simulation was used to estimate net monetary benefits (NB) and to calculate VOI measures. Compared with standard hospital diet, nutritional support was cost saving at AU$425 per patient, and more effective with an average 0.005 quality-adjusted life years (QALY) gained. At a willingness-to-pay of AU$50,000 per QALY, the incremental NB was AU$675 per patient, with a probability of 87 % that nutritional support is cost-effective. The expected value of perfect information was AU$5 million and the expected value of perfect parameter information was highest for the relative risk of developing a pressure ulcer at AU$2.5 million. For a future trial investigating the relative effectiveness of the interventions, the expected net benefit of research would be maximised at AU$100,000 with 1,200 patients in each arm if nutritional support was perfectly implemented. The opportunity cost of withholding the decision to implement the intervention until the results of the future study are available would be AU$14 million. Nutritional support is cost-effective in preventing pressure ulcers in high-risk hospitalised patients compared with standard diet. Future research to reduce decision uncertainty is worthwhile however, given the opportunity losses associated with delaying the implementation, "implement and research" is the approach recommended for this intervention.

A randomised controlled trial of a tele-based lifestyle intervention for colorectal cancer survivors ('CanChange'): study protocol.

Publisher: Springer Science and Business Media LLC

Date: 18-08-2009

DOI: 10.1186/1471-2407-9-286

Diabetes mellitus and the progression of non‐alcoholic fatty liver disease to decompensated cirrhosis: a retrospective cohort study

Publisher: Wiley

Date: 25-09-2023

DOI: 10.5694/MJA2.52104

Screening for Financial Toxicity in Clinical Care With Finance-Related Outcome Measures

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 03-2021

DOI: 10.1097/NCC.0000000000000926

Opinions and strategies of Australian health professionals on tackling cancer‐related financial toxicity: A nationwide survey

Publisher: Wiley

Date: 19-05-2023

DOI: 10.1111/AJCO.13786

Abstract: To understand the opinions and current practices of health professionals on the topic of addressing cancer‐related financial toxicity among patients. A cross‐sectional online survey was distributed through Australian clinical oncology professional organizations/networks. The multidisciplinary Clinical Oncology Society of Australia Financial Toxicity Working Group developed 25 questions relating to the frequency and comfort levels of patient–clinician discussions, opinions about their role, strategies used, and barriers to providing solutions for patients. Descriptive statistics were used and subgroup analyses were undertaken by occupational groups. Two hundred and seventy‐seven health professionals completed the survey. The majority were female ( n = 213, 77%), worked in public facilities (200, 72%), and treated patients with varied cancer types across all of Australia. Most participants agreed that it was appropriate in their clinical role to discuss financial concerns and 231 (88%) believed that these discussions were an important part of high‐quality care. However, 73 (28%) stated that they did not have the appropriate information on support services or resources to facilitate such conversations, differing by occupation group 7 (11%) social workers, 34 (44%) medical specialists, 18 (25%) nurses, and 14 (27%) of other occupations. Hindrances to discussing financial concerns were insufficient resources or support systems to refer to, followed by lack of time in a typical consultation. Health professionals in cancer care commonly address the financial concerns of their patients but attitudes differed across occupations about their role, and frustrations were raised about available solutions. Resources supporting financial‐related discussions for all health professionals are urgently needed to advance action in this field.

Cost-Effectiveness and Value of Information Analyses of Nutritional Support in Preventing Pressure Ulcers in High Risk Hospitalised Patients

Publisher: Elsevier BV

Date: 11-2014

DOI: 10.1016/J.JVAL.2014.08.2150

Cost-effectiveness of dual-energy X-ray absorptiometry plus antiresorptive treatment in Australian women with breast cancer who receive aromatase inhibitors

Publisher: Springer Science and Business Media LLC

Date: 11-03-2017

DOI: 10.1007/S00774-016-0742-2

Abstract: Postmenopausal women with breast cancer on aromatase inhibitor (AI) treatment are at increased risk of bone mineral density loss, which may lead to minimal trauma fractures. We examined the cost-effectiveness of dual energy X-ray absorptiometry (DXA) with antiresorptive (AR) therapy compared with fracture risk assessment, lifestyle advice, and vitamin supplementation. We used a hypothetical Markov cohort model of lifetime duration for 60-year-old women with early stage breast cancer receiving AIs. The data to inform the model came from medical literature, epidemiological reports, and costing data sets. Two eligibility scenarios for AR therapy were considered: (A) osteoporosis and (B) osteopenia or osteoporosis. The main outcomes were incremental cost per quality-adjusted life years gained and cumulative fractures per 1000 women, calculated relative to the comparator. Key aspects of the model were explored in sensitivity analyses. Due to relatively low effectiveness gains, the outcomes were primarily driven by the costs. The incremental cost per quality-adjusted life year gained was A$47,556 and A$253,000 for scenarios A and B, respectively. The numbers of fractures avoided were 56 and 77 per 1000 women, respectively. The results were most sensitive to the initial probability of osteoporosis, baseline risk of fracture, and cohort starting age. Compared with risk assessment and lifestyle advice only, a DXA scan followed by an AR treatment is potentially cost-effective for women aged 60 and over undergoing AI therapy for early breast cancer. However, the number of fractures averted through this intervention is small.

Toward More Efficient Surveillance of Barrett's Esophagus: Identification and Exclusion of Patients at Low Risk of Cancer

Publisher: Springer Science and Business Media LLC

Date: 23-11-2017

DOI: 10.1007/S00268-016-3819-0

Abstract: Endoscopic surveillance of Barrett's esophagus (BE) is probably not cost-effective. A sub-population with BE at increased risk of high-grade dysplasia (HGD) or esophageal adenocarcinoma (EAC) who could be targeted for cost-effective surveillance was sought. The outcome for BE surveillance from 2003 to 2012 in a structured program was reviewed. Incidence rates and incidence rate ratios for developing HGD or EAC were calculated. Risk stratification identified in iduals who could be considered for exclusion from surveillance. A health-state transition Markov cohort model evaluated the cost-effectiveness of focusing on higher-risk in iduals. During 2067 person-years of follow-up of 640 patients, 17 in iduals progressed to HGD or EAC (annual IR 0.8%). In iduals with columnar-lined esophagus (CLE) ≥2 cm had an annual IR of 1.2% and >8-fold increased relative risk of HGD or EAC, compared to CLE <2 cm [IR-0.14% (IRR 8.6, 95% CIs 4.5-12.8)]. Limiting the surveillance cohort after the first endoscopy to in iduals with CLE ≥2 cm, or dysplasia, followed by a further restriction after the second endoscopy-exclusion of patients without intestinal metaplasia-removed 296 (46%) patients, and 767 (37%) person-years from surveillance. Limiting surveillance to the remaining in iduals reduced the incremental cost-effectiveness ratio from US$60,858 to US$33,807 per quality-adjusted life year (QALY). Further restrictions were tested but failed to improve cost-effectiveness. Based on stratification of risk, the number of patients requiring surveillance can be reduced by at least a third. At a willingness-to-pay threshold of US$50,000 per QALY, surveillance of higher-risk in iduals becomes cost-effective.

The inaccuracy of automatic devices taking postural measurements in the emergency department

Publisher: Wiley

Date: 21-09-2011

DOI: 10.1111/J.1440-172X.2011.01958.X

Estimation of avoidable skin cancers and cost-savings to government associated with regulation of the solarium industry in Australia

Publisher: Elsevier BV

Date: 03-2009

DOI: 10.1016/J.HEALTHPOL.2008.07.003

Abstract: In Australia there is growing concern about the expanding solarium industry, and the additive effect of persons seeking exposure to artificial ultraviolet radiation (UVR) against already intense background levels of solar UVR. We estimated the numbers of potential skin cancers prevented through regulation of solaria and the associated cost-savings to the Federal Government. A lifetime decision-analytic model was created using relative risk estimates based on a meta-analysis of the literature assessing the link between skin cancer risk and solarium use. The costs were limited to those incurred by Medicare Australia, for the medical care of in iduals treated for skin cancer. With stricter regulations, we estimated between 18 and 31 melanomas, 200-251 squamous cell carcinomas and associated costs of $AU 256,054 would be avoided per 100,000 persons. Our base findings were sensitive to estimates for prevalence of use, skin cancer risk and discounting rates. Continued growth in the Australian solarium industry is likely to inflate the already substantial skin cancer burden. Subject to some limitations, our study indicates that by successfully enforcing solarium regulations to prohibit use by minors and by those with fair skin colour, the Federal Government could expect favourable cost and health benefits.

A systematic review of financial toxicity among cancer survivors: We can't pay the co-pay

Publisher: Springer Science and Business Media LLC

Date: 31-10-2017

DOI: 10.1007/S40271-016-0204-X

Abstract: To determine the extent of financial toxicity (FT) among cancer survivors, identify the determinants and how FT is measured. A systematic review was performed in MEDLINE, CINAHL and PsycINFO, using relevant terminology and included articles published from 1 January, 2013 to 30 June, 2016. We included observational studies where the primary outcomes included FT and study s les were greater than 200. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. From 417 citations, a total of 25 studies were included in this review. Seventy outcomes of FT were reported with 47 covering monetary, objective and subjective indicators of FT. A total of 28-48% of patients reported FT using monetary measures and 16-73% using subjective measures. The most commonly reported factors associated with FT were: being female, younger age, low income at baseline, adjuvant therapies and more recent diagnosis. Relative to non-cancer comparison groups, cancer survivors experienced significantly higher FT. Most studies were cross-sectional and causal inferences between FT and determinants were not possible. Measures of FT were varied and most were not validated, while monetary values of out-of-pocket expenses included different cost components across studies. A substantial proportion of cancer survivors experience financial hardship irrespective of how it is measured. Using standardised outcomes and longitudinal designs to measure FT would improve determination of the extent of FT. Further research is recommended on reduced work participation and income losses occurring concurrently with FT and on the impacts on treatment non-adherence.

Multiplicity of skin cancers in Queensland and their cost burden to government and patients

Publisher: Elsevier BV

Date: 02-2018

DOI: 10.1111/1753-6405.12738

Abstract: To determine the cost burden to government and patients for in iduals with multiple skin cancers. We used self-reported baseline data on socio-demographics, phenotype and sun exposure behaviours from participants in the QSkin Sun and Health Study with at least one histopathologically confirmed keratinocyte cancer or melanoma (n=5,673). Linkage to Australian Medicare data (2011-2014) provided resource data and government and out-of-pocket patient costs. Generalised linear models examined costs by frequency of skin cancer groups separately for melanoma and keratinocyte cancer. Over three years, 539 participants were diagnosed with melanoma (11% had ≥2 melanomas) and 5,134 participants were treated for keratinocyte cancers (10% had ≥6). Median Medicare costs per person were $1,325 (maximum $6,117) for ≥2 melanomas and $2,126 (maximum $54,618) for ≥6 keratinocyte cancers. Increased costs were associated with private health insurance. In iduals who are multiply affected by skin cancers are relatively common and the accompanying in idual and government cost burden can be substantial. These findings support skin cancer being classified as a chronic disease. Implications for public health: Over time, the economic burden for skin cancer for in iduals and health providers is high and investment in prevention remains important from an economic viewpoint.

Cost-effectiveness Analysis of Nutritional Support for the Prevention of Pressure Ulcers in High-Risk Hospitalized Patients

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 06-2016

DOI: 10.1097/01.ASW.0000482992.87682.4C

Transitions in work participation after a diagnosis of colorectal cancer

Publisher: Elsevier BV

Date: 12-2008

DOI: 10.1111/J.1753-6405.2008.00312.X

Abstract: How cancer adversely affects an in idual's work role is an understudied survivorship issue. There are no Australian studies quantifying work participation after cancer or the potential barriers to work continuance. Using a large, population-based cohort of working adults with colorectal cancer, we assessed changes in work participation separately for men (n=621) and women (n=354). Telephone survey methods collected data on colorectal cancer survivors identified through the Queensland Cancer Registry. Status at baseline and one-year post-diagnosis were described, and logistic regression models assessed correlates of work cessation. Among working adults who were diagnosed with colorectal cancer, 33% of men and 40% of women were not working at one-year post-diagnosis. Radiation therapy among men (OR=2.55, 95%CI: 1.35-4.83) and chemotherapy among women (OR=2.49, 95% Cl: 1.23-5.04) were associated with a higher prevalence of work cessation. Having private health insurance was linked with resuming work for both men and women. A large proportion of working men and women leave the workforce by 12 months following a diagnosis of colorectal cancer. Factors correlated with work cessation after colorectal cancer appear different for men and women. A better understanding of how cancer affects working adults and contributes to unwanted work cessation is required to identify in iduals who may benefit from occupational rehabilitation programs.

Hospitalisations for falls and hip fractures attributable to vitamin D deficiency in older Australians

Publisher: Cambridge University Press (CUP)

Date: 29-01-2021

DOI: 10.1017/S0007114521000416

Abstract: Vitamin D deficiency is associated with an increased risk of falls and fractures. Assuming this association is causal, we aimed to identify the number and proportion of hospitalisations for falls and hip fractures attributable to vitamin D deficiency (25 hydroxy D (25(OH)D) nmol/l) in Australians aged ≥65 years. We used 25(OH)D data from the 2011/12 Australian Health Survey and relative risks from published meta-analyses to calculate population-attributable fractions for falls and hip fracture. We applied these to data published by the Australian Institute of Health and Welfare to calculate the number of events each year attributable to vitamin D deficiency. In men and women combined, 8·3 % of hospitalisations for falls (7991 events) and almost 8 % of hospitalisations for hip fractures (1315 events) were attributable to vitamin D deficiency. These findings suggest that, even in a sunny country such as Australia, vitamin D deficiency contributes to a considerable number of hospitalisations as a consequence of falls and for treatment of hip fracture in older Australians in countries where the prevalence of vitamin D deficiency is higher, the impact will be even greater. It is important to mitigate vitamin D deficiency, but whether this should occur through supplementation or increased sun exposure needs consideration of the benefits, harms, practicalities and costs of both approaches.

Association between change in employment participation and quality of life in middle-aged colorectal cancer survivors compared with general population controls

Publisher: Wiley

Date: 15-12-2017

DOI: 10.1002/PON.4306

Abstract: This study aimed to examine the association between change in employment participation for a 12-month period and quality of life among in iduals with colorectal cancer compared with general population controls. This was a prospective, registry-based study that enrolled middle-aged (45-64 years) residents of Queensland, Australia, who were in the paid workforce, and newly diagnosed with colorectal cancer. Participants completed structured telephone interviews at 6 and 12 months after diagnosis assessing quality of life and employment status ("retired/ceased work," "increased work," "decreased work," and "maintained work"). Survivors were matched on demographic and occupation characteristics in a 1:2 ratio with in iduals from the general population who had participated in both Wave 10 (2010) and 11 (2011) of the Household, Income and Labour Dynamics in Australia survey. Almost half (66/148, 45%) of colorectal cancer survivors ceased or decreased work during the study period, compared with 27% in the control group (79/295, P = .001). Physical and mental well-being did not fluctuate over time in the general population. However, there were significant improvements in physical well-being, functional well-being, and overall quality of life during the study period for participants with colorectal cancer. At 12 months postdiagnosis, participants with colorectal cancer who maintained or increased work had significantly better functional well-being and overall quality of life compared with those who decreased work or retired. A diagnosis of colorectal cancer often impairs the ability of a person to maintain work. The impairments are predominantly physical and functional. Interventions to assist with occupational rehabilitation should be trialed.

Cost-Effectiveness Analysis from a Randomized Controlled Trial of Tailored Exercise Prescription for Women with Breast Cancer with 8-Year Follow-Up

Publisher: MDPI AG

Date: 19-11-2020

DOI: 10.3390/IJERPH17228608

Abstract: Studies show conflicting results on whether exercise interventions to improve outcomes for women with breast cancer are cost-effective. We modelled the long-term cost-effectiveness of the Exercise for Health intervention compared with usual care. A lifetime Markov cohort model for women with early breast cancer was constructed taking a societal perspective. Data were obtained from trial, epidemiological, quality of life, and healthcare cost reports. Outcomes were calculated from 5000 Monte Carlo simulations, and one-way and probabilistic sensitivity analyses. Over the cohort’s remaining life, the incremental cost for the exercise versus usual care groups were $7409 and quality-adjusted life years (QALYs) gained were 0.35 resulting in an incremental cost per QALY ratio of AU$21,247 (95% Uncertainty Interval (UI): Dominant, AU$31,398). The likelihood that the exercise intervention was cost-effective at acceptable levels was 93.0%. The incremental cost per life year gained was AU$8894 (95% UI Dominant, AU$11,769) with a 99.4% probability of being cost effective. Findings were most sensitive to the probability of recurrence in the exercise and usual care groups, followed by the costs of out-of-pocket expenses and the model starting age. This exercise intervention for women after early-stage breast cancer is cost-effective and would be a sound investment of healthcare resources.

Diagnosis and management costs of suspicious skin lesions from a population-based melanoma screening programme

Publisher: SAGE Publications

Date: 06-2007

DOI: 10.1258/096914107781261963

Abstract: Background: Recently, massive increases in health-care costs for the diagnosis and management of skin lesions have been observed (2000–05). The aim of this study was to describe the health system costs attributed to the diagnosis and management of suspicious skin lesions detected during a trial of a population melanoma screening programme (1998–2001). Setting: Queensland, Australia. Methods: Data from the trial and Medicare Australia were used to categorize and cost all suspicious skin lesions arising from the trial, which included general practitioner consultations, diagnosis/management and pathology. Comparisons were made with other screened and unscreened populations. Results: Overall, 2982 lesions were treated within the trial producing a mean cost of Aus& dollar per lesion. Excisions for benign lesions contributed the greatest proportion of total costs (45%). The total cost burden was approximately 10% higher for men than women, and 63% of overall costs were for persons aged & ge years. For diagnosis and management procedures, the estimated average cost per 1000 in iduals was Aus& dollar ,560 for men aged & ge years from the skin cancer screening trial, compared with Aus& dollar ,967 for BreastScreen Australia and Aus& dollar for the National Cervical Screening Program. Conclusions: The proportion of costs for benign skin lesions and biopsies arising from the screening programme were no higher than in the two-year period outside the trial. While comparisons are difficult, it appears that diagnostic and management costs for skin cancer as a result of screening may be comparable with those for BreastScreen Australia, if screening is targeted at men aged ≥50 years.

Financial toxicity and symptom burden: what is the big deal?

Publisher: Springer Science and Business Media LLC

Date: 13-02-2018

DOI: 10.1007/S00520-018-4092-6

Exercise following breast cancer: exploratory survival analyses of two randomised, controlled trials

Publisher: Springer Science and Business Media LLC

Date: 23-10-2017

DOI: 10.1007/S10549-017-4541-9

Abstract: The Exercise for Health trials were randomised, controlled trials designed to evaluate an 8-month pragmatic exercise intervention, commencing 6 weeks post-surgery for women with newly diagnosed breast cancer residing in urban or rural/regional Australia. For these exploratory analyses, the primary and secondary outcomes were overall survival (OS) and disease-free survival (DFS), respectively. Consenting urban- (n = 194) and rural/regional-residing women (n = 143) were randomised to exercise (intervention delivered face-to-face or by telephone) or usual care. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CI) for survival outcomes (exercise group, n = 207, 65% urban women usual care group, n = 130, 46% urban women). After a median follow-up of 8.3 years, there were 11 (5.3%) deaths in the exercise group compared with 15 (11.5%) deaths in the usual care group (OS HR for the exercise group: 0.45, 95% CI 0.20-0.96 p = 0.04). DFS events for the exercise versus usual care group were 25 (12.1%) and 23 (17.7%), respectively (HR: 0.66, 95% CI 0.38-1.17 p = 0.16). HRs for OS favoured exercise irrespective of age, body mass index, stage of disease, intervention compliance, and physical activity levels at 12 months post-diagnosis, although were stronger (p < 0.05) for younger women, women with stage II + disease, women with 1 + comorbidity at time of diagnosis, higher intervention compliance and for those who met national physical activity guidelines at 12 months post-diagnosis. An exercise intervention delivered during and beyond treatment for breast cancer, and that was designed to cater for all women irrespective of place of residence and access to health services, has clear potential to benefit survival. Trial numbers: ACT RN: 012606000233527 ACT RN: 12609000809235.

Perceptions of upper-body problems during recovery from breast cancer treatment

Publisher: Springer Science and Business Media LLC

Date: 02-2004

DOI: 10.1007/S00520-003-0554-5

Abstract: Despite improved recognition recently, restrictions in upper-body movement continue to cause impairment and distress for many women long after breast cancer treatment. The purpose of this research is to investigate this issue through the perceptions of breast cancer survivors in the context of their everyday lives. Twenty-four women recruited from a private breast clinic in south-eastern Queensland, Australia, participated in a qualitative study. Discussion groups comprised women treated for breast cancer within the previous 18 months. Discussions centred on experiences of physical difficulties, follow-up support, arm lymphoedema and exercise therapy during the women's recoveries. Returning to normal activities for women after breast surgery was felt to take longer than either the women's or their physicians' expectations. Many women reported difficulties in upper-body tasks, which worsened simple everyday responsibilities. The physical impact leads to psychological strain, as the women are constantly reminded of their illness and the possibility they may never return to their full capacity. These upper-body difficulties may include discomfort while driving and sleeping, posture disturbances, reduced employability in physical work, and decreased ability to do housework and gardening. Having lymphoedema or the threat of developing it was very distressing for most women. The potential preventive role of physiotherapy-led exercises to prevent further decline and improve function was strongly emphasised during these discussions. Clinicians need to recognise that it is very common for women with breast cancer to experience upper-body morbidity long after their treatment, and consequently every effort to enhance recovery and avoid further deterioration in function is required.

Evaluating the economic effects of genomic sequencing of pathogens to prioritise hospital patients competing for isolation beds

Publisher: CSIRO Publishing

Date: 2021

DOI: 10.1071/AH20071

Abstract: ObjectiveThis study compared the costs and patient movements of a new hospital protocol to discontinue contact precautions for patients with non-multiresistant methicillin-resistant Staphylococcus aureus (nmMRSA), based on whole-genome sequencing (WGS) of pathogens with current practice. MethodsA hybrid simulation model was constructed and analysed over a 12-month time horizon. Six multidrug-resistant organisms and influenza were modelled concurrently where infected patients competed for isolation beds. Model inputs included pathogen incidence, resources for WGS, staff and contact precautions, hospital processes, room allocations and their associated costs. Data were sourced from aggregated records of patient admissions during 2017–18, clinical records and published reports. ResultsThe WGS protocol resulted in 389 patients isolated (44% of current practice), 5223 ‘isolation bed days’ (56%) and 268 closed-bed days (88%). Over 1 year, the mean (±s.d.) total cost for the WGS protocol was A$749243±126667 compared with current practice, the overall cost savings were A$690864±300464. ConclusionUsing WGS to inform infection control teams of pathogen transmission averts patients from isolation rooms and reduces significant resources involved in implementing contact precautions. What is known about the topic?There are an estimated 265000 hospital-acquired infections (HAI) in Australia each year. WGS can accurately identify the genetic lineage among HAIs and determine transmission clusters that can help infection control staff manage patients. Economic appraisals are lacking to inform whether pathogen genomics services should be adopted within already-stretched hospital budgets. What does this paper add?An isolation protocol using pathogen genomics to provide additional information on the relatedness of a pathogen between colonised patients showed favourable results for healthcare costs and patient flow. Using WGS, in a confirmatory role, to discontinue certain patients from contact precautions and isolation rooms resulted in cost savings of A$690864 across 1 year for a single major hospital. What are the implications for practitioners?Using pathogen WGS services for infection control potentially curbs hospital spending, averts patient isolations and improves patient flow within hospitals.

A review of the cost-effectiveness of face-to-face behavioural interventions for smoking, physical activity, diet and alcohol

Publisher: SAGE Publications

Date: 06-2007

DOI: 10.1177/1742395307081732

Abstract: Objective: To assess the evidence for the cost-effectiveness of health behaviour interventions that address the major behavioural risk factors for chronic disease, including smoking, physical inactivity, poor diet, and alcohol misuse. Methods: Medical and economic databases were searched for relevant economic evaluations. Studies were critically appraised using a published 35-point checklist, and the results are described using a narrative approach, noting methodological limitations. The review included 64 studies from 1995—2005, including 17 reports on multiple behaviour interventions. Results: There was considerable variation among the studies by target populations, intervention components, primary outcomes, and economic methods, but the reported incremental cost-effectiveness ratios were consistently low (e.g. ,000 per quality-adjusted life-year gained for smoking-cessation programmes in 2006 Euros) as compared to certain preventive pharmaceutical and invasive interventions. Interventions targeting high-risk-population subgroups were relatively better value for money as compared to those targeting general populations. Discussion: In general, the results of this review demonstrate favourable cost-effectiveness for smoking interventions, physical activity interventions and multiple behaviour interventions in high-risk groups. Although alcohol and dietary interventions appeared to be economically favourable, it is difficult to draw conclusions because of the variety in study outcomes. However, methodological limitations weaken the generalizability of findings, and suggest that the results of any given study should be considered carefully when being used to inform resource allocation.

Budget impact analysis of routinely using whole-genomic sequencing of six multidrug-resistant bacterial pathogens in Queensland, Australia

Publisher: BMJ

Date: 02-2021

DOI: 10.1136/BMJOPEN-2020-041968

Abstract: To predict the cost and health effects of routine use of whole-genome sequencing (WGS) of bacterial pathogens compared with those of standard of care. Budget impact analysis was performed over the following 5 years. Data were primarily from sequencing results on clusters of multidrug-resistant organisms across 27 hospitals. Model inputs were derived from hospitalisation and sequencing data, and epidemiological and costing reports, and included multidrug resistance rates and their trends. Queensland, Australia. Hospitalised patients. WGS surveillance of six common multidrug-resistant organisms ( Staphylococcus aureus , Escherichia coli , Enterococcus faecium , Klebsiella pneumoniae , Enterobacter sp and Acinetobacter baumannii ) compared with standard of care or routine microbiology testing. Expected hospital costs, counts of patient infections and colonisations, and deaths from bloodstream infections. In 2021, 97 539 patients in Queensland are expected to be infected or colonised with one of six multidrug-resistant organisms with standard of care testing. WGS surveillance strategy and earlier infection control measures could avoid 36 726 infected or colonised patients and avoid 650 deaths. The total cost under standard of care was $A170.8 million in 2021. WGS surveillance costs an additional $A26.8 million but was offset by fewer costs for cleaning, nursing, personal protective equipment, shorter hospital stays and antimicrobials to produce an overall cost savings of $30.9 million in 2021. Sensitivity analyses showed cost savings remained when input values were varied at 95% confidence limits. Compared with standard of care, WGS surveillance at a state-wide level could prevent a substantial number of hospital patients infected with multidrug-resistant organisms and related deaths and save healthcare costs. Primary prevention through routine use of WGS is an investment priority for the control of serious hospital-associated infections.

The return to work experiences of middle-aged Australian workers diagnosed with colorectal cancer: A matched cohort study

Publisher: Springer Science and Business Media LLC

Date: 17-09-2014

DOI: 10.1186/1471-2458-14-963

Indoor tanning prevalence after the International Agency for Research on Cancer statement on carcinogenicity of artificial tanning devices: systematic review and meta-analysis

Publisher: Oxford University Press (OUP)

Date: 16-10-2020

DOI: 10.1111/BJD.18412

Abstract: Exposure to artificial tanning devices is carcinogenic to humans, and government regulations to restrict or ban indoor tanning appear to be increasing. We evaluated changes in the international prevalence of indoor tanning among adolescents and adults after artificial tanning devices were classified as carcinogenic by the International Agency for Research on Cancer (IARC) in 2009. Systematic searches in PubMed and Web of Science databases were undertaken. Overall, 43 studies reporting 'ever' or 'past-year' indoor tanning exposure after 2009 were identified. We used metaregression analysis to evaluate the prevalence of indoor tanning over time. Random effects meta-analysis was used to summarize the prevalence of indoor tanning in adolescents and adults according to sex, region and presence of age prohibitions. Global prevalence of indoor tanning in adolescents for 2013-2018 was 6·5% [95% confidence interval (CI) 3·3-10·6], 70% lower than the 22·0% (95% CI 17·2-26·8) prevalence for 2007-2012. Among adults, the prevalence was 10·4% (95% CI 5·7-16·3) for 2013-2018, a decrease of 35% from 18·2% for 2007-2012. Since 2009, the overall past-year prevalence among adolescents was 6·7% (95% CI 4·4-9·6) and 12·5% (95% CI 9·5-15·6) among adults. The prevalence of tanning indoors in the past year was similar in North America (adults, 12·5% adolescents, 7·6%) and Europe (adults, 11·1% adolescents, 5·1%). In 2009, three countries had regulations restricting indoor tanning, compared with 26 countries today. Prevalence of indoor tanning has declined substantially and significantly in adolescents and adults since the 2009 IARC statement, reflecting the rise in regulations that limit this source of unnecessary exposure to carcinogenic ultraviolet radiation. What is already known about this topic? Indoor tanning is associated with an increased risk of melanoma. A meta-analysis of worldwide indoor tanning prevalence for 1986-2012 found a past-year prevalence of 18% in adolescents and 14% in adults, with higher prevalences during the period 2007-2012. Policies to regulate indoor tanning began to be implemented across the globe in 2009. Only one study carried out in the U.S.A. has evaluated the efficacy of such policies in reducing indoor tanning prevalence. What does this study add? For the period 2013-2018, we found indoor tanning prevalences of 6·7% in adolescents and 11·9% in adults. This implies a reduction in indoor tanning use of 70% in adolescents and 35% in adults during the last 10 years. Our study encourages policy makers to strengthen indoor tanning regulations that reduce sunbed use among the general population in order to produce maximum public health benefit.

Value of information analysis optimizing future trial design from a pilot study on catheter securement devices

Publisher: SAGE Publications

Date: 31-07-2014

DOI: 10.1177/1740774514545634

Abstract: Value of information analysis has been proposed as an alternative to the standard hypothesis testing approach, which is based on type I and type II errors, in determining s le sizes for randomized clinical trials. However, in addition to s le size calculation, value of information analysis can optimize other aspects of research design such as possible comparator arms and alternative follow-up times, by considering trial designs that maximize the expected net benefit of research, which is the difference between the expected cost of the trial and the expected value of additional information. To apply value of information methods to the results of a pilot study on catheter securement devices to determine the optimal design of a future larger clinical trial. An economic evaluation was performed using data from a multi-arm randomized controlled pilot study comparing the efficacy of four types of catheter securement devices: standard polyurethane, tissue adhesive, bordered polyurethane and sutureless securement device. Probabilistic Monte Carlo simulation was used to characterize uncertainty surrounding the study results and to calculate the expected value of additional information. To guide the optimal future trial design, the expected costs and benefits of the alternative trial designs were estimated and compared. Analysis of the value of further information indicated that a randomized controlled trial on catheter securement devices is potentially worthwhile. Among the possible designs for the future trial, a four-arm study with 220 patients/arm would provide the highest expected net benefit corresponding to 130% return-on-investment. The initially considered design of 388 patients/arm, based on hypothesis testing calculations, would provide lower net benefit with return-on-investment of 79%. Cost-effectiveness and value of information analyses were based on the data from a single pilot trial which might affect the accuracy of our uncertainty estimation. Another limitation was that different follow-up durations for the larger trial were not evaluated. The value of information approach allows efficient trial design by maximizing the expected net benefit of additional research. This approach should be considered early in the design of randomized clinical trials.

Associations of health behaviours with return to work outcomes after colorectal cancer

Publisher: Springer Science and Business Media LLC

Date: 23-07-2016

DOI: 10.1007/S00520-015-2855-X

Abstract: Engaging in positive health behaviours can improve quality of life amongst cancer survivors, whether this facilitates return to work is unknown. We examined associations of health behaviours with return to work outcomes following a diagnosis of colorectal cancer in middle-aged men and women (45-64 years). We recruited 239 participants through the Queensland Cancer Registry between January 2010 and September 2011. Data were collected through telephone-administered interviews and postal questionnaires at 6 and 12 months post-diagnosis. Logistic regression examined likelihood of ceasing or reducing work, and Cox regression examined factors associated with time to return to work. No significant associations were observed between health behaviours (fruit and vegetables consumption, alcohol consumption, smoking status, physical activity or sitting time) at 6 months and ceasing or reducing work at 12 months post-diagnosis. Participants who reported excessive sleep (≥9 h/day) were 2.69 times more likely to reduce work time or retire (relative to those sleeping the recommended 7 to <9 h/day 95 % CI 1.06, 6.87, adjusted for cancer treatment). In Cox regression analysis, excessive sleep was associated with a longer work re-entry time (relative to sleeping 7 to <9 h/day HR = 0.47 95 % CI 0.22, 1.00, adjusted for education and cancer treatment). Further research into how excessive sleep might be related to return to work amongst colorectal cancer survivors is warranted. Interventions focused on achieving optimal sleep patterns may assist colorectal cancer survivors to return to work and should be tested in future studies.

An Individualized Exercise Intervention for People with Multiple Myeloma—Study Protocol of a Randomized Waitlist-Controlled Trial

Publisher: MDPI AG

Date: 07-02-2022

DOI: 10.3390/CURRONCOL29020077

Abstract: People with multiple myeloma (MM) are second only to people with lung cancer for the poorest reported health-related quality of life (HRQoL) of all cancer types. Whether exercise can improve HRQoL in MM, where bone pain and lesions are common, requires investigation. This trial aims to evaluate the efficacy of an exercise intervention compared with control on HRQoL in people with MM. Following baseline testing, people with MM (n = 60) will be randomized to an exercise (EX) or waitlist control (WT) group. EX will complete 12-weeks of supervised (24 sessions) and unsupervised (12 sessions) in idualized, modular multimodal exercise training. From weeks 12–52, EX continue unsupervised training thrice weekly, with one optional supervised group-based session weekly from weeks 12–24. The WT will be asked to maintain their current activity levels for the first 12-weeks, before completing the same protocol as EX for the following 52 weeks. Primary (patient-reported HRQoL) and secondary (bone health and pain, fatigue, cardiorespiratory fitness, muscle strength, body composition, disease response, and blood biomarkers) outcomes will be assessed at baseline, 12-, 24- and 52-weeks. Adverse events, attendance, and adherence will be recorded and cost-effectiveness analysis performed. The findings will inform whether exercise should be included as part of standard myeloma care to improve the health of this unique population.

The cost-effectiveness and consumer acceptability of taxation strategies to reduce rates of overweight and obesity among children in Australia: Study protocol

Publisher: Springer Science and Business Media LLC

Date: 12-2013

DOI: 10.1186/1471-2458-13-1182

Value of Information Analysis Informing Adoption and Research Decisions in a Portfolio of Health Care Interventions

Publisher: SAGE Publications

Date: 07-2016

DOI: 10.1177/2381468316642238

Abstract: Background: Value of information (VOI) analysis quantifies the value of additional research in reducing decision uncertainty. It addresses adoption and research decisions simultaneously by comparing the expected benefits and costs of research studies. Nevertheless, the application of this approach in practice remains limited. Objectives: To apply VOI analysis in health care interventions to guide adoption decisions, optimize trial design, and prioritize research. Methods: The analysis was from the perspective of Queensland Health, Australia. It included four interventions: clinically indicated catheter replacement, tissue adhesive for securing catheters, negative pressure wound therapy (NPWT) in caesarean sections, and nutritional support for preventing pressure ulcers. For each intervention, cost-effectiveness analysis was performed, decision uncertainty characterized, and VOI calculated using Monte Carlo simulations. The benefits and costs of additional research were considered together with the costs and consequences of acting now versus waiting for more information. All values are reported in 2014 Australian dollars (AU$). Results: All interventions were cost-effective, but with various levels of decision uncertainty. The current evidence is sufficient to support the adoption of clinically indicated catheter replacement. For the tissue adhesive, an additional study before adoption is worthwhile with a four-arm trial of 220 patients per arm. Additional research on NPWT before adoption is worthwhile with a two-arm trial of 200 patients per arm. Nutritional support should be adopted with a two-arm trial of 1200 patients per arm. Based on the expected net monetary benefits, the studies were ranked as follows: 1) NPWT (AU$1.2 million), 2) tissue adhesive (AU$0.3 milliion), and 3) nutritional support (AU$0.1 million). Conclusions: VOI analysis is a useful and practical approach to inform adoption and research decisions. Efforts should be focused on facilitating its integration into decision making frameworks.

Evaluation of a telehealth psychological support intervention for people with primary brain tumour and their family members: Study protocol for a randomised controlled trial

Publisher: Hindawi Limited

Date: 07-2019

DOI: 10.1111/ECC.13132

Abstract: There is a lack of research on interventions that address the specific psychosocial needs of people with brain tumour and their families. This paper describes the protocol for a pragmatic randomised control trial (RCT) evaluating the clinical efficacy and cost-effectiveness of the Making Sense of Brain Tumour program delivered via telehealth (Tele-MAST) relative to standard care. The 148 adults with primary brain tumour will be randomly allocated to the 10-session Tele-MAST videoconferencing program or standard care from a cancer counselling service. The primary outcome is level of depression and secondary outcomes are quality of life, mental health and incremental cost per quality-adjusted life year. The mental health and quality of life of family members will also be assessed. Assessments will be conducted at pre-intervention, post-intervention (primary endpoint), 6-weeks post-intervention and 6-months post-intervention. The main analysis will determine whether the Tele-MAST intervention is more effective than standard care at post-intervention, and whether these effects are sustained at follow-up. Results will indicate whether the Tele-MAST program is associated with better clinical outcomes and is more cost-effective than existing cancer support services. Such outcomes will contribute to effective and accessible psychosocial care for the brain tumour population.

Increase in preventive behaviour by organ transplant recipients after sun protection information in a skin cancer surveillance clinic

Publisher: Oxford University Press (OUP)

Date: 05-09-2018

DOI: 10.1111/BJD.16836

Sunbed Use among 11- to 17-Year-Olds and Estimated Number of Commercial Sunbeds in England with Implications for a ‘Buy-Back’ Scheme

Publisher: MDPI AG

Date: 14-05-2021

DOI: 10.3390/CHILDREN8050393

Abstract: Prior to 2011 legislation prohibiting children from using commercial sunbeds, the prevalence of sunbed use in 15- to 17-year-olds in some areas in England was as high as 50%. Despite significant decreases since 2011, children today still practice indoor tanning. We estimated current sunbed use in 11- to 17-year-olds in England, the number of available commercial sunbed units, and the associated cost of a ‘buy-back’ scheme to remove commercial sunbeds under a potential future policy to ban sunbeds. We undertook a calibration approach based on published prevalence rates in English adults and other sources. Internet searches were undertaken to estimate the number of sunbed providers in Greater Manchester, then we extrapolated this to England. Estimated mean prevalence of sunbed use was 0.6% for 11- to 14-year-olds and 2.5% for 15- to 17-year-olds, equating to 62,130 children using sunbeds in England. A predicted 2958 premises and 17,865 sunbeds exist nationally and a ‘buy-back’ scheme would cost approximately GBP 21.7 million. Public health concerns remain greatest for 11- to 17-year-olds who are particularly vulnerable to developing skin cancers after high ultraviolet exposure.

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Publisher: Oxford University Press (OUP)

Date: 24-03-2021

DOI: 10.1093/BJS/ZNAB101

Abstract: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18–49, 50–69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351 best case 196, worst case 816) or non-cancer surgery (733 best case 407, worst case 1664). Both exceeded the NNV in the general population (1840 best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population.

The Working after Cancer Study (WACS): A population-based study of middle-aged workers diagnosed with colorectal cancer and their return to work experiences

Publisher: Springer Science and Business Media LLC

Date: 29-07-2011

DOI: 10.1186/1471-2458-11-604

Lifetime costs of surviving cancer-a queensland study (Cos-q): Protocol of a large healthcare data linkage study

Publisher: MDPI AG

Date: 20-04-2020

DOI: 10.3390/IJERPH17082831

Abstract: Australia-wide, there are currently more than one million cancer survivors. There are over 32 million world-wide. A trend of increasing cancer incidence, medical innovations and extended survival places growing pressure on healthcare systems to manage the ongoing and late effects of cancer treatment. There are no published studies of the long-term health service use and cost of cancer survivorship on a population basis in Australia. All residents of the state of Queensland, Australia, diagnosed with a first primary malignancy from 1997–2015 formed the cohort of interest. State and national healthcare databases are linked with cancer registry records to capture all health service utilization and healthcare costs for 20 years (or death, if this occurs first), starting from the date of cancer diagnosis, including hospital admissions, emergency presentations, healthcare costing data, Medicare services and pharmaceuticals. Data analyses include regression and economic modeling. We capture the whole journey of health service contact and estimate long-term costs of all cancer patients diagnosed and treated in Queensland by linking routinely collected state and national healthcare data. Our results may improve the understanding of lifetime health effects faced by cancer survivors and estimate related healthcare costs. Research outcomes may inform policy and facilitate future planning for the allocation of healthcare resources according to the burden of disease.

A Multi-Disciplinary Team Approach to Genomic Testing for Drug-Resistant Epilepsy Patients—The GENIE Study

Publisher: MDPI AG

Date: 21-07-2022

DOI: 10.3390/JCM11144238

Abstract: Background. The genomic era has led to enormous progress in clinical care and a multi-disciplinary team (MDT) approach is imperative for integration of genomics into epilepsy patient care. Methods. The MDT approach involved patient selection, genomic testing choice, variant discussions and return of results. Genomics analysis included cytogenomic testing and whole exome sequencing (WES). Neurologist surveys were undertaken at baseline and after genomic testing to determine if genomic diagnoses would alter their management, and if there was a change in confidence in genomic testing and neurologist perceptions of the MDT approach. Results. The total diagnostic yield from all genomic testing was 17% (11/66), with four diagnoses from cytogenomic analyses. All chromosomal microarray (CMA) diagnoses were in patients seen by adult neurologists. Diagnostic yield for WES was 11% (7/62). The most common gene with pathogenic variants was DCX, reported in three patients, of which two were mosaic. The genomic diagnosis impacted management in 82% (9/11). There was increased confidence with integrating genomics into clinical care (Pearson chi square = 83, p = 0.004) and qualitative comments were highly supportive of the MDT approach. Conclusions. We demonstrated diagnostic yield from genomic testing, and the impact on management in a cohort with drug-resistant epilepsy. The MDT approach increased confidence in genomic testing and neurologists valued the input from this approach. The utility of CMA was demonstrated in epilepsy patients seen by adult neurologists as was the importance of considering mosaicism for previously undiagnosed patients.

Tanning behaviors and determinants of solarium use among indoor office workers in Queensland, Australia

Publisher: SAGE Publications

Date: 30-11-2011

DOI: 10.1177/1359105311427476

Abstract: Using cross-sectional survey data from Brisbane, Australia, this study identifies prevalence and factors associated with indoor tanning in office workers. Over 12-months, 72/2867 (2.5%) survey participants used solaria. Twenty-eight sunbed users (39%) tanned outdoors and used spray-tans and 42 (58%) reported burns after indoor tanning. Results from regression modelling suggests the strongest predictors of sunbed use were beliefs that tanning was safer indoors than outdoors (OR 6.1, 95%CI: 2.6–14.0) and engaging in outdoor tanning (OR 4.1, 95%CI: 1.8–9.0). We recommend that health authorities promote health gains by reducing ultraviolet radiation exposure or substituting indoor tanning with a spray-on tan.

Cost-effectiveness analyses and modelling the lifetime costs and benefits of health-behaviour interventions

Publisher: SAGE Publications

Date: 06-2006

DOI: 10.1179/174592006X110978

A hybrid simulation model approach to examine bacterial genome sequencing during a hospital outbreak.

Publisher: Springer Science and Business Media LLC

Date: 23-01-2020

DOI: 10.1186/S12879-019-4743-3

Abstract: Hospital infection control requires timely detection and identification of organisms, and their antimicrobial susceptibility. We describe a hybrid modeling approach to evaluate whole genome sequencing of pathogens for improving clinical decisions during a 2017 hospital outbreak of OXA-181 carbapenemase-producing Escherichia coli and the associated economic effects. Combining agent-based and discrete-event paradigms, we built a hybrid simulation model to assess hospital ward dynamics, pathogen transmission and colonizations. The model was calibrated to exactly replicate the real-life outcomes of the outbreak at the ward-level. Seven scenarios were assessed including genome sequencing (early or late) and no sequencing (usual care). Model inputs included extent of microbiology and sequencing tests, patient-level data on length of stay, hospital ward movement, cost data and local clinical knowledge. The main outcomes were outbreak size and hospital costs. Model validation and sensitivity analyses were performed to address uncertainty around data inputs and calibration. An estimated 197 patients were colonized during the outbreak with 75 patients detected. The total outbreak cost was US$318,654 with 6.1% of total costs spent on sequencing. Without sequencing, the outbreak was estimated to result in 352 colonized patients costing US$531,109. Microbiology tests were the largest cost component across all scenarios. A hybrid simulation approach using the advantages of both agent-based and discrete-event modeling successfully replicated a real-life bacterial hospital outbreak as a foundation for evaluating clinical outcomes and efficiency of outbreak management. Whole genome sequencing of a potentially serious pathogen appears effective in containing an outbreak and minimizing hospital costs.

Early cost–utility analysis of genetically guided therapy for patients with drug‐resistant epilepsy

Publisher: Wiley

Date: 17-10-2022

DOI: 10.1111/EPI.17408

Abstract: Existing gene panels were developed to understand the etiology of epilepsy, and further benefits will arise from an effective pharmacogenomics panel for personalizing therapy and achieving seizure control. Our study assessed the cost‐effectiveness of a pharmacogenomics panel for patients with drug‐resistant epilepsy, compared with usual care. A cost–utility analysis was employed using a discrete event simulation model. The microsimulation model aggregated the costs and benefits of genetically guided treatment versus usual care for 5000 simulated patients. The 10‐year model combined data from various sources including genomic databases on prevalence of variants, population‐level pharmaceutical claims on antiseizure medications, published long‐term therapy retention rates, patient‐level cost data, and systematic reviews. Incremental cost per quality‐adjusted life‐year (QALY) gained was computed. Deterministic and probabilistic sensitivity analyses were undertaken to address uncertainty in model parameters. The mean cost of the genetically guided treatment option was AU$98 199 compared with AU$95 386 for usual care. Corresponding mean QALYs were 4.67 compared with 4.28 for genetically guided and usual care strategies, respectively. The incremental cost per QALY gained was AU$7381. In probabilistic sensitivity analyses, the incremental cost per QALY gained was AU$6321 (95% uncertainty interval = AU$3604–AU$9621), with a 100% likelihood of being cost‐effective in the Australian health care system. The most influential drivers of the findings were the monthly health care costs associated with reduced seizures, costs when seizures continued, and the quality‐of‐life estimates under genetically guided and usual care strategies. This early economic evaluation of a pharmacogenomics panel to guide treatment for drug‐resistant epilepsy could potentially be cost‐effective in the Australian health care system. Clinical trial evidence is necessary to confirm these findings.

Clinical and Economic Outcomes of Genome Sequencing Availability on Containing a Hospital Outbreak of Resistant Escherichia coli in Australia

Publisher: Elsevier BV

Date: 08-2020

DOI: 10.1016/J.JVAL.2020.03.006

Association of Indoor Tanning Regulations With Health and Economic Outcomes in North America and Europe

Publisher: American Medical Association (AMA)

Date: 04-2020

DOI: 10.1001/JAMADERMATOL.2020.0001

Adverse breast cancer treatment effects: the economic case for making rehabilitative programs standard of care

Publisher: Springer Science and Business Media LLC

Date: 05-12-2015

DOI: 10.1007/S00520-014-2539-Y

Abstract: The purpose of this work was to evaluate the patient-borne financial cost of common, adverse breast cancer treatment-associated effects, comparing cost across women with or without these side effects. Two hundred eighty-seven Australian women diagnosed with early-stage breast cancer were prospectively followed starting at 6 months post-surgery for 12 months, with three monthly assessments of detailed treatment-related side effects and their direct and indirect patient costs attributable to breast cancer. Bootstrapping statistics were used to analyze cost data, and adjusted logistic regression was used to evaluate the association between costs and adverse events from breast cancer. Costs were inflated and converted from 2002 Australian to 2014 US dollars. More than 90 % of women experienced at least one adverse effect (i.e., post-surgical issue, reaction to radiotherapy, upper-body symptoms or reduced function, lymphedema, fatigue, or weight gain). On average, women paid $5,636 (95 % confidence interval (CI), $4,694, $6,577) in total costs. Women with any one of the following symptoms (fatigue, reduced upper-body function, upper-body symptoms) or women who report ≥4 adverse treatment-related effects, have 1.5 to nearly 4 times the odds of having higher healthcare costs than women who do not report these complaints (p < 0.05). Women face substantial economic burden due to a range of treatment-related health problems, which may persist beyond the treatment period. Improving breast cancer care by incorporating prospective surveillance of treatment-related side effects and strategies for prevention and treatment of concerns (e.g., exercise) has real potential for reducing patient-borne costs.

Response

Publisher: Elsevier BV

Date: 07-2014

DOI: 10.1016/J.GIE.2014.02.020

A comparison of the direct medical costs for individuals with or without basal or squamous cell skin cancer: A study from Australia.

Publisher: SAGE Publications

Date: 2016

DOI: 10.1177/2050312116646030

Abstract: The composition of the medical costs incurred by people treated for basal cell and squamous cell carcinomas (hereafter keratinocyte cancers) is not adequately understood. We sought to compare the medical costs of in iduals with or without keratinocyte cancers. We used national health insurance data to analyze the direct medical costs of 2000 cases and 2000 controls nested within the QSkin prospective cohort study (n = 43,794) conducted in Australia. We reconstructed the medical history of patients using medical and pharmaceutical item codes and then compared the health service costs of in iduals treated for keratinocyte cancers with those not treated for keratinocyte cancers. In iduals treated for keratinocyte cancers consumed on average AUD$1320 per annum more in medical services than those without keratinocyte cancers. Only 23.2% of costs were attributed to the explicit treatment of keratinocyte cancers. The principal drivers of the residual costs were medical attendances, surgical procedures on the skin, and histopathology services. We found significant positive associations between history of treatment for keratinocyte cancers with treatments for other health conditions, including melanoma, cardiovascular disease, lipidemia, osteoporosis, rheumatoid arthritis, colorectal cancer, prostate cancer, and tuberculosis. In iduals treated for keratinocyte cancers have substantially higher medical costs overall than in iduals without keratinocyte cancers. The direct costs of skin cancer excision account for only one-fifth of this difference.

The ENHANCES study: a randomised controlled trial of a nurse-led survivorship intervention for patients treated for head and neck cancer

Publisher: Springer Science and Business Media LLC

Date: 02-04-2019

DOI: 10.1007/S00520-019-04748-7

Abstract: A randomised controlled trial was conducted to evaluate the effectiveness of a nurse-delivered Head and Neck Cancer Survivor Self-Management Care Plan (HNCP) for patients who had completed treatment for head and neck cancer (HNC). Ten oncology nurses were trained to deliver the HNCP. The HNCP consisted of one face-to-face hour-long meeting in which the patient's treatment was recorded, as were contact details of health professionals involved in their care and follow-up schedules. Patients were guided to nominate up to three goals for their future well-being and assisted to devise an action plan to achieve these. The HNCP was given to the patient and a copy was forwarded to their primary care physician. One hundred and nine patients were randomised after definitive curative intent treatment, 36 to HNCP, 36 to receive information about survivorship, and 37 to usual care. The primary outcome, analysed by intention-to-treat, was change in quality of life measured by the FACT-H&N from baseline to 6-month follow-up. Quality of life of all groups decreased at 3 months but was close to baseline at 6 months. Compared with the usual care group, the only statistically significant mean difference at 6 months was for the information group on the physical well-being domain (mean difference 0.4, 95% - 1.8, 2.6, p < 0.05). A single-session nurse-delivered intervention is insufficient to improve the quality of life in HNC survivors compared with usual care. Provision of detailed written information about HNC survivorship is associated with improved physical well-being. ACTRN12613000542796.

Cost-Effectiveness of Repetitive Transcranial Magnetic Stimulation versus Antidepressant Therapy for Treatment-Resistant Depression

Publisher: Elsevier BV

Date: 07-2015

DOI: 10.1016/J.JVAL.2015.04.004

Abstract: Repetitive transcranial magnetic stimulation (rTMS) therapy is a clinically safe, noninvasive, nonsystemic treatment for major depressive disorder. We evaluated the cost-effectiveness of rTMS versus pharmacotherapy for the treatment of patients with major depressive disorder who have failed at least two adequate courses of antidepressant medications. A 3-year Markov microsimulation model with 2-monthly cycles was used to compare the costs and quality-adjusted life-years (QALYs) of rTMS and a mix of antidepressant medications (including selective serotonin reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors, tricyclics, noradrenergic and specific serotonergic antidepressants, and monoamine oxidase inhibitors). The model synthesized data sourced from published literature, national cost reports, and expert opinions. Incremental cost-utility ratios were calculated, and uncertainty of the results was assessed using univariate and multivariate probabilistic sensitivity analyses. Compared with pharmacotherapy, rTMS is a dominant/cost-effective alternative for patients with treatment-resistant depressive disorder. The model predicted that QALYs gained with rTMS were higher than those gained with antidepressant medications (1.25 vs. 1.18 QALYs) while costs were slightly less (AU $31,003 vs. AU $31,190). In the Australian context, at the willingness-to-pay threshold of AU $50,000 per QALY gain, the probability that rTMS was cost-effective was 73%. Sensitivity analyses confirmed the superiority of rTMS in terms of value for money compared with antidepressant medications. Although both pharmacotherapy and rTMS are clinically effective treatments for major depressive disorder, rTMS is shown to outperform antidepressants in terms of cost-effectiveness for patients who have failed at least two adequate courses of antidepressant medications.

ProsCan for Men: Randomised controlled trial of a decision support intervention for men with localised prostate cancer

Publisher: Springer Science and Business Media LLC

Date: 24-07-2008

DOI: 10.1186/1471-2407-8-207

Transrectal versus transperineal prostate biopsy under intravenous anaesthesia: a clinical, microbiological and cost analysis of 2048 cases over 11 years at a tertiary institution

Publisher: Springer Science and Business Media LLC

Date: 05-08-2021

DOI: 10.1038/S41391-020-0263-X

Evaluating a risk assessment tool to improve triaging of patients to colonoscopies

Publisher: Wiley

Date: 10-2019

DOI: 10.1111/IMJ.14267

Abstract: Colonoscopy is the gold standard in the diagnosis of significant bowel disease (SBD), including colorectal cancer, high-risk adenoma and inflammatory bowel disease. As the demand for colonoscopy services is placing significant pressure on hospital resources, new solutions are needed to manage patients more efficiently and effectively. We investigated the impact of using a risk assessment tool (RAT) to improve selection of patients for colonoscopy procedures to detect SBD. A hybrid simulation model was constructed to replicate the current patient triage bookings and waiting times in a large metropolitan hospital. The model used data on 327 patients who were retrospectively assessed for risk of SBD. Risk assessment incorporated blood and faecal immunochemical test results, gender and age in addition to patient symptoms. The model was calibrated over 12 months to current outcomes and was compared with the RAT and a third scenario where low-risk patients did not proceed to a colonoscopy. One-way sensitivity analyses were undertaken. Using the RAT was expected to shorten waiting times by 153 days for moderately-urgent patients and 138 days for non-urgent patients. If low-risk patients did not proceed to colonoscopy, waiting times were expected to reduce for patients with SBD by 17 days producing cost-savings of AU$373 824 through avoided colonoscopies. A hybrid model that combines patient-level characteristics with hospital-level resource constraints can demonstrate improved efficiency in a hospital clinic. Further research on risk assessment is required to improve quality patient care and reduce low-value service delivery.

Regular sunscreen use is a cost-effective approach to skin cancer prevention in subtropical settings

Publisher: Elsevier BV

Date: 12-2009

DOI: 10.1038/JID.2009.141

Abstract: In many developed countries, total costs to health systems for cutaneous basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs) are among the highest of all cancers, yet the investment value of preventive measures remains unknown. Using primary data from a randomized controlled trial, we estimated the cost-effectiveness of a skin cancer prevention initiative based on regular sunscreen use. Compared with usual practice (discretionary use), the sunscreen intervention cost an additional USD 106,449 (2007) to prevent 11 BCCs, 24 SCCs, and 838 actinic keratoses among 812 residents over 5 years. These health outcomes required an annual average investment of USD 0.74 per person and saved the Australian government a total of USD 88,203 in health-care costs over the same period. Such community-based interventions promoting regular sunscreen use among Caucasians in subtropical settings can prevent skin cancer and related skin tumors in practical ways and with great cost efficiency.

Exploring the economic impact of breast cancers during the 18 months following diagnosis

Publisher: Wiley

Date: 2007

DOI: 10.1002/PON.1182

Abstract: The economic impact on in iduals with breast cancer is not well understood. We sought to identify and describe the direct and indirect economic losses to breast cancer survivors in Australia. A longitudinal, population-based study of 287 women was used to explore economic outcomes (costs and lost income) for women with breast cancer 0-18 months post-diagnosis. Survey methods collected data on out-of-pocket costs, care-giving support, paid and unpaid work reductions, and perceptions from participants on these financial impacts. Bootstrapping was used to estimate 95% confidence intervals around means. Data were sub-grouped by cost type, age category and disease severity. Lost income, health service expenditures and lost unpaid work were the greatest sources of economic burden. Women with positive lymph nodes reported significantly higher costs than those with negative lymph nodes (US$6674 versus US$3533, p<0.001), and younger women (< or =50 years) with positive lymph nodes experienced costs 80% greater than older women (US$8880 versus US$4937, p<0.001). Economic costs related to breast cancer may continue to affect women 18 months post-diagnosis. Economic research adds an important dimension for understanding the impact of breast cancer, and findings may be used to help improve supportive care services for women and families confronted by this disease.

E-Commerce and V-Business

Publisher: Routledge

Date: 15-08-2007

DOI: 10.4324/9780080549781

Testing for vitamin D and other trends in the clinical management of osteoporosis

Publisher: Springer Science and Business Media LLC

Date: 21-11-2013

DOI: 10.1007/S11657-013-0161-0

Abstract: This descriptive paper identifies some salient trends in the Australian management of osteoporosis. Changes in pharmaceutical consumption and medical utilisation are analysed. The total national consumption of four pharmaceuticals is estimated. From 2001 to 2011, the consumption of bisphosphonates and vitamin D increased. After 2006, the management rate for osteoporosis decreased. During the first decade of the millennia, the total cost of vitamin D tests has increased significantly within many health care jurisdictions worldwide. Australia reports a 100-fold increase. Legitimately, concerns regarding the economic effectiveness of this test exist. The purpose of this paper is to identify what other salient clinical trends could affect the efficacy of this test when treating osteoporosis. Longitudinal data from two Australian datasets are analysed. The first are data obtained from Medicare Australia, which report pharmaceutical consumption. The second are data obtained from a national survey of general practitioners. The management of osteoporosis has been characterised by a movement away from single to combination formularies. The consumption of calcium carbonate has declined, and the use of bisphosphonates has increased. While the gross consumption of risedronate increased steadily over the decade (8.4 to 186.5 kg), the consumption of alendronate declined after 2007. The consumption of vitamin D (over-the-counter and prescription) has increased from 0.58 to 2.8 kg over the decade. While prescription vitamin D comprised just 10% of the total, its consumption has undergone a 20-fold increase since 2006. Importantly, we can also report that the management of osteoporosis by Australia's general practitioners increased steadily until 2007-2008, before declining by 36%. Further research is required to determine possible casual relationships that may exist between these data. Until a formal economic evaluation of vitamin D testing in this clinical setting is completed, no conclusions regarding its economic effectiveness should be drawn.

A cost-effectiveness analysis of two community models of care for patients with venous leg ulcers.

Publisher: Mark Allen Group

Date: 09-2006

DOI: 10.12968/JOWC.2006.15.8.26942

Abstract: To conduct a cost-effectiveness analysis based on data from a randomised controlled trial comparing traditional community home nursing with a community Leg Club model for chronic venous leg ulcer management in the south-east metropolitan area of Queensland, Australia. Participants were randomised to the Leg Club (n=28) or home visits (n=28). Data were obtained on resources/related costs incurred by the service provider, clients and carers, and the community. From the collective perspective (service provider, clients and carers, and the community), at six months the incremental cost per healed ulcer was $AU515 (₠318) and the incremental cost per reduced pain score was $AU322 (₠199). For the service provider, Leg Club intervention resulted in cost savings and better health effects when compared with home nursing. On both clinical and economic grounds, the Leg Club model appears to be more cost-effective than traditional home nursing for the treatment of chronic venous leg ulcers. However, clients and the local community contribute substantial financial and in-kind support to the operation of both services. This project has been supported by a grant from the Queensland Nursing Council, Australia. The views expressed do not necessarily represent the views of the Council or the members, executive officer or staff of the Council.

Comparison of four alternative national universal anterior cruciate ligament injury prevention programme implementation strategies to reduce secondary future medical costs

Publisher: BMJ

Date: 19-12-2018

DOI: 10.1136/BJSPORTS-2016-096667

Abstract: Anterior cruciate ligament (ACL) injury is a common and devastating sporting injury. With or without ACL reconstruction, the risk of knee osteoarthritis (OA) and permanent disability later in life is markedly increased. While neuromuscular training programmes can prevent 50–80% of ACL injuries, no national implementation strategies exist in Australia. The aim of this study was to compare the ability of four alternative national universal ACL injury prevention programme implementation strategies to reduce future medical costs secondary to ACL injury. A Markov economic decision model was constructed to estimate the value in lifetime future medical costs prevented by implementing a national ACL prevention programme among four hypothetical cohorts: high-risk sport participants (HR) aged 12–25 years HR 18–25 years HR 12–17 years all youths (ALL) 12–17 years. Of the four programmes examined, the HR 12–25 programme provided the greatest value, averting US$693 of direct healthcare costs per person per lifetime or US$221 870 880 in total. Without training, 9.4% of this cohort will rupture their ACL and 16.8% will develop knee OA. Training prevents 3764 lifetime ACL ruptures per 100 000 in iduals, a 40% reduction in ACL injuries. 842 lifetime cases of OA per 100 000 in iduals and 584 TKRs per 100 000 are subsequently averted. Numbers needed to treat ranged from 27 for the HR 12–25 to 190 for the ALL 12–17. The HR 12–25 programme was the most effective implementation strategy. Estimation of the break-even cost of health expenditure savings will enable optimal future programme design, implementation and expenditure.

Cost-utility analysis of negative pressure wound therapy in high-risk cesarean section wounds

Publisher: Elsevier BV

Date: 05-2015

DOI: 10.1016/J.JSS.2015.02.008

Abstract: Obese women undergoing cesarean section are at increased risk of postoperative infection. There is growing interest in negative pressure wound therapy (NPWT) to prevent closed surgical incision complications including surgical site infection however, the evidence on the effectiveness and cost-effectiveness of this technology is limited. The objective of this study was to evaluate the cost-effectiveness of NPWT compared with that of standard dressing in preventing surgical site infection in obese women undergoing elective cesarean section based on current evidence and to estimate the value and optimal design of additional research to study this technology. The analysis was from the perspective of Queensland Health, Australia, using a decision model. Parameters were obtained from the published literature, a pilot clinical trial, and expert opinion. Monte Carlo simulation was performed to calculate the net monetary benefit, characterize decision uncertainty, and estimate the value of additional research. Comparing the expected monetary benefits and costs of alternative trial s le sizes informed the optimal future study design. The incremental net monetary benefit of NPWT was Australian dollars 70, indicating that NPWT is cost-effective compared with that of standard dressing. The probability of NPWT being cost-effective was 65%. The estimated value of additional research to resolve decision uncertainty would be Australian dollars 2.7 million. The optimal s le size of a future trial investigating the relative effectiveness of NPWT would be 200 patients per arm. Based on the current evidence, NPWT is cost-effective however, there is high uncertainty surrounding the decision to adopt this technology. Additional research is worthwhile before implementation.

Efficient Value of Information Calculation Using a Nonparametric Regression Approach: An Applied Perspective

Publisher: Elsevier BV

Date: 06-2016

DOI: 10.1016/J.JVAL.2016.01.011

Abstract: Value-of-information (VOI) analysis provides an analytical framework to assess whether obtaining additional evidence is worthwhile to reduce decision uncertainty. The reporting of VOI measures, particularly the expected value of perfect parameter information (EVPPI) and the expected value of s le information (EVSI), is limited because of the computational burden associated with typical two-level Monte-Carlo-based solution. Recently, a nonparametric regression approach was proposed that allows the estimation of multiparameter EVPPI and EVSI directly from a probabilistic sensitivity analysis s le. To demonstrate the value of the nonparametric regression approach in calculating VOI measures in real-world cases and to compare its performance with the standard approach of the Monte-Carlo simulation. We used the regression approach to calculate EVPPI and EVSI in two models, and compared the results with the estimates obtained via the standard Monte-Carlo simulation. The VOI values from the two approaches were very close computation using the regression method, however, was faster. The nonparametric regression approach provides an efficient and easy-to-implement alternative for EVPPI and EVSI calculation in economic models.

Evaluation of the efficacy of 3D total-body photography with sequential digital dermoscopy in a high-risk melanoma cohort: Protocol for a randomised controlled trial

Publisher: BMJ

Date: 11-2019

DOI: 10.1136/BMJOPEN-2019-032969

Abstract: Melanoma is Australia’s fourth most common cancer. Early detection is fundamental in maximising health outcomes and minimising treatment costs. To date, population-based screening programmes have not been justified in health economic studies. However, a skin surveillance approach targeting high-risk in iduals could improve the cost-benefit ratio. This paper describes a 2-year longitudinal randomised controlled trial (RCT) to compare routine clinical care (control) with an intensive skin surveillance programme (intervention) consisting of novel three-dimensional (3D) total-body photography (TBP), sequential digital dermoscopy and melanoma-risk stratification, in a high-risk melanoma cohort. Primary outcomes will evaluate clinical, economic and consumer impact of the intervention. Clinical outcomes will evaluate differences in the rate of lesion excisions/biopsies per person, benign to malignant ratio for excisions and thickness of melanomas diagnosed. A health economic analysis using government data repositories will capture healthcare utilisation and costs relating to skin surveillance. Consumer questionnaires will examine intervention acceptability, the psychological impact, and attitudes towards melanoma risk and sun protective behaviour. Secondary outcomes include the development of a holistic risk algorithm incorporating clinical, phenotypic and genetic factors to facilitate the identification of those most likely to benefit from this surveillance approach. Furthermore, the feasibility of integrating the intervention with teledermatology to enhance specialist care in remote locations will be evaluated. This will be the first RCT to compare a targeted surveillance programme utilising new 3D TBP technology against current routine clinical care for in iduals at high risk of melanoma. This study has received Human Research Ethics Committee (HREC) approval from both Metro South Health HREC (HREC/17/QPAH/816) and The University of Queensland HREC (2018000074). ANZCTR12618000267257 Pre-results.

It is time to update sun safety campaigns to recognise population diversity: Findings from two citizens' juries in Australia

Publisher: Wiley

Date: 07-08-2023

DOI: 10.1002/HPJA.786

Abstract: While the links between sun exposure and skin cancer are well known, the benefits of sun exposure, particularly as a source of vitamin D, are less well known. This paper reports on a deliberative study exploring public perspectives about sun exposure harms and benefits. Two citizens' juries were conducted in Brisbane and Adelaide to consider questions about sun exposure, vitamin D and health promotion. Members of the general population (jurors) listened to evidence from expert witnesses about the harms and benefits of sun exposure. Most witness sessions extended for 60 min, with 6 sessions over 2 days. At each citizens' jury, jurors were asked to listen to expert testimony, consider the evidence and make policy recommendations. The planning and design of the citizens' juries were informed by well‐established citizens' jury methods. Jurors proposed that Australia needs improved public information about the harms and benefits of sun exposure. They argued for information that supports personal decision‐making that accounts for differences in skin tone and geographical region. Jurors agreed that Australia needs an updated sun safety c aign that reflects new research and addresses ersity. A one‐size‐fits‐all approach to sun protection may no longer be appropriate. While a new c aign should address both harms and benefits, jurors felt the need for skin cancer prevention outweighs the desirability of generating vitamin D through sun exposure. More nuanced public health messages are needed, which balance the need for skin protection and vitamin D, and acknowledge the ersity of Australia's population. Previous research studies are typically siloed into the separate areas of vitamin D or skin cancer research. This study incorporated both topics and pooled the views of participants in two citizens' juries who agreed on the need for improved information about the harms and benefits of sun exposure to reflect a modern Australian population.

Unexpected benefit of COVID-19 hospital restrictions: Reduction in patients isolating with multidrug resistant organisms after restrictions were lifted

Publisher: Elsevier BV

Date: 02-2021

DOI: 10.1016/J.IDH.2021.08.001

The impact of rehabilitation support services on health-related quality of life for women with breast cancer

Publisher: Springer Science and Business Media LLC

Date: 10-2005

DOI: 10.1007/S10549-005-5151-5

Abstract: As the number of women surviving breast cancer increases, with implications for the health system, research into the physical and psychosocial sequelae of the cancer and its treatment is a priority. This research estimated self-reported health-related quality of life (HRQoL) associated with two rehabilitation interventions for breast cancer survivors, compared to a non-intervention group. Women were selected if they received an early home-based physiotherapy intervention (DAART, n = 36) or a group-based exercise and psychosocial intervention (STRETCH, n = 31). Questionnaires on HRQoL, using the Functional Assessment of Cancer Therapy - Breast Cancer plus Arm Morbidity module, were administered at pre-, post-intervention, 6- and 12-months post-diagnosis. Data on a non-intervention group (n = 208) were available 6- and 12-months post-diagnosis. Comparing pre ost-intervention measures, benefits were evident for functional well-being, including reductions in arm morbidity and upper-body disability for participants completing the DAART service at one-to-two months following diagnosis. In contrast, minimal changes were observed between pre ost-intervention measures for the STRETCH group at approximately 4-months post-diagnosis. Overall, mean HRQoL scores (adjusted for age, chemotherapy, hormone therapy, high blood pressure and occupation type) improved gradually across all groups from 6- to 12-months post-diagnosis, and no prominent differences were found. However, this obscured declining HRQoL scores for 20-40% of women at 12 months post-diagnosis, despite receiving supportive care services. Greater awareness and screening for adjustment problems among breast cancer survivors is required throughout the disease trajectory. Early physiotherapy after surgery has the potential for short-term functional, physical and overall HRQoL benefits.

Noninvasive fetal RHD genotyping of RhD negative pregnant women for targeted anti-D therapy in Australia: A cost-effectiveness analysis

Publisher: Wiley

Date: 12-2017

DOI: 10.1002/PD.5176

Abstract: To undertake a cost-effectiveness analysis of noninvasive fetal RHD genotyping to target pregnant women for antenatal anti-D prophylaxis therapy. A decision-analytic model was constructed to compare RHD testing and targeted anti-D prophylaxis, with current universal anti-D prophylaxis among pregnant women with RhD negative blood type. Model estimates were derived from national perinatal statistics, published literature, donor program records, and national cost sources. One-way sensitivity analyses addressed the uncertainty of variables on the main findings. The unit cost for RHD genotyping was estimated at AU$45.48 (US$31.84). The "mean cost per healthy baby" was AU$7495 (US$5247) for universal prophylaxis and AU$7471 (US$5230) for targeted prophylaxis. The findings were sensitive to the unit costs of anti-D 625 IU (AU$59-AU$88) (US$41-US$62), the genetic test (AU$36-AU$55) (US$25-US$39), and packaging/transport costs of the s les for testing (AU$15-AU$40, US$11-US$28 per s le). With RHD genotyping, 13 938 women would avoid antenatal anti-D prophylaxis at a total cost savings to the National Blood Authority of AU$2.1 million (US$1.5 million) per year. To the health system, net cost savings of AU$159 701 (US$111 791) per year (0.05%) were predicted for total health care costs. Given the vulnerable supply of donor plasma and other health concerns, RHD genotyping is an economically sound option for Australia.

Factors associated with treatment uptake, completion, and subsequent symptom improvement in a national digital mental health service

Publisher: Elsevier BV

Date: 03-2022

DOI: 10.1016/J.INVENT.2022.100506

Timing of surgery following SARS‐CoV‐2 infection: an international prospective cohort study

Publisher: Wiley

Date: 09-03-2021

DOI: 10.1111/ANAE.15458

Abstract: Peri‐operative SARS‐CoV‐2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS‐CoV‐2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre‐operative SARS‐CoV‐2 infection were compared with those without previous SARS‐CoV‐2 infection. The primary outcome measure was 30‐day postoperative mortality. Logistic regression models were used to calculate adjusted 30‐day mortality rates stratified by time from diagnosis of SARS‐CoV‐2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre‐operative SARS‐CoV‐2 diagnosis. Adjusted 30‐day mortality in patients without SARS‐CoV‐2 infection was 1.5% (95%CI 1.4–1.5). In patients with a pre‐operative SARS‐CoV‐2 diagnosis, mortality was increased in patients having surgery within 0–2 weeks, 3–4 weeks and 5–6 weeks of the diagnosis (odds ratio (95%CI) 4.1 (3.3–4.8), 3.9 (2.6–5.1) and 3.6 (2.0–5.2), respectively). Surgery performed ≥ 7 weeks after SARS‐CoV‐2 diagnosis was associated with a similar mortality risk to baseline (odds ratio (95%CI) 1.5 (0.9–2.1)). After a ≥ 7 week delay in undertaking surgery following SARS‐CoV‐2 infection, patients with ongoing symptoms had a higher mortality than patients whose symptoms had resolved or who had been asymptomatic (6.0% (95%CI 3.2–8.7) vs. 2.4% (95%CI 1.4–3.4) vs. 1.3% (95%CI 0.6–2.0), respectively). Where possible, surgery should be delayed for at least 7 weeks following SARS‐CoV‐2 infection. Patients with ongoing symptoms ≥ 7 weeks from diagnosis may benefit from further delay.

Reduced employment and financial hardship among middle-aged individuals with colorectal cancer

Publisher: Hindawi Limited

Date: 03-08-2017

DOI: 10.1111/ECC.12744

Abstract: Financial hardship may affect up to 30% of cancer survivors, however, little research has addressed the effect of employment change on financial hardship. This study compared the self-reported financial hardship of middle-aged (45-64 years) colorectal cancer survivors (n = 187) at 6 and 12 months following diagnosis with that of a matched general population group (n = 355). Colorectal cancer survivors were recruited through the Queensland Cancer Registry, Australia data from the Household Income and Labour Dynamics in Australia (HILDA) Survey were used for the general population group. Pearson chi-square tests were used to assess the differences in proportions between the two groups and McNemar tests to assess differences across time among the same group. Generalised linear modelling was performed to produce prevalence ratios. A higher proportion of workers with colorectal cancer reported financial strain (money shortage for living essentials) at 6 months (15%) but eased and was comparable to the comparison group at 12 months (7%). Middle-aged working cancer survivors who ceased or reduced work were more likely to report not being financially comfortable, compared with those who had continued work (adjusted prevalence ratio 1.66, 95%CI: 1.12, 2.44) at 12 months. Health professionals, employers and government services should address the impact of impaired employment on financial hardship among cancer survivors.

Characteristics associated with inter-individual variability in financial distress in patients with breast cancer prior to and for 12 months following surgery

Publisher: Springer Science and Business Media LLC

Date: 03-09-2022

DOI: 10.1007/S00520-021-06524-Y

Abstract: To evaluate for inter-in idual differences in financial distress and identify demographic, clinical, and symptom characteristics associated with higher levels of financial distress. Patients (n = 387) were enrolled prior to breast cancer surgery and followed for 12 months. Financial distress was measured using a 0 (no problem) to 10 (severe problem) numeric rating scale. Hierarchical linear modeling was used to evaluate for inter-in idual differences in trajectories of financial distress and characteristics associated with financial distress at enrollment and over 12 months. Patients' mean age was 55.0 (± 11.7) years and the majority underwent breast conservation surgery (80.6%). Mean financial distress score prior to surgery was 3.3 (± 3.4 range 0 to 10). Unconditional model for financial distress demonstrated no significant changes over time (-0.006/month). Younger age, lower income, receipt of an axillary lymph node dissection and adjuvant chemotherapy, and lower attentional function were associated with higher preoperative levels of financial distress. Risk factors identified in this study can be used to inform clinicians regarding the need to initiate financial discussions and social work referrals for some patients. Additional clinical or system level interventions should be considered for vulnerable groups with these risk factors.

Correction to: Navigate: a study protocol for a randomised controlled trial of an online treatment decision aid for men with low-risk prostate cancer and their partners

Publisher: Springer Science and Business Media LLC

Date: 27-01-2021

DOI: 10.1186/S13063-021-05070-6

Abstract: An amendment to this paper has been published and can be accessed via the original article.

Impact of a Video-Based Intervention to Improve the Prevalence of Skin Self-examination in Men 50 Years or Older

Publisher: American Medical Association (AMA)

Date: 07-2011

DOI: 10.1001/ARCHDERMATOL.2011.48

Abstract: To improve the proportion of men 50 years or older who conduct a thorough whole-body skin self-examination (SSE), because these men are at increased risk of being diagnosed as having thick melanomas and dying of melanoma. Randomized trial of a video-based intervention to increase whole-body SSE compared with brochures-only control. Men from an Australian population register. The study included 930 men 50 years or older. The men were randomly assigned to receive either written materials only (control) or written materials along with a DVD or video and 2 postcard reminders (intervention). Telephone interviews were conducted at baseline and at 7 and 13 months. The proportion of men who conducted a whole-body SSE with the help of 2 mirrors and/or a person to assist with difficult-to-see areas. Compared with baseline (10%), by 13 months both groups had increased their whole-body SSE behaviors similarly (36% intervention and 31% control) (P = .85). At 7 months, the intervention group was significantly more likely to examine at least 1 part of their back (P < .001) and to examine a greater number of body sites (P < .001). At 7 months, the proportion of men conducting any SSE increased by 28% in the intervention group compared with 13% in the control group (P < .001), but at 13 months, the prevalence of any self-examination (83% vs 80%) was again similar. While men 50 years or older are responsive to appropriately targeted intervention materials to increase their SSE behaviors, the addition of a video or DVD to written materials had only a transient advantage for optimal SSE practices. anzctr.org.au Identifier: 12608000384358.

Potential hospital cost-savings attributed to improvements in outcomes for colorectal cancer surgery following self-audit

Publisher: Springer Science and Business Media LLC

Date: 27-01-2010

DOI: 10.1186/1471-2482-10-4

A cost-effectiveness analysis of two rehabilitation support services for women with breast cancer

Publisher: Springer Science and Business Media LLC

Date: 11-2005

DOI: 10.1007/S10549-005-5828-9

Abstract: The purpose of this research was to estimate the cost-effectiveness of two rehabilitation interventions for breast cancer survivors, each compared to a population-based, non-intervention group (n = 208). The two services included an early home-based physiotherapy intervention (DAART, n = 36) and a group-based exercise and psychosocial intervention (STRETCH, n = 31). A societal perspective was taken and costs were included as those incurred by the health care system, the survivors and community. Health outcomes included: (a) 'rehabilitated cases' based on changes in health-related quality of life between 6 and 12 months post-diagnosis, using the Functional Assessment of Cancer Therapy-Breast Cancer plus Arm Morbidity (FACT-B+4) questionnaire, and (b) quality-adjusted life years (QALYs) using utility scores from the Subjective Health Estimation (SHE) scale. Data were collected using self-reported questionnaires, medical records and program budgets. A Monte-Carlo modelling approach was used to test for uncertainty in cost and outcome estimates. The proportion of rehabilitated cases was similar across the three groups. From a societal perspective compared with the non-intervention group, the DAART intervention appeared to be the most efficient option with an incremental cost of $1344 per QALY gained, whereas the incremental cost per QALY gained from the STRETCH program was $14,478. Both DAART and STRETCH are low-cost, low-technological health promoting programs representing excellent public health investments.

Cost-effectiveness of skin cancer referral and consultation using teledermoscopy in Australia

Publisher: American Medical Association (AMA)

Date: 24-06-0002

DOI: 10.1001/JAMADERMATOL.2018.0855

Making the sunshine vitamin – How much sun exposure is needed to maintain 25‐hydroxy vitamin D concentration?

Publisher: Wiley

Date: 10-09-2023

DOI: 10.1111/PHP.13854

The skin awareness study: Promoting thorough skin self-examination for skin cancer among men 50 years or older

Publisher: Elsevier BV

Date: 2010

DOI: 10.1016/J.CCT.2009.11.003

Abstract: Incidence and mortality from skin cancers including melanoma are highest among men 50 years or older. Thorough skin self-examination may be beneficial to improve skin cancer outcomes. To develop and conduct a randomized-controlled trial of a video-based intervention to improve skin self-examination behavior among men 50 years or older. Pilot work ascertained appropriate targeting of the 12-minute intervention video towards men 50 years or older. Overall, 968 men were recruited and 929 completed baseline telephone assessment. Baseline analysis assessed randomization balance and demographic, skin cancer risk and attitudinal factors associated with conducting a whole-body skin self-examination or receiving a whole-body clinical skin examination by a doctor during the past 12 months. Randomization resulted in well-balanced intervention and control groups. Overall 13% of men reported conducting a thorough skin self-examination using a mirror or the help of another person to check difficult to see areas, while 39% reported having received a whole-body skin examination by a doctor within the past 12 months. Confidence in finding time for and receiving advice or instructions by a doctor to perform a skin self-examination were among the factors associated with thorough skin self-examination at baseline. Men 50 years or older can successfully be recruited to a video-based intervention trial with the aim to reduce their burden through skin cancer. Randomization by computer generated randomization list resulted in good balance between control and intervention group and baseline analysis determined factors associated with skin cancer early detection behavior.

The ethical implications of opportunistic detection of melanoma in clinical care

Publisher: Oxford University Press (OUP)

Date: 03-03-2023

DOI: 10.1093/BJD/LJAD055

Abstract: We sought to explore several ethical issues relating to opportunistic detection of melanoma, given current controversies in melanoma control. We suggest that these should be considered in conjunction with the quantitative yardsticks that accompany decision-making about disease detection. Researchers should focus on capturing and providing evidence to support decision-making for patients and their doctors.

Uptake of skin self-examination and clinical examination behavior by outdoor workers ashley

Publisher: Informa UK Limited

Date: 05-02-2014

DOI: 10.1080/19338244.2013.771247

Abstract: This study investigated the association between outdoor work and response to a behavioral skin cancer early detection intervention among men 50 years or older. Overall, 495 men currently working in outdoor, mixed, or indoor occupations were randomized to a video-based intervention or control group. At 7 months post intervention, indoor workers reported the lowest proportion of whole-body skin self-examination (wbSSE 20%). However, at 13 months mixed workers engaged more commonly in wbSSE (36%) compared with indoor (31%) and outdoor (32%) workers. In adjusted analysis, the uptake of early detection behaviors during the trial did not differ between men working in different settings. Outdoor workers compared with men in indoor or mixed work settings were similar in their response to an intervention encouraging uptake of secondary skin cancer prevention behaviors during this intervention trial.

What impact would effective solarium regulation have in Australia?

Publisher: AMPCo

Date: 10-2008

DOI: 10.5694/J.1326-5377.2008.TB02082.X

Abstract: 1) Leading international health organisations are concerned about high use of artificial tanning services and the associated risk of skin cancer. Similar concerns exist about the growing Australian solarium industry. 2) Pre-teens appear to be ignoring sun safety messages in their desire to tan and use solaria. 3) A significantly elevated risk of melanoma exists among people exposed to artificial ultraviolet radiation the risk is higher for those younger than 35 years at first solarium use. For all users, the risk of squamous cell carcinoma is more than doubled compared with non-users. 4) We estimated the numbers of new melanoma cases and melanoma-related deaths attributable to solarium use by younger people in the five most populous Australian states and indirectly quantified potential costs to the health system that could be saved by effective regulation of the solarium industry. 5) Annually, 281 new melanoma cases, 43 melanoma-related deaths and 2572 new cases of squamous cell carcinoma were estimated to be attributable to solarium use. 6) The annual cost to the health system--predominantly Medicare Australia--for these avoidable skin cancer cases and deaths is about $3 million. 7) By successfully enforcing solarium regulations that ban use by people younger than 18 years or with fair skin, favourable health and cost benefits could be expected.

Modelling the healthcare costs of skin cancer in South Africa

Publisher: Springer Science and Business Media LLC

Date: 02-04-2016

DOI: 10.1186/S12913-016-1364-Z

Health system costs of skin cancer and cost-effectiveness of skin cancer prevention and screening: A systematic review

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 03-2015

DOI: 10.1097/CEJ.0000000000000056

Estimating the healthcare costs of treating prostate cancer in Australia: A Markov modelling analysis

Publisher: Elsevier BV

Date: 03-2018

DOI: 10.1016/J.UROLONC.2017.10.024

Abstract: To estimate the health system costs of prostate cancer by disease risk category and treatment type over 2016 to 2025 and to identify potential strategies to contain the cost increase. A Markov cohort model was developed using clinical pathways from US prostate cancer guidelines and clinical expertise. Estimates of the probabilities of various treatments and outcomes and their unit costs were sourced from systematic reviews, meta-analyses, epidemiological publications and national cost reports. Estimated costs by stage of disease, by major treatments and by age at diagnosis were reported in 2016 US dollars. One-way and probabilistic sensitivity analyses assessed potential variation in the modeled costs. Australia-wide costs of prostate cancer were estimated at US$270.9 million in 2016 rising to US$384.3 million in 2025, an expected increase of 42%. Of this total increase, newly diagnosed low risk cases will contribute US$32.9 million, intermediate-risk US$56.8 million, high-risk US$53.3 million and advanced US$12.6 million. For men diagnosed at age 65 with low-risk disease, lifetime costs per patient were US$14,497 for surgery, US$19,665 for radiation therapies to the primary lesion, and US$9,234 for active surveillance. For intermediate- or high-risk disease, mean costs per patient were US$34,941 for surgery plus radiation and US$31,790 for androgen deprivation therapy plus radiation while advanced cancer therapies were at US$31,574 per patient. Additional costs for managing iatrogenic disease secondary to these treatments were excluded. Strategies for identifying patients early before cancers have spread are critical to contain the estimated 42% increase in costs over the next decade. Increased uptake of active surveillance would also lead to substantial cost-savings in the management of low-risk prostate cancer.

Healthcare costs of investigations for stillbirth from a population-based study in Australia

Publisher: CSIRO Publishing

Date: 28-10-2021

DOI: 10.1071/AH20291

Abstract: Objective Stillbirth investigations incur healthcare costs, but these investigations are necessary to provide information that will help reduce the risk of a recurrent stillbirth, as well as advice regarding family planning and future pregnancies. The aims of this study were to determine the healthcare costs of investigations for stillbirths, identify drivers and assess cost differences between explained and unexplained stillbirths. Methods Data from 697 stillbirths were extracted from the Stillbirth Causes Study covering the period 2013–18. The dataset comprised all investigations related to stillbirth on the mother, baby and placenta. Unit costs applied were sourced from the Australian Medicare Benefits Schedule, local hospital estimates and published literature. Multivariable regression analyses were used to assess key factors in cost estimates. Results In all, 200 (28.7%) stillbirths were unexplained and 76.8% of these had between five and eight core investigations. Unexplained stillbirths were twice as likely to have eight core investigations as explained stillbirths (16.5% vs 7.7%). The estimated aggregated cost of stillbirth investigations for 697 stillbirths was A$2.13 million (mean A$3060, median A$4246). The main cost drivers were autopsies or cytogenetic screening. Mean costs were similar when stillbirths had known or unknown causes and by reason for stillbirth among cases with definable causes. Conclusion Investigations for stillbirth in Australia cost approximately A$4200 per stillbirth on average and are critical for managing future pregnancies and preventing more stillbirths. These findings improve our understanding of the costs that may be averted if stillbirths can be prevented through primary prevention initiatives. What is known about the topic? Approximately 2000 stillbirths occur each year in Australia, and this trend has not changed for several decades. Stillbirth investigations incur healthcare costs, but these investigations are necessary to provide information to help reduce the risk of a recurrent stillbirth and advice regarding family planning and future pregnancies. Recommendations for the core set of stillbirth investigations have recently been agreed upon by consensus. What does this paper add? The costs of stillbirth investigations are unknown in Australia. The assessment of these costs is challenging because not all investigations involved in stillbirths are recorded within formal administrative systems because a stillborn baby is not formally recognised as a patient. The present population-based analysis of 697 stillbirths in Australia estimated that, on average, A$4200 was spent on investigations for each stillbirth, with key drivers being autopsies and cytogenetic screening. These costs are typical, with most cases having between five and eight of the core eight recommended investigations. What are the implications for practitioners? There are cost implications for stillbirth investigations, and this analysis gives a true account of current practice in Australia. Together with the high downstream economic costs of stillbirths, the cost burden of stillbirth investigations is high but ultimately avoidable when practitioners adhere to the core investigations, build knowledge around preventable risk factors and use this information to reduce the number of stillbirths.

Lifetime cost-effectiveness of skin cancer prevention through promotion of daily sunscreen use

Publisher: Elsevier BV

Date: 03-2012

DOI: 10.1016/J.JVAL.2011.10.009

Abstract: Health-care costs for the treatment of skin cancers are disproportionately high in many white populations, yet they can be reduced through the promotion of sun-protective behaviors. We investigated the lifetime health costs and benefits of sunscreen promotion in the primary prevention of skin cancers, including melanoma. A decision-analytic model with Markov chains was used to integrate data from a central community-based randomized controlled trial conducted in Australia and other epidemiological and published sources. Incremental cost per quality-adjusted life-year was the primary outcome. Extensive one-way and probabilistic sensitivity analyses were performed to test the uncertainty in the base findings with plausible variation to the model parameters. Using a combined household and government perspective, the discounted incremental cost per quality-adjusted life-year gained from the sunscreen intervention was AU$40,890. Over the projected lifetime of the intervention cohort, this would prevent 33 melanomas, 168 cutaneous squamous-cell carcinomas, and 4 melanoma-deaths at a cost of approximately AU$808,000. The likelihood that the sunscreen intervention was cost-effective was 64% at a willingness-to-pay threshold of AU$50,000 per quality-adjusted life-year gained. Subject to the best-available evidence depicted in our model, the active promotion of routine sunscreen use to white populations residing in sunny settings is likely to be a cost-effective investment for governments and consumers over the long term.

Cost-Effectiveness Analysis of a Skin Awareness Intervention for Early Detection of Skin Cancer Targeting Men Older Than 50 Years

Publisher: Elsevier BV

Date: 04-2017

DOI: 10.1016/J.JVAL.2016.12.017

Abstract: To assess the cost-effectiveness of an educational intervention encouraging self-skin examinations for early detection of skin cancers among men older than 50 years. A lifetime Markov model was constructed to combine data from the Skin Awareness Trial and other published sources. The model incorporated a health system perspective and the cost and health outcomes for melanoma, squamous and basal cell carcinomas, and benign skin lesions. Key model outcomes included Australian costs (2015), quality-adjusted life-years (QALYs), life-years, and counts of skin cancers. Univariate and probabilistic sensitivity analyses were undertaken to address parameter uncertainty. The mean cost of the intervention was A$5,298 compared with A$4,684 for usual care, whereas mean QALYs were 7.58 for the intervention group and 7.77 for the usual care group. The intervention was thus inferior to usual care. When only survival gain is considered, the model predicted the intervention would cost A$1,059 per life-year saved. The likelihood that the intervention was cost-effective up to A$50,000 per QALY gained was 43.9%. The model was stable to most data estimates nevertheless, it relies on the specificity of clinical diagnosis of skin cancers and is subject to limited health utility data for people with skin lesions. Although the intervention improved skin checking behaviors and encouraged men to seek medical advice about suspicious lesions, the overall costs and effects from also detecting more squamous and basal cell carcinomas and benign lesions outweighed the positive health gains from detecting more thin melanomas.

Clinical Management of Financial Toxicity–Identifying Opportunities through Experiential Insights of Cancer Survivors, Caregivers, and Social Workers

Publisher: MDPI AG

Date: 14-10-2022

DOI: 10.3390/CURRONCOL29100609

Abstract: Perspectives of cancer survivors, caregivers, and social workers as key stakeholders on the clinical management of financial toxicity (FT) are critical to identify opportunities for better FT management. Semi-structured interviews (cancer survivors, caregivers) and a focus group (social workers) were undertaken using purposive s ling at a quaternary public hospital in Australia. People with any cancer diagnosis attending the hospital were eligible. Data were analysed using inductive-deductive content analysis techniques. Twenty-two stakeholders (n = 10 cancer survivors of mixed-cancer types, n = 5 caregivers, and n = 7 social workers) participated. Key findings included: (i) genuine concern for FT of cancer survivors and caregivers shown through practical support by health care and social workers (ii) need for clarity of role and services (iii) importance of timely information flow and (iv) proactive navigation as a priority. While cancer survivors and caregivers received financial assistance and support from the hospital, the lack of synchronised, shared understanding of roles and services in relation to finance between cancer survivors, caregivers, and health professionals undermined the effectiveness and consistency of these services. A proactive approach to anticipate cancer survivors’ and caregivers’ needs is recommended. Future research may develop and evaluate initiatives to manage cancer survivors and families FT experiences and outcomes.

Healthcare Costs Before and After Diagnosis of Cancer of Unknown Primary Versus Ovarian Cancer in Australia

Publisher: Springer Science and Business Media LLC

Date: 17-10-2023

DOI: 10.1007/S41669-022-00371-1

The ENHANCES study—Enhancing Head and Neck Cancer patients’ Experiences of Survivorship: study protocol for a randomized controlled trial

Publisher: Springer Science and Business Media LLC

Date: 28-05-2014

DOI: 10.1186/1745-6215-15-191

QIMR Berghofer Medical Research Institute

Location: Australia

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University Of New England

Location: Australia

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Queensland University Of Technology

Location: Australia

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Making Solar Better: Advanced For Distributed Energy Storage

Start Date: 2017

End Date: 2019

Funder: Advance Queensland

Discovery Projects - Grant ID: DP150101985

Start Date: 2015

End Date: 01-2018

Amount: $364,700.00

Funder: Australian Research Council