Paul Scuffham

Differences in wage rates for males and females in the health sector: a consideration of unpaid overtime to decompose the gender wage gap

Publisher: Springer Science and Business Media LLC

Date: 25-02-2013

DOI: 10.1186/1478-4491-11-9

Abstract: In Australia a persistent and sizable gender wage gap exists. In recent years this gap has been steadily widening. The negative impact of gender wage differentials is the disincentive to work more hours. This implies a substantial cost on the Australian health sector. This study aimed to identify the magnitude of gender wage differentials within the health sector. The investigation accounts for unpaid overtime. Given the limited availability of information, little empirical evidence exists that accounts for unpaid overtime. Information was collected from a s le of 10,066 Australian full-time employees within the health sector. Initially, ordinary least-squares regression was used to identify the gender wage gap when unpaid overtime was included and then excluded from the model. The s le was also stratified by gender and then by occupation to allow for comparisons. Later the Blinder–Oaxaca decomposition method was employed to identify and quantify the contribution of in idual endowments to wage differentials between males and females. The analyses of data revealed a gender wage gap that varied across occupations. The inclusion of unpaid overtime in the analysis led to a slight reduction in the wage differential. The results showed an adjusted wage gap of 16.7%. Unpaid overtime made a significant but small contribution to wage differentials. Being female remained the major contributing factor to the wage gap. Given that wage differentials provide a disincentive to work more hours, serious attempts to deal with the skilled labour shortage in the health sector need to address the gender wage gap.

Measuring psychosocial outcomes of men living with prostate cancer: feasibility of regular assessment of patient-reported outcomes

Publisher: Hindawi Limited

Date: 26-12-2021

DOI: 10.1111/ECC.13393

A cost-effectiveness analysis of front-line treatment strategies in early stage follicular lymphoma

Publisher: Cold Spring Harbor Laboratory

Date: 26-03-2021

DOI: 10.1101/2021.03.24.21254220

Abstract: Recent data suggests the use of radiotherapy alone (RT) in Early-Stage Follicular Lymphoma is declining. Cost-effectiveness analysis of treatments has not been performed. We constructed a partitioning model (15-year horizon) to compare RT, combined-modality therapy (CMT) and immunochemotherapy with rituximab maintenance (ICT+RM) from a PET-staged cohort from the Australian Lymphoma Alliance. Lifetime direct health care costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs) were calculated. AUD $75,000 was defined as the willingness-to-pay threshold (WTP). The direct healthcare costs were: RT $12,791, CMT $29,391 and ICT+RM $42,644. Compared with RT, CMT demonstrated minimal improvement in QALYs (+0.01) and an ICER well above the WTP threshold ($1,535,488). Compared with RT, ICT+RM demonstrated an improvement in QALYs (+0.41) with an ICER of $73,319. Modelling a 25% cost reduction with a rituximab biosimilar led to further ICER reductions with ICT+RM ($52,476). ICT+RM is cost-effective in early stage FL from the Australian taxpayer perspective.

The cost-effectiveness of universal influenza vaccination for 50-64 year-olds in Australia

Publisher: Elsevier BV

Date: 11-2007

DOI: 10.1016/S1098-3015(10)65534-9

Indigenous brigades change the spatial patterns of wildfires, and the influence of climate on fire regimes

Publisher: Wiley

Date: 03-2022

DOI: 10.1111/1365-2664.14139

Abstract: Indigenous people have been managing fire‐prone landscapes for millennia, especially in tropical savannas, thereby maintaining carbon stocks and pyro ersity and ensuring food security. In some indigenous lands in Brazil, fire brigades are composed of indigenous people, integrating their traditional knowledge in Brazilian fire management policies however, the effectiveness of their management is largely undocumented. Nevertheless, we need to know the effectiveness of indigenous fire brigades and their influence on fire patterns. Here, we evaluate an 18‐year historical series of fire patterns and burn scars, comparing periods with and without indigenous brigade activity, to describe the role of indigenous fire brigades in the Kadiwéu Indigenous Territory. In this Indigenous Territory, fire brigades composed of indigenous people have been instituted, trained and maintained by the National Center of Prevention and Combat of Wildfire (PREVFOGO/IBAMA) since 2009. These brigades are responsible for fire management throughout the Kadiwéu Indigenous Territory using controlled burning, prescribed burning and combating wildfires. We found that fire management by the indigenous brigades has reduced fire frequency by 80% in the areas with high fire frequency (over 70% of the analysed time). Management also reduced the size of the area burned by 53% and the influence of climate over the total area burned. According to our models, the area affected by fires is mainly influenced by annual rainfall in the absence of indigenous brigades in contrast, climatic factors could not explain the variation in the burned area in the period without indigenous brigades. Synthesis and applications . The fire management realized by the indigenous brigades can modify the fire regime. These changes in the fire regime can include: changes in spatial patterns, the magnitude of fires and reduction in the influence of climate on fire regimes. Hence, the management carried out by the indigenous brigades can be considered an important tool for fire management. In addition to demonstrating the importance of programs that integrate traditional indigenous knowledge with fire management policies, such as the Integrated Fire Management (IFM), to construct effective management strategies.

Framing, moral foundations and health taxes: interpretive analysis of Ethiopia's tobacco excise tax policy passage

Publisher: BMJ

Date: 10-2023

DOI: 10.1136/BMJGH-2023-012058

A break-even analysis of delivering a memory clinic by videoconferencing

Publisher: SAGE Publications

Date: 10-2013

DOI: 10.1177/1357633X13506532

Abstract: We analysed the costs of two kinds of dementia clinic. In the conventional clinic, held in a rural area, the specialist travels to the clinic from the city. In the videoconferencing clinic, patients are also seen in a rural area, but the specialist conducts the assessment by video from the city. The fixed costs common to both modalities, such as clinic infrastructure, were ignored. The total fixed cost of a monthly conventional clinic was $522 and the total fixed cost of a monthly videoconferencing clinic was $881. The additional variable cost of the specialist travelling to the conventional clinic was $2.62 per minute of the specialist's travelling time. The break-even point at which the cost of the two modalities is the same was just over two hours (138 min round trip). A sensitivity analysis showed that the break-even point was not particularly sensitive to changes in staff wages, but slightly more sensitive to the non labour costs of videoconferencing. Air travel is not an efficient alternative to travel by car. Reducing the number of clinics to six per year results in a much higher cost of running the videoconferencing service compared to the conventional service. Videoconferencing for the purpose of diagnosing dementia is both a reliable and cost effective method of health service provision when a specialist is required to drive for more than about two hours (round trip) to provide a memory disorder clinic service.

Using Rasch and factor analysis to develop a Proxy-Reported health state classification (descriptive) system for Cerebral Palsy

Publisher: Informa UK Limited

Date: 06-01-2020

DOI: 10.1080/09638288.2019.1709565

Abstract: The Cerebral Palsy quality of life instrument is a well-known health-related quality of life measure for children with Cerebral Palsy. Due to its length it is not suitable as the basis of a preference-based instrument. The aim of this study is to develop a short version of the Cerebral Palsy quality of life instrument that can subsequently be scored as a multi-attribute utility instrument through assigning preference-based values. A s le of 473 participants who have a child with Cerebral Palsy completed the Cerebral Palsy quality of life instrument(proxy-version) instrument. After deleting questions related only to the proxy, the dimensional structure was obtained using exploratory factor analysis. Extended Rasch analysis was then undertaken to test the psychometric performance of items and select the best item to represent each dimension. Expert opinion was sought to confirm the dimensions and items. A six-dimension classification system was identified, in which four domains were extracted from the factor analysis. Following expert opinion, two other domains were also added, as these were considered to have significant impact on health-related quality of life in children with Cerebral Palsy. The combination of Factor and Rasch analysis along with consultation with patients, clinicians and experts in health-related quality-of-life instrument development, has resulted in a short version of the Cerebral Palsy quality of life instrument.IMPLICATION FOR REHABILITATIONThis study provides the first classification system for children with Cerebral Palsy.The Cerebral Palsy-six dimension (CP-6D) survey, which is a short version of Cerebral Palsy Quality Of Life instrument, can be timesaving when measuring quality of life in children with Cerebral Palsy.The short version (CP-6D) can be used in preference based measurement and generate quality adjusted life years for children with Cerebral Palsy.

The Australian Managed Entry Scheme: Are We Getting it Right?

Publisher: Springer Science and Business Media LLC

Date: 24-02-2018

DOI: 10.1007/S40273-018-0633-6

Abstract: In 2010, the Australian Government introduced the managed entry scheme (MES) to improve patient access to subsidised drugs on the Pharmaceutical Benefits Scheme and enhance the quality of evidence provided to decision makers. The aim of this paper was to critically review the Australian MES experience. We performed a comprehensive review of publicly available Pharmaceutical Benefits Advisory Committee online documents from January 2010 to July 2017. Relevant information on each MES agreement was systematically extracted, including its rationale, the conditions that guided its implementation and its policy outcomes. We identified 11 drugs where an MES was considered. Most of the identified drugs (75%) were antineoplastic agents and the main uncertainty was the overall survival benefit. More than half of the MES proposals were made by sponsors and most of the schemes were considered after previous rejected/deferred submissions for reimbursement. An MES was not established in 8 of 11 drugs (73%) despite the high evidence uncertainty. Nevertheless, six of these eight drugs were listed after the sponsors reduced their prices. Three MESs were established and implemented by Deeds of Agreement. The three cases were concluded and the required data were submitted within the agreed time frames. The need for feasibility and value of an MES should be carefully considered by stakeholders before embarking on such an agreement. It is essential to engage major stakeholders, including patient representatives, in this process. The conditions governing MESs should be clear, transparent and balanced to address the expectations of various stakeholders.

The cost-effectiveness of continuous subcutaneous insulin infusion compared with multiple daily injections for the management of diabetes

Publisher: Wiley

Date: 27-06-2003

DOI: 10.1046/J.1464-5491.2003.00991.X

Abstract: To estimate the cost effectiveness of continuous subcutaneous insulin infusion (CSII) compared with multiple daily injections (MDI) for patients using insulin pumps. We constructed a Markov model to estimate the costs and outcomes for patients with insulin-dependent diabetes (IDDM) treated with CSII using an insulin pump compared with MDI. Key parameters were obtained from the published scientific literature. The primary outcome was quality-adjusted life years (QALYs). Monte Carlo simulations were undertaken for 10 000 hypothetical patients over 8 years of monthly cycles (the expected life of a pump). Over an 8-year period an average patient could expect to gain 0.48 [standard deviation (sd) 0.20] QALYs using CSII compared with MDI. The additional cost over 8 years for this gain was pounds 5462 (sd pounds 897). The incremental cost per QALY was pounds 11,461 (sd pounds 3656). CSII was most cost-effective in patients who had more than two severe hypoglycaemic events per year and who required admission to hospital at least once every year. Cases where CSII might be not economically viable are cases where diabetes is well controlled with few severe hypoglycaemic events. Results were most sensitive to the number of hypoglycaemic events per patient and the utility weights used to estimate QALYs. CSII is a worthwhile investment when targeted to those who might benefit most.

The health care costs of diabetic nephropathy in the United States and the United Kingdom

Publisher: Elsevier BV

Date: 2004

DOI: 10.1016/S1056-8727(03)00035-7

Queensland Cardiovascular Data Linkage (QCard): A population-based cohort study

Publisher: F1000 Research Ltd

Date: 23-04-2020

DOI: 10.12688/F1000RESEARCH.23261.1

Abstract: Queensland is Australia's hotspot for cardiovascular disease (CVD). Critically, beyond modifiable lifestyle risk factors socio-demographic differences and environmental factors account for significant variations in healthcare use and outcomes among cardiac patients across the country. To better understand the impacts of these factors on the health of cardiac patients, there is a need for a comprehensive and robust longitudinal cohort study that can unpack the underlying dynamics. This paper describes the protocol for the Queensland Cardiovascular Linkage (QCard) Study. The QCard is a longitudinal linkage cohort study of cardiac patients who were first hospitalised with any cardiac condition in 2010, with follow up hospitalisations until December 2015. The primary aim of the QCard is to identify and characterise the nature and impact of socio-demographic inequality among those presenting for the first time with the most common form of CVD in Australia (heart disease) in Queensland from 2010 with minimum 5-years follow-up of subsequent healthcare utilisation and outcomes. A secondary aim is to undertake an exploration of the impact of environmental and specific health service factors on healthcare use and survival time in the same QCard cohort. Administrative public and private hospital inpatient, outpatient and emergency department data for all of Queensland will be linked with in idual primary care data and pharmaceutical data. These data will also be linked to regional socio-demographic data and environmental data, as well as data that describes the features of each hospital in the region. The findings from the study will provide critical information for cardiac patients, clinicians and health policymakers. Such information ranges from identifying most vulnerable cardiac patients who may require targeted needs to providing estimates for cost-effective ways of evaluating healthcare interventions that seek to improve the health of cardiac patients.

Prolotherapy injections and eccentric loading exercises for painful Achilles tendinosis: A randomised trial

Publisher: BMJ

Date: 22-06-2011

DOI: 10.1136/BJSM.2009.057968

Abstract: To compare the effectiveness and cost-effectiveness of eccentric loading exercises (ELE) with prolotherapy injections used singly and in combination for painful Achilles tendinosis. A single-blinded randomised clinical trial. The primary outcome measure was the VISA-A questionnaire with a minimum clinically important change (MCIC) of 20 points. Five Australian primary care centres. 43 patients with painful mid-portion Achilles tendinosis commenced and 40 completed treatment protocols. Participants were randomised to a 12-week program of ELE (n=15), or prolotherapy injections of hypertonic glucose with lignocaine alongside the affected tendon (n=14) or combined treatment (n=14). VISA-A, pain, stiffness and limitation of activity scores treatment costs. At 12 months, proportions achieving the MCIC for VISA-A were 73% for ELE, 79% for prolotherapy and 86% for combined treatment. Mean (95% CI) increases in VISA-A scores at 12 months were 23.7 (15.6 to 31.9) for ELE, 27.5 (12.8 to 42.2) for prolotherapy and 41.1 (29.3 to 52.9) for combined treatment. At 6 weeks and 12 months, these increases were significantly less for ELE than for combined treatment. Compared with ELE, reductions in stiffness and limitation of activity occurred earlier with prolotherapy and reductions in pain, stiffness and limitation of activity occurred earlier with combined treatment. Combined treatment had the lowest incremental cost per additional responder ($A1539) compared with ELE. For Achilles tendinosis, prolotherapy and particularly ELE combined with prolotherapy give more rapid improvements in symptoms than ELE alone but long-term VISA-A scores are similar. ACTRN: 12606000179538.

Impact of information and deliberation on the consistency of preferences for prioritization in health care – evidence from discrete choice experiments undertaken alongside citizens’ juries

Publisher: Informa UK Limited

Date: 28-10-2023

DOI: 10.1080/13696998.2023.2262329

Structural mapping of GABRB3 variants reveals genotype–phenotype correlations

Publisher: Elsevier BV

Date: 03-2022

DOI: 10.1016/J.GIM.2021.11.004

Economic evaluation strategies in telehealth: Obtaining a more holistic valuation of telehealth interventions

Publisher: SAGE Publications

Date: 27-10-2016

DOI: 10.1177/1357633X16671407

Abstract: Telehealth is an emerging area of medical research. Its translation from conception, to research and into practice requires tailored research and economic evaluation methods. Due to their nature telehealth interventions exhibit a number of extra-clinical benefits that are relevant when valuing their costs and outcomes. By incorporating methods to measure societal values such as patient preference and willingness-to-pay, a more holistic value can be placed on the extra-clinical outcomes associated with telehealth and evaluations can represent new interventions more effectively. Cost-benefit analysis is a method by which relevant costs and outcomes in telehealth can be succinctly valued and compared. When health economic methods are conducted using holistic approaches such as cost-benefit analysis they can facilitate the translation of telehealth research into policy and practice.

Genetic Testing for Inherited Heart Diseases: Longitudinal Impact on Health-Related Quality of Life

Publisher: Elsevier BV

Date: 2012

DOI: 10.1016/J.HLC.2012.05.656

The WHICH? trial: rationale and design of a pragmatic randomized, multicentre comparison of home- vs. clinic-based management of chronic heart failure patients

Publisher: Wiley

Date: 08-2011

DOI: 10.1093/EURJHF/HFR048

Abstract: To describe the rationale and design of the Which Heart failure Intervention is most Cost-effective & consumer friendly in reducing Hospital care (WHICH?) trial. WHICH? is a pragmatic, multicentre, randomized controlled trial that seeks to determine if multidisciplinary management of chronic heart failure (CHF) patients post-acute hospitalization delivered in a patient's own home is superior to care delivered via a specialist CHF outpatient clinic. The composite primary endpoint is all-cause, unplanned recurrent hospitalization or death during 12-18 months of follow-up. Of 688 eligible patients, 280 patients (73% male and 66% principal diagnosis of CHF) with a mean age of 71 ± 14 years have been randomized to home- (n = 143) or clinic-based (n = 137) post-discharge management. This will provide 80% power (two-sided alpha of 0.05) to detect a 15% absolute difference in both the primary end-point and rate of all-cause hospital stay. Preliminary data suggest that the two groups are well matched in nearly all baseline socio-economic and clinical parameters. The majority of patients have significant co-morbidity, including hypertension (63%), coronary artery disease (55%), and atrial fibrillation (53%) with an accordingly high Charlson Index of Comorbidity Score (6.1 ± 2.4). Despite its relatively small size, the WHICH? trial is well placed to examine the relative impact of two of the most commonly applied forms of face-to-face management designed to reduce recurrent hospitalization and prolong survival in CHF patients.

Health-related productivity losses increase when the health condition is co-morbid with psychological distress: findings from a large cross-sectional sample of working Australians

Publisher: Springer Science and Business Media LLC

Date: 31-05-2011

DOI: 10.1186/1471-2458-11-417

Optimising Secondary Cardiovascular Prevention in Privately Insured Cardiac Patients: The Young @ Heart Multicentre Randomised Controlled Trial

Publisher: Elsevier BV

Date: 2012

DOI: 10.1016/J.HLC.2012.05.770

The assessment of pharmaceuticals for government subsidy in Australia: recent developments

Publisher: Informa Healthcare

Date: 2007

DOI: 10.3111/200710163169

An Empirical Comparison Of A Markov Cohort Model And A Discrete Event Simulation For Cost-Effectiveness Analysis In Orthopaedics

Publisher: Elsevier BV

Date: 05-2014

DOI: 10.1016/J.JVAL.2014.03.023

Rising unemployment reduces the demand for healthcare services among people with cardiovascular disease: an Australian cohort study

Publisher: Springer Science and Business Media LLC

Date: 19-03-2021

DOI: 10.1007/S10198-021-01281-5

Investigation of current models of care for genetic heart disease in Australia: A national clinical audit

Publisher: Elsevier BV

Date: 05-2021

DOI: 10.1016/J.IJCARD.2021.02.010

Cost analysis of home telerehabilitation for speech treatment in people with Parkinson’s disease

Publisher: SAGE Publications

Date: 26-08-2020

DOI: 10.1177/1357633X20948302

Abstract: Geographical barriers and impaired physical mobility among people with Parkinson’s disease (PD) hinder their timely access to speech pathology services. We compared the costs of delivering a speech treatment via in-person consultation versus telerehabilitation. We used data from a non-inferiority randomised controlled trial delivering the Lee Silverman Voice Treatment (LSVT LOUD®), where patients with dysarthria associated with PD were assigned to either the urban in-person group ( N = 16) or the urban online group ( N = 15), supplemented with a non-randomised group (regional online N = 21). We compared costs over a one-month treatment period from a health-system perspective and a patient perspective. The mean treatment costs of both urban online ($1076) and regional ($1206) treatments tended to be slightly higher than urban in-person ($1020) from a health-system perspective. From a patient perspective, the mean treatment cost was $831 in the urban in-person group, $247 in the urban online group and $200 in the regional group. LSVT LOUD® may be delivered via telerehabilitation at a slightly higher cost than in-person delivery from a health-system perspective, but it is cost saving from a patient perspective. Telerehabilitation is an economically beneficial alternative for the delivery of the LSVT LOUD® programme in PD patients with speech disorders.

Standard vs. intensified management of heart failure to reduce healthcare costs: Results of a multicentre, randomized controlled trial

Publisher: Oxford University Press (OUP)

Date: 20-05-2017

DOI: 10.1093/EURHEARTJ/EHX259

Public use and perceptions of emergency departments: A population survey

Publisher: Wiley

Date: 21-06-2015

DOI: 10.1111/1742-6723.12420

Abstract: To inform demand management strategies aimed at reducing congestion in EDs by: (i) identifying public use of EDs, decision-making and reasons and (ii) measuring acceptance of alternative care models. A cross-sectional telephone survey of a random s le of Queensland population aged 18 years or older residing in a dwelling unit in Queensland that could be contacted on a land-based telephone service was conducted. One person per household was selected according to a predetermined algorithm to ensure sex and regional balance were interviewed. The main outcome measures were: ED use, attitudes towards ED staff and services, and alternative models of care. The final s le included a total of 1256 respondents (response rate = 40.3%). Twenty-one per cent attended EDs in the preceding 12 months. The decision to attend was made by patients (51%), health and medical professionals (31%), and others (18%). The main reasons included perceived severity of the illness (47%), unavailability of alternative services (26%) and better care (11%). Most respondents agreed with more flexible care models of service delivery including incentives for general practitioners (90%), private health insurance coverage for ED use (89%), and enhanced roles for paramedics and nurses. Main reason for attending ED is perceived severity of illness, followed by lack of alternative care. The majority of both consumers and the public are in favour of more flexible care models. However, further research is necessary to detail those alternatives and to test and validate their effectiveness.

Prevalence and profile of “seasonal frequent flyers” with chronic heart disease: Analysis of 1598 patients and 4588 patient-years follow-up

Publisher: Elsevier BV

Date: 03-2019

DOI: 10.1016/J.IJCARD.2018.12.060

Abstract: Peaks and troughs in cardiovascular events correlated with seasonal change is well established from an epidemiological perspective but not a clinical one. Retrospective analysis of the recruitment, baseline characteristics and outcomes during minimum 12-month exposure to all four seasons in 1598 disease-management trial patients hospitalised with chronic heart disease. Seasonality was prospectively defined as ≥4 hospitalisations (all-cause) AND >45% of related bed-days occurring in any one season during median 988 (IQR 653, 1394) days follow-up. Patients (39% female) were aged 70 ± 12 years and had a combination of coronary artery disease (58%), heart failure (54%), atrial fibrillation (50%) and multimorbidity. Overall, 29.9% of patients displayed a pattern of seasonality. Independent correlates of seasonality were female gender (adjusted OR 1.27, 95% CI 1.01-1.61 p = 0.042), mild cognitive impairment (adjusted OR 1.51, 95% CI 1.16-1.97 p = 0.002), greater multimorbidity (OR 1.20, 95% CI 1.15-1.26 per Charlson Comorbidity Index Score p < 0.001), higher systolic (OR 1.01, 95%CI 1.00-1.01 per 1 mmHg p = 0.002) and lower diastolic (OR 0.99, 95% CI 0.98-1.00 per 1 mmHg p = 0.002) blood pressure. These patients were more than two-fold more likely to die (adjusted HR 2.16, 95% CI 1.60-2.90 p < 0.001) with the highest and lowest number of deaths occurring during spring (31.7%) and summer (19.9%), respectively. Despite high quality care and regardless of their diagnosis, we identified a significant proportion of "seasonal frequent flyers" with concurrent poor survival in this real-world cohort of patients with chronic heart disease.

Systematic review of model-based analyses reporting the cost-effectiveness and cost-utility of cardiovascular disease management programs

Publisher: Oxford University Press (OUP)

Date: 16-05-2015

DOI: 10.1177/1474515114536093

Abstract: The reported cost effectiveness of cardiovascular disease management programs (CVD-MPs) is highly variable, potentially leading to different funding decisions. This systematic review evaluates published modeled analyses to compare study methods and quality. Articles were included if an incremental cost-effectiveness ratio (ICER) or cost-utility ratio (ICUR) was reported, it is a multi-component intervention designed to manage or prevent a cardiovascular disease condition, and it addressed all domains specified in the American Heart Association Taxonomy for Disease Management. Nine articles (reporting 10 clinical outcomes) were included. Eight cost-utility and two cost-effectiveness analyses targeted hypertension (n=4), coronary heart disease (n=2), coronary heart disease plus stoke (n=1), heart failure (n=2) and hyperlipidemia (n=1). Study perspectives included the healthcare system (n=5), societal and fund holders (n=1), a third party payer (n=3), or was not explicitly stated (n=1). All analyses were modeled based on interventions of one to two years' duration. Time horizon ranged from two years (n=1), 10 years (n=1) and lifetime (n=8). Model structures included Markov model (n=8), 'decision analytic models' (n=1), or was not explicitly stated (n=1). Considerable variation was observed in clinical and economic assumptions and reporting practices. Of all ICERs/ICURs reported, including those of subgroups (n=16), four were above a US$50,000 acceptability threshold, six were below and six were dominant. The majority of CVD-MPs was reported to have favorable economic outcomes, but 25% were at unacceptably high cost for the outcomes. Use of standardized reporting tools should increase transparency and inform what drives the cost-effectiveness of CVD-MPs.

Rare Cancers, no Rare Solutions: Risk Sharing Arrangemnts to Reimburse Medicines for Rare Cancers in Australia

Publisher: Elsevier BV

Date: 09-2018

DOI: 10.1016/J.JVAL.2018.07.839

Reducing risks and improving health outcomes for prisoners in watch houses: Do emergency department nurses in the custodial setting make a difference?

Publisher: Elsevier BV

Date: 02-2016

DOI: 10.1016/J.PATHOL.2015.12.063

Creating sustainable health care systems

Publisher: Emerald

Date: 18-03-2019

DOI: 10.1108/JHOM-02-2018-0065

Abstract: In order to create sustainable health systems, many countries are introducing ways to prioritise health services underpinned by a process of health technology assessment. While this approach requires technical judgements of clinical effectiveness and cost effectiveness, these are embedded in a wider set of social (societal) value judgements, including fairness, responsiveness to need, non-discrimination and obligations of accountability and transparency. Implementing controversial decisions faces legal, political and public challenge. To help generate acceptance for the need for health prioritisation and the resulting decisions, the purpose of this paper is to develop a novel way of encouraging key stakeholders, especially patients and the public, to become involved in the prioritisation process. Through a multidisciplinary collaboration involving a series of international workshops, ethical and political theory (including accountability for reasonableness) have been applied to develop a practical way forward through the creation of a values framework. The authors have tested this framework in England and in New Zealand using a mixed-methods approach. A social values framework that consists of content and process values has been developed and converted into an online decision-making audit tool. The authors have developed an easy to use method to help stakeholders (including the public) to understand the need for prioritisation of health services and to encourage their involvement. It provides a pragmatic way of harmonising different perspectives aimed at maximising health experience. All health care systems are facing increasing demands within finite resources. Although many countries are introducing ways to prioritise health services, the decisions often face legal, political, commercial and ethical challenge. The research will help health systems to respond to these challenges. This study helps in increasing public involvement in complex health challenges. No other groups have used this combination of approaches to address this issue.

The cost-effectiveness of introducing a varicella vaccine to the New Zealand immunisation schedule

Publisher: Elsevier BV

Date: 09-1999

DOI: 10.1016/S0277-9536(99)00115-X

Abstract: This study examined the cost-effectiveness of adding a varicella vaccine to an existing childhood immunisation schedule relative to a counterfactual where the varicella vaccine is available on a user-pays basis (the current New Zealand situation). The costs and consequences of chickenpox in an annual cohort of 57,200, 15-month old children were simulated for a 30-year period. The cohort simulation design captures the 'phasing-in' effects of routine varicella vaccination on the population. From a health care payer's perspective (medical costs only) every dollar invested in a vaccination programme would return NZ $0.67. However, from a societal point of view (which includes the value of work-loss), a vaccination programme would return NZ $2.79 for every dollar invested. To implement a varicella vaccination programme covering 80% of 15-month old children in New Zealand would add more than NZ $1 million in net direct (health care) costs each year. However, the indirect cost savings from reduced losses of work-time exceed NZ $2 million annually. The net average health care cost per child vaccinated over the 30-year modelling period was $54 whereas the cost-savings from work-loss averted averaged $101 per child vaccinated. Total cost-savings to society of $47 per child vaccinated, on average, could be gained from a vaccination programme. The finding that the addition to vaccination costs resulting from a routine programme (including the cost of complications from the vaccine) were greater than the offsetting health care cost savings from reduced incidence of chickenpox were robust to a sensitivity analysis on all assumptions within plausible ranges. Overall cost-effectiveness estimates were most sensitive to assumptions regarding lost work-time, the discount rate, and the price and efficacy of the vaccine. Estimates were relatively insensitive to changes in assumptions regarding health care utilisation.

Impact of home versus clinic-based management of chronic heart failure: The WHICH? (Which heart failure intervention is most cost-effective & consumer friendly in reducing hospital care) multicenter, randomized trial

Publisher: Elsevier BV

Date: 10-2012

DOI: 10.1016/J.JACC.2012.06.025

Abstract: The goal of this study was to make a head-to-head comparison of 2 common forms of multidisciplinary chronic heart failure (CHF) management. Although direct patient contact appears to be best in delivering CHF management overall, the precise form to optimize health outcomes is less clear. This prospective, multicenter randomized controlled trial with blinded endpoint adjudication comprised 280 hospitalized CHF patients (73% male, age 71 ± 14 years, and 73% with left ventricular ejection fraction ≤45%) randomized to home-based intervention (HBI) or specialized CHF clinic-based intervention (CBI). The primary endpoint was all-cause, unplanned hospitalization or death during 12- to 18-month follow-up. Secondary endpoints included type/duration of hospitalization and healthcare costs. The primary endpoint occurred in 102 of 143 (71%) HBI versus 104 of 137 (76%) CBI patients (adjusted hazard ratio [HR]: 0.97 [95% confidence interval (CI): 0.73 to 1.30], p = 0.861): 96 (67.1%) HBI versus 95 (69.3%) CBI patients had an unplanned hospitalization (p = 0.887), and 31 (21.7%) versus 38 (27.7%) died (p = 0.252). The median duration of each unplanned hospitalization was significantly less in the HBI group (4.0 [interquartile range (IQR): 2.0 to 7.0] days vs. 6.0 [IQR: 3.5 to 13] days p = 0.004). Overall, 75% of all hospitalization was attributable to 64 (22.9%) patients, of whom 43 (67%) were CBI patients (adjusted odds ratio: 2.55 [95% CI: 1.37 to 4.73], p = 0.003). HBI was associated with significantly fewer days of all-cause hospitalization (-35% p = 0.003) and from cardiovascular causes (-37% p = 0.025) but not for CHF (-24% p = 0.218). Consequently, healthcare costs ($AU3.93 vs. $AU5.53 million) were significantly less for the HBI group (median: $AU34 [IQR: 13 to 81] per day vs. $AU52 [17 to 140] per day p = 0.030). HBI was not superior to CBI in reducing all-cause death or hospitalization. However, HBI was associated with significantly lower healthcare costs, attributable to fewer days of hospitalization. (Which Heart failure Intervention is most Cost-effective & consumer friendly in reducing Hospital care [WHICH?] ACTRN12607000069459).

Discrete choice experiments to generate utility values for multi-attribute utility instruments: a systematic review of methods

Publisher: Springer Science and Business Media LLC

Date: 04-05-2020

DOI: 10.1007/S10198-020-01189-6

Abstract: In recent years, discrete choice experiments (DCEs) have become frequently used to generate utility values, but there are a erse range of approaches to do this. The primary focus of this systematic review is to summarise the methods used for the design and analysis of DCEs when estimating utility values in both generic and condition-specific preference-based measures. Published literature using DCEs to estimate utility values from preference-based instruments were identified from MEDLINE, Embase, Cochrane Library and CINAHL using PRISMA guidelines. To assess the different DCE methods, standardised information was extracted from the articles including the DCE design method, the number of choice sets, the number of DCE pairs per person, randomisation of questions, analysis method, logical consistency tests and techniques for anchoring utilities. The CREATE checklist was used to assess the quality of the studies. A total of 38 studies with s les from the general population, students and patients were included. Values for health states described using generic multi attribute instruments (MAUIs) (especially the EQ-5D) were the most commonly explored using DCEs. The studies showed considerable methodology and design ersity (number of alternatives, attributes, s le size, choice task presentation and analysis). Despite these differences, the quality of articles reporting the methods used for the DCE was generally high. DCEs are an important approach to measure utility values for both generic and condition-specific instruments. However, a gold standard method cannot yet be recommended.

One-year cost-effectiveness of supervised center-based exercise training in addition to a post-discharge disease management program for patients recently hospitalized with acute heart failure: The EJECTION-HF study

Publisher: Elsevier BV

Date: 09-2019

DOI: 10.1016/J.HRTLNG.2019.03.003

Abstract: Combining supervised exercise training (ET) and disease management program (DMP) may benefit people with heart failure (HF) but will require additional resources. To assess the 1-year cost-effectiveness of a 24-week ET program added to a post-discharge DMP in patients recently hospitalized with HF. Using randomized controlled trial data, within-trial cost-utility analyses were undertaken in the overall population (n = 278), patients aged <70 (n = 180), and those aged ≥70 (n = 98). Incremental net monetary benefits (INMB) were calculated based on quality-adjusted life-years (QALY) and healthcare costs from the perspective of a state health department (Queensland, Australia). At the AU$50,000/QALY threshold, ET showed 29.6% and 1.7% probability of being cost-effective in the overall population (INMB AU$ -1,472) and patients aged ≥70 (INMB AU$ -11,469), respectively. In patients aged <70, ET was potentially cost-effective with 83.6% probability (INMB AU$4,059). Adding ET to DMP was not cost-effective overall or in patients aged ≥70 but was relatively cost-effective in those aged <70.

Shoulder pain cost-of-illness in patients referred for public orthopaedic care in Australia

Publisher: CSIRO Publishing

Date: 15-10-2019

DOI: 10.1071/AH17242

Abstract: Objective The aim of this study was to calculate the societal economic burden of shoulder pain in patients on the orthopaedic waiting list at an Australian public hospital and calculate the cost (from the government’s perspective) of care delivered by the hospital for those patients. Methods A cost-of-illness analysis was undertaken in a cohort of 277 orthopaedic patients on the Gold Coast in Australia. Outcomes included a health care costs and impacts questionnaire, work absenteeism, presenteeism questionnaires (Work Limitations Questionnaire (WLQ) and Work Productivity and Activity Impairment Questionnaire (WPAI)) and hospital care provision over a 2-year period. Results The mean societal cost of healthcare and domestic support was AU$20.72 per day (AU$7563 annually) per patient on the orthopaedic waiting list. When absenteeism and presenteeism were included, the cost per patient who was employed was AU$38.04 per day (AU$13 885 annually) calculated with the WLQ and AU$61.31 per day (AU$22 378 annually) calculated with the WPAI. The mean per-patient cost to government of public hospital care was AU$2622 in Year 1 and AU$3835.78 (s.d. 4961.28) over 2 years. The surgical conversion rate was 22%, and 51% of hospital care cost was attributable to outpatient services. Conclusions Public orthopaedic shoulder waiting lists create a large economic burden for society few referrals require surgery and just over half the hospital care costs are for out-patient services. New models of care that better manage shoulder pain and identify surgical candidates before orthopaedic referral could reduce this burden. What is known about the topic? Little is known about the cost of shoulder pain in Australia, or the cost of patients referred for public orthopaedic care. What does this paper add? This article quantifies the costs of shoulder pain and the value of lost production from shoulder pain. The time spent waiting for public hospital orthopaedic appointments and the costs associated with waiting demonstrate that the time spent on a waiting list is a key driver of the economic burden. What are the implications for practitioners? Greater resourcing to reduce public orthopaedic shoulder waiting lists may be helpful, but system change is also required. Earlier and more accurate identification of surgical cases could reduce inefficient referrals and improve hospital productivity. Collaboration between clinicians and policy makers is needed to design more economically efficient shoulder care.

Effects of micro- and mesograzers on intertidal macroalgal recruitment

Publisher: Springer Science and Business Media LLC

Date: 03-2014

DOI: 10.1007/S00227-014-2411-0

Research data management in practice: Results from a cross-sectional survey of health and medical researchers from an academic institution in Australia

Publisher: SAGE Publications

Date: 11-03-2020

DOI: 10.1177/1833358319831318

Abstract: Building or acquiring research data management (RDM) capacity is a major challenge for health and medical researchers and academic institutes alike. Considering that RDM practices influence the integrity and longevity of data, targeting RDM services and support in recognition of needs is especially valuable in health and medical research. This project sought to examine the current RDM practices of health and medical researchers from an academic institution in Australia. A cross-sectional survey was used to collect information from a convenience s le of 81 members of a research institute (68 academic staff and 13 postgraduate students). A survey was constructed to assess selected data management tasks associated with the earlier stages of the research data life cycle. Our study indicates that RDM tasks associated with creating, processing and analysis of data vary greatly among researchers and are likely influenced by their level of research experience and RDM practices within their immediate teams. Evaluating the data management practices of health and medical researchers, contextualised by tasks associated with the research data life cycle, is an effective way of shaping RDM services and support in this group. This study recognises that institutional strategies targeted at tasks associated with the creation, processing and analysis of data will strengthen researcher capacity, instil good research practice and, over time, improve health informatics and research data quality.

Alternative New Mono-scaled Quantitative Benefit–Risk Assessment of Human Papillomavirus Vaccine in Japan

Publisher: Springer Science and Business Media LLC

Date: 22-06-2020

DOI: 10.1007/S43441-020-00189-1

An economic analysis of email-based telemedicine: A cost minimisation study of two service models

Publisher: Springer Science and Business Media LLC

Date: 22-05-2008

DOI: 10.1186/1472-6963-8-107

Abstract: Email-based telemedicine has been reported to be an efficient method of delivering online health services to patients at a distance and is often described as a low-cost form of telemedicine. The service may be low-cost if the healthcare organisation utilise their existing email infrastructure to provide their telemedicine service. Many healthcare organisations use commercial-off-the-shelf (COTS) email applications. COTS email applications are designed for peer-to-peer communication hence, in situations where multiple clinicians need to be involved, COTS applications may be deficient in delivering telemedicine. Larger services often rely on different staff disciplines to run their service and telemedicine tools for supervisors, clinicians and administrative staff are not available in COTS applications. Hence, some organisations may choose to develop a purpose-written email application to support telemedicine. We have conducted a cost-minimisation analysis of two different service models for establishing and operating an email service. The first service model used a COTS email application and the second used a purpose-written telemedicine application. The actual costs used in the analysis were from two organisations that originally ran their counselling service with a COTS email application and later implemented a purpose-written application. The purpose-written application automated a number of the tasks associated with running an email-based service. We calculated a threshold at which the higher initial costs for software development were offset by efficiency gains from automation. We also performed a sensitivity analysis to determine the effect of in idual costs on the threshold. The cost of providing an email service at 1000 consultations per annum was $19,930 using a COTS email application and $31,925 using a purpose-written application. At 10,000 consultations per annum the cost of providing the service using COTS email software was $293,341 compared to $272,749 for the purpose-written application. The threshold was calculated at a workload of 5216 consultations per annum. When more than 5216 email consultations per annum are undertaken, the purpose-written application was cheaper than the COTS service model. The sensitivity analysis showed the threshold was most sensitive to changes in administrative staff salaries. In the context of telemedicine, we have compared two different service models for email-based communication – purpose-written and COTS applications. Under the circumstances described in the paper, when workload exceeded 5216 email consultations per annum, there were savings made when a purpose-written email application was used. This analysis provides a useful economic model for organisations contemplating the use of an email-based telemedicine system.

Designing Organisational Management Frameworks to Empower Episodic Volunteering

Publisher: Springer Science and Business Media LLC

Date: 29-04-2020

DOI: 10.1007/S11266-020-00226-5

The cost-effectiveness of compulsory bicycle helmets in New Zealand

Publisher: Wiley

Date: 12-02-2010

DOI: 10.1111/J.1753-6405.1995.TB00409.X

Abstract: This paper examines the cost-effectiveness for primary school children (age 5-12 years), secondary school children (13-18 years) and adults (over 18 years) of the legislation enacted on 1 January 1994 requiring road-cyclists in New Zealand to wear helmets. The cost to cyclists not in possession of a helmet before they became compulsory of either obtaining one or quitting cycling was compared with the number of deaths and hospitalisations expected to be prevented over the average life of a helmet. Corresponding to Victorian and United States estimates of the efficacy of cycle helmets at preventing serious head injuries, the cost per life saved was $88 379 to $113 744 for primary school children, $694 013 to $817 874 for secondary school children, and $890 041 to $1 014 850 for adults (New Zealand dollars = approximately 0.95 Australian dollars). The cost per hospitalisation avoided was $3304 to $4252, $17 207 to $20 278, and $49 143 to $56 035 respectively. These estimates are extremely sensitive to the estimated efficacy of helmets at protecting cyclists. Mainly anecdotal evidence for New Zealand suggests that they are not to be very effective at preventing serious head injuries future research into the change in injury patterns as a result of the helmet regulation would be valuable. Nonetheless, the ranking of the abovementioned estimates does not contradict the policy in some parts of the world requiring helmets for children and/or teenagers, but not adults.

'Born before arrival': user and provider perspectives on health facility childbirths in Kapiri Mposhi district, Zambia.

Publisher: Springer Science and Business Media LLC

Date: 16-09-2014

DOI: 10.1186/1471-2393-14-323

Economic implications of cardiovascular disease management programs: moving beyond one-off experiments

Publisher: Informa UK Limited

Date: 14-05-2015

DOI: 10.1586/14737167.2015.1046842

Abstract: Substantial variation in economic analyses of cardiovascular disease management programs hinders not only the proper assessment of cost-effectiveness but also the identification of heterogeneity of interest such as patient characteristics. The authors discuss the impact of reporting and methodological variation on the cost-effectiveness of cardiovascular disease management programs by introducing issues that could lead to different policy or clinical decisions, followed by the challenges associated with net intervention effects and generalizability. The authors conclude with practical suggestions to mitigate the identified issues. Improved transparency through standardized reporting practice is the first step to advance beyond one-off experiments (limited applicability outside the study itself). Transparent reporting is a prerequisite for rigorous cost-effectiveness analyses that provide unambiguous implications for practice: what type of program works for whom and how.

Telephone consultations for general practice: a systematic review

Publisher: Springer Science and Business Media LLC

Date: 03-07-2017

DOI: 10.1186/S13643-017-0529-0

Cost-effectiveness analyses for injury prevention initiatives in low- and middle-income countries

Publisher: BMJ

Date: 08-2008

DOI: 10.1136/IP.2008.019315

Private Health Insurance Incentives in Australia: In Search of Cost-Effective Adjustments

Publisher: Springer Science and Business Media LLC

Date: 12-07-2018

DOI: 10.1007/S40258-017-0338-6

Abstract: The appropriate structure, scope and cost of government incentives in the private health insurance (PHI) market is a matter of ongoing debate. In order to inform policy decisions we designed a two-stage study to (1) model the uptake of PHI covering hospital treatment in Australia, and (2) identify the costs of various policy scenarios to the government. Using a microsimulation with a cost-benefit component, we modelled the insurance decisions made by in iduals who collectively represented the Australian insurance population in the financial year 2014-15. We found that the mean willingness to pay (WTP) for PHI ranged from A$446 to A$1237 per year depending on age and income. Our policy scenarios showed a considerable range of impacts on the government budget (from A$4 billion savings to A$6 billion expense) and PHI uptake (from 3.4 million fewer to 2.5 million more in iduals insured), with cost-effectiveness ranging from -A$305 to A$22,624 per additional person insured, relative to the status quo. Based on the scenario results we recommend policy adjustments that either increase the PHI uptake at a small per-person cost to the public budget or substantially reduce government subsidisation of PHI at a relatively small loss in terms of persons insured.

An econometric analysis of motor vehicle traffic crashes and macroeconomic factors.

Publisher: Elsevier BV

Date: 2002

DOI: 10.1016/S0965-8564(01)00034-9

COST-EFFECTIVENESS OF A SECONDARY PREVENTION PROGRAM IN PATIENTS WITH MYOCARDIAL INFARCTION: RESULTS FROM A RANDOMISED CONTROLLED TRIAL (PROACTIVE HEART)

Publisher: Elsevier BV

Date: 11-2012

DOI: 10.1016/J.JVAL.2012.08.1819

Evaluating Pharmaceuticals for Health Policy and Reimbursement

Publisher: Springer Science and Business Media LLC

Date: 2005

DOI: 10.2165/00148365-200504030-00009

Effects of telemonitoring on glycaemic control and healthcare costs in type 2 diabetes: A randomised controlled trial

Publisher: SAGE Publications

Date: 16-08-2017

DOI: 10.1177/1357633X17723943

Abstract: This study examined the effect of a telehealth intervention on the control of type 2 diabetes and subsequent potential cost-savings to the health system. This prospective randomised controlled trial randomised adults with type 2 diabetes to the intervention (diabetes program) or control (usual care) arm. Key eligibility criteria included an HbA1c level of at least 58 mmol/mol (7.5%) without severe or unstable comorbidities. All participants continued their usual healthcare, but participants in the intervention arm received additional diabetes care from a diabetes care coordinator via a home monitor that captured clinical measures. Data collected included biomedical, quality of life measures and healthcare (GP, outpatient and inpatient) costs. The primary outcome was HbA1c collected at baseline and 6 months. Analysis was conducted on a complete case intention-to-treat basis. The healthcare system perspective was taken to calculate the incremental cost per percentage-point reduction in HbA1c. Results from 63 participants from each study arm were analysed. HbA1c in the intervention group decreased from a median 68 mmol/mol (8.4%) to 58 mmol/mol (7.5%), and remained unchanged in the control group at median 65 mmol/mol (8.1%) at the 6-month endpoint. The intervention effect on HbA1c change was statistically significant ( p = .004). Total healthcare costs in the intervention group, including the intervention costs, were lower (mean $3781 vs. $4662 p .001) compared with usual care. There was a clinically meaningful and statistically significant benefit from the telehealth intervention at a lower cost thus, telehealth was cost-saving and produced greater health benefits compared with usual care.

Economic modelling of telehealth substitution of face-to-face specialist outpatient consultations for Queensland correctional facilities

Publisher: CSIRO Publishing

Date: 2018

DOI: 10.1071/AH17135

Abstract: Objective The provision of healthcare services to inmates in correctional facilities is costly and resource-intensive. This study aimed to estimate the costs of transporting prisoners from 11 Queensland correctional facilities to the Princess Alexandra Hospital Secure Unit (PAHSU) in Brisbane for non-urgent specialist outpatient consultations and identify the cost consequences that would result from the substitution of face-to-face visits with telehealth consultations. Methods A 12-month retrospective review of patient activity at the PAHSU was conducted to obtain the number of transfers per correctional facility. The total cost of transfers was calculated with estimates for transport vehicle costs and correctional staff escort wages, per diem and accommodation costs. A cost model was developed to estimate the potential cost savings from substituting face-to-face consultations with telehealth consultations. A sensitivity analysis on the cost variables was conducted. Costs are reported from a government funding perspective and presented in 2016 Australian dollars (A$). Results There were 3539 inmate appointments from July 2015 to June 2016 at the PAHSU, primarily for imaging, general practice, and orthopaedics. Telehealth may result in cost savings from negligible to A$969 731, depending on the proportion, and travel distance, of face-to-face consultations substituted by telehealth. Wages of correctional staff were found to be the most sensitive variable. Conclusions Under the modelled conditions, telehealth may reduce the cost of providing specialist outpatient consultations to prisoners in Queensland correctional facilities. Telehealth may improve the timeliness of services to a traditionally underserved population. What is known about the topic? Specialist medical services are located in only a few metropolitan centres across Australia, which requires some populations to travel long distances to attend appointments. Some face-to-face specialist outpatient consultations can be substituted by telehealth. What does this paper add? Prisoners from correctional facilities represent one specific population that requires complex travel arrangements for specialist medical appointments. Transportation of prisoners for specialist health appointments represents a substantial cost to the government. This paper quantifies the annual cost in Queensland for transporting prisoners, taking into account fuel and vehicle costs, staff wages, per diem rates, and accommodation. In addition, it quantifies the costs of substituting face-to-face consultations with telehealth consultations. What are the implications for practitioners? This research encourages practitioners to consider using telehealth services for prisoners, as well providing an argument for tertiary centres to include telehealth as a model of care for this population. Telehealth can result in major cost savings and state and federal governments should consider implementation especially in Australia where correctional facilities and specialist services are separated by great geographic distances.

The cost-effectiveness of varicella vaccine programs for Australia

Publisher: Elsevier BV

Date: 14-10-1999

DOI: 10.1016/S0264-410X(99)00261-3

Abstract: to examine the cost-effectiveness of three different varicella vaccination programs compared with no vaccination program. cost-effectiveness study. Simulations of the costs and consequences of chickenpox and the vaccination programs over a 30-year period. Direct (health-care) costs only were used in the simulations. Australia.Participants/subjects: annual birth cohorts of infants (12-months old) and adolescents (12 years old). strategy I (no vaccination) was compared with three different varicella vaccination programs: strategy II - all infants strategy III - adolescents without a history of varicella and strategy IV ('catch-up')- all infants plus, for the first 11 years, adolescents without a history. fatalities and hospitalisations for varicella and its complications (encephalitis, pneumonitis, long-term disability). the average cost per case of chickenpox averted was $64, $530 and $418 in the infant, adolescent and catch-up programs, respectively. The infant program was the most cost-effective of the three. This program could avert 4. 4 million cases, 13,500 hospitalisations and 30 fatalities for chickenpox over a 30-year period. RESULTS were sensitive to the price of the vaccine and the discount rate, but relatively insensitive to changes in vaccine efficacy, coverage rates or vaccine complication rates. Improved accuracy of a negative varicella history in adolescents would substantially reduce the costs of the adolescent and catch-up programs making these programs feasible. the infant vaccine program is the preferred program, but the direct costs of any of the vaccination programs considered here are greater than the direct costs of no vaccination program.

Development of an EORTC-8D utility algorithm for Sri Lanka

Publisher: SAGE Publications

Date: 17-11-2015

DOI: 10.1177/0272989X14559274

Abstract: Background. Currently there are no reported cancer-specific health state valuations in low- and middle-income countries using a validated preference-based measure. The EORTC-8D, a cancer-specific preference-based measure, has 81,920 health states and is useful for economic evaluations in cancer care. The aim of this study was to develop a utility algorithm to value EORTC-8D health states using preferences derived from a representative population s le in Sri Lanka. Methods. The time-tradeoff method was used to elicit preferences from a general population s le of 780 in Sri Lanka. A block design of 85 health states, with a time horizon of 10 years, was used for the direct valuation. Data were analyzed using generalized least squares with random effects. All respondents with at least one logical inconsistency were excluded from the analysis. Results. After logical inconsistencies were excluded, 4520 observations were available from 717 respondents for the analysis. The preferred model specified main effects with an interaction term for any level 4 or worse descriptor within a health state. Worsening of physical functioning had a substantially greater utility decrement than any other dimension in this population. Limitations are that the data collection could not include the whole country and that females formed a large part of the s le. Conclusions. Preference weights for EORTC-8D health states for Sri Lanka have been derived: These will be very useful in economic evaluations of cancer-related interventions in a range of low- and middle-income countries.

Socioeconomic disparities in prepregnancy BMI and impact on maternal and neonatal outcomes and postpartum weight retention: The EFHL longitudinal birth cohort study

Publisher: Springer Science and Business Media LLC

Date: 08-09-2014

DOI: 10.1186/1471-2393-14-314

The cost-effectiveness of a web-based multimodal therapy for unilateral cerebral palsy: the Mitii randomized controlled trial

Publisher: Wiley

Date: 03-2017

DOI: 10.1111/DMCN.13414

Abstract: To estimate the cost-effectiveness of the Mitii training system for improvements in upper limb function for children with unilateral cerebral palsy (CP). Mitii is a web-based programme delivered at home with set-up and monitoring by therapists. A randomized controlled trial was conducted comparing the Mitii training programme to usual care. The Assessment of Motor and Process Skills (AMPS) and Canadian Occupational Performance Measure (COPM) were collected for each child at baseline and 20 weeks. Responders to training were characterized as those who met a minimally important difference on either the AMPS (0.3 logits) or COPM (2 points). Costs of the intervention were calculated by quantifying the equipment and staff cost. A cost per responder was calculated for each of the outcome measures. A total of 102 participants (52 males, 50 females) were included in the analysis. There were significantly more responders in the training group on both the AMPS motor and process scales and the COPM performance and satisfaction scales. The cost per responder for the Mitii programme ranged from AU$3078 to AU$4191 depending on the scale used. The cost of delivering the Mitii training system is modest relative to the improvements in function.

Predictors of government subsidized pharmaceutical use in patients with diabetes or cardiovascular disease in a primary care setting: Evidence from a prospective randomized trial

Publisher: Informa Healthcare

Date: 2011

DOI: 10.3111/13696998.2011.614304

Abstract: This study uses data from a prospective randomized controlled trial to estimate predictors of pharmaceutical expenditure in diabetes (DM) or cardiovascular disease (CVD) patients. Identifying drivers of pharmaceutical use and the extent to which they are modifiable may inform cost-effective policy-making. The trial followed 260 patients aged >18 years (mean 68) from three general practices for 12 months. Patients had type 2 diabetes (90 patients) or cardiovascular disease (170 patients). Costs for pharmaceuticals prescribed on the Pharmaceutical Benefits Scheme (PBS) were obtained retrospectively at 12 months. Sociodemographic data and health-related quality-of-life (QoL) were recorded from questionnaires. Clinical measures (including body mass index (BMI), blood pressure, high and low density lipoprotein (LDL), and HbA1c) were also collected. Mean pharmaceutical costs for DM patients (AU$4119) was greater than CVD patients (AU$2424). The largest contributor to costs in both groups was pharmaceuticals used for management of conditions other than CVD or DM. QoL (EQ5D) and BMI were significant predictors of costs in both groups. A history of cardiac events, HbA1c, age, and unemployment were significant predictors of costs in the DM group. A diagnosis of heart failure, frequency of hospital admissions, and LDL levels were significant predictors of costs in the CVD group. Roughly one third of total variation of costs can be explained by the regressors in both models. Generalizability will be limited as data was derived from a trial and the study was not powered for this post-hoc analysis. Missing data imputation and self-reporting bias may also impact on results. Factors such as QoL BMI, HbA1c levels, and a history of cardiac events are significant predictors of costs. The results suggest there may be a place for interventions that improve quality-of-life and concurrently reduce pharmaceutical costs in patients with CVD or DM.

Utility Values for the CP-6D, a Cerebral Palsy-Specific Multi-Attribute Utility Instrument, Using a Discrete Choice Experiment

Publisher: Springer Science and Business Media LLC

Date: 19-10-2020

DOI: 10.1007/S40271-020-00468-X

Evaluation of the Gold Coast Integrated Care for patients with chronic disease or high risk of hospitalisation through a non-randomised controlled clinical trial: a pilot study protocol

Publisher: BMJ

Date: 06-2017

DOI: 10.1136/BMJOPEN-2017-016776

Setting Medical Research Future Fund priorities: assessing the value of research

Publisher: AMPCo

Date: 02-2017

DOI: 10.5694/MJA16.00672

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

From growers to patients: Multi-stakeholder views on the use of, and access to medicinal cannabis in Australia

Publisher: Public Library of Science (PLoS)

Date: 11-11-2022

DOI: 10.1371/JOURNAL.PONE.0277355

Abstract: Patient interest in the use of cannabis-based medicines (CBMs) has increased in Australia. While recent policy and legislative changes have enabled health practitioners to prescribe CBMs for their patients, many patients still struggle to access CBMs. This paper employed a thematic analysis to submissions made to a 2019 Australian government inquiry into current barriers of patient access to medical cannabis. We identified 121 submissions from patients or family members (n = 63), government bodies (n = 5), non-government organisations (i.e., professional health bodies, charities, consumer organisations or advocacy groups n = 25), medical cannabis and pharmaceutical industry (n = 16), and in idual health professionals, academics, or research centres (n = 12). Data were coded using NVivo 12 software and thematically analysed. The findings were presented narratively using a modified Levesque’s patient-centred access to care framework which includes: i) appropriateness ii) availability and geographic accessibility iii) acceptability and iv) affordability. Submissions from government agencies and professional health bodies consistently supported maintaining the current regulatory frameworks and access pathways, whereas an overwhelming majority of patients, advocacy groups and the medical cannabis industry described the current regulatory and access models as ‘not fit for purpose’. These differing views seem to arise from ergent persepctives on (i) what and how much evidence is needed for policy and practice, and (ii) how patients should be given access to medical cannabis products amidst empirical uncertainty. Notwithstanding these differences, there were commonalities among some stakeholders regarding the various supply, regulatory, legislative, financial, and dispensing challenges that hindered timely access to CBMs. Progress in addressing the fundamental barriers that determine if and how a patient accesses and uses CBMs needs i) a ‘system-level’ reform that gives due consideration to the geographic disparity in access to prescribers and medical cannabis, and ii) reframing societal and health professional’s views of CBMs by decoupling recreational vs medical cannabis.

Standard versus atrial fibrillation-specific management strategy (SAFETY) to reduce recurrent admission and prolong survival: pragmatic, multicentre, randomised controlled trial

Publisher: Elsevier BV

Date: 02-2015

DOI: 10.1016/S0140-6736(14)61992-9

Pharmacoeconomic benefits of dasatinib in the treatment of imatinib-resistant patients with chronic myelogenous leukemia

Publisher: Informa UK Limited

Date: 04-2009

DOI: 10.1586/ERP.09.1

Abstract: Treatment with imatinib has demonstrated high response rates and improved prognosis in chronic myelogenous leukemia. However, while the short-term response to imatinib is high, there are some concerns that the long-term response is substantially lower. Durable response with imatinib is difficult to achieve in patients with resistant disease. The use of higher doses has also been associated with increased toxicity and intolerance. Dasatinib is a new SRC-ABL-kinase inhibitor that has been developed for treating chronic myelogenous leukemia patients, across all phases of disease, who are resistant or intolerant to imatinib. This article details the existing evidence on the clinical efficacy, safety and value for money of dasatinib in the treatment of imatinib-resistant and -intolerant patients with chronic myelogenous leukemia. Dasatinib is associated with higher levels of response compared with high-dose imatinib. In addition, higher levels of response are associated with improved health outcomes in terms of both quality- and quantity-of-life years.

Study protocol for valuing EQ-5D-3L and EORTC-8D health states in a representative population sample in Sri Lanka

Publisher: Springer Science and Business Media LLC

Date: 2013

DOI: 10.1186/1477-7525-11-149

Challenges in the development of e-health strategies for geriatric medicine

Publisher: SAGE Publications

Date: 12-2007

DOI: 10.1258/135763307783247347

Abstract: Comprehensive geriatric assessment (CGA), supported by e-health, was provided to 89 frail veterans aged 70 years or older who were admitted to medical, surgical or orthopaedic units at two private hospitals in rural Queensland. Patients were screened and assessed by trained nurses using the interRAI-Acute Care tools. Data entry, validation, reporting and geriatrician comment were facilitated by an online, secure database and reporting system. The process was evaluated based on its utilization and staff satisfaction. The response to the project was generally very positive, but there were also some problems: (1) lack of staff, staff time and resources to successfully complete the assessments (2) limited referrals from general practitioners (GPs) and difficulty with developing a sustainable communication and referral system between GPs and the hospital (3) significant variations in caseloads between the study sites and (4) the unfamiliarity of sufficient staff at the trial sites with the CGA process. Despite these challenges, the use of e-health-supported strategies in geriatric medicine certainly appears achievable and deserve further study.

The Australian public's preferences for emergency care alternatives and the influence of the presenting context: a discrete choice experiment

Publisher: BMJ

Date: 03-04-2015

DOI: 10.1136/BMJOPEN-2014-006820

Exercise training in recently hospitalized heart failure patients enrolled in a disease management programme: Design of the EJECTION-HF randomized controlled trial

Publisher: Wiley

Date: 12-2011

DOI: 10.1093/EURJHF/HFR139

Abstract: The Exercise Joins Education: Combined Therapy to Improve Outcomes in Newly-discharged Heart Failure (EJECTION-HF) study will evaluate the impact of a supervised exercise training programme (ETP) on clinical outcomes in recently hospitalized heart failure patients attending a disease management programme (DMP). Methods This multisite, pragmatic randomized controlled trial enrols patients discharged from participating hospitals with clinical evidence of heart failure who are willing and able to participate in a DMP and considered clinically safe to exercise. Enrolment includes participants with impaired and preserved left ventricular systolic function. Baseline assessment and programme commencement occur within 6 weeks of hospital discharge. The control group DMP includes in idualized education and follow-up from a multidisciplinary heart failure team a weekly education programme for 12 weeks self-management advice and medical follow-up. Home exercise is recommended for all participants. In addition, intervention participants are offered 36 supervised, structured gym-based 1 h exercise sessions over 24 weeks. Sessions are tailored to exercise capacity and include aerobic, resistance, and balance exercises. Enrolment target is 350 participants. Primary outcome is 12-month mortality and readmissions. Secondary outcomes include blinded evaluation of depressive symptoms, sleep quality, cognition, and functional status (activities of daily living, 6 min walk distance, grip strength) at 3 and 6 months. A cost-utility analysis will be conducted. This study will enrol a representative group of hospitalized heart failure patients and measure a range of patient and health service outcomes to inform the design of post-hospital DMPs for heart failure. Enrolment will be completed in 2013. ACTRN12608000263392.

An evaluation of the error and uncertainty in epibenthos cover estimates from AUV images collected with an efficient, spatially-balanced design

Publisher: Public Library of Science (PLoS)

Date: 18-09-2018

DOI: 10.1371/JOURNAL.PONE.0203827

Cost-Effectiveness Analysis of a Mobile Ear Screening and Surveillance Service versus an Outreach Screening, Surveillance and Surgical Service for Indigenous Children in Australia

Publisher: Public Library of Science (PLoS)

Date: 25-09-2015

DOI: 10.1371/JOURNAL.PONE.0138369

Comment on the use of vignettes and the EQ-5D to value disease-specific health states (Letter to the Editor)

Publisher: Elsevier BV

Date: 05-2012

DOI: 10.1016/J.JVAL.2011.12.011

Can a barcode scanner for blood collection improve patient identification integrity in the emergency department? A prospective before-and-after study

Publisher: Wiley

Date: 16-01-2015

DOI: 10.1111/1742-6723.12334

Abstract: To describe the effect of interventions designed to improve patient identification (PI) during pathology collection in the ED. A prospective before-and-after intervention study was conducted between June 2009 and June 2010 in a regional ED in Queensland, Australia. Interventions aimed to improve PI and specimen labelling, and consisted of: (i) education alone and (ii) education plus an armband scanner that voice-prompted collector behaviour. Main outcomes measured included: frequency of correct key behaviours (KBs) during specimen collection, pathology integrity errors and cost of interventions. Data from 282 ED pathology collections were analysed (before: n = 115, after with education: n = 95, after with education plus armband scanner: n = 72). KBs for PI and labelling improved significantly following education plus armband scanner use. Application of armbands before s le collection increased (36% vs 90%, P < 0.001), as did asking the patient to state their name (25% vs 93%, P < 0.001) and date of birth (22% vs 93%, P < 0.001). These results were similar, albeit less pronounced, when the effect of education only was assessed. No primary patient misidentification was detected in this small study. The annual costs for a hospital to adopt the education programme with and without the armband scanner were $104,045 and $5330 respectively. ED staff had poor behaviours for identifying patients and labelling pathology specimens before intervention. These safety behaviours were considered an assumed skill. Education alone improved critical KBs markedly that was further augmented by the armband scanner. The cost to adopt education alone is relatively low compared to the addition of armband scanner technology.

Approaches to prioritising research for clinical trial networks: a scoping review

Publisher: Springer Science and Business Media LLC

Date: 12-12-2022

DOI: 10.1186/S13063-022-06928-Z

Abstract: Prioritisation of clinical trials ensures that the research conducted meets the needs of stakeholders, makes the best use of resources and avoids duplication. The aim of this review was to identify and critically appraise approaches to research prioritisation applicable to clinical trials, to inform best practice guidelines for clinical trial networks and funders. A scoping review of English-language published literature and research organisation websites (January 2000 to January 2020) was undertaken to identify primary studies, approaches and criteria for research prioritisation. Data were extracted and tabulated, and a narrative synthesis was employed. Seventy-eight primary studies and 18 websites were included. The majority of research prioritisation occurred in oncology and neurology disciplines. The main reasons for prioritisation were to address a knowledge gap (51 of 78 studies [65%]) and to define patient-important topics (28 studies, [35%]). In addition, research organisations prioritised in order to support their institution’s mission, invest strategically, and identify best return on investment. Fifty-seven of 78 (73%) studies used interpretative prioritisation approaches (including Delphi surveys, James Lind Alliance and consensus workshops) six studies used quantitative approaches (8%) such as prospective payback or value of information (VOI) analyses and 14 studies used blended approaches (18%) such as nominal group technique and Child Health Nutritional Research Initiative. Main criteria for prioritisation included relevance, appropriateness, significance, feasibility and cost-effectiveness. Current research prioritisation approaches for groups conducting and funding clinical trials are largely interpretative. There is an opportunity to improve the transparency of prioritisation through the inclusion of quantitative approaches.

Health economics

Publisher: Springer Berlin Heidelberg

Date: 12-10-2012

DOI: 10.1007/978-3-642-20801-0_19

Geriatric ward rounds by video conference: a solution for rural hospitals

Publisher: AMPCo

Date: 12-2009

DOI: 10.5694/J.1326-5377.2009.TB03345.X

Abstract: To evaluate the acceptance and cost of a ward-based geriatric consultation service delivered via a mobile videoconferencing system. Prospective observational study conducted in the geriatric unit of Toowoomba Base Hospital, Queensland, comparing a specialist consultation service delivered by videoconference (VC) with a "traditional" in-person service. The VC system was established in January 2007 and evaluated over an 18-month period. Patient satisfaction with the service was assessed by questionnaire during a 1-week period in September 2008. Hospital acceptance of the service patient satisfaction with the service comparative cost of providing in-person and VC-mediated consultations. Uptake of the service increased progressively throughout the study period. Patient acceptance levels were high. The cost of video consultations for a 12-patient ward round and case conference was less than the cost of in-person consultations if the total road distance travelled by the specialist (Brisbane to Toowoomba and back) was 125 km or longer. Consultations via VC are an acceptable alternative to in-person consultations, and are less expensive than in-person consultations for even modest distances travelled by the clinician.

A cost-minimization analysis of a telepaediatric mental health service for patients in rural and remote Queensland

Publisher: SAGE Publications

Date: 12-2007

DOI: 10.1258/135763307783247239

Abstract: The e-Child and Youth Mental Health Service (eCYMHS) is delivered by videoconferencing to nine rural and regional sites in Queensland. Between July 2004 and December 2006, a total of 317 videoconference clinics were offered, with 606 patient consultations. A cost-minimization analysis was undertaken to compare the actual costs of videoconference consultations with the potential costs of face-to-face consultations with the same specialists in Brisbane (i.e. patient travel) and the potential costs of face-to-face consultations in the regions (i.e. visiting psychiatrist). The actual cost of providing telepaediatrics during the 30–month period was $230,753 ($1 = US$0.86 or €0.63). The potential cost of patient travel was $650,389 and the potential cost of a visiting psychiatrist was $299,913. Videoconferencing was the cheapest method of delivering child psychiatry services when the workload exceeded 131 consultations (compared with patient travel) and 379 consultations for the visiting psychiatrist outreach service. Based on the actual workload observed in the study, the use of videoconferencing resulted in a net saving for the health service of about $420,000 compared with patient travel and $70,000 compared with a visiting outreach service.

Characteristics and outcomes of patient presentations made by police to an Australian emergency department

Publisher: Wiley

Date: 06-05-2019

DOI: 10.1111/1742-6723.13301

Abstract: To describe and compare characteristics and outcomes of patient presentations brought in by police (BIBP) with those not BIBP (NBIBP) to one Australian ED. A retrospective observational study. All patient presentations to a tertiary hospital ED made during the period 8 October 2012 to 7 April 2013 were included. Routinely collected ED information data and medical record review data were used. ED care delivery for people BIBP from the watch house (WH) or other location was compared. Univariate comparison and multivariate logistic regression analyses were performed to identify the different characteristics and ED outcomes between BIBP and NBIBP groups. A total of 35 127 ED presentations occurred within the 6 month period 392 (1.1%) were BIBP. Compared with those NBIBP, those BIBP were diagnosed with 'psychiatric' and 'toxicology-related' illnesses in higher proportions. Overlap in health conditions (primarily for physical health reasons) between those BIBP and NBIBP existed. Presentations BIBP from the WH reflected 'physical health emergencies' whereas presentations BIBP from other locations reflected 'behavioural emergencies'. Compared to those NBIBP, those BIBP had a longer wait to be seen (by about 5 min), longer ED length of stay (LOS) if not admitted (by about 20 min) but shorter ED LOS if admitted (by about 59 min). When adjusted for sex, age group and diagnosis, ED LOS (if admitted) and admission rate were statistically significant. For those BIBP, mental health related orders and alcohol breath tests were common. Patients BIBP were different to those NBIBP. Despite comprising a small proportion of overall ED attendances, they are a group where mental health and drug and alcohol issues are over-represented. Differences in ED care delivery for those BIBP highlights potential opportunities for pre-hospital healthcare interventions.

A non-randomised trial investigating the cost-effectiveness of Midwifery Group Practice compared with standard maternity care arrangements in one Australian hospital

Publisher: Elsevier BV

Date: 12-2012

DOI: 10.1016/J.MIDW.2011.10.012

Abstract: to compare cost-effectiveness of two models of maternity service delivery: Midwifery Group Practice (MGP) at a birth centre and standard care (SC). a prospective non-randomised trial. an Australian metropolitan hospital. women at 36 weeks gestation were approached in the birth centre or hospital antenatal clinics between March and December 2008. Of 170 consecutive women who met birth centre eligibility criteria, 70% (n=119) were recruited to the study. Women (MGP n=52 or standard care n=50) were followed through to 6 weeks postpartum. Publically funded care costs were collected from women's diaries, handheld pregnancy health records, medical records and the hospital accounting system. health-care costs to the hospital and government. generalised linear models with covariates of age, nulliparity, private health insurance (yes/no) and household income category. women receiving MGP care were less likely to experience induction of labour, required fewer antenatal visits, received more postnatal care, and neonates were less likely to be admitted to special care nursery than those receiving standard care. Statistically significant lower costs were found for women and babies receiving MGP care compared with women receiving standard care during pregnancy, labour and birth and postpartum to 6 weeks. MGP resulted in lower costs for the hospital ($AUD4,696 vs. $AUD5,521 p<0.001) and the government ($AUD4,722 vs. $AUD5,641 p<0.001). When baby costs were excluded MGP care remained statistically significantly cheaper than standard care. for women at low-risk of birth complications, Midwifery Group Practice was cost effective, and women experienced fewer obstetric interventions compared with standard maternity care. The evidence suggests Midwifery Group Practice is safe and economically viable.

Impact of a Multidisciplinary, Home-Based Health Care Program Versus Usual Care for Privately Insured Cardiac Patients

Publisher: Elsevier BV

Date: 2012

DOI: 10.1016/J.HLC.2012.05.699

Prolonged impact of home versus clinic-based management of chronic heart failure: Extended follow-up of a pragmatic, multicentre randomized trial cohort

Publisher: Elsevier BV

Date: 07-2014

DOI: 10.1016/J.IJCARD.2014.04.164

Abstract: We compared the longer-term impact of the two most commonly applied forms of post-discharge management designed to minimize recurrent hospitalization and prolong survival in typically older patients with chronic heart failure (CHF). We followed a multi-center randomized controlled trial cohort of Australian patients hospitalized with CHF and initially allocated to home-based or specialized CHF clinic-based intervention for 1368 ± 216 days. Blinded endpoints included event-free survival from all-cause emergency hospitalization or death, all-cause mortality and rate of all-cause hospitalization and stay. 280 patients (73% male, aged 71 ± 14 years and 73% left ventricular systolic dysfunction) were initially randomized to home-based (n=143) or clinic-based (n=137) intervention. During extended follow-up (complete for 274 patients), 1139 all-cause hospitalizations (7477 days of hospital stay) and 121 (43.2%) deaths occurred. There was no difference in the primary endpoint 20 (14.0%) home-based versus 13 (7.4%) clinic-based patients remained event-free (adjusted HR 0.89, 95% CI 0.70 to 1.15 p=0.378). Significantly fewer home-based (51/143, 35.7%) than clinic-based intervention (71/137, 51.8%) patients died (adjusted HR 0.62, 95% CI 0.42 to 0.90: p=0.012). Home-based versus clinic-based intervention patients accumulated 592 and 547 all-cause hospitalizations (p=0.087) associated with 3067 (median 4.0, IQR 2.0 to 6.8) versus 4410 (6.0, IQR 3.0 to 12.0) days of hospital stay (p<0.01 for rate and duration of hospital stay). Relative to clinic-based intervention, home-based intervention was not associated with prolonged event-free survival. Home-based intervention was, however, associated with significantly fewer all-cause deaths and significantly fewer days of hospital stay in the longer-term. Australian New Zealand Clinical Trials Registry number 12607000069459 (www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=81803).

Cost-effective analysis of supervised exercise training in men with prostate cancer previously treated with androgen deprivation therapy and radiation

Publisher: Wiley

Date: 31-10-2019

DOI: 10.1111/AJCO.13262

Multicriteria decision analysis (MCDA) for health technology assessment: The Queensland Health experience

Publisher: CSIRO Publishing

Date: 12-09-2019

DOI: 10.1071/AH18042

Abstract: Objectives In determining whether new health technologies should be funded, health technology assessment (HTA) committees prefer explicit to implicit methods of analysis in enhancing transparency and consistency of decision making. The aim of this study was to develop and pilot a multicriteria decision analysis (MCDA) framework for the Queensland Department of Health HTA program committee, which weighted decision making criteria according to their perceived importance as determined by group consensus. Methods The criteria used in the MCDA framework were identified by reviewing the five unweighted criteria used in the existing process, consultation with committee members and literature review. Criteria were clearly defined and ordinal categories of lowest to highest preferred were assigned against which technology submissions would be rated. Criteria weights were determined through a discrete choice experiment (DCE) survey of committee members using validated software. Mean weighted technology scores were then used to guide deliberative discussions in determining final funding decisions. Results The MCDA framework created one additional criterion to the previous five. The criteria and their mean weights identified through the DCE survey were clinical benefit and safety (27.2%), quality of evidence (19.2%), implementation capacity (16.9%), innovation (15.4%), burden of disease and clinical need (13.3%) and societal and ethical values (8.0%). Criterion weights varied considerably between in idual committee members, with one criterion having a difference of 36.9% between the highest and lowest preference weights. Following deliberative discussions, all but one of 10 submissions were awarded funding. The submission not supported received the third lowest score through the MCDA model. Conclusions This pilot application of an MCDA framework, as a complement to committee deliberation, conferred greater transparency and objectivity on HTA assessment of technologies. The framework converted an implicit, unweighted review process to one that is more explicit, flexible in weighting importance and pragmatic. What is known about the topic? HTA programs involve complex decision-making processes requiring the consideration of multiple criteria. Explicit methods of analysis that use weighted criteria according to their relative importance enhance transparency and consistency of decision making by HTA committees, and are preferred to implicit reviews using unweighted criteria. What does this paper add? This article describes the development and piloting of an MCDA framework that aims to improve transparency, objectivity and consistency of funding decisions of the Queensland HTA committee. Criteria were identified through a review of current processes, committee discussions and a literature review, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) quality of evidence system. Criteria were weighted using a discrete choice experiment involving committee members. Using weighted criteria, mean technology scores were calculated and incorporated into deliberative discussions to determine funding decisions. What are the implications for practitioners? The MCDA framework described here converted a more implicit, unweighted process to one that was more pragmatic, explicit and flexible in scoring HTA submissions. This framework may be useful to other HTA programs and could be expanded to resource allocation decision making in many other healthcare settings.

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

Contactable Non-responders Show Different Characteristics Compared to Lost to Follow-Up Participants: Insights from an Australian Longitudinal Birth Cohort Study

Publisher: Springer Science and Business Media LLC

Date: 14-03-2016

DOI: 10.1007/S10995-016-1946-8

Abstract: Objective This research aims to identify predictors of attrition in a longitudinal birth cohort study in Australia and assess differences in baseline characteristics and responses in subsequent follow-up phases between contactable non-responders and uncontactable non-responders deemed "lost to follow-up (LTF)". Methods 3368 women recruited from three public hospitals in Southeast Queensland and Northern New South Wales during antenatal visits in 2006-2011 completed a baseline questionnaire to elicit information on multiple domains of exposures. A follow-up questionnaire was posted to each participant at 1 year after birth to obtain mother's and child's health and development information. Multivariate logistic regression was used to model the association between exposures and respondents' status at 1 year. The effect of an inverse-probability-weighting method to adjust for non-response was studied. Results Overall attrition at 1-year was 35.4 % major types of attrition were "contactable non-response" (27.6 %) and "LTF" (6.7 %). These two attrition types showed different responses at the 3-year follow-up and involved different predictors. Besides shared predictors (first language not English, higher risk of psychological distress, had smoked during pregnancy, higher levels of family conflict), distinguishable predictors of contactable non-responders were younger age, having moved home in the past year and having children under 16 in the household. Attrition rates increased substantially from 20 % in 2006 to 54 % in 2011. Conclusions This observed trend of increased attrition rates raises concern about the use of traditional techniques, such as "paper-based" questionnaires, in longitudinal cohort studies. The supplementary use of electronic communications, such as online survey tools and smart-device applications, could provide a better alternative.

The Economics of N-of-1 Trials

Publisher: Springer Netherlands

Date: 2015

DOI: 10.1007/978-94-017-7200-6_13

A Multicenter, Randomized Trial of a Nurse-Led, Home-Based Intervention for Optimal Secondary Cardiac Prevention Suggests Some Benefits for Men but Not for Women: The Young at Heart Study

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 07-2013

DOI: 10.1161/CIRCOUTCOMES.111.000006

Abstract: We examined the impact of a prolonged secondary prevention program on recurrent hospitalization in cardiac patients with private health insurance. The Young at Heart multicenter, randomized, controlled trial compared usual postdischarge care (UC) with nurse-led, home-based intervention (HBI). The primary end point was rate of all-cause hospital stay (31.5±7.5 months follow-up). In total, 602 patients (aged 70±10 years, 72% men) were randomized to UC (n=296) or HBI (n=306, 96% received ≥1 home visit). Overall, 42 patients (7.0%) died, and 492 patients (82%) accumulated 2397 all-cause hospitalizations associated with 10 258 hospital days costing $17 million. There were minimal group differences (HBI versus UC) in the primary end point of all-cause hospital stay (5405 versus 4853 days median [interquartile range], 0.08 [0.03–0.17] versus 0.07 [0.03–0.13] atient per month). There were similar trends with respect to all hospitalizations (1197 versus 1200 P =0.802) and associated costs ($8.66 versus $8.58 million P =0.375). At 2 years, however, more HBI versus UC (39% versus 27% odds ratio, 1.67 95% confidence interval, 1.15–2.41 P =0.007) patients were assessed as stable and optimally managed. For women, HBI outcomes were predominantly worse than UC outcomes. In men, HBI was associated with reduced risk of cardiovascular hospitalization (adjusted hazard ratio, 0.68 95% confidence interval, 0.46–0.99 P =0.044) with less cardiovascular hospitalizations (192 versus 269 P =0.054) and costs ($2.49 versus $3.53 million P =0.046). HBI did not reduce recurrent all-cause hospitalization compared with UC in privately insured cardiac patients overall. However, it did convey some benefits in cardiac outcomes for men. Australian New Zealand Clinical Trials Registry Unique Identifier: 12608000014358. URL: www.anzctr.org.au/trial_view.aspx?id=82509 .

A pilot study of videotelephone-based support for newly diagnosed paediatric oncology patients and their families

Publisher: SAGE Publications

Date: 09-2008

DOI: 10.1258/JTT.2008.080505

Abstract: As part of the preparation for a randomized controlled trial, we conducted a pilot study to investigate the feasibility of providing videotelephone-based support to a s le of families ( n = 8) with a child diagnosed with cancer, returning home for the first time after diagnosis and initial treatment. Seven of these families received support via videotelephone over a three-month period. Twenty videotelephone calls were made totalling 400 minutes (median 21 min, IQR 16–24). All videotelephone calls involved the specialist nurse providing support to mothers (85%) or fathers (15%) and involved communicating directly with the patient in most of the calls (55%). Social workers were involved in three calls (15%). All families expressed satisfaction with services delivered in this way. There were few technical problems. The use of a hybrid approach to providing videotelephony, using the family home computer and Internet connection for video and the home telephone line for full-duplex audio, was less costly than the custom-made device used in past studies.

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

Development of an Online Time Trade off Methods for Health State Valuation

Publisher: Elsevier BV

Date: 09-2018

DOI: 10.1016/J.JVAL.2018.07.755

RESEARCH PODIUM ABSTRACTS

Publisher: Elsevier BV

Date: 10-2009

DOI: 10.1111/J.1524-4733.2009.00592_1.X

Cost-effectiveness of a home based intervention for secondary prevention of readmission with chronic heart disease

Publisher: Public Library of Science (PLoS)

Date: 10-12-2015

DOI: 10.1371/JOURNAL.PONE.0144545

The importance of population differences: Influence of individual characteristics on the Australian public's preferences for emergency care

Publisher: Elsevier BV

Date: 02-2018

DOI: 10.1016/J.HEALTHPOL.2017.11.006

Abstract: A better understanding of the public's preferences and what factors influence them is required if they are to be used to drive decision-making in health. This is particularly the case for service areas undergoing continual reform such as emergency and primary care. Accordingly, this study sought to determine if attitudes, socio-demographic characteristics and healthcare experiences influence the public's intentions to access care and their preferences for hypothetical emergency care alternatives. A discrete choice experiment was used to elicit the preferences of Australian adults (n=1529). Mixed logit regression analyses revealed the influence of a range of in idual characteristics on preferences and service uptake choices across three different presenting scenarios. Age was associated with service uptake choices in all contexts, whilst the impact of other sociodemographics, health experience and attitudinal factors varied by context. The improvements in explanatory power observed from including these factors in the models highlight the need to further clarify their influence with larger populations and other presenting contexts, and to identify other determinants of preference heterogeneity. The results suggest social marketing programs undertaken as part of demand management efforts need to be better targeted if decision-makers are seeking to increase community acceptance of emerging service models and alternatives. Other implications for health policy, service planning and research, including for workforce planning and the possible introduction of a system of co-payments are discussed.

Can exercise delay transition to active therapy in men with low-grade prostate cancer? A multicentre randomised controlled trial

Publisher: BMJ

Date: 04-2018

DOI: 10.1136/BMJOPEN-2018-022331

Development and Validation of a Prediction Model for Early Diagnosis of SCN1A-Related Epilepsies

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 15-03-2022

DOI: 10.1212/WNL.0000000000200028

Abstract: Pathogenic variants in the neuronal sodium channel α1 subunit gene ( SCN1A ) are the most frequent monogenic cause of epilepsy. Phenotypes comprise a wide clinical spectrum, including severe childhood epilepsy Dravet syndrome, characterized by drug-resistant seizures, intellectual disability, and high mortality and the milder genetic epilepsy with febrile seizures plus (GEFS+), characterized by normal cognition. Early recognition of a child's risk for developing Dravet syndrome vs GEFS+ is key for implementing disease-modifying therapies when available before cognitive impairment emerges. Our objective was to develop and validate a prediction model using clinical and genetic biomarkers for early diagnosis of SCN1A -related epilepsies. We performed a retrospective multicenter cohort study comprising data from patients with SCN1A -positive Dravet syndrome and patients with GEFS+ consecutively referred for genetic testing (March 2001–June 2020) including age at seizure onset and a newly developed SCN1A genetic score. A training cohort was used to develop multiple prediction models that were validated using 2 independent blinded cohorts. Primary outcome was the discriminative accuracy of the model predicting Dravet syndrome vs other GEFS+ phenotypes. A total of 1,018 participants were included. The frequency of Dravet syndrome was 616/743 (83%) in the training cohort, 147/203 (72%) in validation cohort 1, and 60/72 (83%) in validation cohort 2. A high SCN1A genetic score (133.4 [SD 78.5] vs 52.0 [SD 57.5] p 0.001) and young age at onset (6.0 [SD 3.0] vs 14.8 [SD 11.8] months p 0.001) were each associated with Dravet syndrome vs GEFS+. A combined SCN1A genetic score and seizure onset model separated Dravet syndrome from GEFS+ more effectively (area under the curve [AUC] 0.89 [95% CI 0.86–0.92]) and outperformed all other models (AUC 0.79–0.85 p 0.001). Model performance was replicated in both validation cohorts 1 (AUC 0.94 [95% CI 0.91–0.97]) and 2 (AUC 0.92 [95% CI 0.82–1.00]). The prediction model allows objective estimation at disease onset whether a child will develop Dravet syndrome vs GEFS+, assisting clinicians with prognostic counseling and decisions on early institution of precision therapies (scn1a-prediction-model.broadinstitute.org/). This study provides Class II evidence that a combined SCN1A genetic score and seizure onset model distinguishes Dravet syndrome from other GEFS+ phenotypes.

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.

Spectrum of GABAA receptor variants in epilepsy.

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 04-2019

DOI: 10.1097/WCO.0000000000000657

The Efficiency of Increasing the Capacity of Physiotherapy Screening Clinics or Traditional Medical Services to Address Unmet Demand in Orthopaedic Outpatients: A Practical Application of Discrete Event Simulation with Dynamic Queuing

Publisher: Springer Science and Business Media LLC

Date: 26-04-2016

DOI: 10.1007/S40258-016-0246-1

Abstract: Hospital outpatient orthopaedic services traditionally rely on medical specialists to assess all new patients to determine appropriate care. This has resulted in significant delays in service provision. In response, Orthopaedic Physiotherapy Screening Clinics and Multidisciplinary Services (OPSC) have been introduced to assess and co-ordinate care for semi- and non-urgent patients. To compare the efficiency of delivering increased semi- and non-urgent orthopaedic outpatient services through: (1) additional OPSC services (2) additional traditional orthopaedic medical services with added surgical resources (TOMS + Surg) or (3) additional TOMS without added surgical resources (TOMS - Surg). A cost-utility analysis using discrete event simulation (DES) with dynamic queuing (DQ) was used to predict the cost effectiveness, throughput, queuing times, and resource utilisation, associated with introducing additional OPSC or TOMS ± Surg versus usual care. The introduction of additional OPSC or TOMS (±surgery) would be considered cost effective in Australia. However, OPSC was the most cost-effective option. Increasing the capacity of current OPSC services is an efficient way to improve patient throughput and waiting times without exceeding current surgical resources. An OPSC capacity increase of ~100 patients per month appears cost effective (A$8546 per quality-adjusted life-year) and results in a high level of OPSC utilisation (98 %). Increasing OPSC capacity to manage semi- and non-urgent patients would be cost effective, improve throughput, and reduce waiting times without exceeding current surgical resources. Unlike Markov cohort modelling, microsimulation, or DES without DQ, employing DES-DQ in situations where capacity constraints predominate provides valuable additional information beyond cost effectiveness to guide resource allocation decisions.

Improving emergency department transfer for patients arriving by ambulance: A retrospective observational study

Publisher: Wiley

Date: 23-12-2020

DOI: 10.1111/1742-6723.13407

Using videotelephony to support paediatric oncology-related palliative care in the home: from abandoned RCT to acceptability study

Publisher: SAGE Publications

Date: 27-02-2009

DOI: 10.1177/0269216308100251

Abstract: Videotelephony (real-time audio-visual communication) has been used successfully in adult palliative home care. This paper describes two attempts to complete an RCT (both of which were abandoned following difficulties with family recruitment), designed to investigate the use of videotelephony with families receiving palliative care from a tertiary paediatric oncology service in Brisbane, Australia. To investigate whether providing videotelephone-based support was acceptable to these families, a 12-month non-randomised acceptability trial was completed. Seventeen palliative care families were offered access to a videotelephone support service in addition to the 24 hours ‘on-call’ service already offered. A 92% participation rate in this study provided some reassurance that the use of videotelephones themselves was not a factor in poor RCT participation rates. The next phase of research is to investigate the integration of videotelephone-based support from the time of diagnosis, through outpatient care and support, and for palliative care rather than for palliative care in isolation. Trial registration ACTRN 12606000311550

A simulation of dementia epidemiology and resource use in Australia

Publisher: Elsevier BV

Date: 06-2018

DOI: 10.1111/1753-6405.12700

Abstract: The number of people in the developed world who have dementia is predicted to rise markedly. This study presents a validated predictive model to assist decision-makers to determine this population's future resource requirements and target scarce health and welfare resources appropriately. A novel in idual patient discrete event simulation was developed to estimate the future prevalence of dementia and related health and welfare resource use in Australia. When compared to other published results, the simulation generated valid estimates of dementia prevalence and resource use. The analysis predicted 298,000, 387,000 and 928,000 persons in Australia will have dementia in 2011, 2020 and 2050, respectively. Health and welfare resource use increased markedly over the simulated time-horizon and was affected by capacity constraints. This simulation provides useful estimates of future demands on dementia-related services allowing the exploration of the effects of capacity constraints. Implications for public health: The model demonstrates that under-resourcing of residential aged care may lead to inappropriate and inefficient use of hospital resources. To avoid these capacity constraints it is predicted that the number of aged care beds for persons with dementia will need to increase more than threefold from 2011 to 2050.

MARKOV MODELING AND DISCRETE EVENT SIMULATION IN HEALTH CARE: A SYSTEMATIC COMPARISON

Publisher: Cambridge University Press (CUP)

Date: 04-2014

DOI: 10.1017/S0266462314000117

Abstract: Objectives: The aim of this study was to assess if the use of Markov modeling (MM) or discrete event simulation (DES) for cost-effectiveness analysis (CEA) may alter healthcare resource allocation decisions. Methods: A systematic literature search and review of empirical and non-empirical studies comparing MM and DES techniques used in the CEA of healthcare technologies was conducted. Results: Twenty-two pertinent publications were identified. Two publications compared MM and DES models empirically, one presented a conceptual DES and MM, two described a DES consensus guideline, and seventeen drew comparisons between MM and DES through the authors’ experience. The primary advantages described for DES over MM were the ability to model queuing for limited resources, capture in idual patient histories, accommodate complexity and uncertainty, represent time flexibly, model competing risks, and accommodate multiple events simultaneously. The disadvantages of DES over MM were the potential for model overspecification, increased data requirements, specialized expensive software, and increased model development, validation, and computational time. Conclusions: Where in idual patient history is an important driver of future events an in idual patient simulation technique like DES may be preferred over MM. Where supply shortages, subsequent queuing, and ersion of patients through other pathways in the healthcare system are likely to be drivers of cost-effectiveness, DES modeling methods may provide decision makers with more accurate information on which to base resource allocation decisions. Where these are not major features of the cost-effectiveness question, MM remains an efficient, easily validated, parsimonious, and accurate method of determining the cost-effectiveness of new healthcare interventions.

Randomised controlled trial of a secondary prevention program for myocardial infarction patients ('ProActive Heart'): Study protocol. Secondary prevention program for myocardial infarction patients

Publisher: Springer Science and Business Media LLC

Date: 09-05-2009

DOI: 10.1186/1471-2261-9-16

Simulation of health care and related costs in people with dementia in Australia

Publisher: CSIRO Publishing

Date: 24-09-2019

DOI: 10.1071/AH18022

Abstract: Objectives The aim of this study was to develop a validated model to predict current and future Australian costs for people with dementia to help guide decision makers allocate scarce resources in the presence of capacity constraints. Methods A hybrid discrete event simulation was developed to predict costs borne in Australia for people with dementia from 2015 to 2050. The costs captured included community-based care, permanent and respite residential aged care, hospitalisation, transitional care, pharmaceuticals, aged care assessments, out of hospital medical services and other programs. Results The costs borne for people with dementia in Australia are predicted to increase from A$11.8 billion in 2015 to A$33.6 billion in 2050 at 2013–14 prices, ceteris paribus. If real per capita health and social expenditure increased by 1.0% annually, these costs are predicted to increase by around A$14.2 billion to a total of around A$47.8 billion by 2050. Conclusions This simulation provides useful estimates of the potential future costs that will be borne for people with dementia and allows the exploration of the effects of capacity constraints on these costs. The model demonstrates that the level of real annual per capita growth in health and social expenditure has significant implications for the future sustainability of dementia care in Australia. What is known about the topic? With the aging of the Australian population, the number of people living with dementia is predicted to rise markedly in the next four decades. As the number of people living with dementia increases, so too will the financial burden these debilitating and degenerative diseases place on private and public resources. These increases are likely to challenge the efficiency and sustainability of many health systems in the developed world. What does this paper add? This research provides a validated model to predict current and future Australian costs for people with dementia to help guide decision makers allocate scarce resources in the presence of capacity constraints (i.e. where the supply of resources does not meet demand). The model predicts an increase in costs for people with dementia from A$11.8 billion in 2015 to A$33.6 billion in 2050 at 2013–14 prices. If real per capita health and social expenditure increased by 1.0% annually, these costs are predicted to increase by around A$14.2 billion to a total of around A$47.8 billion by 2050. What are the implications for practitioners? This simulation provides useful estimates of the potential future costs that will be borne for people with dementia and allows the exploration of the effects of capacity constraints on these costs. The model demonstrates that the level of real annual per capita growth in health and social expenditure has significant implications for the future sustainability of dementia care in Australia.

Acute coronary syndromes in Europe: 1-year costs and outcomes

Publisher: Informa Healthcare

Date: 06-02-2007

DOI: 10.1185/030079906X167462

An empirical comparison of Markov cohort modeling and discrete event simulation in a capacity-constrained health care setting

Publisher: Springer Science and Business Media LLC

Date: 29-12-2017

DOI: 10.1007/S10198-015-0756-Z

Abstract: To empirically compare Markov cohort modeling (MM) and discrete event simulation (DES) with and without dynamic queuing (DQ) for cost-effectiveness (CE) analysis of a novel method of health services delivery where capacity constraints predominate. A common data-set comparing usual orthopedic care (UC) to an orthopedic physiotherapy screening clinic and multidisciplinary treatment service (OPSC) was used to develop a MM and a DES without (DES-no-DQ) and with DQ (DES-DQ). Model results were then compared in detail. The MM predicted an incremental CE ratio (ICER) of $495 per additional quality-adjusted life-year (QALY) for OPSC over UC. The DES-no-DQ showed OPSC dominating UC the DES-DQ generated an ICER of $2342 per QALY. The MM and DES-no-DQ ICER estimates differed due to the MM having implicit delays built into its structure as a result of having fixed cycle lengths, which are not a feature of DES. The non-DQ models assume that queues are at a steady state. Conversely, queues in the DES-DQ develop flexibly with supply and demand for resources, in this case, leading to different estimates of resource use and CE. The choice of MM or DES (with or without DQ) would not alter the reimbursement of OPSC as it was highly cost-effective compared to UC in all analyses. However, the modeling method may influence decisions where ICERs are closer to the CE acceptability threshold, or where capacity constraints and DQ are important features of the system. In these cases, DES-DQ would be the preferred modeling technique to avoid incorrect resource allocation decisions.

Effects of a midwife psycho-education intervention to reduce childbirth fear on women’s birth outcomes and postpartum psychological wellbeing

Publisher: Springer Science and Business Media LLC

Date: 30-10-2015

DOI: 10.1186/S12884-015-0721-Y

PIH3 A COSTING STUDY COMPARING MIDWIFERY GROUP PRACTICE WITH USUAL CARE IN AN AUSTRALIAN METROPOLITAN HOSPITAL

Publisher: Elsevier BV

Date: 11-2010

DOI: 10.1016/S1098-3015(11)73248-X

Patterns of multimorbidity in working Australians

Publisher: Springer Science and Business Media LLC

Date: 02-06-2011

DOI: 10.1186/1478-7954-9-15

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.

A Cost-effectiveness Analysis of Genetic Testing in the Evaluation of Families with Hypertrophic Cardiomyopathy

Publisher: Elsevier BV

Date: 2011

DOI: 10.1016/J.HLC.2011.05.010

Head injuries to bicyclists and the New Zealand bicycle helmet law

Publisher: Elsevier BV

Date: 07-2000

DOI: 10.1016/S0001-4575(99)00081-0

Abstract: The purpose of this study was to examine the effect of helmet wearing and the New Zealand helmet wearing law on serious head injury for cyclists involved in on-road motor vehicle and non-motor vehicle crashes. The study population consisted of three age groups of cyclists (primary school children (ages 5-12 years), secondary school children (ages 13-18 years), and adults (19+ years)) admitted to public hospitals between 1988 and 1996. Data were disaggregated by diagnosis and analysed using negative binomial regression models. Results indicated that there was a positive effect of helmet wearing upon head injury and this effect was relatively consistent across age groups and head injury (diagnosis) types. We conclude that the helmet law has been an effective road safety intervention that has lead to a 19% (90% CI: 14, 23%) reduction in head injury to cyclists over its first 3 years.

Value of Information Analysis Guiding the Reimbursement Decision of Olaparib for Metastatic Breast Cancer

Publisher: Elsevier BV

Date: 11-2019

DOI: 10.1016/J.JVAL.2019.09.544

Cost-effectiveness of prophylaxis and treatment of influenza,Kosteneffektivität der Prophylaxe und Behandlung von Influenza

Publisher: Georg Thieme Verlag KG

Date: 10-2003

DOI: 10.1055/S-2003-43100

Value For Money, the Overlooked Aspect in Research Funding Decisions

Publisher: Elsevier BV

Date: 09-2018

DOI: 10.1016/J.JVAL.2018.07.413

Influenza-related disease: The cost to the Australian healthcare system

Publisher: Elsevier BV

Date: 12-2008

DOI: 10.1016/J.VACCINE.2008.09.086

Abstract: The disease burden attributable to influenza is difficult to determine, as influenza infections are rarely virologically confirmed or recorded. Estimating the influenza-related disease burden is a prerequisite to estimate the costs. Age-specific regression models were used to estimate the number of excess hospitalisations attributable to influenza from influenza and respiratory syncytial virus surveillance data. The number of general practitioner consultations for influenza/influenza-like illness was estimated from a continuous randomly s led national study of general practice activity. Utilising the associated costs for each of these events, a cost-of-illness study was developed from the perspective of the Australian healthcare system. There was an annual average of 310,000 general practitioner consultations for influenza/influenza-like illness and 18,400 hospitalisations attributable to influenza over the period of review. The estimated cost to the Australian healthcare system for these events was $115 million annually. Influenza-related disease places a significant financial burden on the Australian healthcare system.

A trial of a self-assessment tool of problems following treatment of colorectal cancer: A prospective study in Australia primary care

Publisher: Hindawi Limited

Date: 11-06-2016

DOI: 10.1111/ECC.12340

Insights from triangulation of two purchase choice elicitation methods to predict social decision making in healthcare

Publisher: Springer Science and Business Media LLC

Date: 03-2012

DOI: 10.2165/11597100-000000000-00000

Abstract: Discrete choice experiments (DCEs) and the Juster scale are accepted methods for the prediction of in idual purchase probabilities. Nevertheless, these methods have seldom been applied to a social decision-making context. To gain an overview of social decisions for a decision-making population through data triangulation, these two methods were used to understand purchase probability in a social decision-making context. We report an exploratory social decision-making study of pharmaceutical subsidy in Australia. A DCE and selected Juster scale profiles were presented to current and past members of the Australian Pharmaceutical Benefits Advisory Committee and its Economic Subcommittee. Across 66 observations derived from 11 respondents for 6 different pharmaceutical profiles, there was a small overall median difference of 0.024 in the predicted probability of public subsidy (p = 0.003), with the Juster scale predicting the higher likelihood. While consistency was observed at the extremes of the probability scale, the funding probability differed over the mid-range of profiles. There was larger variability in the DCE than Juster predictions within each in idual respondent, suggesting the DCE is better able to discriminate between profiles. However, large variation was observed between in iduals in the Juster scale but not DCE predictions. It is important to use multiple methods to obtain a complete picture of the probability of purchase or public subsidy in a social decision-making context until further research can elaborate on our findings. This exploratory analysis supports the suggestion that the mixed logit model, which was used for the DCE analysis, may fail to adequately account for preference heterogeneity in some contexts.

Funding of drugs: do vaccines warrant a different approach?

Publisher: Elsevier BV

Date: 11-2008

DOI: 10.1016/S1473-3099(08)70258-5

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.

Benchmarking hospital safety and identifying determinants of hospital-acquired complication: the case of Queensland cardiac linkage longitudinal cohort

Publisher: Elsevier BV

Date: 03-2022

DOI: 10.1016/J.INFPIP.2021.100198

The impact of population-based disease management services for selected chronic conditions: The Costs to Australian Private Insurance - Coaching Health (CAPICHe) study protocol

Publisher: Springer Science and Business Media LLC

Date: 10-02-2012

DOI: 10.1186/1471-2458-12-114

Abstract: Recent evidence from a large scale trial conducted in the United States indicates that enhancing shared decision-making and improving knowledge, self-management, and provider communication skills to at-risk patients can reduce health costs and utilisation of healthcare resources. Although this trial has provided a significant advancement in the evidence base for disease management programs it is still left for such results to be replicated and/or generalised for populations in other countries and other healthcare environments. This trial responds to the limited analyses on the effectiveness of providing chronic disease management services through telephone health coaching in Australia. The size of this trial and it's assessment of cost utility with respect to potentially preventable hospitalisations adds significantly to the body of knowledge to support policy and investment decisions in Australia as well as to the international debate regarding the effect of disease management programs on financial outcomes. Intention to treat study applying a prospective randomised design comparing usual care with extensive outreach to encourage use of telephone health coaching for those people identified from a risk scoring algorithm as having a higher likelihood of future health costs. The trial population has been limited to people with one or more of the following selected chronic conditions: namely, low back pain, diabetes, coronary artery disease, heart failure, and chronic obstructive pulmonary disease. This trial will enrol at least 64,835 sourced from the approximately 3 million Bupa Australia private health insured members located across Australia. The primary outcome will be the total (non-maternity) cost per member as reported to the private health insurer (i.e. charged to the insurer) 12 months following entry into the trial for each person. Study recruitment will be completed in early 2012 and the results will be available in late 2013. If positive, CAPICHe will represent a potentially cost-effective strategy to improve health outcomes in higher risk in iduals with a chronic condition, in a private health insurance setting. Australian New Zealand Clinical Trials Registry reference: ACTRN12611000580976

A cost-minimisation analysis comparing photoselective vaporisation (PVP) and transurethral resection of the prostate (TURP) for the management of symptomatic benign prostatic hyperplasia (BPH) in Queensland, Australia

Publisher: Wiley

Date: 10-04-2014

DOI: 10.1111/BJU.12051

Abstract: To compare the costs of photoselective vaporisation (PVP) and transurethral resection of the prostate (TURP) for management of symptomatic benign prostatic hyperplasia (BPH) from the perspective of a Queensland public hospital provider. A decision-analytic model was used to compare the costs of PVP and TURP. Cost inputs were sourced from an audit of patients undergoing PVP or TURP across three hospitals. The probability of re-intervention was obtained from secondary literature sources. Probabilistic and multi-way sensitivity analyses were used to account for uncertainty and test the impact of varying key assumptions. In the base case analysis, which included equipment, training and re-intervention costs, PVP was AU$ 739 (95% credible interval [CrI] -12 187 to 14 516) more costly per patient than TURP. The estimate was most sensitive to changes in procedural costs, fibre costs and the probability of re-intervention. Sensitivity analyses based on data from the most favourable site or excluding equipment and training costs reduced the point estimate to favour PVP (incremental cost AU$ -684, 95% CrI -8319 to 5796 and AU$ -100, 95% CrI -13 026 to 13 678, respectively). However, CrIs were wide for all analyses. In this cost minimisation analysis, there was no significant cost difference between PVP and TURP, after accounting for equipment, training and re-intervention costs. However, PVP was associated with a shorter length of stay and lower procedural costs during audit, indicating PVP potentially provides comparatively good value for money once the technology is established.

Increasing Capacity for the Treatment of Common Musculoskeletal Problems: A Non-Inferiority RCT and Economic Analysis of Corticosteroid Injection for Shoulder Pain Comparing a Physiotherapist and Orth

Publisher: Public Library of Science (PLoS)

Date: 15-09-2016

DOI: 10.1371/JOURNAL.PONE.0162679

An overview of reproductive carrier screening panels for autosomal recessive and/or X‐linked conditions: How much do we know?

Publisher: Wiley

Date: 12-09-2023

DOI: 10.1002/PD.6434

Which Heart Failure Intervention is Most Cost-Effective and Consumer Friendly in Reducing Hospital Care (WHICH?): A Multicentre Randomised Controlled Trial

Publisher: Elsevier BV

Date: 2012

DOI: 10.1016/J.HLC.2012.05.249

Longitudinal study of intravenous versus subcutaneous immunoglobulin replacement therapy in hematological malignancy

Publisher: Wiley

Date: 18-01-2021

DOI: 10.1111/AJCO.13515

Abstract: To present findings from a longitudinal study on infection risk, mortality, and patient perspective of intravenous immunoglobulin (IVIg) and subcutaneous immunoglobulin (SCIg) treatment for patients with hypogammaglobulinemia secondary to hematological malignancy or its treatment (abbreviated as SID). Observational study period included final year of IVIg (13 patients) and of the first 3 years of SCIg (17 patients) with SID. Data were collected on clinical outcomes from medical records and patient perception via study specific questionnaire. The median age was 63 years (53‐76 years), and for 82.4% of patients their hematological malignancy was in complete remission. The annual mean serum IgG trough levels remained stable over the 4 years and were 7.0 g/L (±2.77 g/L) with IVIg, and 8.0 g/L (±1.75 g/L), 8.7 g/L (±2.75 g/L), and 7.6 g/L (±2.89 g/L) (year 1, 2, and 3, respectively) with SCIg. While the annual infection rate was similar, the rate of hospitalization due to infection fluctuated, with 37%, 9%, 15%, and 32% in year 1, 2, 3, and 4 respectively. There were no systemic adverse events with IVIg or SCIg. Patients reported a strong preference for SCIg. One patient died due to progression of underlying disease and infection within the study period. SCIg was the preferred treatment mode over IVIg in our cohort, but both were well tolerated without any systemic adverse events in 4‐year follow up. The dosage and serum IgG levels were stable throughout. However, the number of infections requiring hospitalization fluctuated. It is anticipated that these findings encourage more hospitals to offer SCIg for SID patients.

An experienced physiotherapist prescribing and administering corticosteroid and local anaesthetic injections to the shoulder in an Australian orthopaedic service, a non-inferiority randomised controlled trial and economic analysis: Study protocol for a randomised controlled trial

Publisher: Springer Science and Business Media LLC

Date: 12-2014

DOI: 10.1186/1745-6215-15-503

Commentary

Publisher: Elsevier BV

Date: 09-2005

DOI: 10.1016/J.EBCM.2005.06.031

Coaching Patients Saves Lives and Money

Publisher: Elsevier BV

Date: 04-2018

DOI: 10.1016/J.AMJMED.2017.10.019

Abstract: The Coaching On Achieving Cardiovascular Health (COACH) Program has been proven to improve biomedical and lifestyle cardiovascular disease (CVD) risk factors. The objective of this study was to evaluate the long-term impact of The COACH Program on overall survival, hospital utilization, and costs from the perspective of a private health insurer (payor), in patients with CVD. A prospective parallel-group case-control study design with controls randomly matched to patients based on propensity score. There were 512 participants with CVD engaged in a structured disease management program of 6 months duration (The COACH Program) who were matched to 512 patients with CVD who were allocated to the control group. The independent variables that estimated the propensity score were preprogram hospital admissions, age, and sex. The primary outcome was overall survival with secondary outcomes, including hospital utilization and cost incurred by the private health insurer. Mean follow-up was 6.35 years. Difference in overall survival between the 2 groups was estimated using a Cox proportional hazard ratio (HR) with difference in total cost estimated using a generalized linear model. The COACH Program achieved a significant reduction in overall mortality (HR 0.70 95% confidence interval [CI], 0.53-0.93 P = .014). There was an apparent dose-response effect: those who received up to 3 coaching sessions had no decrease in mortality (HR 1.02 95% CI, 0.69-1.49 P = .926) those who received 4 or more coaching sessions had a substantial decrease in mortality (HR 0.58 95% CI, 0.42-0.81 P = .001). Total cost to the health insurer was substantially lower in the intervention group ($12,707 per person lower P = .078). The reduction in total cost was significantly greater in those who received 4 or more sessions ($19,418 per person P = .006) and in males ($18,947 per person P = .029). Those enrolled in The COACH program achieved a statistically significant decrease in overall mortality compared with usual care at 6.35 years. A substantive reduction in hospital costs was also observed among those who received The COACH program compared with those who did not, particularly in those who received 4 or more sessions and in males.

Nurse-led primary care clinics for the secondary prevention of heart disease appear cost-effective compared to usual care: Commentary

Publisher: Elsevier BV

Date: 09-2005

DOI: 10.1016/J.EBCM.2005.06.030

Does facility type and location impact upon patient experiences in emergency departments? Secondary analysis of a state-wide, cross-sectional survey

Publisher: Wiley

Date: 19-01-2020

DOI: 10.1111/1742-6723.13466

Abstract: To identify the extent to which patient experiences in the ED differ depending on facility type (based on bed numbers, services available and annual separations), and location (level of remoteness). Data from a 2015 state-wide (Queensland, Australia) public ED patient experience survey were linked to sociodemographic and presentation-related characteristics data. Survey items were in idually scored (from 0 to 100), and averaged across 13 pre-determined patient experience topic areas. Descriptive statistics were used to report on patient sociodemographic and presentation-related characteristics. One-way analysis of variance tests were used to identify associations between patient-reported experience scores, facility types and location. A total of 10 553 patients over the age of 16 years completed the survey. All patients reported scores above 75 for 7 of the 13 patient experience topic areas (0 = lowest score, 100 = highest score). Patients from very remote and outer regional EDs reported the highest scores for the topic Environment and facilities, and remote facility patients reported the highest scores for the topic Leaving the ED - Delays. The same two topic areas were scored most highly by patients from smaller facilities in comparison to principal referral hospital EDs. Patients attending smaller and more rurally located EDs reported more positive experiences than those attending larger, metropolitan EDs on two of the 13 topic areas. However, these differences were marginal. Future research should aim to determine what constitutes clinically meaningful differences between groups when comparing patient-reported experience scores, and understand the characteristics of small and rural EDs that may be associated with better patient experiences.

Immunisation status of children presenting to the emergency department: Linkage of a longitudinal birth cohort with national immunisation data

Publisher: Wiley

Date: 31-10-2019

DOI: 10.1111/JPC.14288

Abstract: To describe the relationship between emergency department (ED) diagnosis of infectious disease and immunisation status in children ≤5 years. We also aimed to demonstrate feasibility of proof-of-concept linkage between disparate databases. Data from a cohort of 3404 children born in Southeast Queensland/Far North New South Wales between 2006 and 2011 were linked to Australian Childhood Immunisation Registry data and Emergency Department Information System data for presentations between 2006 and 2014. Immunisation status was assigned using the 2009 National Immunisation Program schedule. Of 1490 children (79% of those consented) with data on immunisation status, 87.2 and 84.6% were fully immunised by 12 and 24 months, respectively. Adding partially immunised children increased this to 93.2 and 91.4% at 12 and 24 months, respectively. Nearly two-thirds of all children made at least one ED presentation. Children presenting to ED with an infectious disease did not differ in immunisation status compared to children with other (non-infectious disease type) presentations but were younger, more likely to live with other children and had a longer ED stay and higher admission rate. Respiratory syncytial virus (RSV) was more frequently diagnosed in unimmunised children. In an existing birth cohort, immunisation rates were lower than the national average. RSV was more prevalent in unimmunised children presenting to ED, but immunisation status was not significantly associated with other infectious disease presentations. Linkage between national immunisation data and Australian ED data is feasible and has the potential to identify previously unrecognised factors related to child immunisation status and health-care utilisation.

Economic evaluation of a community based exercise programme to prevent falls

Publisher: BMJ

Date: 08-2001

DOI: 10.1136/JECH.55.8.600

Abstract: To assess the incremental costs and cost effectiveness of implementing a home based muscle strengthening and balance retraining programme that reduced falls and injuries in older women. An economic evaluation carried out within a randomised controlled trial with two years of follow up. Participants were in idually prescribed an exercise programme (exercise group, n=116) or received usual care and social visits (control group, n=117). 17 general practices in Dunedin, New Zealand. Women aged 80 years and older living in the community and invited by their general practitioner to take part. Number of falls and injuries related to falls, costs of implementing the intervention, healthcare service costs resulting from falls and total healthcare service costs during the trial. Cost effectiveness was measured as the incremental cost of implementing the exercise programme per fall event prevented. 27% of total hospital costs during the trial were related to falls. However, there were no significant differences in health service costs between the two groups. Implementing the exercise programme for one and two years respectively cost $314 and $265 (1995 New Zealand dollars) per fall prevented, and $457 and $426 per fall resulting in a moderate or serious injury prevented. The costs resulting from falls make up a substantial proportion of the hospital costs for older people. Despite a reduction in falls as a result of this home exercise programme there was no significant reduction in healthcare costs. However, the results reported will provide information on the cost effectiveness of the programme for those making decisions on falls prevention strategies.

Comparison of the EQ-5D-3L and the SF-6D (SF-12) contemporaneous utility scores in patients with cardiovascular disease

Publisher: Springer Science and Business Media LLC

Date: 08-2017

DOI: 10.1007/S11136-017-1666-6

Abstract: Multi-attribute utility instruments (MAUIs) are widely used to measure utility weights. This study sought to compare utility weights of two popular MAUIs, the EQ-5D-3L and the SF-6D, and inform researchers in the selection of generic MAUI for use with cardiovascular (CVD) patients. Data were collected in the Young@Heart study, a randomised controlled trial of a nurse-led multidisciplinary home-based intervention compared to standard usual care. Participants (n = 598) completed the EQ-5D-3L and the SF-12v2, from which the SF-6D can be constructed, at baseline and at 24-month follow-up. This study examined discrimination, responsiveness, correlation and differences across the two instruments. Both MAUIs were able to discriminate between the NYHA severity classes and recorded similar changes between the two time points although only SF-6D differences were significant. Correlations between the dimensions of the two MAUIs were low. There were significant differences between the two instruments in mild conditions but they were similar in severe conditions. Substantial ceiling and floor effects were observed. Our findings indicate that the EQ-5D and the SF-6D cover different spaces in health due to their classification systems. Both measures were capable of discriminating between severity groups and responsive to quality of life changes in the follow-up. It is recommended to use the EQ-5D-3L in severe and the SF-6D in mild CVD conditions.

Identifying compliant participants through data matching improved estimation of intervention efficacy: randomized trials with opt-in/opt-out strategies

Publisher: Elsevier BV

Date: 11-2019

DOI: 10.1016/J.JCLINEPI.2019.07.013

Abstract: We propose a data-matching approach to estimate intervention efficacy for randomized controlled trials (RCTs) when there is noncompliance to the allocated treatment with induced selection bias. We considered a large RCT to compare health care costs and hospital length of stay 12 months after randomization. Participants allocated to the intervention group were eligible to receive health-coaching and disease-management services. An opt-out approach was adopted for recruitment. Control-group participants received usual care but were allowed to opt-in to receive the intervention. Using "nearest-neighbor"-matched data, we identified compliant participants in both arms to estimate intervention efficacy. Results were compared with intention-to-treat (ITT), instrumental-variable-adjusted ITT, per-protocol (PP), and as-treated (AT) analyses. The ITT estimated an intervention effect of a 1.5% reduction in cost, but 56.7% of intervention-group participants did not receive health coaching. The PP and AT found an increase in cost of 9.4% and 17.1%, respectively. The matching method estimated a 12.3% reduction in cost. After adjustment for baseline covariates, the intervention group had lower same-day admission cost (13.6% 95% CI: 7.3%-20.0% P < 0.001) and shorter hospital stay (11.2% 95% CI: 2.6%-19.9% P = 0.021). Opt-in/opt-out strategies in RCTs misled intervention comparisons and the matching approach improved estimation of intervention efficacy.

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.

Health status of cardiac genetic disease patients and their at-risk relatives

Publisher: Elsevier BV

Date: 05-2013

DOI: 10.1016/J.IJCARD.2011.08.083

Abstract: Health status is an important outcome measure that incorporates multiple dimensions of health, including symptoms, functional status, and psychosocial factors. While health status has been shown to be a predictor for hospital readmission, morbidity and mortality in the heart failure setting, there are limited data in cardiac genetic disease. We examined health status in a number of cardiac genetic disease groups compared to the general Australian population. A total of 409 in iduals were assessed. In iduals with inherited cardiomyopathies [hypertrophic cardiomyopathy (HCM), familial dilated cardiomyopathy (FDC), arrhythmogenic right ventricular cardiomyopathy (ARVC)] and primary arrhythmogenic disorders [long QT syndrome (LQTS), catecholaminergic polymorphic ventricular tachycardia (CPVT)], as well as their first-degree relatives, completed the Medical Outcomes Survey Short Form-36 (SF-36). The physical and mental component scores (PCS and MCS) and SF-6D utility score were assessed. Patients with HCM (p<0.001), FDC (p<0.05), and CPVT (p<0.05) were found to have a significantly lower PCS, while patients with LQTS (p<0.01) had a lower MCS. In iduals at risk of HCM (p<0.0001) and genotype positive-phenotype negative HCM patients (p<0.01) both had a higher PCS and utility scores compared to the clinically affected HCM population. In iduals at risk of LQTS had significantly higher PCS than those with a clinical diagnosis of LQTS (p<0.05) and similarly in iduals at risk of FDC had significantly higher PCS than FDC patients (p<0.05). In HCM, female gender (p=0.002), presence of co-morbidities (p<0.0001) and higher NYHA functional class (p<0.0001) were predictors of a lower PCS. Patients with a clinical diagnosis of a genetic heart disease have an impaired health status, related to both physical and mental function. Clinical management strategies in such patient groups need to consider health status as an important outcome measure.

Risk assessment with low-pass whole-genome sequencing of cell-free DNA before CD19 CAR T-cell therapy for large B-cell lymphoma

Publisher: American Society of Hematology

Date: 04-08-2022

DOI: 10.1182/BLOOD.2022015601

Abstract: Patients with relapsed or refractory large B-cell lymphomas (rrLBCL) can achieve long-term remission after CD19 chimeric antigen receptor T-cell therapy (CART19). However, more than half of recipients will experience treatment failure. Thus, approaches are needed to identify high-risk patients who may benefit from alternative or consolidative therapy. We evaluated low-pass whole-genome sequencing (lpWGS) of cell-free DNA (cfDNA) before CART19 as a new approach for risk stratification. We performed lpWGS on pretreatment plasma s les from 122 patients at time of leukapheresis who received standard-of-care CART19 for rrLBCL to define DNA copy number alterations (CNAs). In multivariable selection, high focal CNA score (FCS) denoting genomic instability was the most significant pretreatment variable associated with inferior 3-month complete response rates (28% vs 56%, P = .0029), progression-free survival (PFS P = .0007 hazard ratio, 2.11), and overall survival (OS P = .0026 hazard ratio, 2.10). We identified 34 unique focal CNAs in 108 (89%) patients of these, deletion 10q23.3 leading to loss of FAS death receptor was the most highly associated with poor outcomes, leading to inferior PFS (P & .0001 hazard ratio, 3.49) and OS (P = .0027 hazard ratio, 2.68). By combining FCS with traditional markers of increased tumor bulk (elevated lactate dehydrogenase and & extranodal site), we built a simple risk model that could reliably risk stratify patients. Thus, lpWGS of cfDNA is a minimally invasive assay that could rapidly identify high-risk patients and may guide patient selection for and targeted therapies to evaluate in future clinical trials.

Re McKinlay and Marceau's Tale of 3 tails

Publisher: American Public Health Association

Date: 02-2000

DOI: 10.2105/AJPH.90.2.294B

The direct medical and non-medical management costs of lung cancer patients at an Australian tertiary thoracic oncology hospital

Publisher: Elsevier BV

Date: 07-2005

DOI: 10.1016/S0169-5002(05)80822-0

Detecting patterns of change in benthic habitats by acoustic remote sensing

Publisher: Inter-Research Science Center

Date: 12-03-2013

DOI: 10.3354/MEPS10264

Emergency nurses’ experience of providing care to patients who self-harm

Publisher: Elsevier BV

Date: 09-2021

DOI: 10.1016/J.AUEC.2020.10.004

Global article collection: essential reads from around the world

Publisher: Informa UK Limited

Date: 24-06-2022

DOI: 10.1080/13696998.2022.2087960

The cost-effectiveness of fluvastatin in Hungary following successful percutaneous coronary intervention

Publisher: Springer Science and Business Media LLC

Date: 16-06-2006

DOI: 10.1007/S10557-006-8877-3

Abstract: The Lescol Intervention Prevention Study (LIPS) showed substantial gains in health outcomes from statins following PCI. That study was a randomized double-blind placebo-controlled trial undertaken in 77 centres, predominantly in Europe, of patients with moderate hypercholesterolemia who had undergone their first PCI. The evidence on cost-effectiveness has been established for the UK, USA and the Netherlands, but due to different health system cost structures, the results may not be applicable to other European countries. The aim of this study was to estimate the cost-effectiveness of fluvastatin used following first PCI in Hungary. A deterministic Markov model was used to estimate the incremental costs per quality-adjusted life year gained, with cost data drawn from the Hungarian National Health Insurance Fund. Effectiveness data on fluvastatin was derived directly from LIPS and utility weights from previous studies on heart disease. Sensitivity analyses were conducted around key parameters and analyses were conducted for subgroups identified in LIPS. Treatment with fluvastatin cost an additional 1,704 euro and resulted in an additional 0.107 QALYs per patient discounted over 10-years compared with controls. The incremental cost per quality-adjusted life year gained was 15,910 euro. The key determinants of cost-effectiveness were the effectiveness of fluvastatin, utility weights, cost of fluvastatin, and the time horizon evaluated. Fluvastatin was substantially more cost-effective in patients with diabetes, renal disease, multi-vessel disease or LDL-cholesterol >3.4 mmol/l. Fluvastatin is an economically efficient pharmaceutical for reducing heart disease in Hungary and other European countries in patients following PCI.

Characteristics that predict volunteer retention and fundraising in community‐based challenge events

Publisher: Wiley

Date: 14-12-2021

DOI: 10.1002/NVSM.1732

Abstract: The financial viability of many not‐for‐profit organisations is linked to community fundraising by volunteers. This study explored predictors of volunteer retention and fundraising performance in relay for life (RFL), an international volunteer community‐based cancer fundraising event. A self‐report survey completed by 1298 RFL volunteers (24% response) assessed: satisfaction with volunteering organisational commitment psychological sense of connection motives social norms capacity to volunteer as in perceived behavioural control and barriers to volunteering satisfaction with community behavioural intention. Primary outcomes were return participation in RFL and funds raised. Returning volunteers reported higher perceived behavioural control and satisfaction with community. Indirect effects through age‐moderated intention‐to‐return were higher satisfaction with volunteering organisational commitment psychological sense of connection capacity to volunteer. Funds raised were higher in teams with volunteers who were older, strongly committed to the organisation and motivate to fight cancer with low interest in social/entertainment. Strategies to nurture the volunteer‐organisation relationship and enhance volunteer capabilities may be most crucial for event success and long‐term viability.

Cost-effectiveness analysis of germ-line BRCA testing in women with breast cancer and cascade testing in family members of mutation carriers

Publisher: Elsevier BV

Date: 09-2018

DOI: 10.1038/GIM.2017.231

Abstract: To evaluate the cost-effectiveness of BRCA testing in women with breast cancer, and cascade testing in family members of BRCA mutation carriers. A cost-effectiveness analysis was conducted using a cohort Markov model from a health-payer perspective. The model estimated the long-term benefits and costs of testing women with breast cancer who had at least a 10% pretest BRCA mutation probability, and the cascade testing of first- and second-degree relatives of women who test positive. Compared with no testing, BRCA testing of affected women resulted in an incremental cost per quality-adjusted life-year (QALY) gained of AU$18,900 (incremental cost AU$1,880 incremental QALY gain 0.10) with reductions of 0.04 breast and 0.01 ovarian cancer events. Testing affected women and cascade testing of family members resulted in an incremental cost per QALY gained of AU$9,500 compared with testing affected women only (incremental cost AU$665 incremental QALY gain 0.07) with additional reductions of 0.06 breast and 0.01 ovarian cancer events. BRCA testing in women with breast cancer is cost-effective and is associated with reduced risk of cancer and improved survival. Extending testing to cover family members of affected women who test positive improves cost-effectiveness beyond restricting testing to affected women only.

Work Performance Decrements Are Associated With Australian Working Conditions, Particularly the Demand to Work Longer Hours

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 03-2010

DOI: 10.1097/JOM.0B013E3181D1CDBB

Are N-of-1 Trials an Economically Viable Option to Improve Access to Selected High Cost Medications? The Australian Experience

Publisher: Elsevier BV

Date: 2008

DOI: 10.1111/J.1524-4733.2007.00218.X

Abstract: To explore the economic viability of N-of-1 trials for improving access to selected high cost medications in Australia. Cost and effectiveness estimates were derived from two N-of-1 trials conducted by The University of Queensland from 2003 to 2005-celecoxib versus sustained-release paracetamol for osteoarthritis in a general practice setting and gabapentin versus placebo for chronic neuropathic pain in a hospital setting. Effectiveness was determined by the proportion of responders to each medication. The costs of trials were offset against the savings generated by subsequent changes in prescribing. Decision analysis models with semi-Markov processes were used to compare different scenarios of N-of-1 trials versus usual care. The fixed cost of performing N-of-1 trials was approximately AUS$23,000 for each trial and the variable cost was approximately AUS$1300 per participant. Clinical outcomes favored celecoxib over paracetamol in 17% of participants and gabapentin over placebo in 24% of participants. Modeling these results showed that the cost-offsets from efficient use of medications were less than the cost of running a trial however, the incremental costs per quality-adjusted life-year gained were AUS$6,896 and AUS$29,550 for the gabapentin lacebo and celecoxib aracetamol trials, respectively, over a 5-year horizon. Key factors affecting the viability were the time horizon modeled, the variable cost per participant, the probability of response to the intervention medication, and rates of use in nonresponders and the usual care alternative. The N-of-1 strategy offers a realistic and viable option for increasing access to selected high cost medications where the medications are used for the symptomatic treatment of chronic disease, have rapid onset of action, and clinical response is unpredictable without a trial.

Engaging the public in healthcare decision-making: Quantifying preferences for healthcare through citizens' juries

Publisher: BMJ

Date: 04-2014

DOI: 10.1136/BMJOPEN-2014-005437

Mental Ill-Health and the Differential Effect of Employee Type on Absenteeism and Presenteeism

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 11-2008

DOI: 10.1097/JOM.0B013E31818C30A8

Patient preferences for treatment of Achilles tendon pain: Results from a discrete choice experiment

Publisher: Elsevier BV

Date: 2010

DOI: 10.1016/J.JSAMS.2009.10.218

Estimating Influenza-Related Hospital Admissions in Children and Adults

Publisher: Springer Science and Business Media LLC

Date: 2003

DOI: 10.2165/00115677-200311040-00006

Systematic review of cost effectiveness in telemedicine

Publisher: BMJ

Date: 14-09-2002

DOI: 10.1136/BMJ.325.7364.598

Health auctions: A valuation experiment (HAVE) study protocol: Table 1

Publisher: BMJ

Date: 04-2016

DOI: 10.1136/BMJOPEN-2015-009081

Health services utilization of women following a traumatic birth

Publisher: Springer Science and Business Media LLC

Date: 11-01-2015

DOI: 10.1007/S00737-014-0495-7

Abstract: This cohort study compared 262 women with high childbirth distress to 138 non-distressed women. At 12 months, high distress women had lower health-related quality of life compared to non-distressed women (EuroQol five-dimensional (EQ-5D) scale 0.90 vs. 0.93, p = 0.008), more visits to general practitioners (3.5 vs. 2.6, p = 0.002) and utilized more additional services (e.g. maternal health clinics), with no differences for infants. Childbirth distress has lasting adverse health effects for mothers and increases health-care utilization.

Randomised controlled trial of an automated, interactive telephone intervention (TLC Diabetes) to improve type 2 diabetes management: Baseline findings and six-month outcomes

Publisher: Springer Science and Business Media LLC

Date: 03-08-2012

DOI: 10.1186/1471-2458-12-602

Psychological distress is associated with a range of high‐priority health conditions affecting working Australians

Publisher: Elsevier BV

Date: 06-2010

DOI: 10.1111/J.1753-6405.2010.00531.X

Abstract: Psychological distress is growing in prevalence in Australia. Comorbid psychological distress and/or depressive symptoms are often associated with poorer health, higher healthcare utilisation and decreased adherence to medical treatments. The Australian Work Outcomes Research Cost-benefit (WORC) study cross-sectional screening dataset was used to explore the association between psychological distress and a range of health conditions in a s le of approximately 78,000 working Australians. The study uses the World Health Organization Health and Productivity Questionnaire (HPQ), to identify self-reported health status. Within the HPQ is the Kessler 6 (K6), a six-item scale of psychological distress which strongly discriminates between those with and without a mental disorder. Potential confounders of age, sex, marital status, number of children, education level and annual income were included in multivariate logistic regression models. Psychological distress was significantly associated with all investigated health conditions in both crude and adjusted estimates. The conditions with the strongest adjusted association were, in order from highest: drug and alcohol problems, fatigue, migraine, CVD, COPD, injury and obesity. Psychological distress is strongly associated with all 14 health conditions or risk factors investigated in this study. Comorbid psychological distress is a growing public health issue affecting Australian workers.

Demonstration of high value care to improve oral health of a remote Indigenous community in Australia

Publisher: Springer Science and Business Media LLC

Date: 24-02-2020

DOI: 10.1186/S12955-020-01300-8

Abstract: The oral health of Indigenous children in remote communities is much worse than other population groups in Australia. Providing and maintaining an oral health service is challenging due to the remoteness of communities, the associated high cost, and the low retention of clinical staff. An annual preventive intervention delivered by fly-in clinicians may be a more cost-effective way to manage this problem. In this analysis we estimate the cost-effectiveness of an annual professional intervention for the prevention of dental caries in children of a remote Indigenous community in Far North Queensland. A cost-effectiveness analysis was conducted based on an annual preventive intervention protocol. This included treating all dental decay in those with disease, applying fissure sealants, a disinfectant swab, fluoride varnish and providing oral hygiene instructions and dietary advice to all participating school children. This study included an intervention group and a natural comparison group and both groups were followed-up for 2 years after the initial preventive intervention. A Markov model was built to assess the cost-effectiveness of the intervention compared with the usual care. Costs of treatment from the Queensland Department of Health were used and effectiveness was measured as quality-adjusted life years (QALYs) with the CHU-9D. One-way and probabilistic sensitivity analyses were conducted to identify key drivers and quantify uncertainty. The preventive intervention was found to be highly cost-effective. The incremental cost per QALY gained was AU$3747. Probability of new caries and seeking treatment were identified as the main drivers of the model. In probabilistic sensitivity analysis intervention was cost effective in 100% of simulations. An annual preventive intervention for remote Indigenous communities in Australia is a highly cost-effective strategy to prevent dental caries and improve the quality of life of children.

The reach of deliberative democracy

Publisher: Informa UK Limited

Date: 04-05-2015

DOI: 10.1080/01442872.2015.1065969

Correction: Cost-effectiveness analysis of a mobile ear screening and surveillance service versus an outreach screening, surveillance and surgical service for indigenous children in Australia

Publisher: Public Library of Science (PLoS)

Date: 05-06-2020

DOI: 10.1371/JOURNAL.PONE.0234021

Cost and time savings from a rapid access model of care using transient elastography to screen and triage patients with chronic Hepatitis C infection

Publisher: Informa Healthcare

Date: 05-12-2014

DOI: 10.3111/13696998.2013.867271

Abstract: Treatment uptake amongst patients with chronic Hepatitis C virus (HCV) in Australia is relatively low. New approaches to assessment have the potential to reduce public waiting lists, improve access to treatment, and to reduce healthcare costs. To describe the costs to the public hospital system and waiting time associated with a novel integrated rapid access to assessment and treatment (RAAT) model of care that utilizes Transient Elastography (TE) as a specialist outpatient-based approach for a streamlined assessment of patients with chronic HCV, compared to conventional outpatient management with liver biopsy (LB). Time from first medical review to treatment plan and costs associated with detection of fibrosis were recorded for patients receiving RAAT during a 3-month period, and for a similar historical cohort managed conventionally with LB. Costs related to medical and multidisciplinary team reviews and the TE/LB test itself were included. Patients receiving RAAT had lower costs (n = 27, median AU$2716) and shorter time to treatment (median = 194 days) than for conventional management (n = 13, median $5005, 420 days p < 0.01). Differences related to the lower TE test costs and the lower cost of consults between first medical review and establishment of a treatment plan. Based on real world audit data, this evaluation suggests TE, used as part of a new RAAT model of care, is cost saving to the health system in the short-term and reduces waiting times. The analysis reported here was intended to assess the costs related to detection of fibrosis, and is limited by the small s le size and potential selection bias. Future research should undertake a full economic evaluation at a whole of service level, to consider a more comprehensive and longer-term assessment of the costs and benefits associated with HCV management.

Review article: Interventions for people presenting to emergency departments with a mental health problem: A systematic scoping review

Publisher: Wiley

Date: 30-06-2019

DOI: 10.1111/1742-6723.13335

Abstract: The number of people presenting to EDs with mental health problems is increasing. To enhance and promote the delivery of safe and efficient healthcare to this group, there is a need to identify evidence-based, best-practice models of care. This scoping review aims to identify and evaluate current research on interventions commenced or delivered in the ED for people presenting with a mental health problem. A systematic search of eight databases using search terms including emergency department, mental health, psyc* and interventions, with additional reference chaining, was undertaken. For included studies, level of evidence was assessed using the NHMRC research guidelines and existing knowledge was synthesised to map key concepts and identify current research gaps. A total of 277 papers met the inclusion criteria. These were grouped thematically into seven domains based on primary intervention type: pharmacological (n = 43), psychological/behavioural (n = 25), triage/assessment/screening (n = 28), educational/informational (n = 12), case management (n = 28), referral/follow up (n = 36) and mixed interventions (n = 105). There was large heterogeneity observed as to the level of evidence within each intervention group. The interventions varied widely from pharmacological to behavioural. Interventions were focused on either staff, patient or institutional process domains. Few interventions focused on multiple domains (n = 64) and/or included the patient's family (n = 1). The effectiveness of interventions varied. There is considerable, yet disconnected, evidence around ED interventions to support people with mental health problems. A lack of integrated, multifaceted, person-centred interventions is an important barrier to providing effective care for this vulnerable population who present to the ED.

Cost-utility analysis of imatinib mesilate for the treatment of advanced stage chronic myeloid leukaemia

Publisher: Springer Science and Business Media LLC

Date: 08-2003

DOI: 10.1038/SJ.BJC.6601151

Long-term cost-effectiveness of a disease management program for patients with atrial fibrillation compared to standard care – a multi-state survival model based on a randomized controlled trial

Publisher: Informa UK Limited

Date: 2021

DOI: 10.1080/13696998.2020.1860371

Do Patients Treated for Colorectal Cancer Benefit from General Practitioner Support? A Video Vignette Study

Publisher: JMIR Publications Inc.

Date: 05-11-2015

DOI: 10.2196/JMIR.4942

Exploring Spatiotemporal Trends in Commercial Fishing Effort of an Abalone Fishing Zone: A GIS-Based Hotspot Model.

Publisher: Public Library of Science (PLoS)

Date: 20-05-2015

DOI: 10.1371/JOURNAL.PONE.0122995

National drug policies to local formulary decisions in Thailand, China, and Australia: Drug listing changes and opportunities

Publisher: Elsevier BV

Date: 2012

DOI: 10.1016/J.JVAL.2011.11.003

Secondary prevention in coronary artery disease: a risk-guidance may be beneficial

Publisher: Oxford University Press (OUP)

Date: 11-2020

DOI: 10.1093/EHJCI/EHAA946.1358

Abstract: Assessment of secondary event risk is now recommended for all coronary artery disease (CAD) patients. Many risk calculators have been developed for this purpose. However, their contribution to secondary prevention of CAD is limited because it is unknown whether high-risk patients would benefit more from intensive management. This study sought to apply a previously developed risk score of secondary event to predict readmission in CAD patients, and determine if higher-risk patients benefit more from intensive medical and interventional therapies. This State-wide longitudinal study included 19,940 patients admitted to a hospital in 2010 with CAD as the principal diagnosis. Patients were followed up till the end of 2015. A previously developed and validated risk score (PEGASUS-TIMI54) was used to estimate risks of future adverse events and stratify all patients into either low risk (score& ) or high risk (score≥6) as previously recommended. The primary outcome was all-cause readmission. Secondary outcomes included all-cause mortality and days alive and out of hospital within five years of hospital discharge. Cox proportional hazards regression and linear regression were used for analysis. The high risk patients (n=6,573) had a significantly higher proportion of males and Indigenous people, had greater comorbidities, and were more likely to be readmitted or dead (all p& .001) than their counterparts in the low risk group (n=13,367). Beta-blocker (hazards ratio HR=0.87 [95% CI: 0.79–0.95]), ACEi/ARB (HR=0.68 [95% CI: 0.62–0.73]) and PCI (HR=0.91 [95% CI: 0.88–0.95]) were negatively associated with readmission, and showed a negative interaction (p& .001) with patients' predicted risks – implicating greater benefits for high-risk patients. CABG, on the contrary, was positively associated with readmission (HR=1.44 [95% CI: 1.15–1.80]) and showed a negative interaction (p& .001) with patients' predicted risks. This finding suggests that patients receiving CABG were more likely to be readmitted than those not receiving CABG, but this trend reduced for patients with higher risks. Analysis of secondary outcomes suggest that all medical and interventional therapies reduced mortality risks, with the strongest effect size for CABG (HR=0.34 [95% CI: 0.29–0.48]). There was a negative interaction of statins, PCI and CABG with patients' predicted risks, implicating greater survival benefits for patients with higher risks. CAD patients can be effectively risk-stratified. The use of this information for a risk-guided strategy may maximize benefits for high-risk patients. Type of funding source: None

A Cost-Effectiveness Analysis of Front-Line Treatment Strategies in Early Stage Follicular Lymphoma

Publisher: American Society of Hematology

Date: 05-11-2020

DOI: 10.1182/BLOOD-2020-138590

Abstract: Background: Radiation therapy (RT) has been considered the standard of care for front-line management for early-stage follicular lymphoma. Recent data suggests the use of RT is declining with more than half the patients receiving immunochemotherapy (ICT) with or without rituximab maintenance (RM). Cost-effectiveness analysis of these treatments has not been performed. Methods: We constructed a four-state partitioned survival model over a 15-year time horizon to compare RT alone, ICT and ICT+RM. The model was based on a real-world cohort of early-stage FL patients, staged using 18F-fluorodeoxyglucose positron emission tomography,from the Australasian Lymphoma Alliance. Lifetime direct health care costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs) were calculated from an Australian tax-payer perspective. A pre-specified value of AUD $75,000 was defined as the willingness-to-pay (WTP) threshold reflecting recent approvals for therapeutics for indolent lymphoproliferative diseases in Australia. Results: Assuming 5% annual discounting the direct healthcare costs were: RT $14,480, ICT $22,171, ICT+RM $42,830 (Table 1). Compared with RT, ICT demonstrated an improvement in QALYs (+0.17) and an ICER of $44,879. Compared with RT, ICT+RM demonstrated a larger improvement in QALYs (+0.53) with an ICER of $53,062. Modelling a 25% cost reduction with a rituximab biosimilar led to further ICER reductions: ICT ($29,078) ICT+RM ($37,810). Conclusion: Although the initial healthcare-associated costs were higher than RT, over a 15-year horizon ICT and ICT+RM are cost-effective treatments in early stage FL from the Australian tax-payer perspective. Although the costs may differ internationally, the results remain broadly generalisable given the costs incurred related to time in the failure-free state. Table 1:Comparison of healthcare costs, quality-adjusted life-years and cost-effectiveness between front-line therapies in early stage FL Table 1 Tobin: Gilead: Research Funding. Gandhi:Gilead Sciences: Honoraria Mater Research: Current Employment Janssen-Cilag: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding Roche: Other: Travel, accommodation, expenses Genentech: Honoraria Amgen: Honoraria Merck Sharp & Dohme: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees Bristol-Myers Squibb: Research Funding Celgene: Research Funding. Mollee:Amgen: Membership on an entity's Board of Directors or advisory committees Takeda: Membership on an entity's Board of Directors or advisory committees Pfizer: Membership on an entity's Board of Directors or advisory committees Caelum: Membership on an entity's Board of Directors or advisory committees Janssen: Membership on an entity's Board of Directors or advisory committees, Research Funding BMS/Celgene: Membership on an entity's Board of Directors or advisory committees.

Case-control study of risk factors for fatal and non-fatal injury in crashes of rotary-wing aircraft

Publisher: Elsevier BV

Date: 2006

DOI: 10.1016/J.JSR.2006.02.006

Abstract: There have been few studies of the risk factors for fatal injury in air crashes of rotary-wing aircraft, and none of risk factors for all serious injury (fatal and non-fatal) in these aircraft. The aim of the study was to identify the potentially modifiable risk factors for injury in civil rotary-wing aircraft crashes in New Zealand. We analyzed records from all reported civil rotary-wing aircraft crashes in New Zealand between 1988 and 1994. Air crash data from the official databases were merged with nationwide injury records and information obtained from Coroner's files. Crashes where the pilot-in-command was fatally injured were compared with crashes where the pilot-in-command was not fatally injured on 50 variables, covering pilot, aircraft, environmental, and operational characteristics. A second analysis compared crashes where the pilot-in-command was seriously injured (either fatally or non-fatally) with crashes where the pilot-in-command was not hospitalized with an injury. A series of multivariate logistic regression analyses were conducted to estimate the odds associated with each of the factors identified by the univariate analyses. The most significant risk factors for all serious injury were: (a) not obtaining a weather briefing, (b) off-airport location of the crash site, (c) flights carried out for air transport purposes, and (d) non-solo flights. Other risk factors, significant for fatal injury only, included post-crash fire and the nature of the crash terrain. Factors within the control of the pilot, environmental, and flight characteristics are the key determinants of the injury outcome of civil rotary-wing aircraft crashes.

Incidence and costs of unintentional falls in older people in the United Kingdom

Publisher: BMJ

Date: 09-2003

DOI: 10.1136/JECH.57.9.740

Abstract: To estimate the number of accident and emergency (A&E) attendances, admissions to hospital, and the associated costs as a result of unintentional falls in older people. Analysis of national databases for cost of illness. United Kingdom, 1999, cost to the National Health Service (NHS) and Personal Social Services (PSS). Four age groups of people 60 years and over (60-64, 65-69, 70-74, and >/=75) attending an A&E department or admitted to hospital after an unintentional fall. Databases analysed were the Home Accident Surveillance System (HASS) and Leisure Accident Surveillance System (LASS), and Hospital Episode Statistics (HES). There were 647,721 A&E attendances and 204,424 admissions to hospital for fall related injuries in people aged 60 years and over. For the four age groups A&E attendance rates per 10,000 population were 273.5, 287.3, 367.9, and 945.3, and hospital admission rates per 10,000 population were 34.5, 52.0, 91.9, and 368.6. The cost per 10,000 population was pound 300,000 in the 60-64 age group, increasing to pound 1,500,000 in the >/=75 age group. These falls cost the UK government pound 981 million, of which the NHS incurred 59.2%. Most of the costs (66%) were attributable to falls in those aged >/=75 years. The major cost driver was inpatient admissions, accounting for 49.4% of total cost of falls. Long term care costs were the second highest, accounting for 41%, primarily in those aged >/=75 years. Unintentional falls impose a substantial burden on health and social services.

Correction to: Recommendations from Two Citizens’ Juries on the Surgical Management of Obesity (Obesity Surgery, (2018), 28, 6, (1745-1752), 10.1007/s11695-017-3089-4)

Publisher: Springer Science and Business Media LLC

Date: 20-02-2018

DOI: 10.1007/S11695-018-3112-4

Abstract: The spelling of the name of author K. Chalkidou was incorrect in the original article. It is correct here.

A link between labor participation, mental health and class of medication for mental well-being

Publisher: Elsevier BV

Date: 10-2014

DOI: 10.1016/J.EAP.2014.11.006

EQ-5D-3L derived population norms for health related quality of life in Sri Lanka

Publisher: Public Library of Science (PLoS)

Date: 03-11-2014

DOI: 10.1371/JOURNAL.PONE.0108434

Health economics in decision making for influenza management

Publisher: Elsevier BV

Date: 10-2001

DOI: 10.1016/S0531-5131(01)00329-6

How long should we ignore imperfect detection of species in the marine environment when modelling their distribution?

Publisher: Wiley

Date: 02-04-2014

DOI: 10.1111/FAF.12039

New Zealand bicycle helmet law--do the costs outweigh the benefits?

Publisher: BMJ

Date: 12-2002

DOI: 10.1136/IP.8.4.317

Abstract: This paper examines the cost effectiveness of the compulsory bicycle helmet wearing law (HWL) introduced in New Zealand on 1 January 1994. The societal perspective of costs is used for the purchase of helmets and the value of injuries averted. This is augmented with healthcare costs averted from reduced head injuries. Three age groups were examined: cyclists aged 5-12 years, 13-18 years, and >/=19 years. The number of head and non-head injuries averted were obtained from epidemiological studies. Estimates of the numbers of cyclists and the costs of helmets are used to derive the total spending on new bicycle helmets. Healthcare costs were obtained from national hospitalisation database, and the value of injuries averted was obtained directly from a willingness-to-pay survey undertaken by the Land Transport Safety Authority. Cost effectiveness ratios, benefit:cost ratios, and the value of net benefits were estimated. The net benefit (benefit:cost ratios) of the HWL for the 5-12, 13-18, and >/=19 year age groups was $0.3m (2.6), -$0.2m (0.8), and -$1.5m (0.7) (in NZ $, 2000 prices NZ $1.00 = US $0.47 = UK pound 0.31 approx). These results were most sensitive to the cost and life of helmets, helmet wearing rates before the HWL, and the effectiveness of helmets in preventing head injuries. The HWL was cost saving in the youngest age group but large costs from the law were imposed on adult (>/=19 years) cyclists.

The Cost Consequences of the Gold Coast Integrated Care Programme

Publisher: Ubiquity Press, Ltd.

Date: 15-09-2021

DOI: 10.5334/IJIC.5542

Patient preferences for the delivery of disease management in chronic heart failure: A qualitative study

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 05-2012

DOI: 10.1097/JCN.0B013E31821ABF22

Cost effectiveness and budget impact of lamivudine antiviral treatment for chronic hepatitis type B patients in Taiwan

Publisher: Elsevier BV

Date: 11-2005

DOI: 10.1016/S1098-3015(10)67509-2

Economic evaluation of a school clinic intervention to prevent rheumatic fever

Publisher: Elsevier BV

Date: 05-2013

DOI: 10.1016/J.JVAL.2013.03.962

Retaining volunteers for the cause: Hope and pride associated with cause‐related charity events in cancer control

Publisher: Wiley

Date: 05-01-2022

DOI: 10.1002/NVSM.1707

Abstract: Special charity events are an important source of revenue for non‐profit organisations in cancer control yet volunteering is declining and turnover is high. Experiences at cause‐related events may influence retention, particularly emotions connected to the cause and ceremonies which honour cancer survivors and remember loved ones. We explore the degree to which emotions associated with cause‐related volunteering and collective action in the literature are felt in response to Relay For Life and what emotions predict three indicators of retention: intention to return for future events, satisfaction with volunteering, and organisational commitment. Volunteers ( n = 410) completed a cross‐sectional survey at Relay For Life events in Queensland, Australia. Multiple regression analyses examined whether emotions associated with events predicted each indicator of retention, adjusting for number of years spent volunteering for events. Sixty‐two percent reported an intention to return the following year. The most commonly reported event‐related emotions were hope, pride, and empathy (62–69%). Intention to return, satisfaction, and commitment were each significantly predicted by hope and pride. The findings suggest special charity events in cancer control could retain volunteers by fostering pride and hope (e.g., for a cancer free future) however, future prospective research which examines the mechanisms of these relationships is warranted.

Exploring the validity of HPQ-based presenteeism measures to estimate productivity losses in the health and education sectors

Publisher: SAGE Publications

Date: 08-2014

DOI: 10.1177/0272989X13497996

Abstract: Background. Illness-related presenteeism (suboptimal work performance) may be a significant factor in worker productivity. Until now, there has been no generally accepted best method of measuring presenteeism across different industries and occupations. This study sought to validate the Health and Work Performance Questionnaire (HPQ)–based measure of presenteeism across occupations and industries and assess the most appropriate method for data analysis. Methods. Work performance was measured using the modified version of the HPQ conducted in workforce s les from the education and health workforce in Queensland, Australia ( N = 30,870) during 2005 and 2006. Three approaches to data analysis of presenteeism measures were assessed using absolute performance, the ratio of own performance to others’ performance, and the difference between others’ and own performance. The best measure is judged by its sensitivity to changes in health indicators. Results. The measure that best correlated to health indicators was absolute presenteeism. For ex le, in the health sector, correlations between physical health status and absolute presenteeism were 4 to 5 times greater than the ratio or difference approaches, and in the education sector, these correlations were twice as large. Using this approach, the estimated cost of presenteeism in 2006 was $Aus8338 and $Aus8092 per worker per annum for the health and education sectors, respectively. Conclusions. The HPQ is a valid measure of presenteeism. Transforming responses by perceived performance of peers is unnecessary as absolute presenteeism correlated best with health indicators. Absolute presenteeism was more insightful for ascertaining the cost of presenteeism.

PDB17 PREDICTED COSTS AND OUTCOMES FROM REDUCED VIBRATION DETECTION IN PEOPLE WITH DIABETES IN THE UK

Publisher: Elsevier BV

Date: 11-2003

DOI: 10.1016/S1098-3015(10)61741-X

Impacts of air pollution on health: evidence from longitudinal cohort data of patients with cardiovascular diseases

Publisher: Springer Science and Business Media LLC

Date: 15-05-2020

DOI: 10.1007/S10198-020-01198-5

Abstract: This study uses longitudinal cohort data to estimate the impacts of air pollution on health outcomes among people first hospitalised with heart diseases. Despite the generally low level of pollution in Australia, we find that acute exposure to pollution increases readmissions to hospitals within 3-12 months after discharge and is more evident among those suffering from heart failure. We further show that chronic exposure to air pollution increases the risk of death within 72 months, hospital admissions and general practitioner (GP) visits. Patients with coronary heart disease or cerebrovascular disease are the most affected groups. Finally, a cost saving of $1.3 billion will be generated to the health sector, if the monthly concentration of PM

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.

Predicting general practice attendance for follow-up cancer care

Publisher: JCFCorp SG PTE LTD

Date: 03-2015

DOI: 10.5993/AJHB.39.2.2

An economic evaluation alongside a randomised controlled trial on psycho-education counselling intervention offered by midwives to address women's fear of childbirth in Australia

Publisher: Elsevier BV

Date: 03-2017

DOI: 10.1016/J.SRHC.2016.08.003

Abstract: The rate of caesarean section continues to increase, and there is evidence that childbirth fear is a contributing factor. Insufficient evidence is available on the impact of reducing childbirth fear on health-related quality of life and health service use. We undertook an economic evaluation of a psycho-education counselling intervention offered by midwives to address women's fear of childbirth in Australia. Pregnant women (n = 339) with high childbirth fear were randomised to a midwife-led psycho-education intervention for childbirth fear or to usual care. This paper presents the economic evaluation of the intervention based on health-related quality of life and health service use from recruitment to six weeks postpartum (n = 184). The changes in health-related quality of life after birth (EQ-5D-3L: 0.016 vs. 0.010, p = 0.833, for usual care and intervention) and total health care use cost (AUS$10,110 vs. AUS$9980, p = 0.819) were similar between groups. The intervention did not increase costs however, in a post hoc analysis, the interventions might be cost-effective for those women with very high childbirth fear. This brief psycho-education intervention by midwives did not improve the health-related quality of life of women, and had no impact on overall cost.

Quality-of-Life Implications of Immediate Surgery and Watchful Waiting in Asymptomatic Aortic Stenosis: A Decision-Analytic Model

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 09-2011

DOI: 10.1161/CIRCOUTCOMES.111.961839

Abstract: Traditional management of severe aortic stenosis (AS) is based on delay in aortic valve replacement (AVR) until the development of symptoms. Surgery for asymptomatic AS has been proposed to reduce the small risk of sudden death before AVR and avoid heart failure (HF) after AVR. Because a trial to compare these options is unlikely, we developed a Markov model to inform the choice between immediate surgery and watchful waiting in asymptomatic AS. We defined health states as preoperative, postoperative, postcomplication, and death. We calculated the implications of watchful waiting, tissue and mechanical AVR-based on risks, transitions, utilities, and cost derived from literature review. Further analyses evaluated situations thought to favor immediate surgery and watchful waiting. Sensitivity analyses were based on the likelihood of preoperative death and HF in follow-up. In the reference case (age, 65 years post-AVR utility, 0.9 annualized pre-AVR mortality, 1% and post-AVR HF, 11.3%), the utility of watchful waiting was superior to that of immediate mechanical or tissue AVR (quality-adjusted life-years, 7.4 versus 5.3 versus 5.3, respectively), and the cost was less than immediate surgery. Sensitivity analyses showed immediate surgery was not likely to be more effective regardless of the yearly probability of post-AVR HF in the watchful waiting group (range, 0% to 80%). Immediate surgery was likely to be effective when pre-AVR annual mortality reached 13%. Immediate surgery in asymptomatic severe AS does not improve outcomes unless risk of sudden death pre-AVR and HF after AVR are higher than currently reported.

We need to talk about values: a proposed framework for the articulation of normative reasoning in health technology assessment

Publisher: Cambridge University Press (CUP)

Date: 27-09-2023

DOI: 10.1017/S1744133123000038

Weather Trumps Festivity? More Cardiovascular Disease Events Occur in Winter than in December Holidays in Queensland, Australia

Publisher: MDPI AG

Date: 27-09-2021

DOI: 10.3390/IJERPH181910158

Abstract: Objective: Cardiovascular disease (CVD) is the leading cause of hospitalisations and deaths in Australia. This study estimates the excess CVD hospitalisations and deaths across seasons and during the December holidays in Queensland, Australia. Methods: The study uses retrospective, longitudinal, population-based cohort data from Queensland, Australia from January 2010 to December 2015. The outcomes were hospitalisations and deaths categorised as CVD-related. CVD events were grouped according to when they occurred in the calendar year. Excess hospitalisations and deaths were estimated using the multivariate ordinary least squares method after adjusting for confounding effects. Results: More CVD hospitalisations and deaths occurred in winter than in summer, with 7811 (CI: 1353, 14,270 p 0.01) excess hospitalisations and 774 (CI: 35, 1513 p 0.01) deaths compared to summer. During the coldest month (July), there was an excess of 42 hospitalisations and 7 deaths per 1000 patients. Fewer CVD hospitalisations (−20 (CI: −29, −9 p 0.01)) occurred during the December holidays than any other period during the calendar year. Non-CVD events were mostly not statistically significant different between periods. Conclusion: Most CVD events in Queensland occurred in winter rather than during the December holidays. Potentially cost-effective initiatives should be explored such as encouraging patients with CVD conditions to wear warmer clothes during cold temperatures and/or insulating the homes of CVD patients who cannot otherwise afford to.

Clinical utility of reproductive carrier screening for preconception and pregnant couples for multiple genetic conditions: a systematic review and meta-analysis

Publisher: Informa UK Limited

Date: 24-04-2023

DOI: 10.1080/14737159.2023.2206519

The Gold Coast Integrated Care Programme: The Perspectives of Patients, Carers, General Practitioners and Healthcare Staff

Publisher: Ubiquity Press, Ltd.

Date: 07-05-2021

DOI: 10.5334/IJIC.5550

Differential impact of a nurse-led, home-based intervention for optimal secondary cardiac prevention on recurrent hospitalization in men and women: the Young @ Heart multicentre, randomized trial

Publisher: Oxford University Press (OUP)

Date: 02-08-2013

DOI: 10.1093/EURHEARTJ/EHT309.P3359

Development of a preference-based heart disease-specific health state classification system using MacNew heart disease-related quality of life instrument

Publisher: Springer Science and Business Media LLC

Date: 26-05-2022

DOI: 10.1007/S11136-021-02884-4

Abstract: The MacNew Heart Disease Health-Related Quality of Life Instrument (MacNew) is a validated, clinically sensitive, 27-item disease-specific questionnaire. This study aimed to develop a new heart disease-specific classification system for the MacNew amenable for use in health state valuation. Patients with heart disease attending outpatient clinics and inpatient wards in Brisbane, Australia, completed MacNew. The development of the new disease-specific classification system included three stages. First, a principal component analysis (PCA) established dimensionality. Second, Rasch analysis was used to select items for each dimension. Third, Rasch analysis was used to explore response-level reduction. In addition, clinician and patient judgement informed item selection. Participants included 685 patients (acute coronary 6%, stable coronary 41%, chronic heart failure 20%). The PCA identified 4 dimensions (restriction, emotion, perception of others, and symptoms). The restriction dimension was ided into physical and social dimensions. One item was selected from each to be included in the classification system. Three items from the emotional dimension and two symptom items were also selected. The final classification system had seven dimensions with four severity levels in each: physical restriction excluded from doing things with other people worn out or low in energy frustrated, impatient or angry unsure and lacking in self-confidence shortness of breath and chest pain. This study generated a brief heart disease-specific classification system, consisting of seven dimensions with four severity levels in each. The classification system is amenable to valuation to enable the generation of utility value sets to be developed for use in economic evaluation.

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.

Use of anthropogenic sea floor structures by Australian fur seals: Potential positive ecological impacts of marine industrial development?

Publisher: Public Library of Science (PLoS)

Date: 07-2015

DOI: 10.1371/JOURNAL.PONE.0130581

Systematic review of trial-based analyses reporting the economic impact of heart failure management programs compared with usual care

Publisher: Oxford University Press (OUP)

Date: 16-10-2016

DOI: 10.1177/1474515114556031

Abstract: The cost-effectiveness of heart failure management programs (HF-MPs) is highly variable. We explored intervention and clinical characteristics likely to influence cost outcomes. A systematic review of economic analyses alongside randomized clinical trials comparing HF-MPs and usual care. Electronic databases were searched for English peer-reviewed articles published between 1990 and 2013. Of 511 articles identified, 34 comprising 35 analyses met the inclusion criteria. Eighteen analyses (51%) reported a HF-MP as more effective and less costly four analyses (11%), and five analyses (14%) also reported they were more effective but with no significant or an increased cost difference, respectively. Alternatively, five analyses (14%) reported no statistically significant difference in effects or costs, and one analysis (3%) reported no statistically significant effect difference but was less costly. Finally, two analyses (6%) reported no statistically significant effect difference but were more costly. Interventions that reduced hospital admissions tended to result in favorable cost outcomes, moderated by increased resource use, intervention cost and/or the durability of the intervention effect. The reporting quality of economic evaluation assessed by the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist varied substantially between 5% and 91% (median 45% 34 articles) of the checklist criteria adequately addressed. Overall, none of the study, patient or intervention characteristics appeared to independently influence the cost-effectiveness of a HF-MP. The extent that HF-MPs reduce hospital readmissions appears to be associated with favorable cost outcomes. The current evidence does not provide a sufficient evidence base to explain what intervention or clinical attributes may influence the cost implications.

Impact of a nurse-led home and clinic-based secondary prevention programme to prevent progressive cardiac dysfunction in high-risk individuals: the Nurse-led Intervention for Less Chronic Heart Failure (NIL-CHF) randomized controlled study

Publisher: Wiley

Date: 21-04-2015

DOI: 10.1002/EJHF.272

Abstract: The aim of this study was to determine the effectiveness of a long-term, nurse-led, multidisciplinary programme of home/clinic visits in preventing progressive cardiac dysfunction in in iduals at risk of developing de novo chronic heart failure (CHF). A pragmatic, single-centre (tertiary-referral hospital with specialist cardiological services), open-label, randomized controlled trial with blinded endpoint adjudication was carried out. In total, 624 cardiac inpatients (66 ± 11 years, 71% male, and 70% with CAD) were randomly allocated (1:1) to standard care or the study intervention. The intention-to-treat cohort comprised 310 standard care and 301 intervention participants. During 51.0 ± 8.2 months follow-up, 38/310 (12%) standard care [mean event-free survival 1865 days, 95% confidence interval (CI) 1817-1913 days] vs. 41/301 (14%) intervention participants (1855 days, 95% CI 1804-1906 days) experienced the primary composite endpoint of de novo CHF hospitalization or all-cause mortality (P = 0.574). Although there were no statistically significant differences in the rate of cardiovascular-related and emergency hospitalizations, the NIL-CHF (Nurse-led Intervention for Less Chronic Heart Failure) group accumulated 478 (0.214 ± 0.70 vs. 0.095 ± 0.284 days articipant/month P = 0.052) and 1097 fewer days of hospital stay (0.391 ± 1.80 vs. 0.199 ± 0.47 days articipant/month P = 0.023), respectively, compared with standard care. The intervention group also showed better cardiac recovery on echocardiography at 3 years [81/226 (35.8%) vs. 56/225 (24.9%), odds ratio 1.44, 95% CI 1.08-1.92, P = 0.011]. Relative to a high level of standard care, the NIL-CHF intervention was ineffective in preventing CHF and rehospitalization. On the other hand, it was associated with reduced hospital stay and improved cardiac function over the long term. Australian New Zealand Clinical Trials Registry (No. 12608000022369).

Explaining Performance in Elite Middle-Aged Runners: Contributions from Age and from Ongoing and Past Training Factors

Publisher: Human Kinetics

Date: 12-2008

DOI: 10.1123/JSEP.30.6.737

Abstract: Researchers have contended that patterns of age-related decline are not necessarily due to age, but rather to disuse, or declining practice (Bortz, 1982 Ericsson, 2000 Maharam, Bauman, Kalman, Skolnik, & Perle, 1999). A regression approach was used to examine age and training variables as predictors of 10-km running performance between 40 and 59 years of age. A s le of 30 Masters runners ( M age = 50.1 years, M 10-km time = 39:19) reported data for ongoing training, cumulative running in the past 5 years, and cumulative running earlier in a career. In Analysis 1, ongoing training variables explained more variance in performance than age alone, and reduced the unique variance attributable to age in a combined model. In Analysis 2, findings were replicated using past cumulative running variables and age running in the past 5 years explained more unique variance than age alone. Discussion focuses on how findings relate to the selective maintenance account (Kr e & Ericsson, 1996), how various aspects of training help to preserve performance in aging populations, and recommendations for future research.

Genetic testing for inherited heart diseases: Longitudinal impact on health-related quality of life

Publisher: Elsevier BV

Date: 08-2012

DOI: 10.1038/GIM.2012.47

Abstract: Purpose:A genetic diagnosis is an extremely useful tool in the management and care of families with inherited heart diseases, particularly in allowing clarification of risk status of asymptomatic family members. The psychosocial consequences of genetic testing in this group are poorly understood. This longitudinal pilot study sought to determine changes in health-related quality of life in patients and asymptomatic family members undergoing genetic testing for inherited heart diseases.Methods:In iduals attending two specialized multidisciplinary cardiac genetic clinics in Australia were invited to participate. Patients undergoing proband or predictive genetic testing for an inherited cardiomyopathy or primary arrhythmogenic disorder were eligible. The Medical Outcomes Short Form-36 (version 2) was administered before the genetic result was given, and follow-up surveys were completed 1-3, 6, and 12 months after the result was given.Results:A total of 54 in iduals with hypertrophic cardiomyopathy, familial dilated cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, and long QT syndrome completed baseline and at least one follow-up survey, including 33 probands and 21 asymptomatic relatives. Physical and mental component scores analyzed at baseline and 1-3 months were found to be unchanged in all groups. Furthermore, no significant differences were observed up to 12 months after result.Conclusion:In this longitudinal pilot study, no change in health-related quality of life was observed up to 12 months after the result was given in patients and their asymptomatic family members undergoing genetic testing for an inherited heart disease.Genet Med 2012 advance online publication 3 May 2012.

Habitat Classification of Temperate Marine Macroalgal Communities Using Bathymetric LiDAR

Publisher: MDPI AG

Date: 07-03-2014

DOI: 10.3390/RS6032154

Patient Preferences and Willingness-To-Pay for a Home or Clinic Based Program of Chronic Heart Failure Management: Findings from the Which? Trial

Publisher: Public Library of Science (PLoS)

Date: 07-03-2013

DOI: 10.1371/JOURNAL.PONE.0058347

Developing a cerebral palsy-specific preference-based measure for a six-dimensional classification system (CP-6D): protocol for a valuation study

Publisher: BMJ

Date: 09-2019

DOI: 10.1136/BMJOPEN-2019-029325

Abstract: Cerebral palsy (CP) is a lifelong condition. The CP quality of life (CPQOL) instrument is a frequently used disease-specific instrument to assess health-related quality of life (HRQoL) in people with CP, but it cannot be used to generate quality-adjusted life years (QALY) which are the basis of cost utility analysis (CUA). Generic utility instruments (such as the EQ-5D or SF-6D) that are used to value HRQOL may be insensitive to small but important health changes in children with CP. This study aims to generate a preference-based scoring algorithm for the CP six dimensions (CP-6D), a classification system developed from the CPQOL. A discrete choice experiment with duration (DCEtto) will be administrated to value health states described by the CP-6D classification system. These health states will be presented to members of Australian general population and parents of children with CP via an online survey. Conditional logit regression will be used to produce the utility algorithm for CP-6D. The Griffith University Human Research Ethics Committee approved for the study (reference HREC/number 2018/913). The developed algorithm can be applied to previous and future economic evaluation of interventions and treatments targeting people with CP which have used either the CPQOL or CP-6D.

Healthcare resource use in patients of the Australian Transition Care Program

Publisher: CSIRO Publishing

Date: 2015

DOI: 10.1071/AH14054

Abstract: Objective The aim of the present study was to describe, from the perspective of the healthcare funder, the cost components of the Australian Transition Care Program (TCP) and the healthcare resource use and costs for a group of transition care clients over a 6-month period following admission to the program. Methods A prospective cohort observational study of 351 consenting patients entering community-based transition care at six sites in two states in Australia from November 2009 to September 2010 was performed. Patients were followed up 6 months after admission to the TCP to ascertain current living status and hospital re-admissions over the follow-up period. Cost data were collected by transition care teams and from administrative data (hospital and Medicare records). Results The TCP provides a range of services with most costs attributed to provision of personal care support, case management, physiotherapy and occupational therapy. Most healthcare costs up to 6 months after transition care admission were incurred from the hospital admission leading to transition care and from re-admissions. Orthopaedic conditions incurred the highest costs, with many of these for elective procedures and others resulting from falls. Hospital re-admission rates in the present study were 10% lower than in a previous evaluation of the TCP. Over 6 months, approximately 40% of patients in the study were re-admitted to hospital at an average cost of A$7038. Conclusions Although the cost of the TCP is relatively high, it may have some impact on reducing hospital re-admissions and preventing or delaying residential care admissions. What is known about the topic? A majority of healthcare costs occur in older age. What does this paper add? Hospital costs, both initial and re-admissions, are the major contributor to healthcare costs in transition care recipients. Orthopaedic conditions are the most expensive to treat and neurological conditions are the most variable. What are the implications for practitioners? Reducing the length of hospitalisation and reducing re-admissions for older frail people is a key economic concern for health services. Services such as the TCP aim to do both however, the evidence that this is effective is limited. Streamlining referrals to transition care to enable earlier access and involving the transition care provider in re-admission decisions may help reduce healthcare costs in future.

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 structure and process evaluation of a police Watch House Emergency Nurse (WHEN) model of care

Publisher: Elsevier BV

Date: 11-2019

DOI: 10.1016/J.IENJ.2019.100790

Abstract: Increasing presentations to the Emergency Department (ED) via police (which include detainees, prisoners and community residing persons) and the increase in chronic and mental health illness in detainee and prisoner populations has prompted an increased requirement for healthcare delivery within the custodial environment. This study aimed to describe the Watch House Emergency Nurse (WHEN) role, focusing on structures and processes underpinning the role. In this qualitative, descriptive study, semi-structured interviews were undertaken in 2015 with 14 key stakeholders from health, police, and ambulance services. Interviews were analysed using content analysis to inform the findings. Important structural elements of the WHEN role included an ED triage competent registered nurse, a 2-day integrated training program, and clear guidelines to provide a framework for identifying, prioritising and managing healthcare needs. Important process elements were clear communication between nurses, police, and medical staff, and a clear understanding of roles and responsibilities to facilitate continuity of care and appropriate referral. The underpinning perceived benefit of the WHEN role was 'safety'. This was in terms of personal, professional, and detainee safety. The structures and processes underpinning the innovative WHEN role provides a valuable foundation for guiding evaluations of other nursing roles in other early custody settings.

Do consumer voices in health‐care citizens’ juries matter?

Publisher: Wiley

Date: 28-09-2015

DOI: 10.1111/HEX.12397

Spectrum of neurodevelopmental disease associated with the GNAO1 guanosine triphosphate-binding region.

Publisher: Wiley

Date: 25-01-2019

DOI: 10.1111/EPI.14653

Understanding implementability in clinical trials: a pragmatic review and concept map

Publisher: Springer Science and Business Media LLC

Date: 26-03-2021

DOI: 10.1186/S13063-021-05185-W

Abstract: The translation of evidence from clinical trials into practice is complex. One approach to facilitating this translation is to consider the ‘implementability’ of trials as they are designed and conducted. Implementability of trials refers to characteristics of the design, execution and reporting of a late-phase clinical trial that can influence the capacity for the evidence generated by that trial to be implemented. On behalf of the Australian Clinical Trials Alliance (ACTA), the national peak body representing networks of clinician researchers conducting investigator-initiated clinical trials, we conducted a pragmatic literature review to develop a concept map of implementability. Documents were included in the review if they related to the design, conduct and reporting of late-phase clinical trials described factors that increased or decreased the capacity of trials to be implemented and were published after 2009 in English. Eligible documents included systematic reviews, guidance documents, tools or primary studies (if other designs were not available). With an expert reference group, we developed a preliminary concept map and conducted a snowballing search based on known relevant papers and websites of key organisations in May 2019. Sixty-five resources were included. A final map of 38 concepts was developed covering the domains of validity, relevance and usability across the design, conduct and reporting of a trial. The concepts drew on literature relating to implementation science, consumer engagement, pragmatic trials, reporting, research waste and other fields. No single resource addressed more than ten of the 38 concepts in the map. The concept map provides trialists with a tool to think through a range of areas in which practical action could enhance the implementability of their trials. Future work could validate the strength of the associations between the concepts identified and implementability of trials and investigate the effectiveness of steps to address each concept. ACTA will use this concept map to develop guidance for trialists in Australia. This review did not include health-related outcomes and was therefore not eligible for registration in the PROSPERO register.

The Baby Steps Web Program for the Well-Being of New Parents: Randomized Controlled Trial

Publisher: JMIR Publications Inc.

Date: 26-11-2021

DOI: 10.2196/23659

Abstract: New parents face increased risks of emotional distress and relationship dissatisfaction. Digital interventions increase support access, but few preventive programs are optimized for both parents. This study aims to conduct the first randomized controlled trial on universal self-guided digital programs to support positive perinatal adjustment of both mothers and fathers. Effects of childcare information (Baby Care) and information plus an interactive program (Baby Steps Wellbeing) were compared from the third trimester baseline to 3 and 6 months subsequently. The study recruited 388 co-parenting male-female adult couples expecting their first single child (26-38 weeks’ gestation), using web-based registration. Most (337/388, 86.8%) were obtained from prenatal hospital classes. Couples’ randomization was automated and stratified by Edinburgh Postnatal Depression Scale (EPDS) scores (50% couples scored high if either mother , father ). All assessments were web-based self-reports: the EPDS and psychosocial quality of life were primary outcomes relationship satisfaction, social support, and self-efficacy for parenting and support provision were secondary. Linear mixed models provided intention-to-treat analyses, with linear and quadratic effects for time and random intercepts for participants and couples. Selection criteria were met by 63.9% (248/388) of couples, who were all randomized. Most participants were married (400/496, 80.6%), tertiary educated (324/496, 65.3%), employed full time (407/496, 82%), and born in Australia (337/496, 67.9%). Their mean age was 32.2 years, and average gestation was 30.8 weeks. Using an EPDS cutoff score of 13, 6.9% (18/248) of men, and 16.1% (40/248) of women screened positive for depression at some time during the 6 months. Retention of both partners was 80.6% (201/248) at the 6-month assessments, and satisfaction with both programs was strong (92% ≥50). Only 37.3% (185/496) of participants accessed their program more than once, with higher rates for mothers (133/248, 53.6%) than fathers (52/248, 20.9% P .001). The EPDS, quality of life, and social support did not show differential improvements between programs, but Baby Steps Wellbeing gave a greater linear increase in self-efficacy for support provision (P=.01 Cohen d=0.26) and lower reduction in relationship satisfaction (P=.03 Cohen d=0.20) than Baby Care alone. Mothers had greater linear benefits in parenting self-efficacy over time than fathers after receiving Baby Steps Wellbeing rather than Baby Care (P=.01 Cohen d=0.51). However, the inclusion of program type in analyses on parenting self-efficacy and relationship satisfaction did not improve model fit above analyses with only parent gender and time. Three secondary outcomes showed differential benefits from Baby Steps Wellbeing, but for one (parenting self-efficacy), the effect only occurred for mothers, perhaps reflecting their greater program use. Increased engagement will be needed for more definitive testing of the potential benefits of Baby StepsWellbeing for perinatal adjustment. Australian New Zealand Clinical Trials Registry ACTRN12614001256662 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=367277

Mitii™ ABI: study protocol of a randomised controlled trial of a web-based multi-modal training program for children and adolescents with an Acquired Brain Injury (ABI).

Publisher: Springer Science and Business Media LLC

Date: 19-08-2015

DOI: 10.1186/S12883-015-0381-6

Cost–utility analysis comparing hospital‐based intravenous immunoglobulin with home‐based subcutaneous immunoglobulin in patients with secondary immunodeficiency

Publisher: Wiley

Date: 18-03-2019

DOI: 10.1111/VOX.12760

Abstract: Immunoglobulin replacement therapy (IRT) is often used to support patients with primary immunodeficiency disease (PID) and secondary immunodeficiency disease (SID). Home-based subcutaneous immunoglobulin (SCIg) is reported to be a cheaper and more efficient option compared to hospital-based intravenous immunoglobulin (IVIg) for PID. In contrast, there is little information on the cost-effectiveness of IRT in SID. However, patients who develop hypogammaglobulinaemia secondary to other conditions (SID) have different clinical aetiology compared to PID. This study assesses whether SCIg provides a good value-for-money treatment option in patients with secondary immunodeficiency disease (SID). A Markov cohort simulation model with six health states was used to compare cost-effectiveness of IVIg with SCIg from a healthcare system perspective. The costs of treatment, infection and quality-adjusted life years (QALYs) for IVIg and SCIg treatment options were modelled with a time horizon of 10 years and weekly cycles. Deterministic and probabilistic sensitivity analyses were performed around key parameters. The cumulative cost for IVIg was A$151 511 and for SCIg A$144 296. The QALYs with IVIg were 3·07 and with SCIg 3·51. Based on the means, SCIg is the dominant strategy with better outcomes and at lower cost. The probabilistic sensitivity analysis shows that 88·3% of the 50 000 iterations fall below the nominated willingness to pay threshold of A$50 000 per QALY. Therefore, SCIg is a cost-effective treatment option. For SID patients in Queensland (Australia), the home-based SCIg treatment option provides better health outcomes and cost savings.

The cost-effectiveness of a universal influenza vaccination program for adults aged 50–64 years in Australia

Publisher: Elsevier BV

Date: 04-2008

DOI: 10.1016/J.VACCINE.2008.01.050

Abstract: Currently the Australian government funds universal influenza vaccine for all those aged > or =65 years under the National Immunisation Program (NIP). Annual vaccination rates in those aged 50-64 years are significantly lower than vaccination rates in those aged > or =65 years, and currently less than half those at high-risk of influenza-related complications aged 50-64 years are immunised. This study used a decision tree model to examine the cost-effectiveness of lowering the age threshold for the influenza NIP in Australia to include those aged 50-64 years. From a healthcare payer perspective, a new influenza vaccination policy would cost $8908/QALY gained. From a societal perspective, a new influenza vaccination policy would cost $8338/QALY gained. From a governmental perspective, a new influenza vaccination policy would cost $22,408/QALY gained. The most influential parameters in deterministic sensitivity analysis included: probability of death due to influenza, vaccine efficacy against mortality, vaccine uptake, vaccine cost, and vaccine administration cost. Influenza vaccination for people aged 50-64 years appears highly cost-effective, and should be a strong candidate for funding under the NIP.

Intravenous 0.9% sodium chloride therapy does not reduce length of stay of alcohol-intoxicated patients in the emergency department: A randomised controlled trial

Publisher: Wiley

Date: 08-11-2013

DOI: 10.1111/1742-6723.12151

A review of the cost-effectiveness of genetic testing for germline variants in familial cancer

Publisher: Informa UK Limited

Date: 16-12-2022

DOI: 10.1080/13696998.2022.2152233

Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) statement: updated reporting guidance for health economic evaluations

Publisher: Springer Science and Business Media LLC

Date: 27-01-2022

DOI: 10.1007/S10198-021-01426-6

Abstract: Health economic evaluations are comparative analyses of alternative courses of action in terms of their costs and consequences. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement, published in 2013, was created to ensure health economic evaluations are identifiable, interpretable, and useful for decision making. It was intended as guidance to help authors report accurately which health interventions were being compared and in what context, how the evaluation was undertaken, what the findings were, and other details that may aid readers and reviewers in interpretation and use of the study. The new CHEERS 2022 statement replaces previous CHEERS reporting guidance. It reflects the need for guidance that can be more easily applied to all types of health economic evaluation, new methods and developments in the field, as well as the increased role of stakeholder involvement including patients and the public. It is also broadly applicable to any form of intervention intended to improve the health of in iduals or the population, whether simple or complex, and without regard to context (such as health care, public health, education, social care, etc.). This summary article presents the new CHEERS 2022 28-item checklist and recommendations for each item. The CHEERS 2022 statement is primarily intended for researchers reporting economic evaluations for peer reviewed journals as well as the peer reviewers and editors assessing them for publication. However, we anticipate familiarity with reporting requirements will be useful for analysts when planning studies. It may also be useful for health technology assessment bodies seeking guidance on reporting, as there is an increasing emphasis on transparency in decision making.

A systematic review of scope and quality of health economic evaluations conducted in Ethiopia

Publisher: Oxford University Press (OUP)

Date: 21-02-2022

DOI: 10.1093/HEAPOL/CZAC005

Abstract: There has been an increased interest in health technology assessment and economic evaluations for health policy in Ethiopia over the last few years. In this systematic review, we examined the scope and quality of healthcare economic evaluation studies in Ethiopia. We searched seven electronic databases (PubMed/MEDLINE, EMBASE, PsycINFO, CINHAL, Econlit, York CRD databases and CEA Tufts) from inception to May 2021 to identify published full health economic evaluations of a health-related intervention or programme in Ethiopia. This was supplemented with forward and backward citation searches of included articles, manual search of key government websites, the Disease Control Priorities-Ethiopia project and WHO-CHOICE programme. The quality of reporting of economic evaluations was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. The extracted data were grouped into subcategories based on the subject of the economic evaluation, organized into tables and reported narratively. This review identified 34 full economic evaluations conducted between 2009 and 2021. Around 14 (41%) of studies focussed on health service delivery, 8 (24%) on pharmaceuticals, vaccines and devices, and 4 (12%) on public-health programmes. The interventions were mostly preventive in nature and focussed on communicable diseases (n = 19 56%) and maternal and child health (n = 6 18%). Cost-effectiveness ratios varied widely from cost-saving to more than US $37 313 per life saved depending on the setting, perspectives, types of interventions and disease conditions. While the overall quality of included studies was judged as moderate (meeting 69% of CHEERS checklist), only four out of 27 cost-effectiveness studies characterized heterogeneity. There is a need for building local technical capacity to enhance the design, conduct and reporting of health economic evaluations in Ethiopia.

Within trial cost-utility analysis of disease management program for patients hospitalized with atrial fibrillation: Results from the SAFETY trial

Publisher: Informa UK Limited

Date: 04-07-2019

DOI: 10.1080/13696998.2019.1631831

A model of traffic crashes in New Zealand

Publisher: Elsevier BV

Date: 09-2002

DOI: 10.1016/S0001-4575(01)00067-7

Abstract: The aim of this study was to examine the changes in the trend and seasonal patterns in fatal crashes in New Zealand in relation to changes in economic conditions between 1970 and 1994. The Harvey and Durbin (Journal of the Royal Statistical Society 149 (3) (1986) 187-227) structural time series model (STSM), an 'unobserved components' class of model, was used to estimate models for quarterly fatal traffic crashes. The dependent variable was modelled as the number of crashes and three variants of the crash rate (crashes per 10,000 km travelled, crashes per 1,000 vehicles, and crashes per 1000 population). Independent variables included in the models were unemployment rate (UER), real gross domestic product per capita, the proportion of motorcycles, the proportion of young males in the population, alcohol consumption per capita, the open road speed limit, and dummy variables for the 1973 and 1979 oil crises and seat belt wearing laws. UERs, real GDP per capita, and alcohol consumption were all significant and important factors in explaining the short-run dynamics of the models. In the long-run, real GDP per capita was directly related to the number of crashes but after controlling for distance travelled was not significant. This suggests increases in income are associated with a short-run reduction in risk but increases in exposure to a crash (i.e. distance travelled) in the long-run. A 1% increase in the open road speed limit was associated with a long-run 0.5% increase in fatal crashes. Substantial reductions in fatal crashes were associated with the 1979 oil crisis and seat belt wearing laws. The 1984 universal seat belt wearing law was associated with a sustained 15.6% reduction in fatal crashes. These road policy factors appeared to have a greater influence on crashes than the role of demographic and economic factors.

A cost-effectiveness analysis of front-line treatment strategies in early-stage follicular lymphoma

Publisher: Informa UK Limited

Date: 29-07-2021

DOI: 10.1080/10428194.2021.1957866

Abstract: Recent data suggest the use of radiotherapy alone (RT) in Early-Stage Follicular Lymphoma is declining. Cost-effectiveness analysis of treatments has not been performed. We constructed a partitioning model (15-year horizon) to compare RT, combined-modality therapy (CMT) and immunochemotherapy with rituximab maintenance (ICT + RM) from a PET-staged cohort from the Australian Lymphoma Alliance. Lifetime direct health care costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs) were calculated. AUD $75,000 was defined as the willingness-to-pay threshold (WTP). The direct healthcare costs were: RT $12,791, CMT $29,391 and ICT + RM $42,644. Compared with RT, CMT demonstrated minimal improvement in QALYs (+0.01) and an ICER well above the WTP threshold ($1,535,488). Compared with RT, ICT + RM demonstrated an improvement in QALYs (+0.41) with an ICER of $73,319. Modeling a 25% cost reduction with a rituximab biosimilar led to further ICER reductions with ICT + RM ($52,476). ICT + RM is cost-effective in early-stage FL from the Australian taxpayer perspective.

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.

High Costs of Management of Oral Cancer in Sri Lanaka Mandate Prevention as Priority

Publisher: Elsevier BV

Date: 2018

DOI: 10.2139/SSRN.3253316

PCV45 MEDICAL MALPRACTICE AND LITIGATION:WHAT DOES THIS MEAN FOR THE COST-EFFECTIVENESS OF DIAGNOSING CHEST PAIN?

Publisher: Elsevier BV

Date: 11-2010

DOI: 10.1016/S1098-3015(11)73171-0

The Internet of Things: Impact and Implications for Health Care Delivery

Publisher: JMIR Publications Inc.

Date: 10-11-2020

DOI: 10.2196/20135

Abstract: The Internet of Things (IoT) is a system of wireless, interrelated, and connected digital devices that can collect, send, and store data over a network without requiring human-to-human or human-to-computer interaction. The IoT promises many benefits to streamlining and enhancing health care delivery to proactively predict health issues and diagnose, treat, and monitor patients both in and out of the hospital. Worldwide, government leaders and decision makers are implementing policies to deliver health care services using technology and more so in response to the novel COVID-19 pandemic. It is now becoming increasingly important to understand how established and emerging IoT technologies can support health systems to deliver safe and effective care. The aim of this viewpoint paper is to provide an overview of the current IoT technology in health care, outline how IoT devices are improving health service delivery, and outline how IoT technology can affect and disrupt global health care in the next decade. The potential of IoT-based health care is expanded upon to theorize how IoT can improve the accessibility of preventative public health services and transition our current secondary and tertiary health care to be a more proactive, continuous, and coordinated system. Finally, this paper will deal with the potential issues that IoT-based health care generates, barriers to market adoption from health care professionals and patients alike, confidence and acceptability, privacy and security, interoperability, standardization and remuneration, data storage, and control and ownership. Corresponding enablers of IoT in current health care will rely on policy support, cybersecurity-focused guidelines, careful strategic planning, and transparent policies within health care organizations. IoT-based health care has great potential to improve the efficiency of the health system and improve population health.

Valuing the Dental Caries Utility Index in Australia

Publisher: SAGE Publications

Date: 19-09-2023

DOI: 10.1177/0272989X231197149

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.

Health technology assessments reporting cost-effectiveness of transcatheter aortic valve implantation

Publisher: Cambridge University Press (CUP)

Date: 2016

DOI: 10.1017/S0266462316000180

Abstract: Objectives: Made available since 2002, transcatheter aortic valve implantation (TAVI) is a minimally invasive new intervention which can provide significant survival improvement to patients with aortic stenosis. However, TAVI is expensive and currently not reimbursed by many governments. Some governments and institutions have been conducting health technology assessments (HTAs) to inform their reimbursement decisions. The aim of the present study is to review HTAs that have relied on a cost-effectiveness analysis to inform reimbursement decisions of TAVI. Methods: A systematic literature review was conducted among published literature as well as reports released by HTA agencies. Predetermined inclusion and exclusion criteria, following the Preferred Reporting System for Systematic Reviews and Meta-Analysis guidelines, were used to select relevant HTAs. The selected papers were assessed against the Consolidated Health Economic Evaluation Reporting Standards. Results: HTAs on TAVI from three countries were available for this review: Canada, Belgium, and the United Kingdom. All three HTAs used the Placement of Aortic Transcatheter Valve (PARTNER) trial data with Markov models to estimate the incremental cost effectiveness ratio. The three HTAs recommended conditional reimbursement for TAVI for otherwise inoperable patients. The HTAs did not use clear methods to estimate the health-related utility which ultimately affected their cost-effectiveness results. The UK HTA showed the best value for money (US$20,416 per quality-adjusted life-year). Conclusion: All studies found TAVI to be more costly and less effective for high-risk patients suitable for surgery, whereas TAVI was consistently found to be cost effective for otherwise inoperable patients.

Prioritising patients for bariatric surgery: Building public preferences from a discrete choice experiment into public policy

Publisher: BMJ

Date: 10-2015

DOI: 10.1136/BMJOPEN-2015-008919

Testing for selection bias and moral hazard in private health insurance: Evidence from a mixed public-private health system

Publisher: Wiley

Date: 13-09-2022

DOI: 10.1002/HEC.4605

Abstract: Separating selection bias from moral hazard in private health insurance (PHI) markets has been a challenging task. We estimate selection bias and moral hazard in Australia's mixed public‐private health system, where PHI premiums are community‐rated rather than risk‐rated. Using longitudinal cohort data, with fine‐grained measures for medical services predominantly funded by PHI providers, we find consistent and robust estimates of advantageous selection among hospitalized cardiovascular disease (CVD) patients. Specifically, we show that in addition to their risk‐averse attributes, CVD patients who purchase PHI use fewer services that are not covered by PHI providers (e.g., general practitioners and emergency departments) and have fewer comorbidities. Finally, unlike previous studies, we show that ex‐post moral hazard exists in the use of specific “in‐hospital” medical services such as specialist and physician services, miscellaneous diagnostic procedures, and therapeutic treatments. From the perspective of PHI providers, the annual cost of moral hazard translates to a lower bound estimate of $707 per patient, equivalent to a 3.03% reduction in their annual profits.

Children's untreated decay is positively associated with past caries experience and with current salivary loads of mutans Streptococci; negatively with self‐reported maternal iron supplements during p

Publisher: Wiley

Date: 14-12-2018

DOI: 10.1111/JPHD.12301

Abstract: This study explored the association of children's salivary characteristics, past caries experience, birth weight, and reported maternal prenatal vitamin and mineral supplementation with the dental untreated decay of the child. This cross-sectional study, a sub-study of Griffith University Environments for Healthy Living birth cohort study, was conducted on 174 mother-child dyads. Mother's prenatal usage of vitamin and mineral supplements child's birthweight salivary pH, buffering capacity, and levels of salivary MS and LB were explored as risk indicators. Dental caries experience was assessed using International Caries Detection and Assessment System criteria. Path analysis was conducted to evaluate the association of risk indicators with children's current and past dental caries experience. Children's past caries experience (β = 0.332, p = 0.018), and salivary MS counts (β = 0.215, p = 0.032) were positively associated with untreated decay at time of examination. With a trend towards significance, children whose mothers had reported taking iron supplements during pregnancy experienced lower levels of past caries (β = -0.137, p = 0.068) and untreated dental caries (β = -0.046, p = 0.051). This study confirms that a child's levels of untreated decay is positively associated with their past caries, and that it correlates with current levels of salivary MS. Children of mothers who reported to have taken iron supplements during pregnancy experienced less caries throughout their lives. These observations confirm the importance to offspring of monitoring maternal health throughout pregnancy and of early monitoring of children's oral health in preventing future dental disease.

The association between misperceptions around weight status and quality of life in adults in Australia

Publisher: Springer Science and Business Media LLC

Date: 2017

DOI: 10.1186/S12955-017-0627-7

Comparison of contemporaneous responses for EQ-5D-3L and Minnesota Living with Heart Failure; a case for disease specific multiattribute utility instrument in cardiovascular conditions

Publisher: Elsevier BV

Date: 2017

DOI: 10.1016/J.IJCARD.2016.11.030

Abstract: The EQ-5D-3L, a generic multi-attribute utility instrument (MAUI), is widely employed to assist in economic evaluations in health care. The EQ-5D-3L lacks sensitivity when used in conditions such as cardiovascular disease (CVD). Although there are number of CVD specific quality of life instruments, currently, there are no CVD specific MAUIs. The aim of this study is to investigate the discriminative ability and responsiveness of the EQ-5D-3L and the Minnesota Living with Heart Failure Questionnaire (MLHF), a CVD specific quality of life instrument in a group of heart failure patients. The psychometric performance of the EQ-5D-3L and the MLHF was assessed using data from a randomised trial for a heart failure management intervention. The two instruments were compared for discrimination, responsiveness and agreement. The severity groups were defined using New York Heart Association functional classes. The effect sizes for severe classes were generally similar showing good discrimination. The MLHF recorded better responsiveness between the time points than the EQ-5D-3L which was indicated by higher effect sizes and standardised response means. The change in MLHF summary scores between the time points was significant (p<0.005 paired t-test). The overall agreement between the two measures was low. The low correlation indicates that the two classification systems cover different aspects of health space. Comparison of CVD specific instruments with other generic MAUIs such as EQ-5D-3L and AQOL-8D is recommended for further research.

PCV29 DESIGN OF A DISCRETE CHOICE EXPERIMENT TO QUANTIFY CONSUMER PREFERENCES FOR CHRONIC HEART FAILURE MANAGEMENT PROGRAMS

Publisher: Elsevier BV

Date: 11-2010

DOI: 10.1016/S1098-3015(11)73155-2

Employer Benefits from an Early Intervention Program for Depression: A Cost-Benefit Analysis

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 03-2017

DOI: 10.1097/JOM.0000000000000939

The Association Between Mental Disorders and Productivity in Treated and Untreated Employees

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 09-2009

DOI: 10.1097/JOM.0B013E3181B2EA30

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.

My Diabetes Coach, a Mobile App–Based Interactive Conversational Agent to Support Type 2 Diabetes Self-Management: Randomized Effectiveness-Implementation Trial

Publisher: JMIR Publications Inc.

Date: 05-11-2020

DOI: 10.2196/20322

Abstract: Delivering self-management support to people with type 2 diabetes mellitus is essential to reduce the health system burden and to empower people with the skills, knowledge, and confidence needed to take an active role in managing their own health. This study aims to evaluate the adoption, use, and effectiveness of the My Diabetes Coach (MDC) program, an app-based interactive embodied conversational agent, Laura, designed to support diabetes self-management in the home setting over 12 months. This randomized controlled trial evaluated both the implementation and effectiveness of the MDC program. Adults with type 2 diabetes in Australia were recruited and randomized to the intervention arm (MDC) or the control arm (usual care). Program use was tracked over 12 months. Coprimary outcomes included changes in glycated hemoglobin (HbA1c) and health-related quality of life (HRQoL). Data were assessed at baseline and at 6 and 12 months, and analyzed using linear mixed-effects regression models. A total of 187 adults with type 2 diabetes (mean 57 years, SD 10 years 41.7% women) were recruited and randomly allocated to the intervention (n=93) and control (n=94) arms. MDC program users (92/93 participants) completed 1942 chats with Laura, averaging 243 min (SD 212) per person over 12 months. Compared with baseline, the mean estimated HbA1c decreased in both arms at 12 months (intervention: 0.33% and control: 0.20%), but the net differences between the two arms in change of HbA1c (−0.04%, 95% CI −0.45 to 0.36 P=.83) was not statistically significant. At 12 months, HRQoL utility scores improved in the intervention arm, compared with the control arm (between-arm difference: 0.04, 95% CI 0.00 to 0.07 P=.04). The MDC program was successfully adopted and used by in iduals with type 2 diabetes and significantly improved the users’ HRQoL. These findings suggest the potential for wider implementation of technology-enabled conversation-based programs for supporting diabetes self-management. Future studies should focus on strategies to maintain program usage and HbA1c improvement. Australia New Zealand Clinical Trials Registry (ACTRN) 12614001229662 anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12614001229662

A systematic review of episodic volunteering in public health and other contexts

Publisher: Springer Science and Business Media LLC

Date: 24-09-2014

DOI: 10.1186/1471-2458-14-992

The Association between Social Support and Levels of Psychological Distress in Pregnant Women in Australia

Publisher: Sciknow Publications

Date: 2014

DOI: 10.12966/IJMCH.02.03.2014

Navigating the fine line between benefit and risk in chronic atrial fibrillation: Rationale and design of the Standard versus Atrial Fibrillation spEcific managemenT studY (SAFETY)

Publisher: Elsevier BV

Date: 06-2013

DOI: 10.1016/J.IJCARD.2011.10.065

Abstract: Health outcomes associated with atrial fibrillation (AF) continue to be poor and standard management often does not provide clinical stability. The Standard versus Atrial Fibrillation spEcific managemenT studY (SAFETY) compares the efficacy of a post-discharge, nurse-led, multi-disciplinary programme to optimise AF management with usual care. SAFETY is a prospective, multi-centre, randomised controlled trial with blinded-endpoint adjudication. A target of 320 hospitalised patients with a chronic form of AF will be randomised (stratified by "rate" versus "rhythm" control) to usual post-discharge care or the SAFETY Intervention (SI). The SI involves home-based assessment, extensive clinical profiling and the application of optimal gold-standard pharmacology which is in idually tailored according to a "traffic light" framework based on clinical stability, risk profile and therapeutic management. The primary endpoint is event-free survival from all-cause death or unplanned readmission during 18-36 months follow-up. Secondary endpoints include rate of recurrent hospital stay, treatment success (i.e. maintenance of rhythm or rate control and/or application of anti-thrombotic therapy without a bleeding event) and cost-efficacy. With study recruitment to be completed in early 2012, the results of this study will be available in early 2014. If positive, SAFETY will represent a potentially cost-effective and readily applicable strategy to improve health outcomes in high risk in iduals discharged from hospital with chronic AF.

Misperceptions of objective measurements?

Publisher: American Public Health Association

Date: 06-2000

DOI: 10.2105/AJPH.90.6.988B

Optimising emergency department and acute care for people experiencing mental health problems: a nominal group study

Publisher: CSIRO Publishing

Date: 19-11-2021

DOI: 10.1071/AH21092

Abstract: Objective The aim of this study was to identify potential model of care approaches and systems processes for people presenting to acute healthcare settings with mental health problems, including mental illnesses. Methods Five (consensus) nominal group technique sessions were conducted in 2019 with a purposive s le of stakeholders from health, police, ambulance and consumer agencies (n = 21). Sessions were recorded, transcribed and analysed for thematic content. Results Potential model of care approaches and systems processes for people with mental health problems in the emergency department include: a skilled collaborative approach to care consumer-focused service knowledge improvement early assessment the development of models, systems and processes and the built environment. In the broader acute care setting, the themes of formal care, linking of services, enhancing informal and innovative care options, improving information sharing and enhancing training and education were identified. Conclusions Coherent and multifaceted approaches to the provision of care to people with mental health problems and diagnosed mental illnesses who are requiring emergency care include the linking and sharing of systems and information, changing the built environment and exploring new models of service delivery. What is known about the topic? There is considerable evidence of interventions used in the emergency department and acute healthcare settings for this vulnerable group of people with mental health problems and diagnosed mental illnesses however, the evidence for appropriate model of care approaches and systems processes is limited. What does this paper add? For people with mental health problems in emergency departments and for people with diagnosed mental illnesses in acute care settings, targeted directions to further support treatment include the linking and sharing of systems and information, changing the built environment and exploring new models of service delivery. What are the implications for practitioners? Planning changes to services for mental health clients with acute problems needs to incorporate clinicians, health service planners, architects and a range of emergency services personnel.

A DISCRETE CHOICE EXPERIMENT COMPARING PUBLIC AND DECISION-MAKER STATED PREFERENCES FOR PHARMACEUTICAL SUBSIDY DECISIONS

Publisher: Elsevier BV

Date: 10-2009

DOI: 10.1016/S1098-3015(10)74122-X

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.

PCN95 Cost-Effectiveness Analysis of Germline Brca Mutation Testing and Olaparib Treatment in Metastatic Breast Cancer: an Evaluation of Codependent Technologies

Publisher: Elsevier BV

Date: 11-2019

DOI: 10.1016/J.JVAL.2019.09.292

Trading health for wealth: The effect of COVID-19 response stringency

Publisher: MDPI AG

Date: 24-11-2020

DOI: 10.3390/IJERPH17238725

Abstract: International governments’ COVID-19 responses must balance human and economic health. Beyond slowing viral transmission, strict lockdowns have severe economic consequences. This work investigated response stringency, quantified by the Oxford COVID-19 Government Response Tracker’s Stringency Index, and examined how restrictive interventions affected infection rates and gross domestic product (GDP) in China and OECD countries. Accounting for response timing, China imposed the most stringent restrictions, while Sweden and Japan were the least stringent. Expected GDP declines range from −8% (Japan) to −15.4% (UK). While greater restrictions generally slowed viral transmission, they failed to reach statistical significance and reduced GDP (p = 0.006). Timing was fundamental: governments who responded to the pandemic faster saw greater reductions in viral transmission (p = 0.013), but worse decreases in GDP (p = 0.044). Thus, response stringency has a greater effect on GDP than infection rates, which are instead affected by the timing of COVID-19 interventions. Attempts to mitigate economic impacts by delaying restrictions or decreasing stringency may buoy GDP in the short term but increase infection rates, the longer-term economic consequences of which are not yet fully understood. As highly restrictive interventions were successful in some but not all countries, decision-makers must consider whether their strategies are appropriate for the country on health and economic grounds.

PMI21: ESTIMATING INFLUENZA-RELATED EXCESS HOSPITAL ADMISSIONS

Publisher: Elsevier BV

Date: 09-2001

DOI: 10.1016/S1098-3015(11)71554-6

Mapping Sri Lankan EQ-5D-3L to EQ-5D-5L value sets

Publisher: Elsevier BV

Date: 05-2017

DOI: 10.1016/J.VHRI.2017.01.001

Abstract: Quality-adjusted life-years are the common outcome measure in contemporary economic evaluations in health care. Due to the limitations of the sensitivity of the EQ-5D-3L in specific disease conditions, the EuroQoL group has developed a new EQ-5D-5L classification system with 3,125 health states. This study estimated the Sri Lankan value set for the EQ-5D-5L using a crosswalk methodology. The EuroQoL group had developed a crosswalk methods to obtain interim value set for the EQ-5D-5L health states using available EQ-5D-3L values. This was achieved by mapping EQ-5D-3L and EQ-5D-5L ratings through cross tabulations by each dimension level. Using above official EuroQoL crosswalk probabilities, an interim value set for the Sri Lankan EQ-5D-5L health states were generated based upon the Sri Lankan EQ-5D-3L value set (which was estimated using time trade-off method: n= 780). Comparison were conducted between the Sri Lankan EQ-5D-5L values and other countries. The Sri Lankan EQ-5D-5L recorded utility value of -0.73 for the worst health state and 0.85 for a best possible utility for a health state other than the full health. The UK (mean= 0.4) and Japanese (mean = 0.45) EQ-5D-5L mean utility values were higher than the Sri Lankan values (mean = 0.07). However, Thailand median values (0.21) were closer to the Sri Lankan median values (0.14) than the UK (0.41) or Japan (0.45). This study produced the Sri Lankan EQ-5D-5L interim value set using crosswalk methods. Currently, this is the only EQ-5D-5L value set available for the South Asian region.

A mixed treatment comparison of the short-term efficacy of biologic disease modifying anti-rheumatic drugs in established rheumatoid arthritis

Publisher: Informa Healthcare

Date: 18-08-2011

DOI: 10.1185/03007995.2011.608655

Abstract: The short-term efficacy of biological disease modifying anti-rheumatic drugs (bDMARDs) for the treatment of established moderate to severe rheumatoid arthritis (RA) has been demonstrated by various randomized placebo or active treatment controlled trials. However, there is a lack of direct comparison of these agents. To compare the short-term efficacy of nine bDMARDs - abatacept, adalimumab, anakinra, certolizumab, etanercept, golimumab, infliximab, rituximab and tocilizumab - in patients with established RA. A systematic review was conducted to obtain all available efficacy data for each included bDMARD. Medline, EMBASE, and Cochrane clinical trials were searched for trials in patients with RA. Twenty-seven trials were retrieved from a systematic literature search and included in the meta-analysis. Mixed treatment comparison (MTC) techniques were used to perform indirect comparisons. Analyses were conducted to estimate the odds ratio of an ACR20, ACR50, and ACR70 response at approximately six months if treated with a bDMARD compared with placebo or methotrexate. Between-drug comparisons were also made. The analyses were performed including recommended doses only (as per the product information). All drugs except anakinra and golimumab demonstrated a statistically significant advantage compared to control treatment for ACR20 responses. The between-drug comparisons revealed a statistically significant advantage for certolizumab compared to most bDMARDs for ACR20, ACR50 and ACR70 response and for etanercept versus adalimumab and anakinra for ACR20 and ACR50 response, as well as a statistically significant advantage for tocilizumab versus anakinra for ACR50 response. The analyses, using MTC of efficacy of nine bDMARDs suggest that treatment with anakinra is inferior to other bDMARDs and that etanercept and certolizumab may be more effective than other bDMARDs. There are some limitations of our analyses due to MTC assumptions, variations in trial design and the fact that only ACR outcomes at six months were included.

Institutionalizing health technology assessment in Ethiopia: seizing the window of opportunity

Publisher: Cambridge University Press (CUP)

Date: 2023

DOI: 10.1017/S0266462323000454

Abstract: Ethiopia’s commitment to achieving universal health coverage (UHC) requires an efficient and equitable health priority-setting practice. The Ministry of Health aims to institutionalize health technology assessment (HTA) to support evidence-based decision making. This commentary highlights key considerations for successful formulation, adoption, and implementation of HTA policies and practices in Ethiopia, based on a review of international evidence and published normative principles and guidelines. Stakeholder engagement, transparent policymaking, sustainable financing, workforce education, and political economy analysis and power dynamics are critical factors that need to be considered when developing a national HTA roadmap and implementation strategy. To ensure ownership and sustainability of HTA, effective stakeholder engagement and transparency are crucial. Regulatory embedding and sustainable financing ensure legitimacy and continuity of HTA production, and workforce education and training are essential for conducting and interpreting HTA. Political economy analysis helps identify opportunities and constraints for effective HTA implementation. By addressing these considerations, Ethiopia can establish a well-designed HTA system to inform evidence-based and equitable resource allocation toward achieving UHC and improving health outcomes.

The Official Journal of ATTD Advanced Technologies & Treatments for Diabetes Conference Madrid, Spain—February 19–22, 2020

Publisher: Mary Ann Liebert Inc

Date: 02-2020

DOI: 10.1089/DIA.2020.2525.ABSTRACTS

A comparison of health state utility values associated with oral potentially malignant disorders and oral cancer in Sri Lanka assessed using the EQ-5D-3 L and the EORTC-8D

Publisher: Springer Science and Business Media LLC

Date: 11-07-2016

DOI: 10.1186/S12955-016-0502-Y

Can post-acute care programmes for older people reduce overall costs in the health system? A case study using the Australian Transition Care Programme

Publisher: Hindawi Limited

Date: 16-08-2012

DOI: 10.1111/J.1365-2524.2011.01024.X

Abstract: There is an increasing demand for acute care services due in part to rising proportions of older people and increasing rates of chronic diseases. To reduce pressure and costs in the hospital system, community-based post-acute care discharge services for older people have evolved as one method of reducing length of stay in hospital and preventing readmissions. However, it is unclear whether they reduce overall episode cost or expenditure in the health system at a more general level. In this paper, we review the current evidence on the likely costs and benefits of these services and consider whether they are potentially cost-effective from a health services perspective, using the Australian Transition Care Programme as a case study. Evaluations of community-based post-acute services have demonstrated that they reduce length of stay, prevent some re-hospitalisations and defer nursing home placement. There is also evidence that they convey some additional health benefits to older people. An economic model was developed to identify the maximum potential benefits and the likely cost savings from reduced use of health services from earlier discharge from hospital, accelerated recovery, reduced likelihood of readmission to hospital and delayed entry into permanent institutional care for participants of the Transition Care Programme. Assuming the best case scenario, the Transition Care Programme is still unlikely to be cost saving to a healthcare system. Hence for this service to be justified, additional health benefits such as quality of life improvements need to be taken into account. If it can be demonstrated that this service also conveys additional quality of life improvements, community-based programmes such as Transition Care could be considered to be cost-effective when compared with other healthcare programmes.

Investigating the cost-effectiveness of videotelephone based support for newly diagnosed paediatric oncology patients and their families: design of a randomised controlled trial

Publisher: Springer Science and Business Media LLC

Date: 05-03-2007

DOI: 10.1186/1472-6963-7-38

Abstract: Providing ongoing family centred support is an integral part of childhood cancer care. For families living in regional and remote areas, opportunities to receive specialist support are limited by the availability of health care professionals and accessibility, which is often reduced due to distance, time, cost and transport. The primary aim of this work is to investigate the cost-effectiveness of videotelephony to support regional and remote families returning home for the first time with a child newly diagnosed with cancer We will recruit 162 paediatric oncology patients and their families to a single centre randomised controlled trial. Patients from regional and remote areas, classified by Accessibility/Remoteness Index of Australia (ARIA+) greater than 0.2, will be randomised to a videotelephone support intervention or a usual support control group. Metropolitan families (ARIA+ ≤ 0.2) will be recruited as an additional usual support control group. Families allocated to the videotelephone support intervention will have access to usual support plus education, communication, counselling and monitoring with specialist multidisciplinary team members via a videotelephone service for a 12-week period following first discharge home. Families in the usual support control group will receive standard care i.e., specialist multidisciplinary team members provide support either face-to-face during inpatient stays, outpatient clinic visits or home visits, or via telephone for families who live far away from the hospital. The primary outcome measure is parental health related quality of life as measured using the Medical Outcome Survey (MOS) Short Form SF-12 measured at baseline, 4 weeks, 8 weeks and 12 weeks. The secondary outcome measures are: parental informational and emotional support parental perceived stress, parent reported patient quality of life and parent reported sibling quality of life, parental satisfaction with care, cost of providing improved support, health care utilisation and financial burden for families. This investigation will establish the feasibility, acceptability and cost-effectiveness of using videotelephony to improve the clinical and psychosocial support provided to regional and remote paediatric oncology patients and their families.

The costs and potential savings of a novel telepaediatric service in Queensland

Publisher: Springer Science and Business Media LLC

Date: 02-03-2007

DOI: 10.1186/1472-6963-7-35

Abstract: There are few cost-minimisation studies in telemedicine. We have compared the actual costs of providing a telepaediatric service to the potential costs if patients had travelled to see the specialist in person. In November 2000, we established a novel telepaediatric service for selected regional hospitals in Queensland. Instead of transferring patients to Brisbane, the majority of referrals to specialists in Brisbane were dealt with via videoconference. Since the service began, 1499 consultations have been conducted for a broad range of paediatric sub-specialities including burns, cardiology, child development, dermatology, diabetes, endocrinology, gastroenterology, nephrology, neurology, oncology, orthopaedics, paediatric surgery and psychiatry. During a five year period, the total cost of providing 1499 consultations through the telepaediatric service was A$955,996. The estimated potential cost of providing an outpatient service to the same number of patients at the Royal Children's Hospital in Brisbane was A$1,553,264 thus, telepaediatric services resulted in a net saving of approximately A$600,000 to the health service provider. Telepaediatrics was a cheaper method for the delivery of outpatient services when the workload exceeded 774 consultations. A sensitivity analysis showed that the threshold point was most sensitive to changes related to patient travel costs, coordinator salaries and videoconference equipment costs. The study showed substantial savings for the health department, mainly due to reduced costs associated with patient travel.

PHP34 USING DISCRETE CHOICE EXPERIMENT MODELLING TO ASSESS PREFERENCES FOR HEALTH SYSTEM CHARACTERISTICS IN THE UNITED KINGDOWM AND AUSTRALIA

Publisher: Elsevier BV

Date: 10-2009

DOI: 10.1016/S1098-3015(10)74189-9

Application of a risk-guided strategy to secondary prevention of coronary heart disease: analysis from a state-wide data linkage in Queensland, Australia

Publisher: BMJ

Date: 05-2022

DOI: 10.1136/BMJOPEN-2021-057856

Abstract: This study sought whether higher risk patients with coronary heart disease (CHD) benefit more from intensive disease management. Longitudinal cohort study. State-wide public hospitals (Queensland, Australia). This longitudinal study included 20 426 patients hospitalised in 2010 with CHD as the principal diagnosis. Patients were followed-up for 5 years. The primary outcome was days alive and out of hospital (DAOH) within 5 years of hospital discharge. Secondary outcomes included all-cause readmission and all-cause mortality. A previously developed and validated risk score (PEGASUS-TIMI54) was used to estimate the risk of secondary events. Data on sociodemography, comorbidity, interventions and medications were also collected. High-risk patients (n=6573, risk score ≥6) had fewer DAOH (∆=−142 days (95% CI: −152 to –131)), and were more likely to readmit or die (all p .001) than their low-risk counterparts (n=13 367, risk score ). Compared with patients who were never prescribed a medication, those who consumed maximal dose of betablockers (∆=39 days (95% CI: 11 to 67)), angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (∆=74 days (95% CI: 49 to 99)) or statins (∆=109 days (95% CI: 90 to 128)) had significantly greater DAOH. Patients who received percutaneous coronary intervention (∆=99 days (95% CI: 81 to 116)) or coronary artery bypass grafting (∆=120 days (95% CI: 92 to 148)) also had significantly greater DAOH than those who did not. The effect sizes of these therapies were significantly greater in high-risk patients, compared with low-risk patients (interaction p .001). Analysis of secondary outcomes also found significant interaction between both medical and interventional therapies with readmission and death, implicating greater benefits for high-risk patients. CHD patients can be effectively risk-stratified, and use of this information for a risk-guided strategy to prioritise high-risk patients may maximise benefits from additional resources spent on intensive disease management.

A framework for economic evaluation of therapeutic drug monitoring—guided dosing in oncology

Publisher: Wiley

Date: 21-09-2021

DOI: 10.1002/PRP2.862

Abstract: The standard approach for dose in idualization of chemotherapy in the oncology setting has long been based on body surface area (BSA) as a measure of body size. However, for many anticancer drugs, administration of dosages based on BSA may result in some patients receiving supratherapeutic or subtherapeutic concentrations due to substantial interin idual pharmacokinetic variability. Therapeutic drug monitoring (TDM)–guided dosing aims to ensure that the patient's serum drug concentration is in a target range which has been shown to produce optimal clinical outcomes. The management of several malignancies is now moving away from using traditional intravenous chemotherapy to longer‐term treatment with targeted molecular therapies. These targeted anticancer drugs are currently dosed based on a fixed dose for all patients. The pharmacokinetic characteristics of most of these drugs (e.g., tyrosine‐kinase inhibitors) support implementation of in idualized dosing via TDM. However, prior to adopting TDM–guided dosing in oncology settings, the economic efficiency and value for money of introducing TDM interventions should be critically and systematically examined along with the impacts on patient care and outcomes. Yet, current evidence in this area is limited, and more generally, there is lack of methodological guidance on how to identify, estimate and value clinical and cost information necessary to conduct economic evaluations of TDM interventions. In this paper, we propose a coherent framework for conducting economic evaluation of TDM interventions in oncology settings and discuss some practical challenges of conducting economic evaluations of TDM.

Pertussis vaccination strategies for neonates—an exploratory cost-effectiveness analysis

Publisher: Elsevier BV

Date: 07-2004

DOI: 10.1016/J.VACCINE.2003.11.057

Cost-effectiveness analysis of gene-based therapies for patients with spinal muscular atrophy type I in Australia

Publisher: Springer Science and Business Media LLC

Date: 18-08-2022

DOI: 10.1007/S00415-022-11319-0

Abstract: Spinal muscular atrophy (SMA) is an inherited neuromuscular disorder and regarded as one of the most frequent genetic causes of infant mortality. The aim of this study is to develop a cost-effectiveness analysis of AVXS-101 (Onasemnogene Abeparvovec/Zolgensma ® ) and nusinersen (Spinraza ® ) for SMA to inform decision-making on reimbursement policies in Australia. A Markov model was developed with five health states to evaluate the costs and effects for patients with SMA Type I from a healthcare system perspective over a time-horizon of 100 years. The model parameters were based on clinical trials, parametric distributions, published literature, and Australian registries. One-way and probabilistic sensitivity analysis were performed to appraise the uncertainties of the parameters in the model. A threshold analysis was conducted to estimate the cost of AVXS-101 of being cost-effective. The incremental cost-effectiveness ratio (ICER) of AVXS-101 was $1,808,471 per quality-adjusted life year (QALY) and that of nusinersen was $2,772,798 per QALY, compared to standard of care, respectively. The ICER of AVXS-101 was $1,238,288 per QALY compared to nusinersen. The key drivers influencing on ICERs were costs of using treatments and utility values of sitting and walking independently. Both nusinersen and AVXS-101 resulted in health benefits, but they were not cost-effective with a commonly used willingness-to-pay (WTP) threshold of $50,000 per QALY. Developing high-quality clinical data and exploring appropriate WTP thresholds are critical for decision-making on reimbursement policies in the treatment of rare diseases.

The Baby Steps Web Program for the Well-Being of New Parents: Randomized Controlled Trial (Preprint)

Publisher: JMIR Publications Inc.

Date: 21-08-2020

DOI: 10.2196/PREPRINTS.23659

Abstract: ew parents face increased risks of emotional distress and relationship dissatisfaction. Digital interventions increase support access, but few preventive programs are optimized for both parents. his study aims to conduct the first randomized controlled trial on universal self-guided digital programs to support positive perinatal adjustment of both mothers and fathers. Effects of childcare information ( i Baby Care /i ) and information plus an interactive program ( i Baby Steps Wellbeing /i ) were compared from the third trimester baseline to 3 and 6 months subsequently. he study recruited 388 co-parenting male-female adult couples expecting their first single child (26-38 weeks’ gestation), using web-based registration. Most (337/388, 86.8%) were obtained from prenatal hospital classes. Couples’ randomization was automated and stratified by Edinburgh Postnatal Depression Scale (EPDS) scores (50% couples scored i high /i if either mother & , father & ). All assessments were web-based self-reports: the EPDS and psychosocial quality of life were primary outcomes relationship satisfaction, social support, and self-efficacy for parenting and support provision were secondary. Linear mixed models provided intention-to-treat analyses, with linear and quadratic effects for time and random intercepts for participants and couples. election criteria were met by 63.9% (248/388) of couples, who were all randomized. Most participants were married (400/496, 80.6%), tertiary educated (324/496, 65.3%), employed full time (407/496, 82%), and born in Australia (337/496, 67.9%). Their mean age was 32.2 years, and average gestation was 30.8 weeks. Using an EPDS cutoff score of 13, 6.9% (18/248) of men, and 16.1% (40/248) of women screened positive for depression at some time during the 6 months. Retention of both partners was 80.6% (201/248) at the 6-month assessments, and satisfaction with both programs was strong (92% ≥50). Only 37.3% (185/496) of participants accessed their program more than once, with higher rates for mothers (133/248, 53.6%) than fathers (52/248, 20.9% i P& /i .001). The EPDS, quality of life, and social support did not show differential improvements between programs, but i Baby Steps Wellbeing /i gave a greater linear increase in self-efficacy for support provision ( i P= /i .01 Cohen i d /i =0.26) and lower reduction in relationship satisfaction ( i P= /i .03 Cohen i d /i =0.20) than i Baby Care /i alone. Mothers had greater linear benefits in parenting self-efficacy over time than fathers after receiving i Baby Steps Wellbeing /i rather than i Baby Care /i ( i P= /i .01 Cohen i d /i =0.51) i . /i However, the inclusion of program type in analyses on parenting self-efficacy and relationship satisfaction did not improve model fit above analyses with only parent gender and time. hree secondary outcomes showed differential benefits from i Baby Steps Wellbeing /i , but for one (parenting self-efficacy), the effect only occurred for mothers, perhaps reflecting their greater program use. Increased engagement will be needed for more definitive testing of the potential benefits of i Baby Steps /i i Wellbeing /i for perinatal adjustment. ustralian New Zealand Clinical Trials Registry ACTRN12614001256662 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=367277

The increase in healthcare costs associated with frailty in older people discharged to a post-acute transition care program

Publisher: Oxford University Press (OUP)

Date: 13-01-2016

DOI: 10.1093/AGEING/AFV196

Abstract: older people are high users of healthcare resources. The frailty index can predict negative health outcomes however, the amount of extra resources required has not been quantified. to quantify the impact of frailty on healthcare expenditure and resource utilisation in a patient cohort who entered a community-based post-acute program and compare this to a cohort entering residential care. the interRAI home care assessment was used to construct a frailty index in three frailty levels. Costs and resource use were collected alongside a prospective observational cohort study of patients. A generalized linear model was constructed to estimate the additional cost of frailty and the cost of alternative residential care for those with high frailty. participants (n = 272) had an average age of 79, frailty levels were low in 20%, intermediate in 50% and high in 30% of the cohort. Having an intermediate or high level of frailty increased the likelihood of re-hospitalisation and was associated with 22 and 43% higher healthcare costs over 6 months compared with low frailty. It was less costly to remain living at home than enter residential care unless >62% of subsequent hospitalisations in 6 months could be prevented. the frailty index can potentially be used as a tool to estimate the increase in healthcare resources required for different levels of frailty. This information may be useful for quantifying the amount to invest in programs to reduce frailty in the community.

A Framework to Prioritise Health Research Proposals for Funding: Integrating Value for Money

Publisher: Springer Science and Business Media LLC

Date: 07-2019

DOI: 10.1007/S40258-019-00495-2

Abstract: When making funding decisions, research organisations largely consider the merits (e.g. scientific rigour and feasibility) of submitted research proposals yet, there is often little or no reference to their value for money. This may be attributed to the challenges of assessing and integrating value of research into existing research prioritisation processes. We propose a framework that considers both the merits of research and its value for money to guide health research funding decisions. A practical framework is developed based on current processes followed by funding organizations for assessing investigator-initiated research proposals, and analytical methods for evaluating the expected value of research. We apply the analytical methods to estimate the expected return on investment of two real-world grant applications. The framework comprises four sequential steps: (1) initial screening of applications for eligibility and completeness (2) merit assessment of eligible proposals (3) estimating the expected value of research for the shortlisted proposals that pass the first two steps and ranking of proposals based on return on investment and (4) selecting research proposals for funding. We demonstrate how the expected value for money can be efficiently estimated using certain information provided in funding applications. The proposed framework integrates value-for-money assessment into the existing research prioritisation processes. Considering value for money to inform research funding decisions is vital to achieve efficient utilisation of research budgets and maximise returns on research investments.

Cost-effectiveness of combined catheter ablation and left atrial appendage closure for symptomatic atrial fibrillation in patients with high stroke and bleeding risk

Publisher: Elsevier BV

Date: 2021

DOI: 10.1016/J.AHJ.2020.08.008

Detection and Management of Depression in Patients with Chronic Heart Disease: The Take Heart in Primary Care Cluster Randomised Controlled Trial

Publisher: Elsevier BV

Date: 2010

DOI: 10.1016/J.HLC.2010.06.584

Addition of Supervised Exercise Training to a Post-Hospital Disease Management Program for Patients Recently Hospitalized With Acute Heart Failure: The EJECTION-HF Randomized Phase 4 Trial

Publisher: Elsevier BV

Date: 02-2018

DOI: 10.1016/J.JCHF.2017.11.016

Abstract: This study sought to measure the impact on all-cause death or readmission of adding center-based exercise training (ET) to disease management programs for patients with a recent acute heart failure (HF) hospitalization. ET is recommended for patients with HF, but evidence is based mainly on ET as a single intervention in stable outpatients. A randomized, controlled trial with blinded outcome assessor, enrolling adult participants with HF discharged from 5 hospitals in Queensland, Australia. All participants received HF-disease management program plus supported home exercise program intervention participants were offered 24 weeks of supervised center-based ET. Primary outcome was all-cause 12-month death or readmission. Pre-planned subgroups included age ( 40%), and exercise adherence. Between May 2008 and July 2013, 278 participants (140 intervention, 138 control) were enrolled: 98 (35.3%) age ≥70 years, 71 (25.5%) females, and 62 (23.3%) with a left ventricular ejection fraction of >40%. There were no adverse events associated with ET. There was no difference in primary outcome between groups (84 of 140 [60.0%] intervention vs. 90 of 138 [65.2%] control p = 0.37), but a trend toward greater benefit in participants age <70 years (OR: 0.56 [95% CI: 0.30 to 1.02] vs. OR: 1.56 [95% CI: 0.67 to 3.64] p for interaction = 0.05). Participants who exercised to guidelines (72 of 101 control and 92 of 117 intervention at 3 months) had a significantly lower rate of death and readmission (91 of 164 [55.5%] vs. 41 of 54 [75.9%] p = 0.008). Supervised center-based ET was a safe, feasible addition to disease management programs with supported home exercise in patients recently hospitalized with acute HF, but did not reduce combined end-point of death or readmission. (A supervised exercise programme following hospitalisation for heart failure: does it add to disease management? ACTRN12608000263392).

A cost minimisation analysis of a telepaediatric otolaryngology service

Publisher: Springer Science and Business Media LLC

Date: 04-02-2008

DOI: 10.1186/1472-6963-8-30

The Cost to the United Kingdom National Health Service of Managing Erectile Dysfunction

Publisher: Springer Science and Business Media LLC

Date: 2002

DOI: 10.2165/00019053-200220130-00002

Abstract: To estimate the annual direct cost of managing erectile dysfunction (ED) to the UK National Health Service (NHS) and to examine the impact of the introduction of sildenafil in 1998 and Schedule 11 restrictions in 1999. A prevalence-based cost-of-illness approach was used. The period 1997 to 2000 was covered. The numbers of ED prescriptions, prosthesis implantations and general practitioner (GP) consultations were retrieved retrospectively from UK resource utilisation databases. The number of specialist consultations and psychosexual therapy sessions were estimated from NHS clinic data. National resource unit costs were applied. Between 1997 and 2000 the number of men presenting with ED increased from 79,800 to 257,984. The cost to the NHS increased from pounds sterling 29.4 million to pounds sterling 73.8 million (2000 estimates). The cost per patient fell from pounds sterling 368 to pounds sterling 286. In 1997, most NHS costs came from psychosexual therapy (30.7%), specialist consultations (20.2%) and intracavernosal injections (26.6%). By 2000, NHS costs came primarily from specialist consultations (32.0%), sildenafil prescriptions (26.2%), psychosexual therapy (13.6%) and GP consultations (12.0%). The annual cost was most sensitive to the number of drug prescriptions and specialist consultations. The increased NHS cost of managing ED was due mainly to a three-fold increase in the number of men presenting to GPs, substantial numbers of whom were then referred for specialist consultations under Schedule 11 restrictions. This naturally resulted in the increased use of all resources including sildenafil. The cost effectiveness of transferring prescribing responsibility in cases of severe distress from specialists to GPs in primary care remains to be determined.

Oseltamivir and zanamivir are effective for treating influenza, but preventive effects are unclear

Publisher: Elsevier BV

Date: 12-2003

DOI: 10.1016/J.EHBC.2003.09.001

Developing a strategy to improve data sharing in health research: A mixed-methods study to identify barriers and facilitators

Publisher: SAGE Publications

Date: 05-05-2023

DOI: 10.1177/1833358320917207

Abstract: Data sharing presents new opportunities across the spectrum of research and is vital for science that is open, where data are easily discoverable, accessible, intelligible, reproducible, replicable and verifiable. Despite this, it is yet to become common practice. Global efforts to develop practical guidance for data sharing and open access initiatives are underway, however evidence-based studies to inform the development and implementation of effective strategies are lacking. This study sought to determine the barriers and facilitators to data sharing among health researchers and to identify the target behaviours for designing a behaviour change intervention strategy. Data were drawn from a cross-sectional survey of data management practices among health researchers from one Australian research institute. Determinants of behaviour were theoretically derived using well-established behavioural models. Data sharing practices have been described for 77 researchers, and 6 barriers and 4 facilitators identified. The primary barriers to data sharing included perceived negative consequences and lack of competency to share data. The primary facilitators to data sharing included trust in others using the data and social influence related to public benefit. Intervention functions likely to be most effective at changing target behaviours were also identified. Results of this study provide a theoretical and evidence-based process to understand the behavioural barriers and facilitators of data sharing among health researchers. Designing interventions that specifically address target behaviours to promote data sharing are important for open researcher practices.

The structure of costs and production in New Zealand public hospitals: An application of the transcendental logarithmic variable cost function

Publisher: Informa UK Limited

Date: 1996

DOI: 10.1080/00036849600000010

Pediatric Quality of Life Instruments in Oral Health Research: A Systematic Review

Publisher: Elsevier BV

Date: 2018

DOI: 10.1016/J.JVAL.2018.06.019

Abstract: To identify the generic or disease-specific pediatric quality of life (QoL) instruments used in oral health research among children and adolescents and to provide an overview of these QoL instruments. A systematic literature search was performed with multiple databases to identify the pediatric QoL instruments used in oral health research. The literature search yielded 872 records from these, 16 pediatric QoL instruments were identified that had been used among children and adolescents in oral health research. Of these, 11 were oral health-specific QoL instruments and five were generic instruments. Of the 11 oral health-specific QoL instruments, none were multiattribute utility instruments (MAUI), whereas of the five generic instruments, two (Child Health Utility 9D index and EuroQoL-5D youth) were classified as an MAUI. Except for one, all pediatric QoL instruments were published after the year 2000 and the majority originated from the USA (n = 8). Of the 11 oral health-specific QoL instruments, five instruments are designed for the respondent to be a child (i.e., self-report), one uses proxy responses from a parent or guardian, and five instruments have both self and proxy versions. Of the five generic QoL instruments, one uses proxy responses and the other four instruments have both self and proxy versions. This review identified a wide variety of pediatric oral health-specific and generic QoL instruments used in oral health research among children and adolescents. The availability of these QoL instruments provides researchers with the opportunity to select the instrument most suited to address their research question.

Transcatheter Aortic Valve Replacement: A Cost-Effectiveness Analysis for Australia

Publisher: Elsevier BV

Date: 2013

DOI: 10.1016/J.HLC.2013.05.377

Modelling a cost-effective vaccination strategy for the prevention of varicella and herpes zoster infection: A systematic review

Publisher: Elsevier BV

Date: 03-2021

DOI: 10.1016/J.VACCINE.2021.01.061

Quality of life of older frail persons receiving a post-discharge program

Publisher: Springer Science and Business Media LLC

Date: 2013

DOI: 10.1186/1477-7525-11-58

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.

Study protocol for reducing childbirth fear: A midwife-led psycho-education intervention

Publisher: Springer Science and Business Media LLC

Date: 20-10-2013

DOI: 10.1186/1471-2393-13-190

Health state valuation in Sri Lanka using the EQ-5D-3l; Precursor to QALY estimation in South Asia

Publisher: Elsevier BV

Date: 11-2016

DOI: 10.1016/J.JVAL.2016.08.609

Reply

Publisher: Wiley

Date: 24-11-2004

DOI: 10.1111/J.1464-5491.2004.1349B.X

PNS23 Setting Health Priorities in Low-Income and Middle-Income Countries in the ASIA-Pacific Region: The Case of Papua New Guinea

Publisher: Elsevier BV

Date: 09-2020

DOI: 10.1016/J.VHRI.2020.07.442

Use of fluvastatin following percutaneous coronary intervention

Publisher: Informa UK Limited

Date: 04-2005

DOI: 10.1586/14737167.5.2.113

Abstract: The use of percutaneous coronary intervention to remove occlusions from coronary arteries has increased substantially over recent years. Concurrent with the use of percutaneous coronary intervention, the use of lipid-lowering medications, such as statins, has increased. The Lescol Intervention and Prevention Study showed significant reductions with statins in postpercutaneous coronary intervention cardiac events. The cost- effectiveness of initiating statin use for all percutaneous coronary intervention patients is favorable, with significant health benefits (including improved survival) for relatively low additional costs (e.g., pound 3207 per quality-adjusted life year in the UK). Fluvastatin is the lowest cost statin currently available (less than the price of generic statins). Key economic issues include estimates of the current use of statins at the time of percutaneous coronary intervention and the likelihood of switching from more expensive statins to fluvastatin.

The Internet of Things: Impact and Implications for Health Care Delivery (Preprint)

Publisher: JMIR Publications Inc.

Date: 11-05-2020

DOI: 10.2196/PREPRINTS.20135

Abstract: he Internet of Things (IoT) is a system of wireless, interrelated, and connected digital devices that can collect, send, and store data over a network without requiring human-to-human or human-to-computer interaction. The IoT promises many benefits to streamlining and enhancing health care delivery to proactively predict health issues and diagnose, treat, and monitor patients both in and out of the hospital. Worldwide, government leaders and decision makers are implementing policies to deliver health care services using technology and more so in response to the novel COVID-19 pandemic. It is now becoming increasingly important to understand how established and emerging IoT technologies can support health systems to deliver safe and effective care. The aim of this viewpoint paper is to provide an overview of the current IoT technology in health care, outline how IoT devices are improving health service delivery, and outline how IoT technology can affect and disrupt global health care in the next decade. The potential of IoT-based health care is expanded upon to theorize how IoT can improve the accessibility of preventative public health services and transition our current secondary and tertiary health care to be a more proactive, continuous, and coordinated system. Finally, this paper will deal with the potential issues that IoT-based health care generates, barriers to market adoption from health care professionals and patients alike, confidence and acceptability, privacy and security, interoperability, standardization and remuneration, data storage, and control and ownership. Corresponding enablers of IoT in current health care will rely on policy support, cybersecurity-focused guidelines, careful strategic planning, and transparent policies within health care organizations. IoT-based health care has great potential to improve the efficiency of the health system and improve population health.

Preferences for Chronic Heart Failure Management Programs: interviews with patients and development of a Discrete Choice Experiment.

Publisher: Elsevier BV

Date: 2010

DOI: 10.1016/J.HLC.2010.06.598

Comparing multi-attribute utility instruments: CP-6D, a Cerebral palsy specific instrument, vs AQoL-4D

Publisher: Informa UK Limited

Date: 08-04-2021

DOI: 10.1080/14737167.2021.1909477

Abstract: Economic-evaluations of Cerebral palsy (CP) were based on utility estimates of health-related quality of life (HRQoL) from generic multi-attribute utility instruments (MAUIs). However, generic instruments had limited use as they could not capture some of the important aspects of living with CP. The Cerebral palsy 6 Dimension (CP-6D) is a disease specific MAUI. In this study, we compared the results of CP-6D with the Assessment of Quality of Life (AQoL-4D), a generic MAUI, and tested the criterion validity of the CP-6D in the general population. An online survey of the Australian general population (n = 2002), who completed both the AQoL-4D and CP-6D MAUIs, was conducted. Validity was assessed from the correlations between the domains, items and instruments. ANOVA and t-tests were used to assess the instrument's discrimination in different social demographic categories. There was a moderate correlation between the instruments (0.64). Differences in socio-demographic characteristics showed a medium effect size ( Our results suggest that CP-6D and AQoL-4D were measuring a similar underlying construct. Both instruments responded similarly to socio-demographic differences.

Excess mortality at Christmas due to cardiovascular disease in the HUNT study prospective population-based cohort in Norway

Publisher: Springer Science and Business Media LLC

Date: 20-03-2021

DOI: 10.1186/S12889-021-10503-7

Abstract: Although it is known that winter inclusive of the Christmas holiday period is associated with an increased risk of dying compared to other times of the year, very few studies have specifically examined this phenomenon within a population cohort subject to baseline profiling and prospective follow-up. In such a cohort, we sought to determine the specific characteristics of mortality occuring during the Christmas holidays. Baseline profiling and outcome data were derived from a prospective population-based cohort with longitudinal follow-up in Central Norway - the Trøndelag Health (HUNT) Study. From 1984 to 1986 , 88% of the target population comprising 39,273 men and 40,353 women aged 48 ± 18 and 50 ± 18 years, respectively, were profiled. We examined the long-term pattern of mortality to determine the number of excess (all-cause and cause-specific) deaths that occurred during winter overall and, more specifically, the Christmas holidays. During 33.5 (IQR 17.1–34.4) years follow-up, 19,879 (50.7%) men and 19,316 (49.3%) women died at age-adjusted rate of 5.3 and 4.6 deaths per 1000/annum, respectively. Overall, 1540 (95% CI 43–45 deaths/season) more all-cause deaths occurred in winter (December to February) versus summer (June to August), with 735 (95% CI 20–22 deaths per season) of these cardiovascular-related. December 25th–27th was the deadliest 3-day period of the year being associated with 138 (95% CI 96–147) and 102 (95% CI 72–132) excess all-cause and cardiovascular-related deaths, respectively. Accordingly, compared to 1st–21st December (equivalent winter conditions), the incidence rate ratio of all-cause mortality increased to 1.22 (95% CI 1.16–1.27) and 1.17 (95% 1.11–1.22) in men and women, respectively, during the next 21 days (Christmas/New Year holidays). All observed differences were highly significant ( P 0.001). A less pronounced pattern of mortality due to respiratory illnesses (but not cancer) was also observed. Beyond a broader pattern of seasonally-linked mortality characterised by excess winter deaths, the deadliest time of year in Central Norway coincides with the Christmas holidays. During this time, the pattern and frequency of cardiovascular-related mortality changes markedly contrasting with a more stable pattern of cancer-related mortality. Pending confirmation in other populations and climates, further research to determine if these excess deaths are preventable is warranted.

Cost-effectiveness of coronary computed tomography and cardiac stress imaging in the emergency department: A decision analytic model comparing diagnostic strategies for chest pain in patients at low risk of acute coronary syndromes

Publisher: Elsevier BV

Date: 05-2011

DOI: 10.1016/J.JCMG.2011.03.008

Abstract: Emergency department presentations with chest pain are expensive and often unrelated to coronary artery disease (CAD). Coronary computed tomographic angiography (CTA) may allow earlier discharge of low-risk patients, resulting in cost savings. We modeled clinical and economic outcomes of diagnostic strategies in patients with chest pain and at low risk of CAD: exercise electrocardiography (ECG), stress single-photon emission computed tomography (SPECT), stress echocardiography, and a CTA strategy comprising an initial CTA scan with confirmatory SPECT for indeterminate results. Our results suggest that a 2-step diagnostic strategy of CTA with SPECT for intermediate scans is likely to be less costly and more effective for the diagnosis of a patient group at low risk of CAD and a prevalence of 2% to 30%. The CTA strategies were cost saving (lower costs, higher quality-adjusted life-years) compared with stress ECG, echocardiography, and SPECT. Confirming intermediate/indeterminate CTA scans with SPECT results in cost savings and quality-adjusted life-year gains due to reduced hospitalization of patients who returned false-positive initial CTA test. However, CTA may be associated with a higher event rate in negative patients than SPECT, and the diagnostic and prognostic information for the use of CTA in the emergency department is evolving. Large comparative, randomized, controlled trials of the different diagnostic strategies are needed to compare the long-term costs and consequences of each strategy in a population of defined low-risk patients in the emergency department.

Costs of cervical cancer and precancerous lesions treatment in a publicly financed health care system

Publisher: Springer Science and Business Media LLC

Date: 03-09-2010

DOI: 10.1007/S00404-009-1218-6

Abstract: Although cervical cancer is the most frequent cancer for women in Taiwan, no examination of its treatment costs has yet been undertaken. This study aimed to investigate the costs of cervical cancer and precancerous lesion treatment in Taiwan. A total of 7,398 cases of cervical intraepithelial neoplasia (CIN) lesions were identified from the Taiwan Cervical Cancer Screening Registration System in 2003. A further 1,469 cases of invasive cervical cancer (ICC) were also identified from a survey on cervical cancer staging information conducted by the Taiwan Cancer Registration Task Force. Resource usage covering the first 6 months after CIN diagnosis and the 5 years after ICC diagnosis were extracted from the National Health Insurance claims database. The duration of each visit and the transportation costs were collected by means of personal interviews with CIN/ICC patients. The mean and standard deviation of the treatment and indirect costs were estimated. The average total costs for CIN patients were NT$4,201 for CIN1, NT$8,623 for CIN2 and NT$14,406 for CIN3, with the indirect costs accounting for 25-33% of the total. The total costs for ICC patients were NT$210,230 for Stage 1, NT$392,387 for Stage 2, NT$433,969 for Stage 3 and NT$464,701 for Stage 4, with the indirect costs accounting for about 14-17% of the total. CIN and ICC treatment resulted in considerable costs to the healthcare system in Taiwan. Indirect costs associated with such treatment were also substantial and cannot be ignored.

Outcomes of transcatheter aortic valve implantation for intermediate-risk patients in Australia: the SOLACE-AU trial

Publisher: Informa UK Limited

Date: 11-09-2019

DOI: 10.1080/13696998.2019.1663356

A Randomized Controlled Trial of an Interactive Voice Response Telephone System and Specialist Nurse Support for Childhood Asthma Management

Publisher: Informa UK Limited

Date: 18-08-2010

DOI: 10.3109/02770903.2010.493966

Abstract: To evaluate the effects of an automated interactive voice response system (IVR) and Specialist Nurse Support to reduce health care utilization and improve health-related quality of life in children with asthma. A randomized controlled trial in 121 children with doctor-diagnosed asthma and an acute presentation with asthma in the previous 12 months aged between 3 and 16 years. Children were randomized to one of three groups for a 6-month intervention receiving asthma education and management support from a Specialist Nurse by telephone or e-mail (N = 41), from IVR (N = 39), or receiving usual care (control group N = 41). Outcomes included health care utilization and use of oral steroid rescue. Health-related quality of life (HRQOL) data using the Pediatric Asthma Quality of Life Questionnaire and Pediatric Quality of Life Inventory were collected at baseline and at the end of the study. There was no statistically significant benefit identified for either the IVR or the Nurse Support interventions for health care utilization, use of oral steroid rescue, or HRQOL compared with controls. Relative to controls, the incremental costs were -A$225.73 (95% confidence interval [CI]: -A$840, A$391) per child for the Nurse Support intervention and -A$451.45 (-A$1075, A$173) per child for IVR. The results were most sensitive to the frequency of admissions to hospital. This study suggested that both IVR and Nurse Support interventions may be cost-saving from a health system perspective, with IVR providing the greatest benefit and this pilot study provides a strong basis for developing larger trials with longer follow-up.

Composite outcome measures in a pragmatic clinical trial of chronic heart failure management: A comparative assessment

Publisher: Elsevier BV

Date: 04-2015

DOI: 10.1016/J.IJCARD.2015.03.071

Abstract: A number of composite outcomes have been developed to capture the perspective of the patient, clinician and objective measures of health in assessing heart failure outcomes. To date there has been a limited examination in the composition of these outcomes. Three commonly used scoring systems in heart failure trials: Packer's composite, Patient Journey and the African American Heart Failure Trial (A-HeFT) scores were compared in assessing outcomes from the Which heart failure intervention is most cost-effective & consumer friendly in reducing hospital care (WHICH(?)) Trial. Comparability and interpretability of these outcomes and the influence of each component to the final outcome were examined. Despite all three composite outcomes incorporating mortality, hospitalisation and quality of life (QoL), the contribution of each in idual component to the final outcomes differed. The component with the most influence in deteriorating condition for the Packer's composite was hospitalisation (67.7%), while in Patient Journey it was QoL (61.5%) and for A-HeFT composite score it was mortality (45.4%). The contribution made by each component varied in subtle, but important ways. This study emphasises the importance of understanding the value system of the composite outcomes to enable meaningful interpretation of results.

Health System Choice

Publisher: Springer Science and Business Media LLC

Date: 03-2010

DOI: 10.2165/11531170-000000000-00000

Abstract: Citizen preferences surrounding desirable health system characteristics should be considered when undertaking health system reform. The objective of this study was to pilot test a discrete-choice instrument designed to elicit preference weights surrounding health system attributes. A discrete-choice experiment was designed and administered to two convenience s les (n=50 each) recruited from the UK and Australia. The impact of eight health system attributes representing level of health, equity, responsiveness and healthcare financing on the choice between hypothetical health systems was analysed utilizing mixed logit analysis. All characteristics affected the likelihood a health system would be preferred, with the exception of the additional tax contribution levels required to finance the system. There were very few missing or inconsistent responses. The direction of preferences was consistent with expectations for both s les that is, an improvement in attributes describing level of health, equity or responsiveness increased the likelihood that a health system would be preferred. A number of potential improvements to the preference instrument are suggested. The discrete-choice technique used in this study offers a feasible method for eliciting health system preferences, and its use in a larger-scale study to elicit and compare the preferences of representative population s les is supported.

Social and emotional wellbeing assessment instruments for use with Indigenous Australians: A critical review

Publisher: Elsevier BV

Date: 08-2017

DOI: 10.1016/J.SOCSCIMED.2017.06.046

Abstract: There is growing recognition that in addition to universally recognised domains and indicators of wellbeing (such as population health and life expectancy), additional frameworks are required to fully explain and measure Indigenous wellbeing. In particular, Indigenous Australian wellbeing is largely determined by colonisation, historical trauma, grief, loss, and ongoing social marginalisation. Dominant mainstream indicators of wellbeing based on the biomedical model may therefore be inadequate and not entirely relevant in the Indigenous context. It is possible that "standard" wellbeing instruments fail to adequately assess indicators of health and wellbeing within societies that have a more holistic view of health. The aim of this critical review was to identify, document, and evaluate the use of social and emotional wellbeing measures within the Australian Indigenous community. The instruments were systematically described regarding their intrinsic properties (e.g., generic v. disease-specific, domains assessed, extent of cross-cultural adaptation and psychometric characteristics) and their purpose of utilisation in studies (e.g., study setting, intervention, clinical purpose or survey). We included 33 studies, in which 22 distinct instruments were used. Three major categories of social and emotional wellbeing instruments were identified: unmodified standard instruments (10), cross-culturally adapted standard instruments (6), and Indigenous developed measures (6). Recommendations are made for researchers and practitioners who assess social and emotional wellbeing in Indigenous Australians, which may also be applicable to other minority groups where a more holistic framework of wellbeing is applied. It is advised that standard instruments only be used if they have been subject to a formal cross-cultural adaptation process, and Indigenous developed measures continue to be developed, refined, and validated within a erse range of research and clinical settings.

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.

Selection for early surgery in asymptomatic mitral regurgitation: A Markov model

Publisher: Elsevier BV

Date: 05-2013

DOI: 10.1016/J.IJCARD.2011.08.048

Abstract: Current guidelines propose mitral valve repair in asymptomatic chronic mitral regurgitation (MR) when the likelihood of repair is 90% or more. As this figure is not evidence-based, we sought whether the results of a decision-analytic model could facilitate the selection between early surgery (ES) and watchful waiting (WW) based on current guidelines. A Markov model was developed to reflect the anticipated health states in MR (pre-operative, post-operative, post-complication and death). Risks and transitions were informed by the literature. Implications of the strategies for survival, quality-adjusted life years (QALYs), cost and cost-effectiveness were calculated from a US healthcare provider perspective. In the reference case (90% repair), QALY with ES was superior to WW (11.2 [0.4-21.3] vs 10.7 [95%CI: 1.0-21.3]) at an incremental cost-effectiveness of $54,659 ($45,030-$64,288) per QALY. Sensitivity analyses of health benefit showed the main variables influencing outcome were repair rate, operative mortality and risks of heart failure and death with medical management. At the registry repair rate (50%), outcomes of ES were worse than WW, and threshold analysis showed that a repair rate of 84% was required for ES to be superior. High medical risk (yearly heart failure risk 5.6 ± 6.6% and mortality 2.5 ± 4%) was the most favorable scenario for surgery ES was more effective when mortality in the WW group was >3.5%/year. A Markov model might be used to guide the selection of asymptomatic patients for mitral repair, based on local variations in risk and complications as well as repair rate.

An economic evaluation of the Highlands and Islands teledentistry project

Publisher: SAGE Publications

Date: 06-2002

DOI: 10.1258/135763302320118915

Comparison of automated classification techniques for predicting benthic biological communities using hydroacoustics and video observations

Publisher: Elsevier BV

Date: 02-2011

DOI: 10.1016/J.CSR.2010.01.012

Using community-based monitoring with GIS to create habitat maps for a marine protected area in Australia

Publisher: Cambridge University Press (CUP)

Date: 25-07-2008

DOI: 10.1017/S0025315408001835

Abstract: In recent years there has been an increase in community-based monitoring programmes developed and implemented worldwide. This paper describes how the data collected from such a programme could be integrated into a Geographic Information System (GIS) to create temperate subtidal marine habitat maps. A differential Global Positioning System was utilized to accurately record the location of the trained community-based SCUBA er data. These georeferenced data sets were then used to classify benthic habitats using an aerial photograph and digitizing techniques. This study demonstrated that trained community-based volunteers can collect data that can be utilized within a GIS to create reliable and cost-effective maps of shallow temperate subtidal rocky reef systems.

TIMING OF OPERATION IN ASYMPTOMATIC MITRAL REGURGITATION: A DECISION-ANALYTIC MODEL OF QUALITY OF LIFE AND COST

Publisher: Elsevier BV

Date: 2009

DOI: 10.1016/J.HLC.2009.03.019

Wildfires Jeopardise Habitats of Hyacinth Macaw (Anodorhynchus hyacinthinus), a Flagship Species for the Conservation of the Brazilian Pantanal

Publisher: Springer Science and Business Media LLC

Date: 17-01-2022

DOI: 10.1007/S13157-023-01691-6

Stakeholders' Decisions and Preferences for the Provision and Use of Medicinal Cannabis: A Scoping Review

Publisher: Mary Ann Liebert Inc

Date: 08-03-2023

DOI: 10.1089/CAN.2022.0115

Changes to the healthy kids check: Will we get it right?

Publisher: AMPCo

Date: 05-2013

DOI: 10.5694/MJA12.11455

Book reviews

Publisher: Informa UK Limited

Date: 12-1997

DOI: 10.1080/00779959709544276

My Diabetes Coach, a Mobile App–Based Interactive Conversational Agent to Support Type 2 Diabetes Self-Management: Randomized Effectiveness-Implementation Trial (Preprint)

Publisher: JMIR Publications Inc.

Date: 17-05-2020

DOI: 10.2196/PREPRINTS.20322

Abstract: elivering self-management support to people with type 2 diabetes mellitus is essential to reduce the health system burden and to empower people with the skills, knowledge, and confidence needed to take an active role in managing their own health. his study aims to evaluate the adoption, use, and effectiveness of the My Diabetes Coach (MDC) program, an app-based interactive embodied conversational agent, i Laura /i , designed to support diabetes self-management in the home setting over 12 months. his randomized controlled trial evaluated both the implementation and effectiveness of the MDC program. Adults with type 2 diabetes in Australia were recruited and randomized to the intervention arm (MDC) or the control arm (usual care). Program use was tracked over 12 months. Coprimary outcomes included changes in glycated hemoglobin (HbA sub c /sub ) and health-related quality of life (HRQoL). Data were assessed at baseline and at 6 and 12 months, and analyzed using linear mixed-effects regression models. total of 187 adults with type 2 diabetes (mean 57 years, SD 10 years 41.7% women) were recruited and randomly allocated to the intervention (n=93) and control (n=94) arms. MDC program users (92/93 participants) completed 1942 chats with i Laura /i , averaging 243 min (SD 212) per person over 12 months. Compared with baseline, the mean estimated HbA sub c /sub decreased in both arms at 12 months (intervention: 0.33% and control: 0.20%), but the net differences between the two arms in change of HbA sub c /sub (−0.04%, 95% CI −0.45 to 0.36 i P /i =.83) was not statistically significant. At 12 months, HRQoL utility scores improved in the intervention arm, compared with the control arm (between-arm difference: 0.04, 95% CI 0.00 to 0.07 i P /i =.04). he MDC program was successfully adopted and used by in iduals with type 2 diabetes and significantly improved the users’ HRQoL. These findings suggest the potential for wider implementation of technology-enabled conversation-based programs for supporting diabetes self-management. Future studies should focus on strategies to maintain program usage and HbA sub c /sub improvement. ustralia New Zealand Clinical Trials Registry (ACTRN) 12614001229662 anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12614001229662

Mapping of the PDQ-39 to EQ-5D scores in patients with Parkinson’s disease

Publisher: Springer Science and Business Media LLC

Date: 11-07-2012

DOI: 10.1007/S11136-012-0231-6

Abstract: The EuroQoL (EQ-5D) is ideal to compare quality of life across conditions. However, the Parkinson's Disease Questionnaire (PDQ-39) is often the only quality-of-life instrument used in Parkinson's disease research. We aimed to identify associations between PDQ-39 domains and EQ-5D domains, and compare different methods of developing a function to map the PDQ-39 to EQ-5D scores. Adults with Parkinson's disease self-completed both instruments. Ordinal regression identified associations between PDQ-39 domain scores and each EQ-5D domain. Modeling (n = 80) and validation sets (n = 16) were randomly generated. Overall performance of four methods of mapping the PDQ-39 to EQ-5D scores (using PDQ-39 domains and total score in ordinal and linear regression) was assessed with the validation set, followed by assessing the equivalence of observed and predicted EQ-5D scores on the full dataset controlling for sociodemographic factors. Different sets of PDQ-39 domains were associated with each EQ-5D domain. For ex le, PDQ-39 "Activities of Daily Living" and "Social Support" were associated with EQ-5D "Personal Care," while PDQ-39 "Emotional Well-being" was associated with EQ-5D "Anxiety/Depression." Over one-third (37.5 %) of predictions from ordinal regressions had an error <0.01 % (compared to 6.3 % for linear regressions). The EQ-5D scores predicted with ordinal regression using PDQ-39 domains were similar in distribution and association with sociodemographic factors to the observed EQ-5D scores. Of the four methods tested, using PDQ-39 domains in ordinal regression was superior for mapping EQ-5D scores. The function reported here may prove particularly useful for cost-utility analyses comparing Parkinson's disease with other conditions.

A study protocol for a randomised controlled trial of an interactive web-based intervention: CancerCope

Publisher: BMJ

Date: 06-2017

DOI: 10.1136/BMJOPEN-2017-017279

Baby Steps - an online program promoting the wellbeing of new mothers and fathers: a study protocol

Publisher: JMIR Publications Inc.

Date: 07-2016

DOI: 10.2196/RESPROT.5706

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

The relationship between socio-economic status and general practitioner visits for children in . A cost-effectiveness analysis of a telephone-linked care intervention for individuals with Type 2 diabetesthe first 12 months of life: An Australian study

Publisher: CSIRO Publishing

Date: 2015

DOI: 10.1071/AH14108

Abstract: Objective The aim of the present study was to examine the relationship between socioeconomic status (SES) and child general practitioner (GP) visits in the first 12 months of life. Methods A longitudinal analysis of 1202 mother and child dyads was conducted as part of the Environments for Healthy Living study from south-east Queensland, Australia, for participants enrolled between 2006 and 2009. Maternally reported survey data (sociodemographic and child health information) were linked with in idual Medical Benefits Scheme data from birth to 12 months, identifying GP service use. Results On average, children visited the GP 10.2 times in the first 12 months of life. An inverse relationship was found for SES and child GP visits, with maternal education and child gender the strongest predictors of the total number of GP visits. Almost 70% of participants had all GP consultations bulk billed and only 3.5% paid more than A$100 in total. Conclusions Children from lower SES families may have a greater need for health services due to higher rates of illness and injury. Bulk billing and low-cost access to GP services, regardless of length of consultation, improve equity of access however, indirect costs may prevent low-income mothers from accessing care for their child when needed. What is known about the topic? The relationship between health and SES, and the influence that health service use can have on this relationship, are well recognised. Previous studies on adult populations in Australia suggest that people of lower SES have more frequent GP consultations due to greater exposure to health risk. However, consultation times are often shorter because short consultations are more likely to be bulk billed, which is resulting in ongoing unmet need. Early childhood visits to the GP can strongly influence long-term health outcomes however, relatively few studies have examined GP service use among children in Australia. What does this paper add? This paper builds on current knowledge by providing valuable insights into GP service use in the first 12 months of life. It provides evidence to suggest that the relationship between SES and health risk already exists in the first 12 months of life and that bulk billing and low-cost access to GP services improves equity of access. It also highlights the importance of health policy and practice that enables GP service utilisation based on need rather than ability to pay. What are the implications for practitioners? Policies and practice that promote equity of access, such as bulk billing for lower SES families, can assist in improving long-term health outcomes for disadvantaged populations. Greater equity with regard to length of consultation and bulk billing for adults may assist in reducing the disparities in health outcomes between the higher and lower SES populations. Furthermore, indirect costs and the availability of appropriate services for specific groups, such as low income, rural and remote and linguistically and culturally erse populations, may also be important barriers to access.

The cost‐effectiveness of continuous subcutaneous insulin infusion compared with multiple daily injections for the management of diabetes: response to Schuffman and Carr

Publisher: Wiley

Date: 24-11-2004

DOI: 10.1111/J.1464-5491.2004.1349A.X

Valuing EQ-5D health states for Sri Lanka

Publisher: Springer Science and Business Media LLC

Date: 28-12-2015

DOI: 10.1007/S11136-014-0906-2

Abstract: The aim of this study was to derive an algorithm to estimate utility values for the EQ-5D-3L health states based on the preferences of a population s le from Sri Lanka. The time trade-off method was used to directly value 198 EQ-5D-3L health states in a general population s le (n = 780) from Sri Lanka. Stratified cluster s ling with random selection within clusters was used to select the s le from four districts. Each participant valued 15 health states via face-to-face interviews. The best fit model was selected using consistency, parsimony, and goodness of fit. Based on logical inconsistency, numerous sub-s les were also used for model specification. For each model, the numbers of illogical orderings in the resulting value set were also examined. Generalised least squares with random effects were found to be the best specification. The sub-s le consisting of participants with less than seven logical inconsistent observations produced no illogical ordering in the final value set and is considered the preferred model. Compared to value sets in other countries, a high disutility is associated with level 3 deficits in the mobility dimension. More than 50 % of health states in the Sri Lankan value set are deemed worse than death health states. Sri Lankan utility values for EQ-5D-3L states deviate markedly from existing values for upper middle and high-income countries. It is important to have country-specific utility values to conduct cost-utility analysis.

The Impact of Population-Based Disease Management Services on Health Care Utilisation and Costs: Results of the CAPICHe Trial

Publisher: Springer Science and Business Media LLC

Date: 27-09-2019

DOI: 10.1007/S11606-018-4682-5

Cardiovascular Telemedicine Program in Rural Australia (Letter)

Publisher: Massachusetts Medical Society

Date: 27-08-2020

DOI: 10.1056/NEJMC1913719

Guidelines for conducting and reporting economic evaluation of fall prevention strategies

Publisher: Springer Science and Business Media LLC

Date: 23-11-2011

DOI: 10.1007/S00198-010-1482-0

Abstract: Falls in older people result in substantial health burden. Compelling evidence indicates that falls can be prevented. We developed comprehensive guidelines for economic evaluations of fall prevention interventions to facilitate publication of high-quality economic evaluations of the effective strategies and aid decision making. The importance of economics applied to falls and fall prevention in older people has largely been overlooked. The use of different methodologies to assess the costs and health benefits of the interventions and their comparators and the inconsistent reporting in the studies limits the usefulness of these economic evaluations for decision making. We developed guidelines to encourage and facilitate completion of high-quality economic evaluations of effective fall prevention strategies. We used a generic checklist for economic evaluations as a platform to develop comprehensive guidelines for conducting and reporting economic evaluations of fall prevention strategies. We considered the many challenges involved, particularly in identifying, measuring, and valuing the relevant cost items. We recommend researchers include cost outcomes and report incremental cost-effectiveness ratios in terms of falls prevented and quality adjusted life years in all clinical trials of fall prevention interventions. Studies should include the following cost categories: (1) implementing the intervention, (2) delivering the comparator group intervention, (3) total health care costs, (4) costs of fall-related health care resource use, and (5) personal and informal carer opportunity costs. This paper provides a timely benchmark to promote comparability and consistency for conducting and reporting economic evaluations of fall prevention strategies.

The gain of function SCN1A disorder spectrum: novel epilepsy phenotypes and therapeutic implications

Publisher: Oxford University Press (OUP)

Date: 13-06-2022

DOI: 10.1093/BRAIN/AWAC210

Abstract: Brain voltage-gated sodium channel NaV1.1 (SCN1A) loss-of-function variants cause the severe epilepsy Dravet syndrome, as well as milder phenotypes associated with genetic epilepsy with febrile seizures plus. Gain of function SCN1A variants are associated with familial hemiplegic migraine type 3. Novel SCN1A-related phenotypes have been described including early infantile developmental and epileptic encephalopathy with movement disorder, and more recently neonatal presentations with arthrogryposis. Here we describe the clinical, genetic and functional evaluation of affected in iduals. Thirty-five patients were ascertained via an international collaborative network using a structured clinical questionnaire and from the literature. We performed whole-cell voltage-cl electrophysiological recordings comparing sodium channels containing wild-type versus variant NaV1.1 subunits. Findings were related to Dravet syndrome and familial hemiplegic migraine type 3 variants. We identified three distinct clinical presentations differing by age at onset and presence of arthrogryposis and/or movement disorder. The most severely affected infants (n = 13) presented with congenital arthrogryposis, neonatal onset epilepsy in the first 3 days of life, tonic seizures and apnoeas, accompanied by a significant movement disorder and profound intellectual disability. Twenty-one patients presented later, between 2 weeks and 3 months of age, with a severe early infantile developmental and epileptic encephalopathy and a movement disorder. One patient presented after 3 months with developmental and epileptic encephalopathy only. Associated SCN1A variants cluster in regions of channel inactivation associated with gain of function, different to Dravet syndrome variants (odds ratio = 17.8 confidence interval = 5.4–69.3 P = 1.3 × 10−7). Functional studies of both epilepsy and familial hemiplegic migraine type 3 variants reveal alterations of gating properties in keeping with neuronal hyperexcitability. While epilepsy variants result in a moderate increase in action current litude consistent with mild gain of function, familial hemiplegic migraine type 3 variants induce a larger effect on gating properties, in particular the increase of persistent current, resulting in a large increase of action current litude, consistent with stronger gain of function. Clinically, 13 out of 16 (81%) gain of function variants were associated with a reduction in seizures in response to sodium channel blocker treatment (carbamazepine, oxcarbazepine, phenytoin, lamotrigine or lacosamide) without evidence of symptom exacerbation. Our study expands the spectrum of gain of function SCN1A-related epilepsy phenotypes, defines key clinical features, provides novel insights into the underlying disease mechanisms between SCN1A-related epilepsy and familial hemiplegic migraine type 3, and identifies sodium channel blockers as potentially efficacious therapies. Gain of function disease should be considered in early onset epilepsies with a pathogenic SCN1A variant and non-Dravet syndrome phenotype.

PREDICT-CP: study protocol of implementation of comprehensive surveillance to predict outcomes for school-aged children with cerebral palsy

Publisher: BMJ

Date: 07-2017

DOI: 10.1136/BMJOPEN-2016-014950

Pregnancy‐related mortality up to 1 year postpartum in sub‐Saharan Africa: an analysis of verbal autopsy data from six countries

Publisher: Wiley

Date: 19-07-2023

DOI: 10.1111/1471-0528.17606

Abstract: To compare the causes of death for women who died during pregnancy and within the first 42 days postpartum with those of women who died between days and within 1 year postpartum. Open population cohort (Health and Demographic Surveillance Systems). Ten Health and Demographic Surveillance Systems (HDSS) in The Gambia, Kenya, Malawi, Tanzania, Ethiopia and South Africa. 2114 deaths which occurred within 1 year of the end of pregnancy where a verbal autopsy interview was conducted from 2000 to 2019. InterVA5 and InSilicoVA verbal autopsy algorithms were used to attribute the most likely underlying cause of death, which were grouped according to adapted International Classification of Diseases‐Maternal Mortality categories. Multinomial regression was used to compare differences in causes of deaths within 42 days versus 43–365 days postpartum adjusting for HDSS and time period (2000–2009 and 2010–2019). Cause of death and the verbal autopsy Circumstances of Mortality Categories (COMCATs). Of 2114 deaths, 1212 deaths occurred within 42 days postpartum and 902 between 43 and 365 days postpartum. Compared with deaths within 42 days, deaths from HIV and TB, other infectious diseases, and non‐communicable diseases constituted a significantly larger proportion of late pregnancy‐related deaths beyond 42 days postpartum, and health system failures were important in the circumstances of those deaths. The contribution of HIV and TB to deaths beyond 42 days postpartum was greatest in Southern Africa. The causes of pregnancy‐related mortality within and beyond 42 days postpartum did not change significantly between 2000–2009 and 2010–2019. Cause of death data from the extended postpartum period are critical to inform prevention. The dominance of HIV and TB, other infectious and non‐communicable diseases to (late) pregnancy‐related mortality highlights the need for better integration of non‐obstetric care with ante‐, intra‐ and postpartum care in high‐burden settings.

Unwrapping the Surprisingly High Risk of Dying from Cardiovascular Disease at Christmas: The HUNT Prospective Population-based Cohort Study in Norway

Publisher: Research Square Platform LLC

Date: 11-12-2020

DOI: 10.21203/RS.3.RS-123211/V1

Abstract: BackgroundAlthough it is known that winter inclusive of the Christams holiday period is associated with an increased risk of dying compared to other times of the year, very few studies have specifically examined this phenomenon within a population cohort subject to baseline profiling and prospective follow-up. In such a cohort, we sought to determine the specific characteristics of mortality occuring during the Christmas holidays. MethodsBaseline profiling and outcome data were derived from a prospective population-based cohort with longitudinal follow-up in Central Norway - the Nord-Trøndelag Health Study. From 1984-1986, 88% of the target population comprising 39,273 men and 40,353 women aged 48±18 and 50±18 years, respectively, were profiled. We examined the long-term pattern of all-cause mortality and specific causes of death according to season, month and in idual days of the year to determine the number of excess (cause-specific) deaths occuring at key timepoints (including the Christmas holidays). ResultsDuring 33.5 (IQR 17.1-34.4) years follow-up, 19,879 (50.7%) men and 19,316 (49.3%) women died at age-adjusted rate of 5.3 and 4.6 deaths per 1000/annum, respectively. Each winter, there were 44 (95% CI 43-45) more all-cause deaths compared to summer, with 21 (95% CI 20-22) more deaths attributable to cardiovascular disease. Compared to any other time of the year, December 25 th -27 th was the deadliest being associated with an excess of 1.3 (95% CI 1.1-1.5) all-cause and 1.0 (95% CI 0.7-1.3) cardiovascular-related deaths per day each year. Compared to the pre-Christmas/Winter period (1 st -21 st December), the incidence rate ratio of all-cause mortality increased to 1.22 (95% CI 1.16-1.27) and 1.17 (95% 1.11-1.22) in men and women, respectively, in the next 21 days (Christmas/New Year holiday period). All observed differences were highly significant ( P .001). A less pronounced pattern of seasonally-linked deaths attributable to respiratory illnesses (but not cancer) was also observed.ConclusionChristmas in Central Norway is characterised by a distinctive change and increase in cardiovascular-related mortality over and above that observed between winter (more deaths) and summer (fewer deaths). This distinctive pattern contrasted with cancer-related deaths. Further research to address vulnerability to the darker consequences of winter and, more specifically Christmas, is required.

A cost-effectiveness model of genetic testing for the evaluation of families with hypertrophic cardiomyopathy

Publisher: BMJ

Date: 29-11-2012

DOI: 10.1136/HEARTJNL-2011-300368

Abstract: Traditional management of families with hypertrophic cardiomyopathy (HCM) involves periodic lifetime clinical screening of family members, an approach that does not identify all gene carriers owing to incomplete penetrance and significant clinical heterogeneity. Limitations in availability and cost have meant genetic testing is not part of routine clinical management for many HCM families. To determine the cost-effectiveness of the addition of genetic testing to HCM family management, compared with clinical screening alone. A probabilistic Markov decision model was used to determine cost per quality-adjusted life-year and cost for each life-year gained when genetic testing is included in the management of Australian families with HCM, compared with the conventional approach of periodic clinical screening alone. The incremental cost-effectiveness ratio (ICER) was $A785 (£510 or €587) per quality-adjusted life-year gained, and $A12 720 (£8261 or €9509) per additional life-year gained making genetic testing a very cost-effective strategy. Sensitivity analyses showed that the cost of proband genetic testing was an important variable. As the cost of proband genetic testing decreased, the ICER decreased and was cost saving when the cost fell below $A248 (£161 or €185). In addition, the mutation identification rate was also important in reducing the overall ICER, although even at the upper limits, the ICER still fell well within accepted willingness to pay bounds. The addition of genetic testing to the management of HCM families is cost-effective in comparison with the conventional approach of regular clinical screening. This has important implications for the evaluation of families with HCM, and suggests that all should have access to specialised cardiac genetic clinics that can offer genetic testing.

Predicted costs and outcomes from reduced vibration detection in people with diabetes in the U.S.

Publisher: American Diabetes Association

Date: 08-2003

DOI: 10.2337/DIACARE.26.8.2305

Abstract: OBJECTIVE—The ability to perceive vibration (vibration detection) has been shown to be a good predictor of the long-term complications of diabetic peripheral neuropathy (DPN). We aimed to estimate the predicted complications and costs for the U.S. health care system associated with reduced vibration detection (vibration perception threshold ≥25 V), estimated using a quantitative sensory testing device. RESEARCH DESIGN AND METHODS—A Markov model was constructed for a hypothetical cohort of people with DPN. The model was run over a 10-year period using Monte Carlo simulations to estimate disease progression, predicted costs, and complications according to vibration detection levels. RESULTS—The average in idual with reduced vibration detection incurs approximately five times more direct medical costs for foot ulcer and utations, yields 0.18 fewer quality-adjusted life-years, and lives for ∼2 months less than an average in idual with normal vibration detection. CONCLUSIONS—The treatment of foot ulceration and utation is time-consuming and expensive. If in iduals with reduced vibration detection could be identified, then preventative care could be concentrated on those patients, potentially saving valuable resources and improving health outcomes.

Insights into public preferences for pharmaceutical funding

Publisher: Emerald

Date: 05-09-2008

DOI: 10.1108/17506120810903980

Abstract: Taxes are used to subsidise the public use of pharmaceuticals in some countries. This paper seeks to quantify criteria considered important by the Australian public for allocating resources for pharmaceuticals. A discrete choice experiment (DCE) was administered to two s les of adults in Australia. A forced choice design was used in a pilot study, but an opt‐out option was included in the main study to avoid forcing choice. Data were analysed using multinomial logit. For the levels and units presented in the DCE, quality of life (QoL) after treatment was the most important attribute in both the pilot and main studies, followed by survival after treatment and the chance of success for a given pharmaceutical. Cost to the government was of little importance in the pilot study, but was of importance in the main study. By understanding public preferences, marketers can tailor pharmaceutical offerings that appeal to the public and to relevant pharmaceutical funding bodies when making submissions, thus increasing the likelihood of receiving public funding support. Understanding public preferences allows public policy‐makers to direct resources towards those medical technologies which are likely to give the greatest overall societal benefit. This study shows the simultaneous importance of survival, QoL, chance of success and cost to public preferences for pharmaceutical funding. Cost (tax) signals suggest the public are willing to limit the amount they expect the government to pay for effective pharmaceuticals.

A comparison of EQ-5D-3L population norms in Queensland, Australia, estimated using utility value sets from Australia, the UK and USA.

Publisher: Springer Science and Business Media LLC

Date: 28-03-2014

DOI: 10.1007/S11136-014-0676-X

Abstract: To provide population norms for the EQ-5D-3L by age and gender based on a representative adult s le in Queensland, Australia to assess differences in health-related quality of life by applying the Australian, UK and USA value sets to these data and to assess differences in utility scores for key preventive health indicators. A cross-sectional computer-assisted telephone interview survey (March-June 2011) with 5,555 adults. Respondents rated their impairment (none, moderate, severe problems) across five domains (mobility, self-care, usual activities, pain and discomfort, anxiety or depression) using the validated EQ-5D-3L health-related quality of life instrument. Utility score indexes were derived using the Australian, UK and USA value sets. Forty per cent of adults reported pain and discomfort while 3% indicated problems with self-care. Approximately one in six had limitations with mobility, usual activities or anxiety or depression. The three value sets performed similarly in discriminating differences based on most characteristics, and clinically meaningful differences were seen for age, body weight, physical activity and daily smoking. There were no differences in utility scores for gender. This is the first study to report general population findings for the Australian EQ-5D-3L value set. Overall, the Australian value set performed comparably with other value sets commonly used in the Australian population however, differences were observed. Results will enable further refinement to health and economic studies in an Australian-specific context.

The incidence and cost of injurious falls associated with visual impairment in the UK

Publisher: Swets & Zeitlinger Publishers

Date: 2002

DOI: 10.1076/VIMR.4.1.1.15635

Patterns of multimorbid health conditions: a systematic review of analytical methods and comparison analysis

Publisher: Oxford University Press (OUP)

Date: 16-07-2018

DOI: 10.1093/IJE/DYY134

Abstract: The latest review of studies on multimorbidity patterns showed high heterogeneity in the methodology for identifying groups of multimorbid conditions. However, it is unclear how analytical methods used influence the identified multimorbidity patterns. We undertook a systematic review of analytical methods used to identify multimorbidity patterns in PubMed and EMBASE from their inception to January 2017. We conducted a comparison analysis to assess the effect the analytical methods had on the multimorbidity patterns identified, using the Australian National Health Survey (NHS) 2007-08 data. We identified 13 194 studies and excluded 13 091 based on titles/abstracts. From the full-text reviews of the 103 remaining publications, we identified 41 studies that used five different analytical methods to identify multimorbid conditions in the studies. Thirty-seven studies (90%) adopted either the factor-analysis or hierarchical-clustering methods, but heterogeneity arises for the use of different proximity measures within each method to form clusters. Our comparison analysis showed the variation in identified groups of multimorbid conditions when applying the methods to the same NHS data. We extracted main similarities among the groupings obtained by the five methods: (i) cardiovascular and metabolic diseases, (ii) mental health problems and (iii) allergic diseases. We showed the extent of effects for heterogeneous analytical methods on identification of multimorbidity patterns. However, more work is needed to guide investigators for choosing the best analytical method to improve the validity and generalizability of findings. Investigators should also attempt to compare results obtained by various methods for a consensus grouping of multimorbid conditions.

Substitution of doctors with physiotherapists in the management of common musculoskeletal disorders: a systematic review

Publisher: Elsevier BV

Date: 12-2017

DOI: 10.1016/J.PHYSIO.2016.11.006

Abstract: There is large variation in models-of-care involving the professional substitution of doctors with physiotherapists. To establish the impact upon patients and health services, of substituting doctors with physiotherapists in the management of common musculoskeletal disorders. Medline, CINAHL and ABI Complete databases, and hand-searching of related studies. Randomised and non-randomised clinical trials, inter-rater reliability and comparative studies comparing the outcomes of usual care from doctors, with outcomes when the doctor was substituted with a physiotherapist. Two reviewers evaluated all studies using the Downs and Black Instrument. Meta-analysis was not possible due to study heterogeneity. A descriptive review was undertaken. 14 studies of moderate to low quality met the inclusion criteria. Professional substitution with a physiotherapist causes no significant change to health outcomes and inconsistent variation in the use of healthcare resources. There is insufficient health economic data to determine overall efficiency. In the selected presentations studied, physiotherapists made similar diagnostic and management decisions to orthopaedic surgeons and patients are as, or more satisfied with a physiotherapist. Further high quality health and economic research is needed, in less selective patient populations, to determine the optimal role for physiotherapists. Physiotherapists provide a professional alternative to doctors for musculoskeletal disorders but the health economic implications of this model are presently unclear. Systematic Review Registration Number PROSPERO (Registration number CRD42015027671).

Cost-effectiveness of a coronary heart disease secondary prevention program in patients with myocardial infarction: results from a randomised controlled trial (ProActive Heart)

Publisher: Springer Science and Business Media LLC

Date: 05-2013

DOI: 10.1186/1471-2261-13-33

Exploring the potential to remain young @ Heart: Initial findings of a multi-centre, randomised study of nurse-led, home-based intervention in a hybrid health care system

Publisher: Elsevier BV

Date: 2012

DOI: 10.1016/J.IJCARD.2010.08.071

Abstract: Disease management programs have been shown to improve health outcomes in high risk in iduals in many but not all health care systems. Young @ Heart is a multi-centre, randomised controlled study of a nurse-led, home-based intervention (HBI) program vs. usual care (UC) in privately insured patients in Australia aged ≥ 45 years following an acute cardiac admission. Intensity of HBI is tailored to an in idual's clinical stability, management and risk profile. The primary endpoint is the rate of all-cause stay during a mean of 2.5 years follow-up. A target of 602 adults (72% men) were randomised to HBI (n=306) or UC (n=296) their initial profiles being well matched. At baseline, 71% were overweight (body mass index 29.7 ± 3.9 kg/m(2)) and 66% had an elevated blood pressure (153 ± 18/89 ± 7 mm Hg). Over half had a history of smoking and 39% had a sub-optimal total cholesterol level >4 mmol/L. Overall, 62% (376 cases) were treated for coronary artery disease (27% with multi-vessel disease and 39% underwent cardiac revascularisation). A further 20% (120 cases) were treated for a cardiac arrhythmia (predominantly atrial fibrillation) and 19% type 2 diabetes mellitus. At 7-14 days post-discharge, 293 (96%) HBI patients received a home visit triggering urgent clinical review and/or enhanced clinical management in many patients. The Young @ Heart intervention is a well accepted and potentially effective intervention to reduce recurrent hospital stay in privately insured cardiac patients in Australia.

Recommendations from Two Citizens' Juries on the Surgical Management of Obesity

Publisher: Springer Science and Business Media LLC

Date: 07-01-2018

DOI: 10.1007/S11695-017-3089-4

Abstract: It is important that guidelines and criteria used to prioritise access to bariatric surgery are informed by the values of the tax-paying public in combination with the expertise of healthcare professionals. Citizens' juries are increasingly used around the world to engage the public in healthcare decision-making. This study investigated citizens' juries about prioritising patient access to bariatric surgery in two Australian cities. The objective of this study is to examine public priorities for government expenditure on the surgical management of obesity developed through either a one or three-day citizen jury. A three-day jury was held in Brisbane and a one-day jury in Adelaide. Jurors were selected in Brisbane (n = 18) and in Adelaide (n = 12) according to pre-specified criteria. Expert witnesses from various medical disciplines and consumers were cross-examined by jurors. The verdicts of the juries were similar in that both juries agreed bariatric surgery was an important option in the management of obesity and related comorbidities. Recommendations about who should receive treatment differed slightly across the juries. Both juries rejected the use of age as a rationing tool, but managed their objections in different ways. Participants' experiences of the jury process were positive, but our observations suggested that many variables may influence the nature of the final verdict. Citizen's juries, even when shorter in duration, can be an effective tool to guide the development of health policy and priorities. However, our study has identified a range of variables that should be considered when designing and running a jury and when interpreting the verdict.

The Australian Reproductive Genetic Carrier Screening Project (Mackenzie’s Mission)

Publisher: MDPI AG

Date: 28-10-2022

DOI: 10.3390/JPM12111781

Abstract: Reproductive genetic carrier screening (RGCS) provides people with information about their chance of having children with autosomal recessive or X-linked genetic conditions, enabling informed reproductive decision-making. RGCS is recommended to be offered to all couples during preconception or in early pregnancy. However, cost and a lack of awareness may prevent access. To address this, the Australian Government funded Mackenzie’s Mission—the Australian Reproductive Genetic Carrier Screening Project. Mackenzie’s Mission aims to assess the acceptability and feasibility of an easily accessible RGCS program, provided free of charge to the participant. In study Phase 1, implementation needs were mapped, and key study elements were developed. In Phase 2, RGCS is being offered by healthcare providers educated by the study team. Reproductive couples who provide consent are screened for over 1200 genes associated with serious, childhood-onset genetic conditions. Those with an increased chance result are provided comprehensive genetic counseling support. Reproductive couples, recruiting healthcare providers, and study team members are also invited to complete surveys and/or interviews. In Phase 3, a mixed-methods analysis will be undertaken to assess the program outcomes, psychosocial implications and implementation considerations alongside an ongoing bioethical analysis and a health economic evaluation. Findings will inform the implementation of an ethically robust RGCS program.

Outcropping reef ledges drive patterns of epibenthic assemblage diversity on cross-shelf habitats

Publisher: Springer Science and Business Media LLC

Date: 22-02-2016

DOI: 10.1007/S10531-016-1058-1

Fire damage on seeds of Calliandra parviflora Benth. (Fabaceae), a facultative seeder in a Brazilian flooding savanna

Publisher: Wiley

Date: 14-05-2021

DOI: 10.1111/1442-1984.12335

Abstract: Optimal sexual reproduction in relation to fire effects varies in Fabaceae species. Calliandra species have a large investment in reproduction. We investigated the consequences of fire during the fruiting period of Calliandra parviflora Benth., by checking fruit exposure to fire, pre‐dispersal seed predator infestation, and the effect of fruit burning on germination. We conducted this study in a floodable savanna in central Brazil, where we collected burnt and unburnt fruits. We measured the fruit and seed mass, and counted the number of damaged and undamaged seeds and live larvae per fruit. We analyzed the seed germination percentage from burnt and unburnt fruits. The burnt fruits presented greater mass than the unburnt fruits, despite their seed mass being similar. The number of damaged seeds per fruit was only slightly higher in burnt compared to unburnt fruits ( p = 0.047). The number of larvae on pre‐dispersal seeds per fruit varied from 0 to 4 and did not differ between burnt and unburnt fruits. The germination percentage of unburnt fruit seeds (mean = 22 ± 17%), was significantly higher than that of burnt fruit (mean = 3.0 ± 2.0%, p 0.001). Fire during fruiting or pre‐dispersion decreases seed germination from 22 to 3%, but it does not hurt vegetative regeneration or resprout capacity of C. parviflora , which is a facultative seeder. Hence, we suggest that C. parviflora has potential for post‐fire restoration in floodable open grassy savannas, in the ecotone between Cerrado and Pantanal, because this species may sprout quickly after first post‐fire rains.

“She’ll be right, mate!”: do Australians take their health for granted?

Publisher: CSIRO Publishing

Date: 2020

DOI: 10.1071/HC20025

Abstract: ABSTRACT INTRODUCTIONHealth consciousness highlights the readiness of in iduals to undertake health actions and take responsibility for their health and the health of others. AIMTo examine the health consciousness of Australians and its association with health status, health-care utilisation and sociodemographic factors. METHODSThis quantitative cross-sectional study was a part of a larger project aiming to engage the general public in health-care decision-making. Adults from Queensland and South Australia (n=1529) were recruited to participate by a panel company. The questionnaire included the Health Consciousness Scale (HCS), health status, health-care utilisation, sociodemographic and socioeconomic variables. RESULTSThe health consciousness of Australians was relatively low (mean score=21), compared to other international administrations of the HCS, and further investigations revealed that more health-conscious people tended to live in South Australia, be female and single, experience poorer physical and mental health and were more frequent users of health-care services. DISCUSSIONThe general approach to health in this s le of the Australian public may reflect ‘here and now’ concerns. It appears that an attitude of ‘she’ll be right, mate’ prevails until a change in an in idual’s health status or their exposure to the health system demands otherwise. These findings need to be investigated further to see if they are confirmed by others and to clarify the implications for primary health programmes in Australia in redressing the public’s apparent apathy.

Stated Preference Research in Reproductive and Maternal Healthcare Services in Sub-Saharan Africa: A Systematic Review

Publisher: Springer Science and Business Media LLC

Date: 29-10-2022

DOI: 10.1007/S40271-021-00553-9

Abstract: Understanding the preferred choice of healthcare service attributes for women is important, particularly in sub-Saharan Africa where resources are constrained and improving reproductive and maternal healthcare services is of high importance. The aim of this systematic review was to identify attributes of reproductive and maternal healthcare services in sub-Saharan Africa, and summarise the factors shaping women's preference to access these services. PubMed/MEDLINE, EMBASE, PsycINFO and CINAHL were searched from the inception of each database until March 2021 for published studies reporting stated preferences for maternal and reproductive healthcare services in sub-Saharan Africa. Data were extracted using a predefined extraction sheet, and the quality of reporting of included studies was assessed using PREFS and ISPOR (International Society for Pharmacoeconomics and Outcomes Research) checklists. The Donabedian's model for quality of healthcare was used to categorise attributes into "structure", "process" and "outcome". A total of 13 studies (12 discrete choice experiments and one best-worst scaling study) were included. Attributes related to the structure of healthcare services (e.g. availability of technical equipment, medications or diagnostic facilities, having good system conditions) are often included within the studies, and are considered the most important by women. Of the three dimensions of quality of healthcare, the outcome dimension was the least frequently studied across studies. All except one study explored women's preferences and the participants were pregnant women, women aged 18-49 years who had recently given birth and women living with human immunodeficiency virus. The included studies came from five sub-Saharan Africa countries of which Ethiopia and South Africa each contributed three studies. All of the included studies reported on the purpose, findings and significance of the study. However, none of the studies reported on the differences between responders vs non-responders. Nine of the 13 studies employed the ISPOR checklist and reported each item including the research question and the methods for identifying and selecting attributes, and provided the findings in sufficient detail and clarity. Aligning maternal healthcare service provision with women's preferences may foster client-oriented services and thereby improve service uptake and better patient outcomes.

Valuation study for a preference-based quality of life measure for dental caries (Dental Caries Utility Index - DCUI) among Australian adolescents - Study protocol

Publisher: BMJ

Date: 10-2020

DOI: 10.1136/BMJOPEN-2020-038626

Abstract: A new health state classification system has been developed for dental caries - Dental Caries Utility Index (DCUI) to facilitate the assessment of oral health interventions in the cost-utility analysis (CUA). This paper reports the protocol for a valuation study, which aims to generate a preference-based algorithm for the classification system for the DCUI. Discrete choice experiments (DCEs) will be conducted to value health states generated by the DCUI classification system and preferences for these health states will be modelled to develop a utility algorithm. DCEs produce utility values on a latent scale and these values will be anchored into the full health-dead scale to calculate the quality-adjusted life years in CUA. There is no previous evidence for the most suitable anchoring method for dental caries health state valuation. Hence, we will first conduct pilot studies with two anchoring approaches DCE including duration attribute and DCE anchoring to worst heath state in Visual Analogue Scale. Based on the pilot studies, the most suitable anchoring method among two approaches will be used in the main valuation survey, which will be conducted as an online survey among a representative s le of 2000 adults from the Australian general population. Participants will be asked to complete a set of DCE choice tasks along with anchoring tasks, basic social-demographic questions, DCUI, a generic preference-based measure and oral health quality of life instrument. Ethical approval for this study was obtained from the Human Research Ethics Committee, Griffith University (reference number HREC/2019/550). The generated algorithm will facilitate the use of the new dental caries preference-based measure in economic evaluations of oral health interventions. The results will be disseminated through journal articles and professional conferences.

Indicators of Risk for Dental Caries in Children: A Holistic Approach

Publisher: SAGE Publications

Date: 30-04-2019

DOI: 10.1177/2380084419834236

Abstract: Dental caries in children is a major public health problem worldwide, with a multitude of determinants acting upon children to different degrees in different communities. The objective of this study was to determine maternal, environmental, and intraoral indicators of dental caries experience in a s le of 6- to 7-y-old children in South East Queensland, Australia. A total of 174 mother-child dyads were recruited for this cross-sectional study from the Griffith University Environments for Healthy Living birth cohort study. Maternal education, employment status, and prepregnancy body mass index were maternal indicators, and annual household income was taken as a proxy for environmental indicators. These were collected as baseline data of the study. Clinical data on children’s dental caries experience, saliva characteristics of buffering capacity, stimulated flow rate, and colony-forming units per milliliter of salivary mutans streptococci were collected for the oral health substudy. Univariate analysis was performed with 1-way analysis of variance and chi-square tests. Caries experience was the outcome, which was classified into 4 categories based on the number of carious tooth surfaces. Ordinal logistic regression was used to explore the association of risk indicators with caries experience. Age ( P = 0.021), low salivary buffering capacity ( P = 0.001), reduced levels of salivary flow rate ( P = 0.011), past caries experience ( P = 0.001), low annual household income $30,000 (P = 0.050) and $60,000 (P = 0.033) and maternal employment status ( P = 0.043) were associated with high levels of dental caries. These data support the evidence of associations between maternal, environmental, and children’s intraoral characteristics and caries experience among children in a typical Western industrialized country. All of these need to be considered in preventative strategies within families and communities. The results of this study can be used by clinicians, epidemiologists, and policy makers to identify children who are at risk of developing dental caries. With consideration of costs for treatment for the disease, this information could be used to plan cost-effective and patient-centered preventive care.

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.

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.

Varying sun protection of young children by migrant and Australian-born mothers

Publisher: Elsevier BV

Date: 12-2014

DOI: 10.1111/1753-6405.12272

Abstract: To compare sun protection by Australian-born and migrant mothers of three-year-old children. Australian-born and migrant mothers taking part in the Environments for Healthy Living prospective birth-cohort study were asked standard questions about their child's sun protection. Children were given a skin cancer susceptibility score based on grandparents' ethnic origin. Logistic regression was used to estimate odds ratios (ORs) to measure the association of sun protection of children according to mothers' migrant status adjusted for socio-demographic characteristics. A total of 613 Australian-born and 224 migrant mothers of three-year-old children were studied. Mothers who had migrated less than four years ago were more likely to allow their three-year-old to spend more than two hours outdoors between 10 am and 3 pm compared to Australian-born mothers (OR=2.80, 95%CI 1.20-6.57). Mothers from high latitude countries (>45 degrees) were more likely to apply sunscreen to their child than those from lower latitude countries (OR=3.15, 95%CI 1.03-9.61). Strategies should aim to increase general awareness about the need for sun protection of young children, and recent migrants should be alerted to the harms of excessive sun exposure.

Public hesitancy to COVID-19 vaccine and the role of pharmacists in addressing the problem and improving uptake

Publisher: Wiley

Date: 12-2021

DOI: 10.1002/JPPR.1784

Abstract: COVID‐19 is one of the worst pandemics in recent human history, causing huge health, economic, and psychosocial damage. Since the pandemic hit, several unsubstantiated claims regarding exposure, transmission and management have been disseminated. Misinformation and associated public confusion now extend to the COVID‐19 vaccines, spanning from claims based on possible links between some vaccine types and rare blood clots, to baseless claims. As a result, the public’s trust in COVID‐19 vaccines has been eroded, fuelling an already troubling trend of vaccine hesitancy. As medication experts and the most accessible healthcare providers, pharmacists are well equipped with the required skills and knowledge to improve COVID‐19 vaccine uptake by taking roles that range from dispelling myths, to providing reliable evidence‐based information, through to vaccine administration. This paper discusses public hesitancy to COVID‐19 vaccines, major contributing factors, and the role pharmacists can play in reducing hesitancy and increasing vaccine uptake.

Negative pressure wound therapy for skin grafts and surgical wounds healing by primary intention (Protocol)

Publisher: John Wiley & Sons, Ltd

Date: 10-08-2011

DOI: 10.1002/14651858.CD009261

PRIME: impact of previous mental health problems on health-related quality of life in women with childbirth trauma

Publisher: Springer Science and Business Media LLC

Date: 04-10-2013

DOI: 10.1007/S00737-013-0384-5

Abstract: We investigated the impact of pre-existing mental ill health on postpartum maternal outcomes. Women reporting childbirth trauma received counselling (Promoting Resilience in Mothers' Emotions n = 137) or parenting support (n = 125) at birth and 6 weeks. The EuroQol Five dimensional (EQ-5D)-measured health-related quality of life at 6 weeks, 6 and 12 months. At 12 months, EQ-5D was better for women without mental health problems receiving PRIME (mean difference (MD) 0.06 95 % confidence interval (CI) 0.02 to 0.10) or parenting support (MD 0.08 95 % CI 0.01 to 0.14). Pre-existing mental health conditions influence quality of life in women with childbirth trauma.

A cost-effectiveness analysis of fluvastatin in patients with diabetes after successful percutaneous coronary intervention

Publisher: Elsevier BV

Date: 09-2005

DOI: 10.1016/J.CLINTHERA.2005.09.012

Abstract: The Lescol Intervention Prevention Study (LIPS) was a multinational randomized controlled trial that showed a 47% reduction in the relative risk of cardiac death and a 22% reduction in major adverse cardiac events (MACEs) from the routine use of fluvastatin, compared with controls, in patients undergoing percutaneous coronary intervention (PCI, defined as angioplasty with or without stents). In this study, MACEs included cardiac death, nonfatal myocardial infarction, and subsequent PCI and coronary artery bypass graft. Diabetes was the greatest risk factor for MACEs. This study estimated the cost-effectiveness of fluvastatin when used for secondary prevention of MACEs after PCI in people with diabetes. A post hoc subgroup analysis of patients with diabetes from the LIPS was used to estimate the effectiveness of fluvastatin in reducing myocardial infarction, revascularization, and cardiac death. A probabilistic Markov model was developed using United Kingdom resource and cost data to estimate the additional costs and quality-adjusted life-years (QALYs) gained over 10 years from the perspective of the British National Health Service. The model contained 6 health states, and the transition probabilities were derived from the LIPS data. Crossover from fluvastatin to other lipid-lowering drugs, withdrawal from fluvastatin, and the use of lipid-lowering drugs in the control group were included. In the subgroup of 202 patients with diabetes in the LIPS trial, 18 (15.0%) of 120 fluastatin patients and 21 (25.6%) of 82 control participants were insulin dependent (P = NS). Compared with the control group, patients treated with fluvastatin can expect to gain an additional mean (SD) of 0.196 (0.139) QALY per patient over 10 years (P < 0.001) and will cost the health service an additional mean (SD) of 10 pounds ( 448 pounds) (P = NS) (mean [SD] US $16 [$689]). The additional cost per QALY gained was 51 pounds (US $78). The key determinants of cost-effectiveness included the probabilities of repeat interventions, cardiac death, the cost of fluvastatin, and the time horizon used for the evaluation. Fluvastatin was an economically efficient treatment to prevent MACEs in these patients with diabetes undergoing PCI.

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.

Effectiveness, cost-effectiveness and cost-benefit of a single annual professional intervention for the prevention of childhood dental caries in a remote rural Indigenous community

Publisher: Springer Science and Business Media LLC

Date: 29-08-2015

DOI: 10.1186/S12903-015-0076-9

Health state valuation in low- and middle-income countries: A systematic review of the literature

Publisher: Elsevier BV

Date: 09-2013

DOI: 10.1016/J.JVAL.2013.05.006

Abstract: Cost-utility analysis is widely used in high-income countries to inform decisions on efficient health care resource allocation. Cost-utility analysis uses the quality-adjusted life-year as the outcome measure of health. High-income countries have undertaken health state valuation (HSV) studies to determine country-specific utility weights to facilitate valuation of health-related quality of life. Despite an evident need, however, the extent of HSVs in low- and middle-income countries (LMICs) is unclear. The literature was searched systematically by using four databases and additional Web searches to identify HSV studies carried out in LMICs. The Preferred Reporting System for Systematic Reviews and Meta-Analysis (PRISMA) strategy was followed to ensure systematic selection of the articles. The review identified 17 HSV studies from LMICs. Twelve studies were undertaken in upper middle-income countries, while lower middle- and low-income countries contributed three and two studies, respectively. There were 7 generic HSV and 10 disease-specific HSV studies. The seven generic HSVs included five EuroQol five-dimensional questionnaire, one six-dimensional health state short form (derived from short-form 36 health survey), and one Assessment of Quality of Life valuations. Time trade-off was the predominant valuation method used across all studies. This review found that health state valuations from LMICs are uncommon and utility weights are generally unavailable for these countries to carry out health economic evaluation. More HSV studies need to be undertaken in LMICs to facilitate efficient resource allocation in their respective health systems.

Move it to improve it (Mitii): study protocol of a randomised controlled trial of a novel web-based multimodal training program for children and adolescents with cerebral palsy.

Publisher: BMJ

Date: 2013

DOI: 10.1136/BMJOPEN-2013-002853

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.

Quantification of Spatial and Thematic Uncertainty in the Application of Underwater Video for Benthic Habitat Mapping

Publisher: Informa UK Limited

Date: 05-06-2014

DOI: 10.1080/01490419.2013.877105

Are We Predicting the Actual or Apparent Distribution of Temperate Marine Fishes?

Publisher: Public Library of Science (PLoS)

Date: 19-04-2012

DOI: 10.1371/JOURNAL.PONE.0034558

Risk factors associated with 30‐day unplanned hospital readmission for patients with mental illness

Publisher: Wiley

Date: 17-08-2023

DOI: 10.1111/INM.13042

Abstract: Unplanned hospital readmission rate is up to 43% in mental health settings, which is higher than in general health settings. Unplanned readmissions delay the recovery of patients with mental illness and add financial burden on families and healthcare services. There have been efforts to reduce readmissions with a particular interest in identifying patients at higher readmission risk after index admission however, the results have been inconsistent. This systematic review synthesized risk factors associated with 30‐day unplanned hospital readmissions for patients with mental illness. Eleven electronic databases were searched from 2010 to 30 September 2021 using key terms of 'mental illness', 'readmission' and 'risk factors'. Sixteen studies met the selection criteria for this review. Data were synthesized using content analysis and presented in narrative and tabular form because the extracted risk factors could not be pooled statistically due to methodological heterogeneity of the included studies. Consistently cited readmission predictors were patients with lower educational background, unemployment, previous mental illness hospital admission and more than 7 days of the index hospitalization. Results revealed the complexity of identifying unplanned hospital readmission predictors for people with mental illness. Policymakers need to specify the expected standards that written discharge summary must reach general practitioners concurrently at discharge. Hospital clinicians should ensure that discharge summary summaries are distributed to general practitioners for effective ongoing patient care and management. Having an advanced mental health nurse for patients during their transition period needs to be explored to understand how this role could ensure referrals to the general practitioner are eventuated.

Should future health‐care costs be discounted? The case of diabetes in Australia

Publisher: Wiley

Date: 27-02-2006

DOI: 10.1111/J.1445-5994.2006.01017.X

The cost-effectiveness of oral health interventions: a systematic review of cost-utility analyses

Publisher: Wiley

Date: 19-09-2018

DOI: 10.1111/CDOE.12336

Abstract: To assess the usage of cost-utility analysis (CUA) in oral health interventions and to evaluate the methods used and the reporting quality of CUA in publications on oral health interventions. A systematic review was performed on literature published between 2000 and 2016 where cost-utility analyses of oral health interventions were included. The reporting quality of these oral health CUAs was assessed against the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. Of the 6637 publications identified initially, 23 met the inclusion criteria. Of these, 14 (61%) had been published in the last 6 years. Included studies were on oral cancer (n = 6), provision of dental prosthesis (n = 6), dental caries (n = 4), periodontal diseases (n = 3), antibiotic prophylaxis (n = 2), dento-facial anomalies (n = 1) and dental service provision (n = 1). Twenty-one studies were able to identify the most cost-effective intervention among the different options compared. Of the 23 studies identified, 15 (65%) used quality-adjusted life years (QALY) as the outcome measure, and 18 (78%) reported an incremental cost-effectiveness ratio. The economic perspective was clearly stated in 13 articles (57%). Twenty studies (87%) reported the discount rate, and 22 (96%) undertook sensitivity analysis. The reporting quality of studies, appraised by the CHEERS checklist, varied from 75% to 100% (median 92%). The use of CUAs in evaluation of oral health interventions has been increasing recently, especially from 2011 to 2016. The majority of CUA articles were of good reporting quality as assessed by the CHEERS checklist and were able to provide conclusions regarding the most cost-effective intervention among the different options compared: this will assist in healthcare decision-making and resource allocation. These positive outcomes of our study encourage wider use of CUAs within the dental and oral health professions.

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.

Uncertainty and variability in influenza cost‐effectiveness models

Publisher: Elsevier BV

Date: 12-2011

DOI: 10.1111/J.1753-6405.2011.00788.X

Perceptions of knowledge, attitude and skills about non‐suicidal self‐injury: A survey of emergency and mental health nurses

Publisher: Wiley

Date: 02-12-2021

DOI: 10.1111/INM.12825

The relationship between scale and predictor variables in species distribution models applied to conservation

Publisher: Springer Science and Business Media LLC

Date: 10-04-2021

DOI: 10.1007/S10531-021-02176-W

The Use of QALY Weights for QALY Calculations

Publisher: Springer Science and Business Media LLC

Date: 2008

DOI: 10.2165/00019053-200826040-00003

Abstract: QALYs combine survival and health-related quality of life (QOL) into a single index, enabling judgements about the relative value for money of healthcare interventions. To investigate the methods used for estimating QALY weights included in submissions by industry for listing of their products on the Australian Pharmaceutical Benefits Scheme. Retrospective descriptive review of submissions considered by the Pharmaceutical Benefits Advisory Committee (PBAC) 2002-4. The database of submissions considered at PBAC meetings was obtained from the Pharmaceutical Evaluation Section of the Australian Government Department of Health and Ageing. Further information on each included submission was obtained in the form of the Pharmaceutical Evaluation Section commentary (expert report) on the submission. Submissions to the PBAC over 2002-4 presenting QALYs as an outcome measure were reviewed to identify the methods used to obtain preference-based QALY weights. Information was analyzed according to the approach taken to obtain QALY weights (multi-attribute utility instrument [MAUI], health state valuation [HSV] experiment for scaling the health states, or non-preference-based approach) the population from whom the QALY weights were obtained the appropriateness of the population for the instrument the recommendation made by the PBAC and the main indicated category for use of the pharmaceutical. The approach and the population were classified as 'more appropriate' and 'less appropriate'. The 'more appropriate' approaches were where a MAUI was administered to patients who were currently experiencing the health states being valued, or when an HSV experiment was undertaken in either the general population to value a health state derived from clinical and QOL studies or a population of patients to value their own health state. All other approaches were considered 'less appropriate'. MAUIs were used in 39% of approaches reporting QALYs the most frequently used MAUI was the EQ-5D. HSV experiments were used in 36% of the approaches and generally drawn from the published literature. Non-preference-based approaches (24%) included rating scales, mapping transformations and consensus opinions. Responses from patients were used in 58% of the approaches, followed by healthcare professionals and investigators (24% and 9%, respectively). Healthcare professionals and investigators' responses were frequently used in non-preference-based approaches. Submissions for nervous system, infectious disease and neoplasms disease areas were less likely to have presented QALY weights derived from a 'more appropriate' approach. Of the approaches using 'more appropriate' populations and techniques, 56% were rejected by the PBAC compared with 66% of those using 'less appropriate' approaches. The variability in the quality of QALY weights is troubling. The PBAC guidelines that applied over the period studied neither encouraged nor discouraged cost-utility analyses and provided only brief guidance on how QALY studies should be conducted. A consistent approach to the application of standard methods should be used when the QALY is used to inform decisions on resource allocation. The new PBAC guidelines released in 2006 provide more extensive guidance on derivation of QALY estimates and are more encouraging of the presentation of cost-utility analysis. MAUIs offer a straightforward approach to obtaining QALY weights, and ideally should be used routinely in relevant comparative randomized trials to assess patients' health states.

Secondary prevention after PCI: The cost effectiveness of fluvastatin therapy in the Netherlands

Publisher: Elsevier BV

Date: 11-2004

DOI: 10.1016/S1098-3015(10)65794-4

Family stress predicts poorer dietary quality in children: Examining the role of the parent–child relationship

Publisher: Wiley

Date: 08-02-2018

DOI: 10.1002/ICD.2088

Funding of drugs: do vaccines warrant a different approach? – Authors' reply

Publisher: Elsevier BV

Date: 05-2009

DOI: 10.1016/S1473-3099(09)70107-0

Intestinal-Cell Kinase and Juvenile Myoclonic Epilepsy

Publisher: Massachusetts Medical Society

Date: 18-04-2019

DOI: 10.1056/NEJMC1805100

Mortality and hospitalisation costs of rheumatic fever and rheumatic heart disease in New Zealand

Publisher: Wiley

Date: 12-04-2012

DOI: 10.1111/J.1440-1754.2012.02446.X

Abstract: To estimate the annual mortality and the cost of hospital admissions for acute rheumatic fever (ARF) and rheumatic heart disease (RHD) for New Zealand residents. Hospital admissions in 2000-2009 with a principal diagnosis of ARF or RHD (ICD9_AM 390-398 ICD10-AM I00-I099) and deaths in 2000-2007 with RHD as the underlying cause were obtained from routine statistics. The cost of each admission was estimated by multiplying its diagnosis-related group (DRG) cost weight by the national price for financial year 2009/2010. There were on average 159 RHD deaths each year with a mean annual mortality rate of 4.4 per 100, 000 (95% confidence limit 4.2, 4.7). Age-adjusted mortality was five- to 10-fold higher for Māori and Pacific peoples than for non-Māori/Pacific. The mean age at RHD death (male/female) was 56.4/58.4 for Māori, 50.9/59.8 for Pacific and 78.2/80.6 for non-Māori, non-Pacific men and women. The average annual DRG-based cost of hospital admissions in 2000-2009 for ARF and RHD across all age groups was $12.0 million (95% confidence limit $11.1 million, $12.8 million). Heart valve surgery accounted for 28% of admissions and 71% of the cost. For children 5-14 years of age, valve surgery accounted for 7% of admissions and 27% of the cost. Two-thirds of the cost occurs after the age of 30. ARF and RHD comprise a burden of mortality and hospital cost concentrated largely in middle age. Māori and Pacific RHD mortality rates are substantially higher than those of non-Māori/Pacific.

Cost-Effectiveness of Medicinal Cannabis for Management of Refractory Symptoms Associated With Chronic Conditions: A Systematic Review of Economic Evaluations

Publisher: Elsevier BV

Date: 10-2021

DOI: 10.1016/J.JVAL.2021.04.1276

Abstract: Although there is a growing body of evidence suggesting that cannabinoids may relieve symptoms of some illnesses, they are relatively high-cost therapies compared with illicit growth and supply. This article aimed to comprehensively review economic evaluations of medicinal cannabis for alleviating refractory symptoms associated with chronic conditions. Seven electronic databases were searched for articles published up to September 6, 2020. The quality of reporting of economic evaluations was assessed using the Consolidated Health Economic Evaluation Reporting Standards checklist. The extracted data were grouped into subcategories according to types of medical conditions, organized into tables, and reported narratively. This review identified 12 cost-utility analyses conducted across a variety of diseases including multiple sclerosis (MS) (N = 8), pediatric drug-resistant epilepsies (N = 2), and chronic pain (N = 2). The incremental cost-effectiveness ratio varied widely from cost saving to more than US$451 800 per quality-adjusted life-year depending on the setting, perspectives, types of medicinal cannabis, and indications. Nabiximols is a cost-effective intervention for MS spasticity in multiple European settings. Cannabidiol was found to be a cost-effective for Dravet syndrome in a Canadian setting whereas a cost-utility analysis conducted in a US setting deemed cannabidiol to be not cost-effective for Lennox-Gastaut syndrome. Overall study quality was good, with publications meeting 70% to 100% (median 83%) of the Consolidated Health Economic Evaluation Reporting Standards checklist criteria. Medicinal cannabis-based products may be cost-effective treatment options for MS spasticity, Dravet syndrome, and neuropathic pain, although the literature is nascent. Well-designed clinical trials and health economic evaluations are needed to generate adequate clinical and cost-effectiveness evidence to assist in resource allocation.

A baseline profile of the Queensland Cardiac Record Linkage Cohort (QCard) study

Publisher: Springer Science and Business Media LLC

Date: 05-02-2022

DOI: 10.1186/S12872-022-02478-Z

Abstract: Cardiovascular disease (CVD) is one of the leading causes of death in Australia. Longitudinal record linkage studies have the potency to influence clinical decision making to improve cardiac health. This paper describes the baseline characteristics of the Queensland Cardiac Record Linkage Cohort study (QCard). International Classification of Disease, 10th Revision Australian Modification (ICD-10-AM) diagnosis codes were used to identify CVD and comorbidities. Cost and adverse health outcomes (e.g., comorbidities, hospital-acquired complications) were compared between first-time and recurrent admissions. Descriptive statistics and standard tests were used to analyse the baseline data. There were 132,343 patients with hospitalisations in 2010, of which 47% were recurrent admissions, and 53% were males. There were systematic differences between characteristics of recurrent and first-time hospitalisations. Patients with recurrent episodes were nine years older (70 vs. 61 p 0.001) and experienced a twice higher risk of multiple comorbidities (3.17 vs. 1.59 p 0.001). CVD index hospitalisations were concentrated in large metropolitan hospitals. Our study demonstrates that linked administrative health data provide an effective tool to investigate factors determining the progress of heart disease. Our main finding suggests that recurrent admissions were associated with higher hospital costs and a higher risk of having adverse outcomes.

Economic evaluation of a nurse-led home and clinic-based secondary prevention programme to prevent progressive cardiac dysfunction in high-risk individuals: The Nurse-led Intervention for Less Chronic Heart Failure (NIL-CHF) randomized controlled study

Publisher: Oxford University Press (OUP)

Date: 23-11-2018

DOI: 10.1177/1474515117743979

Abstract: The objective of this study was to assess the cost-effectiveness of a long-term, nurse-led, multidisciplinary programme of home/clinic visits in preventing progressive cardiac dysfunction in patients at risk of developing de novo chronic heart failure (CHF). A trial-based analysis was conducted alongside a pragmatic, single-centre, open-label, randomized controlled trial of 611 patients (mean age: 66 years) with subclinical cardiovascular diseases (without CHF) discharged to home from an Australian tertiary referral hospital. A nurse-led home and clinic-based programme (NIL-CHF intervention, n = 301) was compared with standard care ( n=310) in terms of life-years, quality-adjusted life-years (QALYs) and healthcare costs. The uncertainty around the incremental cost and QALYs was quantified by bootstrap simulations and displayed on a cost-effectiveness plane. During a median follow-up of 4.2 years, there were no significant between-group differences in life-years (−0.056, p=0.488) and QALYs (−0.072, p=0.399), which were lower in the NIL-CHF group. The NIL-CHF group had slightly lower all-cause hospitalization costs (AUD$2943 per person p=0.219), cardiovascular-related hospitalization costs (AUD$1142 p=0.592) and a more pronounced reduction in emergency/unplanned hospitalization costs (AUD$4194 per person p=0.024). When the cost of intervention was added to all-cause, cardiovascular and emergency-related readmissions, the reductions in the NIL-CHF group were AUD$2742 ( p=0.313), AUD$941 ( p=0.719) and AUD$3993 ( p=0.046), respectively. At a willingness-to-pay threshold of AUD$50,000/QALY, the probability of the NIL-CHF intervention being better-valued was 19%. Compared with standard care, the NIL-CHF intervention was not a cost-effective strategy as life-years and QALYs were slightly lower in the NIL-CHF group. However, it was associated with modest reductions in emergency/unplanned readmission costs.

Remotely sensed hydroacoustics and observation data for predicting fish habitat suitability

Publisher: Elsevier BV

Date: 02-2017

DOI: 10.1016/J.CSR.2010.02.012

An Economic Evaluation of Fluvastatin used for the Prevention of Cardiac Events Following Successful First Percutaneous Coronary Intervention in the UK

Publisher: Springer Science and Business Media LLC

Date: 2004

DOI: 10.2165/00019053-200422080-00004

Abstract: To estimate the costs, benefits and cost effectiveness, from the UK NHS perspective, of fluvastatin (relative to no HMG-CoA reductase inhibitor [statin]) for the secondary prevention of major adverse cardiac events following a successful first percutaneous coronary intervention (PCI). A cost-effectiveness analysis was undertaken using efficacy data from the Lescol Intervention Prevention Study (LIPS). LIPS was a randomised, double-blind, placebo-controlled trial undertaken in 77 centres (predominantly in Europe). Patients included in the trial had moderate hypercholesterolaemia and had successfully undergone their first PCI. Fluvastatin (Lescol) 40 mg twice daily plus dietary counselling was given to the intervention group for up to 4 years the control group received dietary counselling only. A Markov model was used to estimate the incremental costs per QALY gained over a 10-year period, with cost data drawn from the UK NHS (2002 values). Monte Carlo simulations and multivariate analysis were used to assess uncertainty. Costs were discounted at 6% per annum, and health outcomes at 1.5% per annum. On average, treatment with fluvastatin cost an additional pound 300 (SD pound 303) [euro 423 SD euro 428] per patient and resulted in an additional 0.092 (SD 0.06) QALYs per patient over 10 years compared with controls. The incremental cost per QALY gained with fluvastatin versus the control group was pound 3207 (SD pound 5,497) [euro 4,527 SD euro 7,759]. Fluvastatin was dominant (better outcomes and lower costs) in 15.9% of the simulations and was dominated in 2.9%. The key determinants of cost effectiveness were: the effectiveness of fluvastatin in reducing acute myocardial infarction, subsequent PCI, coronary artery bypass graft and cardiac deaths the utility weight associated with a subsequent post-PCI state the cost of fluvastatin and the time horizon evaluated. Fluvastatin is the only statin which has proven effective in preventing major coronary adverse events in new PCI patients other statins lack this evidence. This Markov model, with its underlying assumptions and data, suggests that fluvastatin is a viable and economically efficient pharmaceutical (relative to no statin) to reduce heart disease in the UK when given routinely to all patients following PCI.

Valuing Health: Results from the Health Auction Valuation Experiment (HAVE) Study

Publisher: Elsevier BV

Date: 11-2016

DOI: 10.1016/J.JVAL.2016.08.586

Cost-Effectiveness of Lenvatinib Compared with Sorafenib for the First-Line Treatment of Advanced Hepatocellular Carcinoma in Australia

Publisher: Springer Science and Business Media LLC

Date: 02-11-2020

DOI: 10.1007/S40261-020-00983-7

A contemporary evaluation of surgical aortic valve replacement outcomes and temporal trends

Publisher: Wiley

Date: 23-04-2023

DOI: 10.1111/ANS.18486

Abstract: Given the ageing population and uptake of transcatheter approaches for treating aortic stenosis (AS), a renewed evaluation of outcomes after surgical aortic valve replacement (SAVR) is warranted. With guidelines recommending age‐based indications for surgical and transcatheter approaches, this study critically evaluates outcomes in age‐based subgroups, with the aim to refine management of AS in the elderly, where there is often no clear consensus. Six hundred and thirteen consecutive patients who underwent SAVR in an Australian tertiary cardiac centre between 1 June 2014 and 13 January 2022 were retrospectively analysed. Of these, 70.31% were years (Group 1) and 29.69% were ≥75 years (Group 2). Groups were compared with respect to early and long‐term outcomes. Logistic regression, Kaplan–Meier survival estimates and Cox proportional hazards regression were performed for all patients and an AS‐specific sub‐group. Patients aged ≥75 years were more likely to be female and have hypercholesterolemia, hypertension, and pre‐existing arrhythmia ( P 0.001). Group 1 experienced a higher incidence of renal failure compared with Group 2, in the overall cohort and AS‐specific subgroup ( P = 0.02). The incidence of stroke was similar between groups, in the overall cohort ( P = 0.22) and the AS‐specific subgroup ( P = 0.32). Age ≥ 75 was not found to be an independent predictor of 30‐day, 1‐year or 5‐year mortality. Temporal trends revealed low consistently low complication rates. Elderly patients should not be denied surgery based on age, despite guideline‐driven age‐based recommendations.

Trends in cycle injury in new zealand under voluntary helmet use

Publisher: Elsevier BV

Date: 1997

DOI: 10.1016/S0001-4575(96)00054-1

Abstract: Twelve months before the wearing of a cycle helmet was to become mandatory in New Zealand, a substantial proportion of cyclists on public roads had 'voluntarily' adopted wearing a helmet. Helmet wearing rates had increased up to 84, 62 and 39% for primary school children, secondary school children, and adults respectively by the end of the period of interest. The purpose of this study was to examine the serious injury trends for three age groups of cyclists: primary school age (5-12 years), secondary school age (13-18 years), and adults (over 18 years) admitted to selected public hospitals between 1980 and 1992 twelve months before the introduction of helmet legislation. Serious injury was defined as 'admitted to hospital' then disaggregated by type of crash and length of stay. Statistical models were constructed that included the proportion of people admitted to hospital with a head injury, then analysed using Poisson regression. Results revealed that the increased helmet wearing percentages has had little association with serious head injuries to cyclists as a percentage of all serious injuries to cyclists for all three groups, with no apparent difference between bicycle only and all cycle crashes. Discussion of the results includes possible explanations for the absence of a decline in the percentage of serious head injury among cyclists as cycle helmet wearing has increased.

Predictive mapping of abalone fishing grounds using remotely-sensed LiDAR and commercial catch data

Publisher: Elsevier BV

Date: 09-2015

DOI: 10.1016/J.FISHRES.2015.04.009

Wealthy, healthy and green: Are we there yet?

Publisher: Elsevier BV

Date: 11-2021

DOI: 10.1016/J.WORLDDEV.2021.105628

Mental health nurses' perspectives of people who self‐harm

Publisher: Wiley

Date: 12-11-2021

DOI: 10.1111/INM.12814

Web-Delivered Cognitive Behavioral Therapy for Distressed Cancer Patients: Randomized Controlled Trial

Publisher: JMIR Publications Inc.

Date: 31-01-2018

DOI: 10.2196/JMIR.8850

Effect of a 24/7 nursing presence in a police watch house on police presentations to the emergency department

Publisher: CSIRO Publishing

Date: 2020

DOI: 10.1071/AH19294

Abstract: ObjectivePeople detained in police custody are a vulnerable population with complex health needs, sometimes requiring emergency care. This study evaluated the effect of a 24/7 nursing presence in a police watch house on police presentations to the emergency department (ED). MethodsThis was a retrospective observational study conducted in a regional ED in Queensland. Equal time periods of 66 days before (T1), during (T2) and after (T3) the pilot service was trialled in 2013 were compared to determine changes in patient and service delivery outcomes. The time to see a doctor in the ED, ED length of stay, hospital admission rate, number of transfers from the watch house to the ED and associated costs were measured. The nature of health care delivered by nurses to detainees in the watch house during the pilot was also examined. ResultsFewer detainees were transferred from the police watch house to the ED during the pilot period (T1, n=40 T2, n=29 T3, n=34). Cost reductions associated with reduced police and ambulance attendance, as well as hospitalisations, outweighed the watch house nursing costs, with cost savings estimated at AUD7800 per week (60% benefiting police 40% benefiting the health service). The most common health problems addressed during the 1313 healthcare delivery episodes provided to 351 detainees in the watch house during the pilot related to substance misuse, chronic disease and mental health problems. ConclusionFewer transfers from the police watch house to the ED were noted when there was a 24/7 nursing presence in the watch house. This model appears to be economically efficient, but further research is required. What is known about the topic?People detained in police custody are a vulnerable population with complex health needs, sometimes requiring emergency care. What does this paper add?Transfers from the police watch house to the ED were fewer when there was a 24/7 nursing presence in the police watch house (an economically efficient model). Nursing care provided to detainees in the watch house setting predominantly related to substance misuse, chronic disease and mental health problems. What are the implications for practitioners?With a 24/7 nursing presence in the police watch house, transfer to the ED was avoided for some detainees. Similar strategies that respond to coronial recommendations advocating for enhancements in police–health collaboration warrant evaluation.

Mental health presentations to the emergency department: A perspective on the involvement of social support networks

Publisher: Elsevier BV

Date: 09-2019

DOI: 10.1016/J.AUEC.2019.06.002

Abstract: The involvement of families, carers and significant others (i.e. social support networks) has a positive corollary for a person experiencing mental health problems. Accordingly, in Australia involvement of social support networks within mental health services is endorsed in national health policy and service guidelines. Despite the endorsement, this is yet to be fully realised in all areas that provide mental health services, including emergency departments. Social support networks are integral in the provision of mental health consumers' care. Supporting the involvement of social support networks in the emergency department can provide healthcare services with opportunities for enhanced and cost-effective care, contributing to improved outcomes for consumers. An overview of some of the barriers and facilitators of social support network involvement is provided. The intention of this paper is to encourage reflection and dialogue on this important area of mental health service provision and support the evolution of a new paradigm of research into social support network involvement in the emergency department.

PID5: MEDICO-ECONOMIC MODELLING OF INFLUENZA MANAGEMENT IN EUROPE: METHODOLOGY USED IN FRANCE AND GERMANY

Publisher: Elsevier BV

Date: 09-2000

DOI: 10.1016/S1098-3015(11)70687-8

PCV21 MODELING THE COST-EFFECTIVENESS OF CORONARY COMPUTED TOMOGRAPHY FOR PATIENTS WITH CHEST PAIN USING BOTH DIAGNOSTIC AND PROGNOSTIC INFORMATION

Publisher: Elsevier BV

Date: 11-2010

DOI: 10.1016/S1098-3015(11)73148-5

Family-centered care for hospitalized children aged 0-12 years: A systematic review of qualitative studies

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 07-2014

DOI: 10.11124/JBISRIR-2014-1683

Harnessing the Potential to Quantify Public Preferences for Healthcare Priorities through Citizens’ Juries

Publisher: Maad Rayan Publishing Company

Date: 2014

DOI: 10.15171/IJHPM.2014.61

Present and past carers' health: Some considerations

Publisher: Wiley

Date: 12-2010

DOI: 10.1111/J.1440-172X.2010.01889.X

Utility Value Sets for Sri Lanka: A Case For Economic Evaluations in South Asia

Publisher: Elsevier BV

Date: 11-2016

DOI: 10.1016/J.JVAL.2016.08.592

First trimester multivitamin/mineral use is associated with reduced risk of pre-eclampsia among overweight and obese women

Publisher: Wiley

Date: 22-05-2016

DOI: 10.1111/MCN.12133

Cost Effectiveness of Strategies to Manage Atrial Fibrillation in Middle- and High-Income Countries: A Systematic Review

Publisher: Springer Science and Business Media LLC

Date: 19-05-2023

DOI: 10.1007/S40273-023-01276-5

Australian Public Preferences for the Funding of New Health Technologies: A Comparison of Discrete Choice and Profile Case Best-Worst Scaling Methods

Publisher: SAGE Publications

Date: 08-04-2014

DOI: 10.1177/0272989X14526640

Abstract: Background. Ethical, economic, political, and legitimacy arguments support the consideration of public preferences in health technology decision making. The objective was to assess public preferences for funding new health technologies and to compare a profile case best-worst scaling (BWS) and traditional discrete choice experiment (DCE) method. Methods. An online survey consisting of a DCE and BWS task was completed by 930 adults recruited via an Internet panel. Respondents traded between 7 technology attributes. Participation quotas broadly reflected the population of Queensland, Australia, by gender and age. Choice data were analyzed using a generalized multinomial logit model. Results. The findings from both the BWS and DCE were generally consistent in that respondents exhibited stronger preferences for technologies offering prevention or early diagnosis over other benefit types. Respondents also prioritized technologies that benefit younger people, larger numbers of people, those in rural areas, or indigenous Australians that provide value for money that have no available alternative or that upgrade an existing technology. However, the relative preference weights and consequent preference orderings differed between the DCE and BWS models. Further, poor correlation between the DCE and BWS weights was observed. While only a minority of respondents reported difficulty completing either task (22.2% DCE, 31.9% BWS), the majority (72.6%) preferred the DCE over BWS task. Conclusions. This study provides reassurance that many criteria routinely used for technology decision making are considered to be relevant by the public. The findings clearly indicate the perceived importance of prevention and early diagnosis. The dissimilarity observed between DCE and profile case BWS weights is contrary to the findings of previous comparisons and raises uncertainty regarding the comparative merits of these stated preference methods in a priority-setting context.

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.

Economic burden of managing oral cancer patients in Sri Lanka: A cross-sectional hospital-based costing study

Publisher: BMJ

Date: 07-2019

DOI: 10.1136/BMJOPEN-2018-027661

Abstract: Cancer of the oral cavity is the leading malignancy among males in Sri Lanka, and sixth among women. This study aimed to estimate costs of managing patients with oral cancer (OCA) in Sri Lanka for a 12 month period from diagnosis. Hospital based costing study. Four selected cancer treatment centres in Sri Lanka. Sixty-nine OCA patients: 60 were males and 12 had recurrent tumours. Societal perspectives (healthcare, household and indirect costs) were itemised. Costs to the healthcare system included surgery, Intensive Care Unit (ICU) care, chemotherapy and radiotherapy. Capital costs including apportioned value of land, buildings, equipment and furniture. Household costs consisted of out of pocket expenditure for healthcare and indirect costs of lost income. Costs were estimated from the stage of presentation for treatment to 1 year of follow-up. Mean cost of managing a single stage II OCA patient for 1 year was Sri Lankan rupees (SLR) 58 979 (US$394, at the midyear exchange rate in 2016) to the health system. Mean household cost was SLR 77 649 (US$518). The annual cost of managing a stage III or IV patient was SLR 303 620 (US$2027), with household costs of SLR 71 932 (US$480). Owing to the high incidence of OCA in Sri Lanka, the economic costs associated with these diseases are enormous, resulting in negative impacts on both the healthcare system and in idual families, seriously impacting the country’s economy. Policy-makers should take note of this burden and increase steps for prevention and control of this devastating disease.

The economic evaluation of an Internet-based parental wellbeing intervention

Publisher: SAGE Publications

Date: 17-11-2022

DOI: 10.1177/1357633X221137113

Abstract: Internet-based parental programmes may improve parental wellbeing and mitigate the burden of mental health issues during the perinatal period. However, few studies have explored the cost and clinical impacts of such interventions. In the present study, we sought to evaluate the cost-effectiveness associated with an online cognitive behaviour therapy intervention ( Baby Steps Wellbeing) to an information-only programme (Baby Care). An alongside-trial cost-effectiveness analysis was undertaken using data from a randomised clinical trial comparing the Baby Steps Wellbeing intervention to Baby Care. Direct healthcare costs, as well as indirect costs attributed to income loss, were considered. The Assessment of Quality of Life-8 Dimensions multi-attribute utility instrument was used to estimate participant utilities, and subsequently calculate quality-adjusted life years (QALYs). Incremental cost-effectiveness ratios were calculated to assess the cost-effectiveness of the intervention. The economic evaluation adopted a societal perspective. In total, 496 parents were randomised to either the Baby Steps Wellbeing intervention or the Baby Care control arm. No significant differences in costs (−$27, 95% confidence interval (CI): −$1189–$1134) or QALYs (0.051, 95% CI: −0.097–0.200) were identified. Bootstrapped results showed that the Baby Steps Wellbeing programme was cost-saving and health improving in 38% of simulations and cost-effective in another 37% of simulations. The Baby Steps Wellbeing programme was slightly cost-saving with slightly improved health outcomes compared with Baby Care. Bootstrapped results indicate the Baby Steps Wellbeing was cost-effective in 75% of simulations. Overall, the Baby Steps Wellbeing programme is an online programme that is cost-effective. Australian & New Zealand Clinical Trials Registry: ANZCTR12614001256662.

Negative pressure wound therapy for skin grafts and surgical wounds healing by primary intention

Publisher: Wiley

Date: 07-10-2014

DOI: 10.1002/14651858.CD009261.PUB3

Screening for Depression in Patients with Chronic Heart Disease using Two Brief Questions: The TAKE HEART in Primary Care Study Cohort

Publisher: Elsevier BV

Date: 2009

DOI: 10.1016/J.HLC.2009.05.243

Negative pressure wound therapy for surgical wounds healing by primary closure

Publisher: Wiley

Date: 26-03-2019

DOI: 10.1002/14651858.CD009261.PUB4

Patient preferences for treatment of achilles tendon pain: Results from a discrete-choice experiment

Publisher: Springer Science and Business Media LLC

Date: 2011

DOI: 10.2165/11532830-000000000-00000

Abstract: Discrete-choice experiments are based on the premise that any good or service can be described by its characteristics (or attributes), and the extent to which an in idual values a good or service depends on the levels of these characteristics. Little is known about patient preferences for treatment of chronic musculoskeletal pain such as Achilles tendinopathy. A discrete-choice experiment was conducted in 58 adults with a history of Achilles tendon pain at the conclusion of a three-arm randomized clinical trial. Participants were asked to complete a questionnaire consisting of ten hypothetical treatment scenarios and some sociodemographic questions. For each scenario, participants were asked to choose which option they would prefer if seeking treatment for their painful Achilles tendon. A mixed logit model was estimated to quantify subject preferences and marginal willingness to pay for the treatment attributes. A response rate of 62% was achieved. A significant positive impact on utility was observed for chance of treatment success. A significant negative impact on utility was observed for cost, weeks before exercise can be completed free of pain, chance of side effects (p = 0.06), and injections as a stand-alone treatment. Respondents were willing to pay Australian dollars ($A)238 (95% CI -312, 788) for a 10% increase in the chance of treatment success. Study participants with Achilles tendon pain who had either participated or expressed an interest in participating in a randomized trial prefer a treatment that costs less, has a greater chance of success, has a shorter duration before being able to exercise free of pain, and has less likelihood of side effects. On average, participants preferred exercises over injections as a stand-alone treatment. Further research is required to confirm the findings in patients outside of the trial setting. Nevertheless, this study contributes to an area that is deficient in research by identifying priorities and marginal willingness to pay for attributes related to Achilles tendinopathy.

Team approach versus ad hoc health services for young people with physical disabilities: A retrospective cohort study

Publisher: Elsevier BV

Date: 10-2002

DOI: 10.1016/S0140-6736(02)11316-X

Abstract: Young people with physical disabilities often have difficulty attaining independence in adult life and consequently need lifelong support from parents and from health-care and social-care services. There are concerns about the organisation and cost-effectiveness of such services and their ability to meet the independence training and serious health needs of these young people. Our aim was to compare a young adult team (YAT) approach with the ad hoc service approach in four locations in England, in terms of their ability to enhance the participation in society of these young people and their cost. We did a retrospective cohort study, in which we interviewed 254 physically disabled young people. 124 healthy controls were given a questionnaire. We interviewed with standardised measures and used logistic regression analysis to test for effects of ad hoc and YAT services. The Mantel-Haenszel chi2 statistic was used to test for differences in resource use between areas in which the YAT and ad hoc services were available. The absence of pain, fatigue, and stress increased the odds of participation two-fold to four-fold. After adjustment for these factors, young people cared for by multidisciplinary YAT teams were 2.54 times (95% CI 1.30-4.98) more likely than those who used ad hoc services to participate in society. Resource use did not differ between the two service types. A YAT approach costs no more to implement than an ad hoc approach, and is more likely to enhance participation in society of young people with physical disabilities.

Annual UK national health service cost attributable to managing erectile dysfunction

Publisher: Elsevier BV

Date: 2002

DOI: 10.1016/S1569-9056(02)80235-4

Habitat suitability for marine fishes using presence-only modelling and multibeam sonar

Publisher: Inter-Research Science Center

Date: 16-12-2010

DOI: 10.3354/MEPS08858

Engaging the public in healthcare decision-making: Results from a Citizens' Jury on emergency care services

Publisher: BMJ

Date: 20-06-2016

DOI: 10.1136/EMERMED-2015-205663

Abstract: Policies addressing ED crowding have failed to incorporate the public's perspectives engaging the public in such policies is needed. This study aimed at determining the public's recommendations related to alternative models of care intended to reduce crowding, optimising access to and provision of emergency care. A Citizens' Jury was convened in Queensland, Australia, to consider priority setting and resource allocation to address ED crowding. Twenty-two jurors were recruited from the electoral roll, who were interested and available to attend the jury from 15 to 17 June 2012. Juror feedback was collected via a survey immediately following the end of the jury. The jury considered that all patients attending the ED should be assessed with a minority of cases erted for assistance elsewhere. Jurors strongly supported enabling ambulance staff to treat patients in their homes without transporting them to the ED, and allowing non-medical staff to treat some patients without seeing a doctor. Jurors supported (in principle) patient choice over aspects of their treatment (when, where and type of health professional) with some support for patients paying towards treatment but unanimous opposition for patients paying to be prioritised. Most of the jurors were satisfied with their experience of the Citizens' Jury process, but some jurors perceived the time allocated for deliberations as insufficient. These findings suggest that the general public may be open to flexible models of emergency care. The jury provided clear recommendations for direct public input to guide health policy to tackle ED crowding.

Exercise in preventing falls for men with prostate cancer: a modelled cost-utility analysis

Publisher: Springer Science and Business Media LLC

Date: 24-02-2022

DOI: 10.1007/S00520-022-06900-2

Abstract: Men who receive androgen deprivation therapy (ADT) for prostate cancer (PCa) are a vulnerable falls population due to the side effects of treatment. The purpose of this paper is to determine the cost-effectiveness of exercise in preventing falls and fractures for this high-risk population in Australia. A decision analytic model was constructed to evaluate the cost utility of an exercise intervention compared to usual care from a health system perspective. The intervention comprised two 1-h sessions of supervised exercise per week over 1 year for men with non-metastatic PCa receiving curative radiation therapy and ADT. A Markov model simulated the transition between five health states: (1) at risk of falling (2) at recurrent risk of falling (3) fracture (minor or major) (4) non-fracture injury (minor or major) and (5) death. Model inputs including transition probabilities and utility scores were obtained from published meta-analyses, and costs were drawn from Australian data sources (e.g. Medical Benefits Schedule). The model time horizon was 3 years, and costs and effects were discounted at 5% annual rate. Costs and quality-adjusted life years (QALYs) were aggregated and compared between the intervention and control to calculate incremental net monetary benefit (iNMB). Uncertainty in the results was explored using deterministic and probabilistic sensitivity analyses (PSA). At a willingness-to-pay of AU$50,000 per QALY, the exercise intervention dominated, as it was less costly and more effective than usual care. The iNMB was $3010 per patient. The PSA showed a 58% probability the intervention was cost-effective. This is the first modelled economic evaluation of exercise for men with PCa. Our results suggest supervised exercise is cost-effective in reducing the risks of falls and fractures in this population.

Negative pressure wound therapy for skin grafts and surgical wounds healing by primary intention

Publisher: John Wiley & Sons, Ltd

Date: 18-04-2012

DOI: 10.1002/14651858.CD009261.PUB2

Incidence of acute rheumatic fever in New Zealand children and youth

Publisher: Wiley

Date: 12-04-2012

DOI: 10.1111/J.1440-1754.2012.02447.X

Abstract: To estimate acute rheumatic fever (ARF) incidence rates for New Zealand children and youth by ethnicity, socioeconomic deprivation and region. National hospital admissions with a principal diagnosis of ARF (ICD9_AM 390-392 ICD10-AM I00-I02) were obtained from routine statistics and stratified by age, ethnicity, socioeconomic deprivation index (NZDep2006) and District Health Board (DHB). The mean incidence rate for ARF in 2000-2009 peaked at 9 to 12 years of age. Incidence rates for children 5 to 14 years of age for Māori were 40.2 (95% confidence interval 36.8, 43.8), Pacific 81.2 (73.4, 89.6), non-Māori/Pacific 2.1 (1.6, 2.6) and all children 17.2 (16.1, 18.3) per 100 000. Māori and Pacific incidence rates increased by 79% and 73% in 1993-2009, while non-Māori/Pacific rates declined by 71%. Overall rates increased by 59%. In 2000-2009, Māori and Pacific children comprised 30% of children 5-14 years of age but accounted for 95% of new cases. Almost 90% of index cases of ARF were in the highest five deciles of socioeconomic deprivation and 70% were in the most deprived quintile. A child living in the most deprived decile has about one in 150 risk of being admitted to the hospital for ARF by 15 years of age. Ten DHBs containing 76% of the population 5 to 14 years of age accounted for 94% of index cases of ARF. ARF with its attendant rheumatic heart disease is an increasing public health issue for disadvantaged North Island communities with high concentrations of Māori and/or Pacific families.

New challenges in psycho‐oncology: Economic evaluation of psychosocial services in cancer: Challenges and best practice recommendations

Publisher: Wiley

Date: 15-11-2019

DOI: 10.1002/PON.4933

Economic evaluation of strategies for the control and management of influenza in Europe

Publisher: Elsevier BV

Date: 06-2002

DOI: 10.1016/S0264-410X(02)00154-8

Abstract: We compared the cost-effectiveness of different strategies for the control and management of influenza for the elderly populations in three European countries (England and Wales, France, Germany). A "no intervention" scenario was compared with six control strategies: opportunistic vaccination (passive recruitment), comprehensive vaccination programmes (active recruitment), 4 weeks chemoprophylaxis course using neuraminidase inhibitors (NIs), 4 weeks chemoprophylaxis course using ion-channel inhibitors (ICIs), early treatment with NIs, and early treatment with ICIs. Vaccination strategies were the most cost-effective. Chemoprophylaxis strategies were highly expensive even under assumptions of optimal timing. Early treatment strategies with antivirals substantially increased demand for GP services and were more expensive than prevention through vaccination.

Using N-of-1 Trials to Improve Patient Management and Save Costs

Publisher: Springer Science and Business Media LLC

Date: 13-04-2010

DOI: 10.1007/S11606-010-1352-7

Development of a classification (descriptive) system for a preference-based quality of life measure for dental caries (dental caries utility index) among adolescents

Publisher: Wiley

Date: 02-12-2022

DOI: 10.1111/JPHD.12490

Abstract: Preference‐based quality‐of‐life measures (PBMs) have been developed in many clinical areas to aid estimation of more accurate utility values for economic evaluations. Existing oral health‐related quality‐of‐life (OHRQoL) instruments are non‐PBM and hence, cannot be used to generate utility values. The objective of this study was to develop a classification system for a new PBM (dental caries utility index‐DCUI) for the most prevalent childhood oral health condition: dental caries. Possible domains and items to be included in the classification system were identified based on the reviewing available pediatric non‐PBM OHRQoL instruments, studies eliciting utility values for oral health outcomes and clinical dentistry textbooks and based on the findings, a draft classification system was developed. To refine the draft classification system, semi‐structured interviews were conducted among a convenience s le of 15 12–17‐year‐old adolescents who had experience with dental caries. The classification system was further refined and validated by a group of dental experts, using a modified Delphi technique. The classification system comprised five items (pain/discomfort, difficulty in eating food/drinking, worried, ability to participate in activities, and appearance) and each item had a four‐level response scale. The classification system developed herein is considered an amenable tool for the subsequent development of a new PBM for dental caries. Once the scoring algorithm is completed, the classification system can be used to incorporate economic evaluations of dental caries health interventions.

Parental-reported allergic disorders and emergency department presentations for allergy in the first five years of life; a longitudinal birth cohort

Publisher: Springer Science and Business Media LLC

Date: 22-05-2018

DOI: 10.1186/S12887-018-1148-1

Going digital: A narrative overview of the effects, quality and utility of mobile apps in chronic disease self-management

Publisher: CSIRO Publishing

Date: 2019

DOI: 10.1071/AH18064

Abstract: Objective Smartphone health applications (apps) are being increasingly used to assist patients in chronic disease self-management. The effects of such apps on patient outcomes are uncertain, as are design features that maximise usability and efficacy, and the best methods for evaluating app quality and utility. Methods In assessing efficacy, PubMed, Cochrane Library and EMBASE were searched for systematic reviews (and single studies if no systematic review was available) published between January 2007 and January 2018 using search terms (and synonyms) of ‘smartphone’ and ‘mobile applications’, and terms for each of 11 chronic diseases: asthma, chronic obstructive lung disease (COPD), diabetes, chronic pain, serious mental health disorders, alcohol and substance addiction, heart failure, ischaemic heart disease, cancer, cognitive impairment, chronic kidney disease (CKD). With regard to design features and evaluation methods, additional reviews were sought using search terms ‘design’, ‘quality,’ ‘usability’, ‘functionality,’ ‘adherence’, ‘evaluation’ and related synonyms. Results Of 13 reviews and six single studies assessing efficacy, consistent evidence of benefit was seen only with apps for diabetes, as measured by decreased glycosylated haemoglobin levels (HbA1c). Some, but not all, studies showed benefit in asthma, low back pain, alcohol addiction, heart failure, ischaemic heart disease and cancer. There was no evidence of benefit in COPD, cognitive impairment or CKD. In all studies, benefits were clinically marginal and none related to morbid events or hospitalisation. Twelve design features were identified as enhancing usability. An evaluation framework comprising 32 items was formulated. Conclusion Evidence of clinical benefit of most available apps is very limited. Design features that enhance usability and maximise efficacy were identified. A provisional ‘first-pass’ evaluation framework is proposed that can help decide which apps should be endorsed by government agencies following more detailed technical assessments and which could then be recommended with confidence by clinicians to their patients. What is known about the topic? Smartphone health apps have attracted considerable interest from patients and health managers as a means of promoting more effective self-management of chronic diseases, which leads to better health outcomes. However, most commercially available apps have never been evaluated for benefits or harms in clinical trials, and there are currently no agreed quality criteria, standards or regulations to ensure health apps are user-friendly, accurate in content, evidence based or efficacious. What does this paper add? This paper presents a comprehensive review of evidence relating to the efficacy, usability and evaluation of apps for 11 common diseases aimed at assisting patients in self-management. Consistent evidence of benefit was only seen for diabetes apps there was absent or conflicting evidence of benefit for apps for the remaining 10 diseases. Benefits that were detected were of marginal clinical importance, with no reporting of hard clinical end-points, such as mortality or hospitalisations. Only a minority of studies explicitly reported using behaviour change theories to underpin the app intervention. Many apps lacked design features that the literature identified as enhancing usability and potential to confer benefit. Despite a plethora of published evaluation tools, there is no universal framework that covers all relevant clinical and technical attributes. An inclusive list of evaluation criteria is proposed that may overcome this shortcoming. What are the implications for practitioners? The number of smartphone apps will continue to grow, as will the appetite for patients and clinicians to use them in chronic disease self-management. However, the evidence to date of clinical benefit of most apps already available is very limited. Design features that enhance usability and clinical efficacy need to be considered. In making decisions about which apps should be endorsed by government agencies and recommended with confidence by clinicians to their patients, a comprehensive but workable evaluation framework needs to be used by bodies assuming the roles of setting and applying standards.

Can we prospectively assess the value for money of oncology clinical trials?

Publisher: Wiley

Date: 30-10-2018

DOI: 10.1111/AJCO.13089

EVALUATION OF THE EFFECTIVENESS OF A COMMUNITY-BASED CRISIS INTERVENTION PROGRAM FOR PEOPLE BEREAVED BY SUICIDE

Publisher: Wiley

Date: 09-12-2014

DOI: 10.1002/JCOP.21586

The epidemiology of vascular injury in the wars in Iraq and Afghanistan.

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 06-2011

DOI: 10.1097/SLA.0B013E31820752E3

Protocol for a feasibility study of an Indigenous Medication Review Service (IMeRSe) in Australia

Publisher: BMJ

Date: 11-2018

DOI: 10.1136/BMJOPEN-2018-026462

Abstract: The age-adjusted rate of potentially preventable hospitalisations for Aboriginal and Torres Strait Islander people is almost five times the rate of other Australians. Quality use of medicines has an important role in alleviating these differences. This requires strengthening existing medication reviewing services through collaboration between community pharmacists and health workers, and ensuring services are culturally appropriate. This Indigenous Medication Review Service (IMeRSe) study aims to develop and evaluate the feasibility of a culturally appropriate medication management service delivered by community pharmacists in collaboration with Aboriginal health workers. This study will be conducted in nine Aboriginal health services (AHSs) and their associated community pharmacies in three Australian states over 12 months. Community pharmacists will be trained to improve their awareness and understanding of Indigenous health and cultural issues, to communicate the quality use of medicines effectively, and to strengthen interprofessional relationships with AHSs and their staff. Sixty consumers (with a chronic condition regnant/within 2 years post partum and at risk of medication-related problems (MRPs) per site will be recruited, with data collection at baseline and 6 months. The primary outcome is the difference in cumulative incidence of serious MRPs in the 6 months after IMeRSe introduction compared with the 6 months prior. Secondary outcomes include potentially preventable medication-related hospitalisations, medication adherence, total MRPs, psychological and social empowerment, beliefs about medication, treatment satisfaction and health expenditure. The protocol received approval from Griffith University (HREC/2018/251), Queensland Health Metro South (HREC/18/QPAH/109), Aboriginal Health and Medical Research Council of New South Wales (1381/18), Far North Queensland (HREC/18/QCH/86-1256) and the Central Australian HREC (CA-18-3090). Dissemination to Indigenous people and communities will be a priority. Results will be available on the Australian Sixth Community Pharmacy Agreement website and published in peer-reviewed journals. ACTRN12618000188235 Pre-results.

Work-related injury in the nursing profession: an investigation of modifiable factors

Publisher: Wiley

Date: 12-01-2011

DOI: 10.1111/J.1365-2648.2010.05544.X

Abstract: This paper is a report of a correlational study of the relationships between work-related injury-risk events and modifiable risk factors in a nursing population after controlling for socioeconomic factors. Nurses are at high risk for work-related injury. Work-related injury is strongly influenced by psychosocial factors and physical job-related exposures, but the magnitude of effect from modifiable factors remains unclear. Data were based on the Work Outcomes Research Cost-benefit survey conducted in Australia during 2005 and 2006. The study s le of 5724 represented ~14% of nurses in Queensland, Australia. Logistic regression was used to determine the magnitude of association of psychological distress (represented by the Kessler 6 score: six-item scale of psychological distress), the number of health conditions and various socioeconomic factors with work place injury. High psychological distress was associated with a 5% probability of injury. As the number of health conditions increased, the probability of injury increased 3 and ≥ 6 health conditions increased the chance of injury by 5% and 15% compared with no health conditions. Compared with the total s le, nurses who reported high levels of psychological distress demonstrated greater sensitivity to the number of health conditions. Computation of the marginal effects showed little difference in the likelihood of injury when the total s le was compared with nurses with < 5 years of work experience. Effective occupational health and safety workplace programmes that target modifiable factors such as psychological distress and physical health conditions may improve the health capital of nurses and productivity levels within the profession.

Emergency department presentations in infants: Predictors from an Australian birth cohort

Publisher: Wiley

Date: 25-07-2017

DOI: 10.1111/JPC.13617

Abstract: Infants under 12 months of age are disproportionately represented amongst emergency department (ED) presentations, and infants are more likely to be frequent ED users. This study aimed to describe and identify psychosocial predictors of ED presentation in infants. A prospective birth cohort from Queensland and New South Wales (Environments for Healthy Living) was used to understand infant health service use. Baseline and 12-month questionnaire data pertaining to children born between 2006 and 2011 were used to identify predictors of ED presentation, using multiple regression analysis. Of the 2184 children in the cohort with available baseline and 12-month data, 579 (27%) presented at least once to an ED during their first 12 months of life. Statistically significant predictors of ED presentation in the multivariate analysis included the mother having asthma (odds ratio (OR) 1.67, 95% confidence interval (CI) 1.15-2.39) and a higher Kessler-6 score (a measure of psychological distress) of the primary carer at baseline (OR 1.04, 95% CI 1.01-1.08). Maternal education level was not associated with ED presentations of infants. This study describes maternal and child factors of children who present to the ED in the first year of life. Factors related to an infant's support system were found to be predictors for an ED presentation in the first year of life. This study emphasises the need to review the maternal medical history and psychosocial situation. There may be benefits for health-care practitioners to take the opportunity (such as during routine childhood immunisation) to perform a brief screening tool (such as the Kessler-6) to understand psychological distress experienced by mothers. This may influence the likelihood of a child presenting to an ED within the first 12 months of life.

Economic evaluation of reproductive carrier screening for recessive genetic conditions: a systematic review

Publisher: Informa UK Limited

Date: 26-10-2022

DOI: 10.1080/14737167.2022.1993063

Abstract: Autosomal recessive (AR) and x-linked (XL) conditions are rare but collectively common which impact millions of people globally on morbidity, mortality and costs. Advanced medical technologies allow prospective parents to make informed reproductive decisions to avoid having affected children. Economic evaluations targeting on reproductive carrier screening (RCS) for AR and/or XL conditions have been conducted, but there has not been a systematic review in this area. A systematic search of economic evaluations for RCS was undertaken using the following databases - EMBASE, MEDLINE and SCOPUS. The search strategy was designed to capture full economic evaluations related to RCS since 1990. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) strategy. The included 23 studies adopted various types of methodologies to conduct economic evaluations. The majority of studies examined a single condition. The various clinical strategies and screened conditions caused the different cost-effectiveness conclusions in the published studies. Establishing a validated and practical clinical strategy of RCS and investigating the cost-effectiveness of multiple conditions in one economic evaluation are critical for implementing RCS in the future. Further economic evaluations are essential to provide evidence-based practice for decision-makers.

Long-term cost-effectiveness of home versus clinic-based management of chronic heart failure: the WHICH? study

Publisher: Informa UK Limited

Date: 12-2017

DOI: 10.1080/13696998.2016.1261031

Abstract: The cost-effectiveness of a heart failure management intervention can be further informed by incorporating the expected benefits and costs of future survival. This study compared the long-term costs per quality-adjusted life year (QALY) gained from home-based (HBI) vs specialist clinic-based intervention (CBI) among elderly patients (mean age = 71 years) with heart failure discharged home (mean intervention duration = 12 months). Cost-utility analysis was conducted from a government-funded health system perspective. A Markov cohort model was used to simulate disease progression over 15 years based on initial data from a randomized clinical trial (the WHICH? study). Time-dependent hazard functions were modeled using the Weibull function, and this was compared against an alternative model where the hazard was assumed to be constant over time. Deterministic and probabilistic sensitivity analyses were conducted to identify the key drivers of cost-effectiveness and quantify uncertainty in the results. During the trial, mortality was the highest within 30 days of discharge and decreased thereafter in both groups, although the declining rate of mortality was slower in CBI than HBI. At 15 years (extrapolated), HBI was associated with slightly better health outcomes (mean of 0.59 QALYs gained) and mean additional costs of AU$13,876 per patient. The incremental cost-utility ratio and the incremental net monetary benefit (vs CBI) were AU$23,352 per QALY gained and AU$15,835, respectively. The uncertainty was driven by variability in the costs and probabilities of readmissions. Probabilistic sensitivity analysis showed HBI had a 68% probability of being cost-effective at a willingness-to-pay threshold of AU$50,000 per QALY. Compared with CBI (outpatient specialized HF clinic-based intervention), HBI (home-based predominantly, but not exclusively) could potentially be cost-effective over the long-term in elderly patients with heart failure at a willingness-to-pay threshold of AU$50,000/QALY, albeit with large uncertainty.

Are we blind to injuries in the visually impaired? A review of the literature

Publisher: BMJ

Date: 06-2002

DOI: 10.1136/IP.8.2.155

Abstract: To review the literature on the risks and types of injuries associated with visual impairment, and to identify pertinent areas for future research. A search of bibliographic databases was conducted in April 2000 for studies published since 1980 and selected studies that met two or more of the following criteria: formal ophthalmic assessment was used adjustment for confounding variables large s le size including numbers of visually impaired and clear definitions and outcomes. Thirty one studies were selected. The majority of these studies (20) assessed falls (including eight on hip fracture and four on multiple falls), eight studies reported traffic related injuries, and three studies assessed occupational injury. The evidence on falls, which relate predominantly to older people, suggests that those with reduced visual acuity are 1.7 times more likely to have a fall and 1.9 times more likely to have multiple falls compared with fully sighted populations. The odds of a hip fracture are between 1.3 and 1.9 times greater for those with reduced visual acuity. Studies of less severe injuries and other causes of injury were either poorly designed, underpowered, or did not exist. There are substantial gaps in research on both injuries to which people with visual impairment are especially susceptible and in evaluating interventions to reduce these injuries. It is recommended that in future studies the minimum data captured includes: formal ophthalmic assessment of visual fields and visual acuity, outcome measurement, control for confounders, and the costs of health care resource use and any interventions.

The role of exercise in the management of adverse effects of androgen deprivation therapy for prostate cancer: a rapid review

Publisher: Springer Science and Business Media LLC

Date: 22-07-2020

DOI: 10.1007/S00520-020-05637-0

Incidence of the adverse effects of androgen deprivation therapy for prostate cancer: a systematic literature review

Publisher: Springer Science and Business Media LLC

Date: 07-01-2020

DOI: 10.1007/S00520-019-05255-5

Abstract: Androgen deprivation therapy (ADT) has broad application in the treatment of prostate cancer (PC) and is associated with numerous, debilitating adverse effects. Increasing use of ADT for PC, longer timeframe for treatment (increased uptake of PSA testing and earlier diagnosis), as well as improved survival and an ageing population, means patients can live for a considerable period of time on or after ADT, experiencing these adverse effects. A number of systematic reviews of adverse effects of ADT for PC exist however, no single systematic review has previously examined the evidence for all adverse effects, including newer forms of ADT. A systematic review of existing systematic reviews of ADT for PC was conducted (2010-February 2019), as per Cochrane guidelines, to identify the highest level of risk/incidence evidence available, supplemented by evidence drawn from in idual studies where no systematic review existed. Incidence data was generated for 19 adverse effect subgroups, classified according to the common terminology criteria for adverse events (CTCAE). Incidence of adverse effects provides valuable information for future burden of disease studies. This information can better guide clinical management to reduce symptoms for patients and assist patients to make more informed decisions about their treatment, potentially improving disease outcomes. It also highlights the importance of supportive care for PC patients receiving ADT and their carers. For analysts conducting economic evaluations, the inclusion of adverse effects in PC decision analytic models can provide more comprehensive and accurate information for decision makers.

PIH10 Utility Values for Use in Health Care Decision Making for Older Frail Adults

Publisher: Elsevier BV

Date: 11-2012

DOI: 10.1016/J.JVAL.2012.08.219

Cost-effectiveness of home versus clinic-based management of chronic heart failure: Extended follow-up of a pragmatic, multicentre randomized trial cohort — The WHICH? study (Which Heart Failure Intervention Is Most Cost-Effective & Consumer Friendly in Reducing Hospital Care)

Publisher: Elsevier BV

Date: 12-2015

DOI: 10.1016/J.IJCARD.2015.08.066

Abstract: To assess the long-term cost-effectiveness of two multidisciplinary management programs for elderly patients hospitalized with chronic heart failure (CHF) and how it is influenced by patient characteristics. A trial-based analysis was conducted alongside a randomized controlled trial of 280 elderly patients with CHF discharged to home from three Australian tertiary hospitals. Two interventions were compared: home-based intervention (HBI) that involved home visiting with community-based care versus specialized clinic-based intervention (CBI). Bootstrapped incremental cost-utility ratios were computed based on quality-adjusted life-years (QALYs) and total healthcare costs. Cost-effectiveness acceptability curves were constructed based on incremental net monetary benefit (NMB). We performed multiple linear regression to explore which patient characteristics may impact patient-level NMB. During median follow-up of 3.2 years, HBI was associated with slightly higher QALYs (+0.26 years per person p=0.078) and lower total healthcare costs (AU$ -13,100 per person p=0.025) mainly driven by significantly reduced duration of all-cause hospital stay (-10 days p=0.006). At a willingness-to-pay threshold of AU$ 50,000 per additional QALY, the probability of HBI being better-valued was 96% and the incremental NMB of HBI was AU$ 24,342 (discounted, 5%). The variables associated with increased NMB were HBI (vs. CBI), lower Charlson Comorbidity Index, no hyponatremia, fewer months of HF, fewer prior HF admissions <1 year and a higher patient's self-care confidence. HBI's net benefit further increased in those with fewer comorbidities, a lower self-care confidence or no hyponatremia. Compared with CBI, HBI is likely to be cost-effective in elderly CHF patients with significant comorbidity.

Funding of drugs: do vaccines warrant a different approach? Authors' reply

Publisher: Elsevier BV

Date: 05-2009

DOI: 10.1016/S1473-3099(09)70091-X