Abiona, O, Haywood, P, Yu, S, Hall, J, Fiebig, DG & van Gool, K 2024, 'Physician responses to insurance benefit restrictions: The case of ophthalmology', Health Economics, vol. 33, no. 5, pp. 911-928.
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AbstractThis study examines the impact of social insurance benefit restrictions on physician behaviour, using ophthalmologists as a case study. We examine whether ophthalmologists use their market power to alter their fees and rebates across services to compensate for potential policy‐induced income losses. The results show that ophthalmologists substantially reduced their fees and rebates for services directly targeted by the benefit restriction compared to other medical specialists' fees and rebates. There is also some evidence that they increased their fees for services that were not targeted. High‐fee charging ophthalmologists exhibited larger fee and rebate responses while the low‐fee charging group raise their rebates to match the reference price provided by the policy environment.
Bailey, C, Howell, M, Raghunandan, R, Dalziel, K, Howard, K, Mulhern, B, Petrou, S, Rowen, D, Salisbury, A, Viney, R, Lancsar, E & Devlin, N 2024, 'The RETRIEVE Checklist for Studies Reporting the Elicitation of Stated Preferences for Child Health-Related Quality of Life', PharmacoEconomics, vol. 42, no. 4, pp. 435-446.
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Blackmore, AM, Mulhern, B, Norman, R, Reddihough, D, Choong, CS, Jacoby, P & Downs, J 2024, 'How Well Does the EQ-5D-Y-5L Describe Children With Intellectual Disability?: “There’s a Lot More to My Child Than That She Can’t Wash or Dress Herself.”', Value in Health, vol. 27, no. 2, pp. 190-198.
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OBJECTIVES: The EQ-5D-5L is a generic health utility instrument for measuring health-related quality of life (HRQoL), with self-report and proxy-report versions for children (EQ-5D-Y-5L). Children with intellectual disability (ID) are a heterogeneous population whose impairments and comorbidities place them at risk of poor HRQoL. This study aimed to describe the content validity and suitability for children with ID of a proxy-report version of the EQ-5D-Y-5L as seen by their caregivers. METHODS: A proxy-report EQ-5D-Y-5L was administered to caregivers of children with ID. Using cognitive think-aloud interviewing, participants were encouraged to provide the reasoning for their choices, assess the questions' relevance, comprehensibility, and comprehensiveness, and comment on the tool's strengths and weaknesses. Qualitative content analysis used both directed (deductive) and conventional (inductive) methods. RESULTS: There were 28 interviews with 30 caregivers of children with ID (aged 8 to 22 years, 17 boys, with autism spectrum disorder, cerebral palsy, Down syndrome, and rare genetic disorders). The EQ-5D-Y-5L was considered clear, concise, and largely relevant, but insufficiently comprehensive for this population. Interviewees sought clarification of the definition of HRQoL, whether it included unchanging impairments (versus fluctuating health states), and what basis of comparison to use (child or peer). Many interviewees suggested inclusion of questions for other domains, including communication and social engagement, equipment and human supports required, and a wider range of mental health questions. CONCLUSIONS: The study suggests that further work is required to ensure accurate responses to the EQ-5D-Y-5L from caregivers of children with ID and to describe these children adequately.
Boland, E, Fitzpatrick, R, Ryan, D, Kane, J, Betzhold, S, Leroi, I & Kinchin, I 2024, 'The high cost of care and limited evidence on cost-effective strategies for Lewy body dementia: systematic review of evidence', BJPsych Open, vol. 10, no. 1.
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Background Lewy body dementia (LBD) is a prevalent yet frequently underdiagnosed form of dementia, accounting for up to 15% of all dementia cases. Aims This study aims to increase awareness and advocacy for LBD by gathering and critically assessing the economic evidence, including the cost of illness and cost-effectiveness of interventions for managing LBD. Method A systematic literature review was undertaken with EMBASE, Medline, CINAHL, PsycINFO, NHS Economic Evaluation Database and EconLit. This search was supplemented by grey literature on Google Scholar and reviewing the reference lists of identified studies. The papers included in the review were published between 2008 and 2023, and involved participants with LBD (dementia with Lewy bodies or Parkinson's disease dementia), which either addressed the cost of illness or conducted an economic evaluation. Results Thirteen papers were included, comprising ten cost-of-illness studies and three economic evaluations. The cost of LBD tends to be higher than that of other forms of dementia, such as Alzheimer's disease, and these costs escalate more steeply as the disease progresses. These cost differences may not be solely influenced by the subtype of dementia, but possibly also by patient characteristics like physical and cognitive abilities. Cost-effectiveness of potential interventions for LBD is limited. Conclusions Despite n...
Cheng, LJ, Pan, T, Chen, LA, Cheng, JY, Mulhern, B, Devlin, N & Luo, N 2024, 'The Ceiling Effects of EQ-5D-3L and 5L in General Population Health Surveys: A Systematic Review and Meta-analysis', Value in Health.
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Dorney, E, I Black, K, Haas, M, Street, D & Church, J 2024, 'The preferences of people in Australia to respond and engage with advertisements to promote reproductive health: Results of a discrete choice experiment', Preventive Medicine Reports, vol. 40, pp. 102657-102657.
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Gye, A, Lourenco, RDA & Goodall, S 2024, 'Discrete Event Simulation to Incorporate Infusion Wait-Time When Assessing Cost-Effectiveness of a Chimeric-Antigen Receptor T Cell Therapy', Value in Health, vol. 27, no. 4, pp. 415-424.
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Hamilton, M, Christine Lin, C-W, Arora, S, Harrison, M, Tracy, M, Nickel, B, Shaheed, CA, Gnjidic, D & Mathieson, S 2024, 'Understanding general practitioners’ prescribing choices to patients with chronic low back pain: a discrete choice experiment', International Journal of Clinical Pharmacy, vol. 46, no. 1, pp. 111-121.
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Abstract Background Although NSAIDs are recommended as a first line analgesic treatment, opioids are very commonly prescribed to patients with low back pain (LBP) despite risks of harms. Aim This study aimed to determine factors contributing to general practitioners’ (GPs’) prescribing choices to patients with chronic LBP in a primary care setting. Method This discrete choice experiment (DCE) presented 210 GPs with hypothetical scenarios of a patient with chronic LBP. Participants chose their preferred treatment for each choice set, either the opioid, NSAID or neither. The scenarios varied by two patient attributes; non-specific LBP or LBP with referred leg pain (sciatica) and number of comorbidities. The three treatment attributes also varied, being: the type of opioid or NSAID, degree of pain reduction and number of adverse events. The significance of each attribute in influencing clinical decisions was the primary outcome and the degree to which GPs preferred the alternative based on the number of adverse events or the amount of pain reduction was the secondary outcome. Results Overall, GPs preferred NSAIDs (45.2%, 95% CI 38.7–51.7%) over opioids (28.8%, 95% CI 23.0–34.7%), however there was no difference between the type of NSAID or opioid preferred. Additionally, the attributes of pain reduction and adverse events did not influence a GP’s choice between NSAIDs or opioids for patients with chronic LBP. Conclusion GPs pr...
Heijdra Suasnabar, JM, Finch, AP, Mulhern, B & van den Akker-van Marle, ME 2024, 'Exploring the measurement of health related quality of life and broader instruments: A dimensionality analysis', Social Science & Medicine, vol. 346, pp. 116720-116720.
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Howard, K, Garvey, G, Anderson, K, Dickson, M, Viney, R, Ratcliffe, J, Howell, M, Gall, A, Cunningham, J, Whop, LJ, Cass, A, Jaure, A & Mulhern, B 2024, 'Development of the What Matters 2 Adults (WM2A) wellbeing measure for Aboriginal and Torres Strait Islander adults', Social Science & Medicine, vol. 347, pp. 116694-116694.
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Jackson, H, Grzeskowiak, L, Enticott, J, Wise, S & Callander, E 2024, 'How the structural determinants of health inequities impact access to prescription medication for pregnant women in Australia: a narrative review', The Lancet Regional Health - Western Pacific, vol. 42, pp. 100934-100934.
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Kenny, P, Liu, D, Fiebig, D, Hall, J, Millican, J, Aranda, S, van Gool, K & Haywood, P 2024, 'Specialist Palliative Care and Health Care Costs at the End of Life', PharmacoEconomics - Open, vol. 8, no. 1, pp. 31-47.
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BACKGROUND/AIMS: The use and costs of health care rise substantially in the months prior to death, and although the use of palliative care services may be expected to lead to less costly care, the evidence is mixed. We analysed the costs of care over the last year of life and the extent to which these are associated with the use and duration of specialist palliative care (SPC) for decedents who died from cancer or another life-limiting illness. METHODS: The decedents were participants in a cohort study of older residents of the state of New South Wales, Australia. Using linked survey and administrative health data from 2007 to 2016, two cohorts were identified: n = 10,535 where the cause of death was cancer; and n = 11,179 where the cause of death was another life-limiting illness. Costs of various types were analysed with separate risk-adjusted linear regression models for the last 1, 3, 6, 9 and 12 months before death and for both cohorts. SPC was categorised according to time to death from first contact with the service as 1-7 days, 7-30 days, 30-180 days and more than 180 days. RESULTS: SPC use was higher among the cancer cohort (30.0%) relative to the non-cancer cohort (4.8%). The mean costs over the final year of life were AU$55,037 (SD 45,059) for the cancer cohort and AU$35,318 (SD 41,948) for the non-cancer cohort. Earlier use of SPC was associated with higher costs over the last year of life but lower costs in the last 1 and 3 months for both cohorts. Initiating SPC use more than 180 days before death was associated with a mean difference relative to the no SPC group of AU$15,590 (95% CI 10,617 to 20,562) and AU$13,739 (95% CI 733 to 26,746) over the last year of life for those dying from cancer and another illness, respectively. The same differences over the last month of life were - AU$2810 (95% CI - 3945 to - 1676) and - AU$4345 (95% CI - 6625 to - 2066). Admitted hospital care was the major driver of costs, with longer SPC associated wi...
Kim, NV, McErlean, G, Yu, S, Kerridge, I, Greenwood, M & Lourenco, RDA 2024, 'Healthcare Resource Utilization and Cost Associated with Allogeneic Hematopoietic Stem Cell Transplantation: A Scoping Review', Transplantation and Cellular Therapy.
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Kuharic, M, Sharp, LK, Turpin, RS, Mulhern, B, Lee, TA, Grace Rose, CE, Monteiro, A & Pickard, AS 2024, 'Care recipient self-perceived burden: Perspectives of individuals with chronic health conditions or personal experiences with caregiving on caregiver burden in the US', SSM - Qualitative Research in Health, vol. 5, pp. 100398-100398.
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Lobb, E, Maccallum, F, Phillips, JL, Agar, M, Hosie, A, Breen, LJ, Tieman, J, DiGiacomo, M, Luckett, T, Philip, J, Ivynian, S, Chang, S, Dadich, A, Harlum, J, Gilmore, I, Kinchin, I, Grossman, C & Glasgow, N 2024, 'The COVID-19 Pandemic: Bereavement Experiences Between Hospital and Home Deaths in Palliative Care', Journal of Pain and Symptom Management, vol. 67, no. 2, pp. 147-156.
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BACKGROUND: Australian COVID-19 public health measures reduced opportunities for people to communicate with healthcare professionals and be present at the death of family members/friends. AIM: To understand if pandemic-specific challenges and public health measures during the COVID-19 pandemic impacted end-of-life and bereavement experiences differently if the death, supported by palliative care, occurred in a hospital or at home. DESIGN: A cross-sectional online survey was completed by bereaved adults during 2020-2022. Analyses compared home and in-patient palliative care deaths and bereavement outcomes. Additional analyses compared health communication outcomes for those identified as persons responsible or next of kin. SETTING/PARTICIPANTS: Of 744 bereaved people; 69% (n = 514) had a death in hospital and 31% (n = 220) at home. RESULTS: The COVID-19 public health measures influenced people's decision to die at home. Compared to hospital deaths, the home death group had higher levels of grief severity and grief-related functional impairment. Only 37% of bereaved people received information about bereavement and support services. 38% of participants who were at least 12 months postdeath scored at a level suggestive of possible prolonged grief disorder. Levels of depression and anxiety between the two groups were not significantly different. CONCLUSIONS: These findings highlight the need for health services to recognize bereavement as fundamental to palliative and health care and provide pre- and post death grief and bereavement care to ensure supports are available particularly for those managing end-of-life at home, and that such supports are in place prior to as well as at the time of the death.
Maccallum, F, Breen, LJ, Phillips, JL, Agar, MR, Hosie, A, Tieman, J, DiGiacomo, M, Luckett, T, Philip, J, Ivynian, S, Chang, S, Dadich, A, Grossman, CH, Gilmore, I, Harlum, J, Kinchin, I, Glasgow, N & Lobb, EA 2024, 'The mental health of Australians bereaved during the first two years of the COVID-19 pandemic: a latent class analysis', Psychological Medicine, vol. 54, no. 7, pp. 1361-1372.
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AbstractBackgroundThe COVID-19 pandemic disrupted many areas of life, including culturally accepted practices at end-of-life care, funeral rites, and access to social, community, and professional support. This survey investigated the mental health outcomes of Australians bereaved during this time to determine how these factors might have impacted bereavement outcomes.MethodsAn online survey indexing pandemic and bereavement experiences, levels of grief, depression, anxiety, and health, work, and social impairment. Latent class analysis (LCA) was used to identify groups of individuals who shared similar symptom patterns. Multinomial regressions identified pandemic-related, loss-related, and sociodemographic correlates of class membership.Results1911 Australian adults completed the survey. The LCA identified four classes: low symptoms (46.8%), grief (17.3%), depression/anxiety (17.7%), and grief/depression/anxiety (18.2%). The latter group reported the highest levels of health, work, and social impairment. The death of a child or partner and an inability to care for the deceased due to COVID-19 public health measures were correlated with grief symptoms (with or without depression and anxiety). Preparedness for the person's death and levels of pandemic-related loneliness and social isolation differentiated all four classes. Unemployment was associated with depression/anxiety (with or without grief).ConclusionsCOVID-19 had profound impacts for the way we lived and died, with effects that are likely to ricochet through society i...
Meili, KW, Mulhern, B, Ssegonja, R, Norstrom, F, Feldman, I, Mansdotter, A, Hjelte, J & Lindholm, L 2024, 'Eliciting a value set for the Swedish Capability-Adjusted Life Years instrument (CALY-SWE)', QUALITY OF LIFE RESEARCH, vol. 33, no. 1, pp. 59-72.
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Meili, KW, Mulhern, B, Ssegonja, R, Norström, F, Feldman, I, Månsdotter, A, Hjelte, J & Lindholm, L 2024, 'Eliciting a value set for the Swedish Capability-Adjusted Life Years instrument (CALY-SWE)', Quality of Life Research, vol. 33, no. 1, pp. 59-72.
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Abstract Purpose Our aim was to elicit a value set for Capability-Adjusted Life Years Sweden (CALY-SWE); a capability-grounded quality of life instrument intended for use in economic evaluations of social interventions with broad consequences beyond health. Methods Building on methods commonly used in the quality-adjusted life years EQ-5D context, we collected time-trade off (TTO) and discrete choice experiment (DCE) data through an online survey from a general population sample of 1697 Swedish participants. We assessed data quality using a score based on the severity of inconsistencies. For generating the value set, we compared different model features, including hybrid modeling of DCE and TTO versus TTO data only, censoring of TTO answers, varying intercept, and accommodating for heteroskedasticity. We also assessed the models’ DCE logit fidelity to measure agreement with potentially less-biased DCE data. To anchor the best capability state to 1 on the 0 to 1 scale, we included a multiplicative scaling factor. Results We excluded 20% of the TTO answers of participants with the largest inconsistencies to improve data quality. A hybrid model with an anchor scale and censoring was chosen to generate the value set; models with heteroskedasticity considerations or individually varying intercepts did not offer substantial improvement. The lowest capability weight was 0.114. Health, social relations, and finance and housing attributes contributed the largest capability gains, followed by occupation, security, and political and civil rights. Conclusion ...
Ratcliffe, J, Lay, K, Crocker, M, Engel, L, Milte, R, Hutchinson, C, Khadka, J, Whitehurst, DGT, Mulhern, B, Viney, R & Norman, R 2024, 'Unravelling the Self-Report Versus Proxy-Report Conundrum for Older Aged Care Residents: Findings from a Mixed-Methods Study', The Patient - Patient-Centered Outcomes Research, vol. 17, no. 1, pp. 53-64.
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OBJECTIVES: No guidance currently exists as to the cognition threshold beyond which self-reported quality of life for older people with cognitive impairment and dementia is unreliable. METHODS: Older aged care residents (≥ 65 years) were randomly assigned to complete the EQ-5D-5L in computer-based (eye movements were tracked) or hard copy (participants were encouraged to 'think aloud') format. Cognition was assessed using the Mini-Mental State Examination (MMSE). Think aloud and eye tracking data were analysed by two raters, blinded to MMSE scores. At the participant level, predefined criteria were used to assign traffic light grades (green, amber, red). These grades indicate the extent to which extracted data elements provided evidence of self-report reliability. The MMSE-defined cognition threshold was determined following review of the distributions of assigned traffic light grades. RESULTS: Eighty-one residents participated and provided complete data (38 eye tracking, 43 think aloud). In the think aloud cohort, all participants with an MMSE score ≤ 23 (n = 10) received an amber or red grade, while 64% of participants with an MMSE score ≥ 24 (21 of 33) received green grades. In the eye tracking cohort, 68% of participants with an MMSE score ≥ 24 (15 of 22) received green grades. Of the 16 eye tracking participants with an MMSE score ≤ 23, 14 (88%) received an amber or red grade. CONCLUSIONS: Most older residents with an MMSE score ≥ 24 have sufficient cognitive capacity to self-complete the EQ-5D-5L. More research is needed to better understand self-completion reliability for other quality-of-life instruments in cognitively impaired populations.
Roberts, MJ, Conduit, C, Davis, ID, Effeney, RM, Williams, S, Martin, JM, Hofman, MS, Hruby, G, Eapen, R, Gianacas, C, Papa, N, Lourenço, RDA, Dhillon, HM, Allen, R, Fontela, A, Kaur, B & Emmett, L 2024, 'The Dedicated Imaging Post‐Prostatectomy for Enhanced Radiotherapy outcomes (DIPPER) trial protocol: a multicentre, randomised trial of salvage radiotherapy versus surveillance for low‐risk biochemical recurrence after radical prostatectomy', BJU International, vol. 133, no. S3, pp. 39-47.
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BackgroundSalvage radiation therapy (SRT) and surveillance for low‐risk prostate‐specific antigen (PSA) recurrence have competing risks and benefits. The efficacy of early SRT to the prostate bed with or without pelvic lymph nodes compared to surveillance in patients with PSA recurrence after radical prostatectomy and no identifiable recurrent disease evident on prostate specific membrane antigen‐positron emission tomography/computer tomography (PSMA‐PET/CT) is unknown.Study DesignThe Dedicated Imaging Post‐Prostatectomy for Enhanced Radiotherapy outcomes (DIPPER) is an open‐label, multicentre, randomised Phase II trial.EndpointsThe primary endpoint is 3‐year event‐free survival, with events comprising one of PSA recurrence (PSA ≥0.2 ng/mL higher than baseline), radiological evidence of metastatic disease, or initiation of systemic or other salvage treatments. Secondary endpoints include patient‐reported outcomes, treatment patterns, participant perceptions, and cost‐effectiveness.Eligibility CriteriaEligible participants have PSA recurrence of prostate cancer after radical prostatectomy, defined by serum PSA level of 0.2–0.5 ng/mL, deemed low risk according to modified European Association of Urology biochemical recurrence risk criteria (International Society for Urological Pathology Grade Group ≤2, PSA doubling time >12 months), with no definite/probable recurrent prostate cancer on PSMA‐PET/CT.Patients and MethodsA total of 100 participants will be recruited from five Australian centres and randomised 1:1 to SRT or surveillance. Participants will undergo 6‐monthly clinical evaluation for up to 36 months. Androgen‐deprivation therapy is not permissible. Enrol...
Tellegen, CL, Schoch, M, Hodges, J, Peters, K, Sanders, MR, Tonge, B, Einfeld, S, Sofronoff, K, Gray, KM, Howlin, P, Emerson, E, Arciuli, J, Rice, L, Horstead, S, Clarke, K, Bezzina, L, Evans, H, Andersson, E, McAuliffe, Z, Haas, K, Louie, E, Hoath, F, Worrall, S, Stace, L, Silove, N, Kostelas, P, Caruana, J, Dossetor, D, Salvador-Carulla, L, Henderson, K, Phillis, K, Rotolone, C, Henry, T, Panahi, B, Aery, A, Hinton, S, Thompson, D-M, Ommensen, B, Mazzucchelli, T, Taffe, J, Hu, N, Boland, R, Knott, R, O'Hagan, G, Rose, O, Shortt, F, Cawood, D, Blackmore, R, Wallman, E, Keating, C, Teague, S, Viney, R, Goodall, S & Arora, S 2024, 'The role of social identity and self-efficacy in predicting service providers’ use of Stepping Stones Triple P following training', Children and Youth Services Review, vol. 156, pp. 107318-107318.
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Background: Identifying factors that may contribute to the use of programs following the completion of training by practitioners is of practical and theoretical importance. Aim: This study examined the role of social identity and self-efficacy in contributing to the delivery of an evidence-based parenting program. Methods and Procedures: A sample of 63 multi-disciplinary professionals trained in the Stepping Stones Triple P-Positive Parenting Program, for parents of children with developmental disability, as part of a statewide roll-out were interviewed two years after training. Data on the number of hours of delivery during the 2-year period was analysed along with quantitative data obtained during interviews that assessed professionals’ self-efficacy and social identity as a Stepping Stones professional. Outcomes and Results: Social identity was associated with the use of SSTP in an independent analysis, but the association was no longer significant when other factors were included in a regression model. Self-efficacy predicted the use of SSTP and was found to be a mediator in the relationship between social identity and use of SSTP. Conclusions and Implications: This first investigation into the role of social identity in the implementation of evidence-based parenting programs showed that social identity could play an important role. The role of self-efficacy in predicting program use was further supported in this study and the mediator function of self-efficacy is explored. The practical and theoretical implications of the role of self-efficacy and social identity in the training of professionals are discussed.
Vargas, C, Addo, R, Lewandowska, M, Haywood, P, De Abreu Lourenco, R & Goodall, S 2024, 'Use of Health Technology Assessment for the Continued Funding of Health Technologies: The Case of Immunoglobulins for the Management of Multifocal Motor Neuropathy', Applied Health Economics and Health Policy, vol. 22, no. 1, pp. 73-84.
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