De Souza, P, Smith, RD, Hall, J, Gurney, H & Harnett, PR 1993, 'A cost-utility approach to the use of 5-fluorouracil and levamisole as adjuvant chemotherapy for Dukes' C colonic carcinoma ', Medical Journal of Australia, vol. 158, no. 12, p. 866.
Gerard, K, Dobson, M & Hall, JP 1993, 'Framing And Labeling Effects In Health Descriptions - Quality Adjusted Life Years For Treatment Of Breast-cancer', Journal Of Clinical Epidemiology, vol. 46, no. 1, pp. 77-84.
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At present there is a growing interest in the use of cost-utility analysis (CUA) to a point where it merits serious consideration by health care decision makers. However, there remain a number of theoretical and practical issues to be resolved including
Limits on health care resources mean that resource allocation decisions should be guided by considerations of cost in relation to benefits. A method of economic evaluation, (cost-utility analysis) was used to evaluate the costs and benefits of a physiotherapy outpatient department. The quality of life of 56 patients was measured before and after physiotherapy intervention and the costs of the treatment compared with the benefits gained. Within the limitations of the study, physiotherapy was found to be good value for money compared with other health care interventions, with treatment for chronic conditions such as back pain, neck pain and osteoarthritis representing better value for money than treatment for acute conditions such as strains and sprains and fractures. © 1993, Australian Physiotherapy Association. All rights reserved.
Keith, AR, Pirkis, JE, Viney, RC, Katz, CM, Lagaida, RM, Britt, H & Baden, L 1993, 'Delivery of primary care in hospital and community settings in Australia', International Journal for Quality in Health Care, vol. 5, no. 2, pp. 131-141.
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This study examined the interface between emergency departments and community general practice in terms of their delivery of primary care services. Through the collection of casemix and treatment data, and interviews with patients, information was gathered relating to the extent of primary care delivery in emergency departments, problems managed and treatments provided in the two settings and patients' characteristics and reasons for choosing to seek primary care in the emergency department. The results indicate a high proportion of primary care delivery is in emergency departments, and that there is a need for delivery in this setting to continue. The results are discussed in terms of such quality assurance issues as monitoring primary care in emergency departments and addressing patient needs. © 1993 Pergamon Press Ltd.
Kenny, PM, King, MT, Cameron, S & Shiell, A 1993, 'Satisfaction with postnatal care: The choice of home or hospital', Midwifery, vol. 9, no. 3, pp. 146-153.
Shiell, A, Cameron, S, Kenny, PM & King, MT 1993, 'Mother's choice: Reasons women choose hospital stay over early discharge', Health and Social Care in the Community, vol. 2, no. 2, pp. 69-76.
Shiell, A, Kenny, PM & Farnworth, M 1993, 'The role of the clinical nurse coordinator in the provision of cost-effective orthopaedic services for elderly people', Journal of Advanced Nursing, vol. 18, no. 9, pp. 1424-1428.
Smith, RD, Hall, J, Gurney, H & Harnett, PR 1993, 'A cost-utility approach to the use of 5-fluorouracil and levamisole ad adjuvant chemotherapy for Dukes' C colonic carcinoma', Medical Journal of Australia, vol. 158, no. 5, pp. 319-320+322.
Objective: To perform an economic evaluation of the joint use of 5-fluorouracil and levamisole as adjuvant chemotherapy in patients with fully resected Dukes' Stage C carcinoma of the colon, compared with resection and no chemotherapy. The evaluation was prompted by a study (N Engl J Med 1990; 322: 352-358) which recommended a new treatment standard for colon cancer: a 52-week course of fluorouracil, with levamisole every second week, as adjuvant chemotherapy. This recommendation raised several concerns, particularly about the quality of life of patients undergoing such a long course of chemotherapy and the costs to the health care system. Methods: The cost of the surgery plus chemotherapy was estimated and compared with the cost of surgery alone. Descriptions of quality of life were developed from interviews with patients and health professionals, and the time trade off technique was then used to derive utility weights from a small sample (16) which were used to adjust length of life to reflect quality, in terms of a 'quality adjusted life year' (QALY). Results: Chemotherapy increases the total cost of treating a patient with colon cancer by $7000, from $6000 to $13000. Incorporating quality of life reduced the extra benefit gained from the chemotherapy from 2.4 life years to 0.4 QALYs. Thus the result is a cost of $17500 to achieve an extra QALY from this particular treatment. Conclusions: The results of this analysis are only tentative, as the quality of life descriptions were not measured over time but from a cross-sectional survey of patients, and the valuations of health states were derived from a small sample. However, we believe them to be indicative, and conclude that it is perhaps more appropriate for the use of chemotherapy to be an option rather than standard treatment until further research on these aspects is complete.
Aristides, M, Shiell, A, Hall, JP, Cameron, S & Madeline, J CHERE 1993, Out of hours: an evaluation of the continuing community cancer care program in western Sydney, CHERE Discussion Paper No 20, Sydney.
LIPID is a randomised controlled trial which is being undertaken jointly by the National Heart Foundation of Australia and the NHMRC Clinical Trials Centre. Its aim is to determine whether HMG-CoA reductase inhibitors reduce coronary heart disease mortality in post myocardial infarction or unstable angina pectoris patients. The cost-effectiveness sub-study, which is being undertaken in collaboration with the Centre for Health Economics Research and Evaluation aims to measure the cost-effectiveness of the intervention. The purpose of the feasibility and pilot costing study is to investigate the most feasible approach for deriving cost estimates of resources used. More specifically, the aim was to examine developments in information systems in NSW and the ACT and to undertake a costing of critical care wards (intensive and coronary care units) in four distinctly different types of hospital. These were a NSW city teaching hospital; a NSW non city teaching hospital; a country hospital and an interstate hospital. The main findings of the study were that it is possible to produce satisfactory unit prices for bed day stay in different hospitals in NSW and the ACT; the prices between the different types of hospital do not appear to vary greatly; and the likely improvements in information systems over the next 2-3 years will provide a superior data set, enabling simpler and more accurate costings to be undertaken at that time. It was therefore recommended that the generation of a full set of costs be left until towards the end of the LIPID study; any future costing be preceded by modelling to assess the sensitivity of the cost-effectiveness analysis results to the accuracy of the variable; and the development of in hospital cost data be closely monitored.
Hall, JP CHERE 1993, The impact of the economic evaluation of health care on policy and practice, CHERE Discussion Paper No 22, Sydney.
Hall, JP & Shiell, A CHERE 1993, Health outcomes: a health economics perspective, CHERE Discussion Paper No 19, Sydney.
Improving the efficiency of general practice requires an understanding of the effects of changes in incentives on General Practitioner (GP) behaviour. In this paper, the theoretical and empirical evidence on how incentives influence GP behaviour and the efficiency of medical practice is reviewed. Two issues are addressed; what mechanisms might promote efficiency in general practice?; and, how can GP behaviour be changed? The empirical evidence suggests that GP behaviour can be changed through remunerative, competitive and educational incentives, and that income is an important determinant of behaviour. However, there are weaknesses in the methods adopted and deficiencies in data which limit the generalisability of the results of most studies. The paucity of evidence in this area leaves much scope for future research. Changes in general practice remuneration and organisation should be properly evaluated if efficient practice is to be promoted.
Shiell, A, Hall, JP, Jan, S & Seymour, J CHERE 1993, Advancing health in NSW: planning in an economic framework, CHERE Discussion Paper No 23, Sydney.
Smith, R & Hall, JP CHERE 1993, The cost of operating a national renal/pancreas transplant unit, CHERE Discussion Paper No 13, Sydney.
Smith, R, Hall, JP, Harnett, P & Gurney, H CHERE 1993, A preliminary cost utility analysis of adjuvant chemotherapy for resected colonic carcinoma, CHERE Discussion Paper No 15, Sydney.