Alison, JA, Kenny, P, King, MT, McKinley, S, Aitken, LM, Leslie, GD & Elliott, D 2012, 'Repeatability of the Six-Minute Walk Test and Relation to Physical Function in Survivors of a Critical Illness', PHYSICAL THERAPY, vol. 92, no. 12, pp. 1556-1563.
View/Download from: Publisher's site
View description>>
Background. The Six-Minute Walk Test (6MWT) is widely used as an outcome measure in exercise rehabilitation. However, the repeatability of the 6MWT performed at home in survivors of a critical illness has not been evaluated. Objective. The purpose of this study was to evaluate, in survivors of a critical illness: (1) the repeatability of the 6MWT performed at home, (2) the effect on estimates of change in functional exercise capacity if only one 6MWT was performed at follow-up assessments, and (3) the relationship between the physical functioning (PF) score of the 36-Item Short-Form Health Survey questionnaire (SF-36) and the 6MWT. Design. Repeated measures of the 6MWT and SF-36 were obtained. Methods. Eligible participants had an intensive care unit (ICU) length of stay of ≥48 hours and were mechanically ventilated for ≥24 hours. Two 6MWTs and the SF-36 were conducted in participants' homes at weeks 1, 8, and 26 after hospital discharge. Results. One hundred seventy-three participants completed the study. The participants had a mean age of 57 years (SD=16), a mean Acute Physiology and Chronic Health Evaluation II (APACHE II) score on admission of 19 (SD=10), a mean ICU length of stay of 9 days (SD=8), and a mean mechanical ventilation time of 140 hours (SD=137). Of the 173 participants, 110 performed two 6MWTs at weeks 1, 8, and 26. There were significant mean increases in 6-minute walk distance in the second test of 15 m (P<.0001) at week 1, 13 m (P<.0001) at week 8, and 9 m (P=.04) at week 26. If only one 6MWT was performed at weeks 8 and 26, the estimate of change in 6-minute walk distance from week 1 was 19 m less (P<.001) at both weeks 8 and 26. There was a moderate to strong correlation between SF-36 PF score and 6-minute walk distance at each assessment (week 1: r=.62, P<.001; week 8: r=.55, P<.001; and week 26: r=.47, P<.001). Limitations. Some study participants were unable to perform a second 6MWT, and these participants may have differed in ...
Blinman, P, King, M, Norman, R, Viney, R & Stockler, MR 2012, 'Preferences for cancer treatments: an overview of methods and applications in oncology', ANNALS OF ONCOLOGY, vol. 23, no. 5, pp. 1104-1110.
View/Download from: Publisher's site
View description>>
This review provides cancer clinicians and researchers with an overview of methods for assessing preferences, with examples and recommendations for their application in oncology. Decisions about cancer treatments involve trade-offs between their relative benefits and harms. An individual's preference for a cancer treatment reflects their evaluation of the relative benefits and harms in comparison with a given alternative or alternatives. Methods of preference assessment include the ranking or rating scale, standard gamble (SG), time trade-off (TTO), visual analogue scale, discrete choice experiment (DCE), and multi-attribute utility instrument (MAUI). The choice of method depends on the purpose of preference assessment; the ranking or rating scale, SG, TTO, and DCEs are best suited to clinical decisions, whereas MAUIs are best suited to health policy decisions. Knowledge of patients' preferences for cancer treatments can better inform clinical decisions about patient management by enabling the tailoring of decisions to individual patients' values, attitudes, and priorities and health policy decisions through economic evaluations of cancer treatments and their suitability for coverage by health payers. © The Author 2012. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.
Chatfield, CH, Mulhern, BJ, Viswanathan, VK & Cianciotto, NP 2012, 'The major facilitator superfamily-type protein LbtC promotes the utilization of the legiobactin siderophore by Legionella pneumophila', Microbiology, vol. 158, no. 3, pp. 721-735.
View/Download from: Publisher's site
Church, J, Goodall, S, Norman, R & Haas, M 2012, 'The cost‐effectiveness of falls prevention interventions for older community‐dwelling Australians', Australian and New Zealand Journal of Public Health, vol. 36, no. 3, pp. 241-248.
View/Download from: Publisher's site
View description>>
Objective: To evaluate the cost-effectiveness of strategies designed to prevent falls among older people. Methods: A decision analytic Markov model of interventions designed to prevent falls was developed. Incremental cost-effectiveness ratios (ICERs) using quality adjusted life year (QALYs) as the measure, were calculated for those interventions aimed at the general population (home exercise, group exercise, tai chi, multiple and multi-factorial interventions); high-risk populations (group exercise, home hazard assessment/modification and multi-factorial interventions); and specific populations (cardiac pacing, expedited cataract surgery and psychotropic medication withdrawal). Uncertainty was explored using univariate and probabilistic sensitivity analysis. Conclusion: In the general population, compared with no intervention the ICERs were tai chi ($44,205), group-based exercise ($70,834), multiple interventions ($72,306), home exercise ($93,432), multifactorial interventions with only referral ($125,868) and multifactorial interventions with an active component ($165,841). The interventions were ranked by cost in order to exclude dominated interventions (more costly, less effective) and extendedly dominated interventions (where an intervention is more costly and less effective than a combination of two other interventions). Tai chi remained the only cost-effective intervention for the general population. Implications: Interventions designed to prevent falls in older adults living in the community can be cost-effective. However, there is uncertainty around some of the model parameters which require further investigation. © 2012 Public Health Association of Australia.
Comino, EJ, Davies, GP, Krastev, Y, Haas, M, Christl, B, Furler, J, Raymont, A & Harris, MF 2012, 'A systematic review of interventions to enhance access to best practice primary health care for chronic disease management, prevention and episodic care', BMC Health Services Research, vol. 12, no. 1, pp. 1-9.
View/Download from: Publisher's site
View description>>
Background Although primary health care (PHC) is a key component of all health care systems, services are not always readily available, accessible or affordable. This systematic review examines effective strategies to enhance access to best practice processes of PHC in three domains: chronic disease management, prevention and episodic care. Methods An extensive search of bibliographic data bases to identify peer and non-peer reviewed literature was undertaken. Identified papers were screened to identify and classify intervention studies that measured the impact of strategies (singly or in combination) on change in use or the reach of services in defined population groups (evaluated interventions). Results The search identified 3,148 citations of which 121 were intervention studies and 75 were evaluated interventions. Evaluated interventions were found in all three domains: prevention (n?=?45), episodic care (n?=?19), and chronic disease management (n?=?11). They were undertaken in a number of countries including Australia (n?=?25), USA (n?=?25), and UK (n?=?15). Study quality was ranked as high (31% of studies), medium (61%) and low (8%). The 75 evaluated interventions tested a range of strategies either singly (n?=?46 studies) or as a combination of two (n?=?20) or more strategies (n?=?9). Strategies targeted both health providers and patients and were categorised to five groups: practice re-organisation (n?=?43 studies), patient support (n?=?29), provision of new services (n?=?19), workforce development (n?=?11), and financial incentives (n?=?9). Strategies varied by domain, reflecting the complexity of care needs and processes. Of the 75 evaluated interventions, 55 reported positive findings with interventions using a combination of strategies more likely to report positive results.
Glekas, GD, Mulhern, BJ, Kroc, A, Duelfer, KA, Lei, V, Rao, CV & Ordal, GW 2012, 'The Bacillus subtilis Chemoreceptor McpC Senses Multiple Ligands Using Two Discrete Mechanisms', Journal of Biological Chemistry, vol. 287, no. 47, pp. 39412-39418.
View/Download from: Publisher's site
View description>>
Bacillus subtilis can perform chemotaxis toward all 20 L-amino acids normally found in proteins. Loss of a single chemoreceptor, McpC, was previously found to reduce chemotaxis to 19 of these amino acids. In this study, we investigated the amino acid-sensing mechanism of McpC. We show that McpC alone can support chemotaxis to 17 of these amino acids to varying degrees. Eleven amino acids were found to directly bind the amino-terminal sensing domain of McpC in vitro. Sequence analysis indicates that the McpC sensing domain exhibits a dual Per-Arnt-Sim (PAS) domain structure. Using this structure as a guide, we were able to isolate mutants that suggest that four amino acids (arginine, glutamine, lysine, and methionine) are sensed by an indirect mechanism. We identified four candidate binding lipoproteins associated with amino acid transporters that may function in indirect sensing: ArtP, GlnH, MetQ, and YckB. ArtP was found to bind arginine and lysine; GlnH, glutamine; MetQ, methionine; and YckB, tryptophan. In addition, we found that ArtP, MetQ, and YckB bind the sensing domain of McpC, suggesting that the three participate in the indirect sensing of arginine, lysine, methionine, and possibly tryptophan as well. Taken together, these results further our understanding of amino acid chemotaxis in B. subtilis and gain insight into how a single chemoreceptor is able to sense many amino acids.
Goodall, S, King, M, Ewing, J, Smith, N & Kenny, P 2012, 'Preferences for support services among adolescents and young adults with cancer or a blood disorder: A discrete choice experiment', Health Policy, vol. 107, no. 2-3, pp. 304-311.
View/Download from: Publisher's site
View description>>
Background: Life-threatening illnesses in young people are traumatic for patients and their families. Support services can help patients and families deal with various non-medical impacts of diagnosis, disease and treatment. The aim of this study was to determine which types of support are most valued by adolescents and young adults (AYA) with cancer or blood disorders and their families. Method: A discrete choice experiment (DCE). Separate experiments were conducted with AYA and their carers. Results: Completed surveys were returned by 83 patients and 78 carers. AYA preferred emotional support for themselves (either by counsellors and/or peers), emotional support for their family, financial support and assistance returning to school/work over services relating to cultural and spiritual needs. Covariate analysis indicated female AYA were more likely than males to prefer emotional support, while males were more likely to prefer assistance returning to work/school. Carers preferred emotional support for their AYA and assistance returning to school/work. Like AYA, they were indifferent about services relating to cultural and spiritual needs. Conclusion: Providing the types of support services that people prefer should maximise effectiveness. This study suggests that AYA patients require support services that included financial aid, assistance returning to work/study, emotional support for themselves and for their family. © 2012 Elsevier Ireland Ltd.
Greene, J & Hall, J 2012, 'The comparability of emergency department waiting time performance data', MEDICAL JOURNAL OF AUSTRALIA, vol. 197, no. 6, pp. 345-348.
View/Download from: Publisher's site
View description>>
Objective: To examine whether the reported urgency mix of an emergency department's (ED's) patients is associated with its waiting time performance. Design and setting: Cross-sectional analysis of data on patient urgency mix and hospital ED performance reported on the MyHospitals website for July 2009 - June 2010. Main outcome measures: ED performance assessed as the proportion of patients whose care was initiated within the recommended time frame for each of four triage categories. Results: Data for 158 hospitals showed that EDs with a higher proportion of patients assigned to the emergency category have poorer waiting time performance, after adjusting for hospital characteristics. Conversely, EDs with a higher proportion of patients assigned to the non-urgent category perform better. If performance scores were adjusted for reported patient urgency mix and hospital peer group, mean adjustments would be modest in size (3.7-7.1 percentage points, depending on the category), but for individual EDs the differences could be large (as large as 31 percentage points) and hospital waiting time performance rankings would be substantively impacted. Conclusion: Since ED performance is related to reported patient urgency mix, adjusting for casemix in the ED may be warranted to ensure valid comparisons between hospitals. Further investigation of the validity of performance measures and appropriate adjustment for differences in hospital and patient characteristics is required if public reporting is to meet its goals.
Greene, J & Hall, J 2012, 'The comparability of emergency department waiting time performance data REPLY', MEDICAL JOURNAL OF AUSTRALIA, vol. 197, no. 11-12, pp. 618-618.
View/Download from: Publisher's site
Haas, M, Hall, J, Viney, R & Gallego, G 2012, 'Breaking up is hard to do: why disinvestment in medical technology is harder than investment', AUSTRALIAN HEALTH REVIEW, vol. 36, no. 2, pp. 148-152.
View/Download from: Publisher's site
View description>>
Healthcare technology is a two-edged sword - it offers new and better treatment to a wider range of people and, at the same time, is a major driver of increasing costs in health systems. Many countries have developed sophisticated systems of health technology assessment (HTA) to inform decisions about new investments in new healthcare interventions. In this paper, we question whether HTA is also the appropriate framework for guiding or informing disinvestment decisions. In exploring the issues related to disinvestment, we first discuss the various HTA frameworks which have been suggested as a means of encouraging or facilitating disinvestment. We then describe available means of identifying candidates for disinvestment (comparative effectiveness research, clinical practice variations, clinical practice guidelines) and for implementing the disinvestment process (program budgeting and marginal analysis (PBMA) and related techniques). In considering the possible reasons for the lack of progress in active disinvestment, we suggest that HTA is not the right framework as disinvestment involves a different decision making context. The key to disinvestment is not just what to stop doing but how to make it happen - that is, decision makers need to be aware of funding disincentives. What is known about this topic? Disinvestment is an increasingly popular topic amongst academics and policy makers. Most discussions focus on the need to increase disinvestment as a corollary of investment, the lack of overt disinvestment decisions and the use of a framework based on health technology assessment (HTA) to implement disinvestment. What does this paper add? This paper focusses on the difficulties associated with deciding which technologies to disinvest in, and the problems in using an HTA framework to make such decisions, when disinvestment involves a different decision making context from that of investment. What are the implications for practitioners? The key to disinv...
Haywood, P, de Raad, J, van Gool, K, Haas, M, Gallego, G, Pearson, S-A, Faedo, M & Ward, R 2012, 'Chemotherapy Administration: Modelling the Costs of Alternative Protocols', PharmacoEconomics, vol. 30, no. 12, pp. 1173-1186.
View/Download from: Publisher's site
View description>>
Background and Objective:Background and Objective: The increasing cost of chemotherapy is placing greater pressures on limited healthcare budgets. A potentially important, but often overlooked, aspect of chemotherapy is the cost associated with administration. This study aims to develop a better understanding of these costs, and in doing so, develop a model to estimate the comparative cost of administering alternative chemotherapy protocols for economic evaluation or local decision making. Abstract: Methods:Methods: We identified the potential tasks and choices related to administering intravenous chemotherapy, grouped tasks according to anticipated resource use, and allocated costs to each task using data from an evidence-based collection of cancer protocols or from primary data collection. The resources were costed from a healthcare system perspective using standard data sources within Australia. The model was applied to alternative protocols used in the treatment of three different cancers: locally advanced and metastatic non-small-cell lung cancer, adjuvant colorectal cancer and adjuvant breast cancer. Abstract: Results:Results: For the three cancer types examined, the cost of completed administration ranged from 1274 Australian dollars ($A) to $A3015 (year 2009 values) for 13 different protocols potentially used for the initial treatment of locally advanced and metastatic non-small-cell lung cancer; $A5175-8445 for seven protocols for adjuvant colorectal cancer treatment; and $A1494-4074 for seven protocols for adjuvant breast cancer treatment. Abstract: Conclusions:Conclusions: The results are of practical significance to those undertaking economic evaluations and to decision makers who use this information within the area of chemotherapy. The examples used suggest that administration costs per visit varied inversely with the number of visits. The results provide information where little has previously been available an...
Hepburn, S, Farid, S, Dawson, J & Goodall, S 2012, 'Thyroid function testing', British Journal of Hospital Medicine, vol. 73, no. Sup8, pp. C114-C118.
View/Download from: Publisher's site
Jeon, Y-H, Luscombe, G, Chenoweth, L, Stein-Parbury, J, Brodaty, H, King, M & Haas, M 2012, 'Staff outcomes from the Caring for Aged Dementia Care REsident Study (CADRES): A cluster randomised trial', INTERNATIONAL JOURNAL OF NURSING STUDIES, vol. 49, no. 5, pp. 508-518.
View/Download from: Publisher's site
View description>>
BACKGROUND: Dementia care mapping and person centred care are well-accepted as processes for improving care and well-being for persons with dementia living in the residential setting. However, the impact of dementia care mapping and person centred care on staff has not been well researched. OBJECTIVES: The impact of person centred care and dementia care mapping compared to each other and to usual dementia care on staff outcomes was examined in terms of staff burnout, general well-being, attitudes and reactions towards resident behavioural disturbances, perceived managerial support, and quality of care interactions. DESIGN: A cluster-randomised, controlled trial. SETTINGS: The study was conducted between 2005 and 2007 in 15 residential aged care sites in the Sydney metropolitan area, Australia, with comparable management structures, staffing mix and ratios, and standards of care. PARTICIPANTS: 194 consenting managers, nurses, therapists and nurse assistants working in the participating sites.
King, MT, Viney, R, Smith, DP, Hossain, I, Street, D, Savage, E, Fowler, S, Berry, MP, Stockler, M, Cozzi, P, Stricker, P, Ward, J & Armstrong, BK 2012, 'Survival gains needed to offset persistent adverse treatment effects in localised prostate cancer', BRITISH JOURNAL OF CANCER, vol. 106, no. 4, pp. 638-645.
View/Download from: Publisher's site
View description>>
BACKGROUND: Men diagnosed with localised prostate cancer (LPC) face difficult choices between treatment options that can cause persistent problems with sexual, urinary and bowel function. Controlled trial evidence about the survival benefits of the full range of treatment alternatives is limited, and patients' views on the survival gains that might justify these problems have not been quantified. METHODS: A discrete choice experiment (DCE) was administered in a random subsample (n=357, stratified by treatment) of a population-based sample (n=1381) of men, recurrence-free 3 years after diagnosis of LPC, and 65 age-matched controls (without prostate cancer). Survival gains needed to justify persistent problems were estimated by substituting side effect and survival parameters from the DCE into an equation for compensating variation (adapted from welfare economics). RESULTS: Median (2.5, 97.5 centiles) survival benefits needed to justify severe erectile dysfunction and severe loss of libido were 4.0 (3.4, 4.6) and 5.0 (4.9, 5.2) months. These problems were common, particularly after androgen deprivation therapy (ADT): 40 and 41% overall (n=1381) and 88 and 78% in the ADT group (n=33). Urinary leakage (most prevalent after radical prostatectomy (n=839, mild 41%, severe 18%)) needed 4.2 (4.1, 4.3) and 27.7 (26.9, 28.5) months survival benefit, respectively. Mild bowel problems (most prevalent (30%) after external beam radiotherapy (n=106)) needed 6.2 (6.1, 6.4) months survival benefit. CONCLUSION: Emerging evidence about survival benefits can be assessed against these patient-based benchmarks. Considerable variation in trade-offs among individuals underlines the need to inform patients of long-term consequences and incorporate patient preferences into treatment decisions. © 2012 Cancer Research UK. All rights reserved.
Knox, SA, Viney, RC, Street, DJ, Haas, MR, Fiebig, DG, Weisberg, E & Bateson, D 2012, 'What's Good and Bad About Contraceptive Products? A Best-Worst Attribute Experiment Comparing the Values of Women Consumers and GPs', PHARMACOECONOMICS, vol. 30, no. 12, pp. 1187-1202.
View/Download from: Publisher's site
View description>>
Our objectives were to compare women's (consumers') preferences and GPs' (providers') views in relation to existing and new contraceptive methods, and particularly to examine what factors increase the acceptability of different contraceptive products. Women and GPs agree that longer-acting methods with less bleeding are important features in preferred methods of contraception; however, women are also attracted to products involving less invasive modes of administration. While the vaginal ring may fill the niche in Australia for a relatively non-invasive, moderately long-acting and effective contraceptive, the results of this study indicate that GPs will need to promote the benefits of the vaginal ring to overcome negative perceptions about this method among women who may benefit from using it.
Laba, T-L, Brien, J-A & Jan, S 2012, 'Understanding rational non-adherence to medications. A discrete choice experiment in a community sample in Australia', BMC Family Practice, vol. 13, no. 1.
View/Download from: Publisher's site
View description>>
Background: In spite of the potential impact upon population health and expenditure, interventions promoting medication adherence have been found to be of moderate effectiveness and cost effectiveness. Understanding the relative influence of factors affecting patient medication adherence decisions and the characteristics of individuals associated with variation in adherence will lead to a better understanding of how future interventions should be designed and targeted. This study aims to explore medication-taking decisions that may underpin intentional medication non-adherence behaviour amongst a community sample and the relative importance of medication specific factors and patient background characteristics contributing to those decisions. Methods. A discrete choice experiment conducted through a web-enabled online survey was used to estimate the relative importance of eight medication factors (immediate and long-term medication harms and benefits, cost, regimen, symptom severity, alcohol restrictions) on the preference to continue taking a medication. To reflect more closely what usually occurs in practice, non-disease specific medication and health terms were used to mimic decisions across multiple medications and conditions.161 general community participants, matching the national Australian census data (age, gender) were recruited through an online panel provider (participation rate: 10%) in 2010. Results: Six of the eight factors (i.e. immediate and long-term medication harms and benefits, cost, and regimen) had a significant influence on medication choice. Patient background characteristics did not improve the model. Respondents with private health insurance appeared less sensitive to cost then those without private health insurance. In general, health outcomes, framed as a side-effect, were found to have a greater influence over adherence than outcomes framed as therapeutic benefits. Conclusions: Medication-taking decisions are the subject of r...
Mulhern, B & Meadows, K 2012, 'PDB75 The Validation of the Diabetes Health Profile (DHP-18) and the Development of a Brief Measure of Health Related Quality of Life in Diabetes (DHP-12)', Value in Health, vol. 15, no. 4, pp. A184-A184.
View/Download from: Publisher's site
Mulhern, B, Brazier, JE, Rowen, D, Young, TA, Smith, SC & Banerjee, S 2012, 'Response to Comments on Mulhern et al., “Improving the Measurement of QALYs in Dementia: Developing Patient- and Carer-Reported Health State Classification Systems Using Rasch Analysis”', Value in Health, vol. 15, no. 5, pp. 787-788.
View/Download from: Publisher's site
Mulhern, B, Churchman, D & Meadows, K 2012, 'PDB58 The Psychometric Performance of the EQ-5D, SF-6D and Diabetes Health Profile (DHP-18) in Type 2 Diabetes', Value in Health, vol. 15, no. 7, pp. A504-A504.
View/Download from: Publisher's site
Mulhern, B, Rowen, D, Jacoby, A, Marson, T, Snape, D, Hughes, D, Latimer, N, Baker, GA & Brazier, JE 2012, 'The development of a QALY measure for epilepsy: NEWQOL-6D', Epilepsy & Behavior, vol. 24, no. 1, pp. 36-43.
View/Download from: Publisher's site
View description>>
Cost-utility analysis is used to inform the allocation of healthcare resources, using the quality-adjusted life year (QALY) as the outcome measure. We report the development of an epilepsy-specific QALY measure (NEWQOL-6D) derived from the NEWQOL measure of health-related quality of life. Firstly, psychometric and Rasch analyses established the dimension structure of NEWQOL and generated a reduced health state classification system including one item per dimension. Secondly, health states generated by the classification system were valued using Time Trade Off, and the results were modeled to generate a utility score for every health state. A classification system with 6 dimensions (worry about attacks; depression; memory; concentration; stigma; control) was produced, and generalized least squares regression was used to generate utility scores for every health state. This study is the first attempt to derive an epilepsy-specific QALY measure, and the utility values can be used in the economic evaluation of emerging technologies for epilepsy. © 2012 Elsevier Inc.
Mulhern, B, Smith, SC, Rowen, D, Brazier, JE, Knapp, M, Lamping, DL, Loftus, V, Young, TA, Howard, RJ & Banerjee, S 2012, 'Improving the Measurement of QALYs in Dementia: Developing Patient- and Carer-Reported Health State Classification Systems Using Rasch Analysis', Value in Health, vol. 15, no. 2, pp. 323-333.
View/Download from: Publisher's site
View description>>
Objectives: Cost-utility analysis is increasingly used to inform resource allocation. This requires a means of valuing health states before and after intervention. Although generic measures are typically used to generate values, these do not perform well with people with dementia. We report the development of a health state classification system amenable to valuation for use in studies of dementia, derived from the DEMQOL system, measure of health-related quality of life in dementia by patient self-report (DEMQOL) and carer proxy-report (DEMQOL-Proxy). Methods: Factor analysis was used to determine the dimensional structure of DEMQOL and DEMQOL-Proxy. Rasch analysis was subsequently used to investigate item performance across factors in terms of item-level ordering, functioning across subgroups, model fit, and severity-range coverage. This enabled the selection of one item from each factor for the classification system. A sample of people with a diagnosis of mild/moderate dementia (n = 644) and a sample of carers of those with mild/moderate dementia (n = 683) were used. Results: Factor analysis found different five-factor solutions for DEMQOL and DEMQOL-Proxy. Following item reduction and selection by using Rasch analysis, a five-dimension classification for DEMQOL and a four-dimension classification for DEMQOL-Proxy were developed. Each item contained four health state levels. Conclusion: Combining Rasch and classical psychometric analysis is a valid method of selecting items for dementia health state classifications from both the patient and carer perspectives. The next stage is to obtain preference weights so that the measure can be used in the economic evaluation of treatment, care, and support arrangements for dementia. Copyright © 2012, International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc.
Norman, R, van Gool, K, Hall, J, Delatycki, M & Massie, J 2012, 'Cost-effectiveness of carrier screening for cystic fibrosis in Australia', JOURNAL OF CYSTIC FIBROSIS, vol. 11, no. 4, pp. 281-287.
View/Download from: Publisher's site
View description>>
Background: Carrier screening for cystic fibrosis is not widely available in Australia, partly due to concerns regarding its cost-effectiveness. The benefit of information from pregnancy to pregnancy has not been widely considered in existing cost-effectiveness analyses. Methods: A decision tree was constructed estimating costs and outcomes from screening, including both initial and subsequent pregnancies. Effectiveness was expressed in terms of CF births averted. Costs were collected using a health service perspective. All costs and outcomes were discounted at 5% per annum. Results: Screening reduced the annual incidence of CF births from 34 to 14/100,000 births (an aggregate number of CF births of 100.9 and 41.9 respectively). In initial pregnancies, costs in the screening arm (A$16.6. million/100,000 births) exceed those in the non-screening arm (A$13.4. million/100,000 births). The incremental cost per CF birth in initial pregnancies is therefore approximately A$150,000. However, this was reversed for subsequent pregnancies, in that the pre-collected information reduces the incidence of CF in subsequent pregnancies at low additional costs. When aggregated, the results suggest screening is likely to be cost-saving. Conclusions: The introduction of national carrier screening for cystic fibrosis should be considered, as it is likely to reduce CF incidence at an acceptable (potentially negative) cost. © 2012 European Cystic Fibrosis Society.
O'Hara, BJ, Phongsavan, P, Venugopal, K, Eakin, EG, Eggins, D, Caterson, H, King, L, Allman-Farinelli, M, Haas, M & Bauman, AE 2012, 'Effectiveness of Australia's Get Healthy Information and Coaching Service (R): Translational research with population wide impact', PREVENTIVE MEDICINE, vol. 55, no. 4, pp. 292-298.
View/Download from: Publisher's site
View description>>
Objective: With increasing rates of non-communicable disease, there is a need for implementing population-wide, evidence-based interventions for improving behavioural risk factors. Telephone-based interventions provide one option. This study reports on the evaluation of the Australia's Get Healthy Information and Coaching Service®, to improve lifestyle behaviours, amongst a population-wide sample who completed the 6-month coaching programme. Methods: Using a pre-post design, New South Wales participants who completed telephone-based coaching between February 2009 and December 2011 were included. Outcomes comprised self-reported weight, waist circumference, height, physical activity and dietary behaviours. Matched pair analyses and multivariate modelling were performed to assess behavioural changes. Results: Participants (n = 1440) reported statistically significant improvements in weight (-3.9. kg (5.1)); waist circumference (-5.0. cm (6.0)); and Body Mass Index (-1.4 BMI units (1.8)); number of walking and moderate-vigorous physical activity sessions of ≥ 30. min per week; number of vigorous physical activity sessions of ≥ 20. min per week and servings of vegetables; fruit; take-away meals and sweetened drinks (all p < 0.001). Improvements in weight, waist, moderate physical activity, fruit and vegetable and take-away meals consumption remained significant after adjusting for socio-demographic characteristics. Conclusions: These results support the effectiveness of replicating an evidence-based intervention in improving population risk factors for chronic disease. © 2012 Elsevier Inc.
Page, K 2012, 'The four principles: Can they be measured and do they predict ethical decision making?', BMC Medical Ethics, vol. 13, no. 1.
View/Download from: Publisher's site
Pearce, A, van Gool, K, Haywood, P & Haas, M 2012, 'Delays in access to affordable medicines: putting policy into perspective', Australian Health Review, vol. 36, no. 4, pp. 412-412.
View/Download from: Publisher's site
View description>>
Background.To save costs, the Australian Government recently deferred approval of seven new medicines recommended by the Pharmaceutical Benefits Advisory Committee (PBAC) for up to 7 months.Objectives.The aim of this research is to examine the timelines of PBAC applications following approval by the Therapeutic Goods Administration (TGA), allowing the recent Cabinet delays to be considered in the context of the overall medicines approval process.Methods.All new chemical entities and products for new indications approved in 2004 by the Australian Drug Evaluation Committee (ADEC) were identified. Outcomes of PBAC meetings from 2004 to 2010 were then searched to identify if and when these products were reviewed by PBAC.Results.ADEC recommended 63 eligible products for registration in 2004. Of the 113 submissions made to PBAC for these products, 66 were successful. Only 43% of the products were submitted to PBAC within 2 years, with an average 17-month delay from TGA approval of a product to consideration by the PBAC.Conclusions.Cabinet decisions to defer listing of new medicines delays access to new treatments. This occurred in addition to other longer delays, earlier in the approval process for medicines, resulting in a significant impact on the overall timeliness of listing.What is known about the topic?There is evidence that the time from registration of new drugs on the TGA to their listing for subsidised availability is increasing. The government’s recent decision to delay the listing of seven new drugs for subsidisation raised concerns about the potential for additional delays to impact the accessibility of new, affordable medicines for patients.What does this paper add?This paper examines delays at various stages in the process of approval for pharmaceutical subsidies on the Pharmaceutical Benefits Scheme (PBS), putting the deferral of new medicine listings in the overall context of the approval process. It identifies th...
Rowen, D, Mulhern, B, Banerjee, S, van Hout, B, Young, TA, Knapp, M, Smith, SC, Lamping, DL & Brazier, JE 2012, 'Estimating Preference-Based Single Index Measures for Dementia Using DEMQOL and DEMQOL-Proxy', Value in Health, vol. 15, no. 2, pp. 346-356.
View/Download from: Publisher's site
View description>>
Objective: Although condition-specific measures are commonly used in dementia, they cannot be used in analyses of cost per quality-adjusted life-year because they do not incorporate preferences. We addressed this gap by estimating two preference-based single index measures: the DEMQOL-U from the self-report DEMQOL (mild-to-moderate dementia severity) and the DEMQOL-Proxy-U from the carer-report DEMQOL-Proxy (all levels of dementia severity). Methods: We conducted valuation studies on 593 members of the general population (306 for the DEMQOL-U, 287 for the DEMQOL-Proxy-U) using the time trade-off elicitation technique. We then fitted a range of mean and individual-level multivariate regression models to the valuation data to derive preference weights for each measure. We applied the estimated weights to a large, clinically representative sample. Results: Mean observed time trade-off values ranged from 0.18 to 0.95 for DEMQOL-U and from 0.33 to 0.96 for DEMQOL-Proxy-U. The best performing models for each measure were main effects models estimated using individual-level data. DEMQOL-Proxy-U had inconsistent but insignificant coefficient estimates for one dimension. Models were estimated to remove these inconsistencies. Conclusion: Preference-based single index measures from DEMQOL and DEMQOL-Proxy for use in economic evaluation will enable economic evaluation using quality-adjusted life-years to be undertaken for people across the full range of dementia severity. Future research will examine how the utilities from each measure can be used and combined to populate cost-effectiveness models. Copyright © 2012, International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc.
Stein-Parbury, J, Chenoweth, L, Jeon, YH, Brodaty, H, Haas, M & Norman, R 2012, 'Implementing Person-Centered Care in Residential Dementia Care', CLINICAL GERONTOLOGIST, vol. 35, no. 5, pp. 404-424.
View/Download from: Publisher's site
View description>>
This article provides a detailed overview of the PCC intervention arm of the study and describes the training and procedures used to facilitate implementation of PCC. Training emphasized the impact of the social world on the person with dementia and promoted the skills of interpersonal engagement, especially in relation to feeling expression. Facilitated on-site learning involved care planning that included obtaining a life story of the person with dementia and observing social interactions.
Street, DJ & Knox, SA 2012, 'Designing for Attribute-Level Best–Worst Choice Experiments', Journal of Statistical Theory and Practice, vol. 6, no. 2, pp. 363-375.
View/Download from: Publisher's site
View description>>
Using the D-optimality criterion, we show that resolution 3 fractional factorial designs perform as well as the complete factorial design in attribute-level best-worst choice experiments, assuming both that all attribute levels are equally attractive and that only main effects of attribute levels are to be used to explain the results. Copyright © Grace Scientific Publishing, LLC.
Valsecchi, R, Wise, S, Mueller, F & Smith, C 2012, 'The practice of teamwork in health industry call centres', Employee Relations, vol. 34, no. 3, pp. 288-305.
View/Download from: Publisher's site
View description>>
PurposeThis paper aims to explore the introduction of teamwork in two health call centres, NHS Direct and NHS24, and intervenes in the emergent debate over teamwork in call centres. Although within the call centre work environment there is no obvious functional rationale for teamwork, teams can be “accounted for” with reference to other purposes, including performance management, normative control, governmentality and institutional isomorphism/management fads. This research provides additional explanations for the use of teamwork in such an adverse work environment.Design/methodology/approachThe paper is based on qualitative data (interviews and non‐participant observations) from NHS Direct and NHS24, the English and Scottish tele‐nursing organisations in the UK.FindingsIn the two tele‐nursing case studies analysed, teamwork was introduced as an expression of managers' aspirations to emulate private sector practices and to reinforce new public management ideals. However, informal teamwork, which cut across organisationally prescribed forms, provided both emotional support and spontaneous knowledge sharing among nurses.Originality/valueThis is an innovative study because teamwork has not been thoroughly explored in a health call centre environment.
Wright, M 2012, 'Pay-for-performance programs - do they improve the quality of primary care?', Aust Fam Physician, vol. 41, no. 12, pp. 989-991.
View description>>
BACKGROUND: The recent release of The Royal Australian College of General Practitioners clinical quality indicators has sparked renewed debate about the role of pay-for-performance (P4P) programs and their potential usefulness in Australian general practice. OBJECTIVE: This article seeks to update recent evidence about the impact of P4P programs on the quality of primary care and presents the evidence based viewpoint that there are potential problems with P4P, which may limit its usefulness. DISCUSSION: P4P programs are attractive to funders as they suggest a theoretical link between provider performance and improvements in healthcare quality - and potentially improved control over costs. Although P4P programs in primary care appear to have an effect on the behaviour of general practitioners, there is little evidence that these programs in their current form improve health outcomes or healthcare system quality. Further research is needed into the effect of these programs on healthcare quality before they are introduced into Australian general practice.
Church, J, Goodall, S, Norman, R, Reeve, RD & Haas, MR 1970, 'PRM19: Using panel data to inform economic evaluation [conference abstract]', Value in Health, Elsevier, Taiwan, pp. 1-1.
Church, J, Goodall, S, Norman, R, Reeve, RD & Haas, MR 1970, 'Using panel data to inform economic evaluation', ISPOR 5th Asia-Pacific Conference, Taipei, Taiwan.
Cronin, PA, Hoggan, B, Goodall, S & Cameron, A 1970, 'CE3: Hyperbaric oxygen therapy for the treatment non-neurological soft tissue radiation injuries: A cost effectiveness analysis [conference abstract]', Value in Health, Elsevier, Taiwan, pp. 1-1.
Cronin, PA, Hoggan, B, Goodall, S & Cameron, A 1970, 'Hyperbaric oxygen therapy for the treatment non-neurological soft tissue radiation injuries: A cost effectiveness analysis', ISPOR 5th Asia-Pacific Conference, Taipei, Taiwan.
Ewing, JE, Goodall, S, King, MT, Smith, NF & Kenny, PM 1970, 'Preferences for support services among adolescents and young adults with cancer or a blood disorder: Results of a discrete choice experiment', COSA 39th Annual Scientific Meeting and IPOS 14th World Congress of Psycho-Oncology, Brisbane.
Ewing, JE, Goodall, S, King, MT, Smith, NF & Kenny, PM 1970, 'Preferences for support services among adolescents and young adults with cancer or a blood disorder: Results of a discrete choice experiment [conference abstract]', Asia-Pacific Journal of Clinical Oncology, COSA 39th Annual Scientific Meeting and IPOS 14th World Congress of Psycho-Oncology, Wiley, Brisbane, pp. 129-129.
Gu, Y, Norman, R & Viney, RC 1970, 'Estimating QALY values from discrete choice experiments using mixed logit models', 34th Australian Conference of Health Economists (AHES), Darwin.
Hou, C, Haas, MR, Viney, RC, Van Gool, K, Gu, Y & Brodaty, H 1970, 'Understanding the cost of dementia in Australia', 34th Australian Conference of Health Economists (AHES), Darwin.
Norman, R, Brazier, JE, Viney, R, Burgess, L, Cronin, P, King, MT, Ratcliffe, J & Street, D 1970, 'Revaluing the SF-6D using ordinal methods for eliciting preferences', QUALITY OF LIFE RESEARCH, International Society for Quality of Life Research Congress, SPRINGER, Budapest, Hungary, pp. 6-6.
Norman, R, Viney, R, Brazier, J, Burgess, L, Cronin, P, King, M, Ratcliffe, J & Street, DJ 1970, 'USING DISCRETE CHOICE EXPERIMENTS TO VALUE HEALTH STATES FOR ECONOMIC EVALUATION - THE SF-6D IN AUSTRALIA', VALUE IN HEALTH, ISPOR Asia-Pacific Congress, Taiwan, pp. A605-A606.
Norman, R, Viney, RC, Brazier, JE, Burgess, LB, Cronin, PA, King, MT, Ratcliffe, J & Street, D 1970, 'A DCE-derived algorithm for the SF-6D', 34th Australian Conference of Health Economists (AHES), Darwin.
Norman, R, Viney, RC, Brazier, JE, Cronin, PA, King, MT, Ratcliffe, J & Street, D 1970, 'Valuing EQ-5D health states: The Australian experience', EuroQoL Group Plenary Meeting, Rotterdam.
Norman, R, Viney, RC, Brazier, JE, King, MT, Cronin, PA, Ratcliffe, J & Street, D 1970, 'Australian algorithms for the EQ-5D-3L and EQ-5D-5L', International Society for Quality of Life Research Congress, Budapest, Hungary.
Parkinson, BT, Viney, RC & Pearson, S 1970, 'Trastuzumab: how economic evaluations arrive at different conclusions', 34th Australian Conference of Health Economists, Darwin.
Pearce, AM, Haas, MR & Viney, RC 1970, 'Examining chemotherapy adverse events in a large administrative data set', 34th Australian Conference of Health Economists, Darwin.
Reeve, RD & Van Gool, K 1970, 'Persistent effects of child abuse in Australia', Australian Institute of Family Studies Conference, Melbourne.
Reeve, RD, Church, J, Haas, MR, Bradford, W & Viney, RC 1970, 'What factors underpin the diabetes gap in non-remote NSW?', 34th Australian Conference of Health Economists (AHES), Darwin.
