Bansback, N, Hole, AR, Mulhern, B & Tsuchiya, A 2014, 'Testing a discrete choice experiment including duration to value health states for large descriptive systems: Addressing design and sampling issues', Social Science & Medicine, vol. 114, pp. 38-48.
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There is interest in the use of discrete choice experiments that include a duration attribute (DCETTO) to generate health utility values, but questions remain on its feasibility in large health state descriptive systems. This study examines the stability of DCETTO to estimate health utility values from the five-level EQ-5D, an instrument with depicts 3125 different health states. Between January and March 2011, we administered 120 DCETTO tasks based on the five-level EQ-5D to a total of 1799 respondents in the UK (each completed 15 DCETTO tasks on-line). We compared models across different sample sizes and different total numbers of observations. We found the DCETTO coefficients were generally consistent, with high agreement between individual ordinal preferences and aggregate cardinal values. Keeping the DCE design and the total number of observations fixed, subsamples consisting of 10 tasks per respondent with an intermediate sized sample, and 15 tasks with a smaller sample provide similar results in comparison to the whole sample model. In conclusion, we find that the DCETTO is a feasible method for developing values for larger descriptive systems such as EQ-5D-5L, and find evidence supporting important design features for future valuation studies that use the DCETTO. © 2014 The Authors.
Barnett, AG, Page, K, Campbell, M, Brain, D, Martin, E, Rashleigh-Rolls, R, Halton, K, Hall, L, Jimmieson, N, White, K, Paterson, D & Graves, N 2014, 'Changes in Healthcare-AssociatedStaphylococcus aureusBloodstream Infections after the Introduction of a National Hand Hygiene Initiative', Infection Control & Hospital Epidemiology, vol. 35, no. 8, pp. 1029-1036.
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BackgroundInterventions that prevent healthcare-associated infection should lead to fewer deaths and shorter hospital stays. Cleaning hands (with soap or alcohol) is an effective way to prevent the transmission of organisms, but rates of compliance with hand hygiene are sometimes disappointingly low. The National Hand Hygiene Initiative in Australia aimed to improve hand hygiene compliance among healthcare workers, with the goal of reducing rates of healthcare-associated infection.MethodsWe examined whether the introduction of the National Hand Hygiene Initiative was associated with a change in infection rates. Monthly infection rates for healthcare-associatedStaphylococcus aureusbloodstream infections were examined in 38 Australian hospitals across 6 states. We used Poisson regression and examined 12 possible patterns of change, with the best fitting pattern chosen using the Akaike information criterion. Monthly bed-days were included to control for increased hospital use over time.ResultsThe National Hand Hygiene Initiative was associated with a reduction in infection rates in 4 of the 6 states studied. Two states showed an immediate reduction in rates of 17% and 28%, 2 states showed a linear decrease in rates of 8% and 11% per year, and 2 showed no change in infection rates.ConclusionsThe intervention was associated with reduced infection rates in most states. The failure in 2 states may have been because those states already had effective initiatives before the national initiative’s introduction or because infection rates were already low and could not be further reduced.
Brazier, J, Connell, J, Papaioannou, D, Mukuria, C, Mulhern, B, Peasgood, T, Lloyd Jones, M, Paisley, S, O’Cathain, A, Barkham, M, Knapp, M, Byford, S, Gilbody, S & Parry, G 2014, 'A systematic review, psychometric analysis and qualitative assessment of generic preference-based measures of health in mental health populations and the estimation of mapping functions from widely used specific measures', Health Technology Assessment, vol. 18, no. 34, pp. 1-188.
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Citation (for this publication as a. ris file) (6.3 KB) Abstract Background Generic preference-based measures of health like the EQ-5D and SF-6D(®) are increasingly being used in economic evaluation and outcome assessment. However, there are concerns as to whether or not these generic measures are appropriate for use in people with mental health problems. Objectives The EQ-5D and SF-36(®) (including its derivatives the SF-12(®) and SF-6D) were assessed using the psychometric criteria of validity and responsiveness using quantitative and qualitative methods. Another aim was to estimate mapping functions between the EQ-5D and SF-6D and condition-specific measures, where appropriate. Design Four studies were undertaken to examine the appropriateness of the measures: (1) a systematic review of quantitative evidence on validity and responsiveness; (2) a further quantitative assessment of these criteria using existing data sets; (3) a review of qualitative research on the quality of life of people with mental health problems; and (4) qualitative semistructured interviews of people with a full range of problems. A fifth study estimated mapping functions between mental health-specific measures and the EQ-5D and SF-6D. Setting A choice of venue was offered for the interviews including the participant's own home, a room at the university or a centre frequently used by mental health services. Participants The interviews were undertaken with 19 people with a broad range of mental health problems at varying levels of severity. Main outcome measures The reviews included the EQ-5D and SF-36 (and the SF-12 and SF-6D). The psychometric analysis included the Hospital Anxiety and Depression Scale (HADS), Clinical Outcomes in Routine Evaluation - Outcome Measure (CORE-OM), Generalised Anxiety Disorder Assessment (GAD-7), General Health Questionnaire (GHQ-12) and Patient Health Questionnaire (PHQ-9). Results (1) and (2) The EQ-5D and SF-36 achieved an adequate level of perf...
Chenoweth, L, Forbes, I, Fleming, R, King, MT, Stein-Parbury, J, Luscombe, G, Kenny, P, Jeon, Y-H, Haas, M & Brodaty, H 2014, 'PerCEN: a cluster randomized controlled trial of person-centered residential care and environment for people with dementia', INTERNATIONAL PSYCHOGERIATRICS, vol. 26, no. 7, pp. 1147-1160.
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Background: There is good evidence of the positive effects of person-centered care (PCC) on agitation in dementia. We hypothesized that a person-centered environment (PCE) would achieve similar outcomes by focusing on positive environmental stimuli, and that there would be enhanced outcomes by combining PCC and PCE. Methods: 38 Australian residential aged care homes with scope for improvement in both PCC and PCE were stratified, then randomized to one of four intervention groups: (1) PCC; (2) PCE; (3) PCC +PCE; (4) no intervention. People with dementia, over 60 years of age and consented were eligible. Co-outcomes assessed pre and four months post-intervention and at 8 months follow-up were resident agitation, emotional responses in care, quality of life and depression, and care interaction quality. Results: From 38 homes randomized, 601 people with dementia were recruited. At follow-up the mean change for quality of life and agitation was significantly different for PCE (p = 0.02, p = 0.05, respectively) and PCC (p = 0.0003, p = 0.002 respectively), compared with the non-intervention group (p = 0.48, p = 0.93 respectively). Quality of life improved non-significantly for PCC+PCE (p = 0.08), but not for agitation (p = 0.37). Improvements in care interaction quality (p = 0.006) and in emotional responses to care (p = 0.01) in PCC+PCE were not observed in the other groups. Depression scores did not change in any of the groups. Intervention compliance for PCC was 59%, for PCE 54% and for PCC+PCE 66%. Conclusion: The hypothesis that PCC+PCE would improve quality of life and agitation even further was not supported, even though there were improvements in the quality of care interactions and resident emotional responses to care for some of this group. The Australian New Zealand Clinical Trials Registry Number is ACTRN 12608000095369. Copyright © International Psychogeriatric Association 2014.
Doiron, D, Hall, J, Kenny, P & Street, DJ 2014, 'Job preferences of students and new graduates in nursing', APPLIED ECONOMICS, vol. 46, no. 9, pp. 924-939.
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This article investigates the preferences of student and newly graduated nurses for pecuniary and nonpecuniary aspects of nursing jobs. It is the first study applying methods based on discrete choice experiments to a developed country nursing workforce. It is also the first to focus on the transition through university training and into work. This is particularly important as junior nurses have the lowest retention levels in the profession. We sample 526 individuals from nursing programmes in two Australian universities. Flexible and newly developed models combining heteroscedasticity with unobserved heterogeneity in scale and preference weights are estimated. Overall, salary remains the most important feature in increasing the probability that a job will be selected. 'Supportive management/staff' and 'quality of care' follow as the most important attributes from a list of 11 nonpecuniary characteristics. However, the subset of new graduates rank 'supportive management/staff' above salary increases, emphasizing the importance of a supportive workplace in the transition from university to the workplace. We find substantial preference heterogeneity and some attributes, such as the opportunity for clinical rotations, are found to be attractive to some nurses while seen as negative by others. Nursing retention could be improved by designing different employment packages to appeal to these different tastes. © 2013 © 2013 Taylor & Francis.
Duffield, C, Baldwin, R, Roche, M & Wise, S 2014, 'Job enrichment: creating meaningful career development opportunities for nurses', JOURNAL OF NURSING MANAGEMENT, vol. 22, no. 6, pp. 697-706.
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© 2013 John Wiley & Sons Ltd. Aim: This paper presents an evaluation of a career development policy in South Australia which increased the number of senior staff nurse positions and provided senior registered nurses with time away from clinical duties to undertake agreed projects. We use Kanter's model of structural power and commitment theory to understand the dimensions of this policy. Background: Development strategies for experienced staff who wish to remain at the bedside are needed, especially in smaller health services with limited opportunities for horizontal or vertical mobility. Methods: Face-to-face semistructured interviews were conducted with 54 senior staff nurses who participated in the career structure arrangements. Results: The policy enhanced the structure of opportunity in three ways: by increasing the number of senior staff nurse positions, the ladder steps were improved; undertaking strategic projects developed new skills; and the job enrichment approach facilitated time out from the immediate pressures of ward work and challenged nurses in a different way. Conclusions: Through job enrichment, South Australia has found a novel way of providing meaningful career development opportunities for experienced nurses. Implications for nursing management: Methods of job enrichment need to be considered as part of career development policy, especially where movement between clinical facilities is limited and staff wish to remain at the bedside.
Eakin, E, Hayes, S, Haas, M, Reeves, M, Goode, A, Vardy, J, Boyle, F, Hiller, J, Mishra, G, Jefford, M, Kocwara, B, Demark-Wahnefried, W, Courneya, K, O’Brien, L, Boltong, A, Sharplin, G, McKiernan, S & Robson, E 2014, 'Translating research into practice: The healthy living after cancer partnership project', Journal of Science and Medicine in Sport, vol. 18, pp. e13-e13.
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Gatt, L, Jan, S, Mondraty, N, Horsfield, S, Hart, S, Russell, J, Laba, TL & Essue, B 2014, 'The household economic burden of eating disorders and adherence to treatment in Australia', BMC Psychiatry, vol. 14, no. 1, p. 338.
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© 2014 Gatt et al.; licensee BioMed Central Ltd. Background: This study investigated the household economic burden of eating disorders and cost-related non-adherence to treatment in Australia. Methods: Multi-centre prospective observational study using a structured questionnaire. Ninety participants were recruited from two clinic settings in New South Wales, Australia and from the community using social media. The primary outcome measures were household economic burden of illness measured in terms of out-of-pocket expenditure, household economic hardship and cost-related non-adherence. Results: The pattern of out-of-pocket expenditure varied by diagnosis, with Bulimia Nervosa associated with the highest total mean expenditure (per three months). Economic hardship was reported in 96.7% of participants and 17.8% reported cost-related non-adherence. Those most likely to report cost-related non-adherence had a longer time since diagnosis. Cost-related non-adherence and higher out-of-pocket expenditure were associated with poorer quality of life, a more threatening perception of the impact of the illness and poor self-reported health. Conclusions: This study is the first to empirically and quantitatively examine the household economic burden of eating disorders from the patient perspective. Results indicate that households experience a substantial burden associated with the treatment and management of an eating disorder. This burden may contribute to maintaining the illness for those who experience cost-related non-adherence and by negatively influencing health outcomes. Current initiatives to implement sustainable and integrated models of care for eating disorders should strive to minimise the economic impact of treatment on families.
Girgis, A, Kelly, B, Boyes, A, Haas, M, Viney, R, Descallar, J, Candler, H, Bellamy, D & Proietto, A 2014, 'The PACT study protocol: a time series study investigating the impact, acceptability and cost of an integrated model for psychosocial screening, care and treatment of patients with urological and head and neck cancers: Table 1', BMJ Open, vol. 4, no. 1, pp. e004147-e004147.
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INTRODUCTION: While there is good evidence of the effectiveness of a variety of interventions and services to prevent and/or relieve distress experienced by people affected by cancer, much of this psychosocial morbidity is undetected and untreated, with consequent exacerbated suffering, decreased satisfaction with care, impaired adherence to treatment regimens and poorer morbidity and mortality outcomes. The objective of this study is to develop, implement and assess the impact, acceptability and cost of an integrated, patient-centred Psychosocial Assessment, Care and Treatment (PACT) model of care for patients with urological and head and neck cancers. METHODS AND ANALYSIS: A time series research design will be used to test the PACT model of care, newly introduced in an Australian tertiary hospital. The primary outcome is system-level impact, assessed through audit of patients' medical records and Medicare claims for follow-up care. The secondary outcomes are impact of the model on patients' experience and healthcare professionals' (HCPs) knowledge and confidence, assessed via patient and HCP surveys at baseline and at follow-up. Acceptability of the intervention will be assessed through HCP interviews at follow-up, and cost will be assessed from Medicare and Pharmaceutical Benefits Scheme claims information and information logged pertaining to intervention activities (eg, time spent by the newly appointed psycho-oncology staff in direct patient contact, providing training sessions, engaging in case review) and their associated costs (eg, salaries, training materials and videoconferencing). ETHICS AND DISSEMINATION: Ethics approval was obtained from the Human Research Ethics Committees of Hunter New England Local Health District and the University of NSW. RESULTS: The results will be widely disseminated to the funding body and through peer-reviewed publications, HCP and consumer publications, oncology conferences and meetings. TRIAL REGISTRATION: The study is re...
Goodall, S & Church, J 2014, 'Cost-Effectiveness of Colonic Stents for the Management of Malignant Large Bowel Obstruction', Value in Health, vol. 17, no. 7, pp. A630-A630.
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Objectives
The aim was to determine the cost-effectiveness of colonic stent insertion for the management of malignant bowel obstructions. Colonic stents are a minimally invasive alternative to open surgery for patients medically unfit for single stage surgery.
Methods
Two economic models were developed. The first compared patients who received palliative or definitive stents and were not medically fit for re-anastomosis. The second compared patients who received stents as a bridge-to-surgery and were medically fit for a second stage of two-stage surgery, this included colostomy or Hartmann’s procedure. ResultsFor patients requiring palliation, the cost of colonic stent insertion was estimated to be $17,809 compared to $20,516 for palliative colostomy (a saving of $2,707). The benefits associated with both procedures were 0.099 QALYs and 0.089 QALYs gained, respectively, an incremental benefit of 0.01 QALYs per patient. For patients requiring a bridge-to-surgery, the cost of colonic stent insertion was estimated to be $29,729, compared to $30,169 for patients that received multi-stage surgery (either a colostomy or a Hartmann’s procedure). This represented a cost savings of $440. The estimated average patient would gain 0.510 QALYs compared to 0.458 QALYs in the multi-stage surgery group. This yields an incremental benefit of 0.052 QALYs per patient. The main drivers of both models were the technical and clinical success of the stent insertion, and length of hospital stay following the procedures. The probability of a resection with primary anastomosis after insertion of a stent and the cost of stenting were also drivers in the bridge-to-surgery model.
Conclusions
In terms of cost-effectiveness, colonic stent insertion for malignant bowel obstruction in patients requiring palliation or a bridge-to-surgery dominated the current alternative surgical procedures.
Hall, J, Kenny, P, Hossain, I, Street, DJ & Knox, SA 2014, 'Providing Informal Care in Terminal Illness', Medical Decision Making, vol. 34, no. 6, pp. 731-745.
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Background: The trend for terminally ill patients to receive much of their end-of-life care at home necessitates the design of services to facilitate this. Care at home also requires that informal care be provided by family members and friends. This study investigated informal carers’ preferences for support services to aid the development of end-of-life health care services. Methods: This cross-sectional study used 2 discrete choice experiments to ascertain the preferences of carers supporting patients with different levels of care need, determined by the assistance needed with personal care and labeled High Care (HC) and Low Care (LC). The sample included 168 informal carers of people receiving palliative care at home from 2 palliative care services in Sydney, Australia. Data were collected in face-to-face interviews; carers chose between 2 hypothetical plans of support services and their current services. Data were analyzed with generalized multinomial logit models that were used to calculate the impact of each attribute on the probability of a carer choosing a service plan. Results: Preferred support included nursing services; the probability of choosing a plan increased significantly if it included nurse home visits and phone advice ( P < 0.001). HC carers also wanted doctor home visits, home respite, and help with personal care ( P < 0.05), and LC carers wanted help with household tasks, transport, and a case coordinator ( P < 0.001). On average, both groups of carers preferred their current services, but this varied with characteristics of the carer and the caregiving situation. Conclusions:The most valued services are those that support carers in their caregiving role; however, supportive care preferences vary with the different circumstances of patients and carers.
Hewitt, J, Refshauge, K, Clemson, L, Goodall, S & Henwood, T 2014, 'Does progressive resistance and balance exercise reduce falls in residential aged care? Randomized controlled trial protocol for the SUNBEAM program', Clinical Interventions in Aging, vol. 9, pp. 369-369.
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Introduction: Falls are common among older adults. It is reported that approximately 60% of residents of aged care facilities fall each year. This is a major cause of morbidity and mortality, and a significant burden for health care providers and the health system. Among community dwelling older adults, exercise appears to be an effective countermeasure, but data are limited and inconsistent among studies in residents of aged care communities. This trial has been designed to evaluate whether the SUNBEAM program (Strength and Balance Exercise in Aged Care) reduces falls in residents of aged care facilities. Research question: Is the program more effective and cost-effective than usual care for the prevention of falls? Design: Single-blinded, two group, cluster randomized trial. Participants and setting: 300 residents, living in 20 aged care facilities. Intervention: Progressive resistance and balance training under the guidance of a physiotherapist for 6 months, then facility-guided maintenance training for 6 months. Control: Usual care. Measurements: Number of falls, number of fallers, quality of life, mobility, balance, fear of falling, cognitive well-being, resource use, and cost-effectiveness. Measurements will be taken at baseline, 6 months, and 12 months. Analysis: The number of falls will be analyzed using a Poisson mixed model. A logistic mixed model will be used to analyze the number of residents who fall during the study period. Intention-to-treat analysis will be used. Discussion: This study addresses a significant shortcoming in aged care research, and has potential to impact upon a substantial health care problem. Outcomes will be used to inform care providers, and guide health care policies.
Hou, C, Siva, S, Haas, M & Viney, R 2014, 'COST-EFFECTIVENESS OF POST-THERAPY PET AND TELEPHONE INTERVIEW IN THE CLINICAL FOLLOW-UP OF PATIENTS TREATED WITH LOCALLY ADVANCED CERVICAL CANCER', Value in Health, vol. 17, no. 7, pp. A736-A737.
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Objectives
Our previous research indicated that post-therapy PET scanning may obviate the need for hospital-based follow-up in patients with locally advanced cervical cancer who achieved a complete metabolic response (CMR). In these patients, asymptomatic recurrences were rarely discovered through examination in the clinic. The aim of this research is to evaluate the cost-effectiveness of applying different follow-up strategies in Australia.
Methods
A decision analytical model was constructed to evaluate cost per quality-adjusted life-year (QALY) and life-years gained (LYG) by comparing two follow-up strategies: 1) Routine hospital-based follow-up and 2) Alternative follow-up involving post-therapy PET and nurse-led telephone interview. A model was built using data from a prospective institutional registry study of 105 consecutive women underwent definitive chemoradiation therapy. Based on published institutional data, it was estimated that patients who had a complete metabolic response identified by PET, would have 5-year overall-survival of 93% and 1.5% recurrence rate, while those without CMR would have a 5-year overall-survival of only 36%.The impact of uncertainty was evaluated using probabilistic sensitivity analysis.
Results
Costs for Alternative follow-up was estimated to be $25,657 compared with $19,982 for Routine follow-up. Alternative follow-up is not cost-saving; this is because the cost of PET screening and additional treatment performed on those without CMR is more than offset by the cost of intensive hospital-based visits avoided. Preliminary modeling suggest that the Alternative follow-up is likely to be cost-effective compared with Routine follow-up with an ICER of $4,094/QALYs gained, given the survival benefit associated with better targeted salvage therapy and that this result is robust to a range of survival gain estimates and other parameters.
Conclusions
Performing PET scan to evaluate patient's risk of recurrence is an appealing prosp...
Kalff, A, Kennedy, N, Smiley, A, Prince, HM, Roberts, AW, Bradstock, K, De Abreu Lourenço, R, Frampton, C & Spencer, A 2014, 'Thalidomide and prednisolone versus prednisolone alone as consolidation therapy after autologous stem-cell transplantation in patients with newly diagnosed multiple myeloma: final analysis of the ALLG MM6 multicentre, open-label, randomised phase 3 study', The Lancet Haematology, vol. 1, no. 3, pp. e112-e119.
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Background: We previously showed that consolidation therapy with thalidomide and prednisolone improved progression-free and overall survival in patients with multiple myeloma who had undergone autologous stem-cell transplantation. We aimed to assess whether these survival advantages were durable at 5 years. Methods: The ALLG MM6 trial was a multicentre, open-label, randomised phase 3 trial done between Jan 13, 2002, and March 15, 2005, at 29 sites in Australia and New Zealand. Patients with newly diagnosed multiple myeloma were randomly assigned (1:1), via computer-generated randomisation charts, to receive indefi nite prednisolone maintenance alone (control group) or in combination with 12 months of thalidomide consolidation (thalidomide group) after autologous stem-cell transplantation. Randomisation was stratifi ed by treating centre and pre-transplantation concentrations of ß2 microglobulin. Patients and treating physicians were not masked to treatment allocation. Primary endpoints were progression-free survival and overall survival. Analysis was by intention to treat. Secondary endpoints were overall response to salvage therapy, incidence of second primary malignancy incidence, and cost-eff ectiveness. This trial is registered with the Australian and New Zealand Clinical Trials Registry, number ACTRN12607000382471. Findings: We randomly assigned 269 patients to the thalidomide (n=114) or control group (n=129). After a median followup of 5·4 years (IQR 3·1-7·2), estimated 5-year progression-free survival was 27% (95% CI 23-32) in the thalidomide group and 15% (11-18) in the control group (hazard ratio [HR] 0·16, 95% CI 0·044-0·58; p=0·0054) and 5-year overall survival was 66% (95% CI 61-70) and 47% (42-51), respectively (HR 0·12, 95% CI 0·028-0·56; p=0·0072). There was no diff erence in overall response to salvage therapy, survival post-progression, or incidence of secondary malignancies between the two groups. Incremental cost-eff ectiveness ratio ...
Kenny, P, King, MT & Hall, J 2014, 'The physical functioning and mental health of informal carers: evidence of care-giving impacts from an Australian population-based cohort', Health & Social Care in the Community, vol. 22, no. 6, pp. 646-659.
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© 2014 John Wiley & Sons Ltd. Informal carers represent a substantial proportion of the population in many countries and health is an important factor in their capacity to continue care-giving. This study investigated the impact of care-giving on the mental and physical health of informal carers, taking account of contextual factors, including family and work. We examined health changes from before care-giving commenced to 2 and 4 years after, using longitudinal data from the Household Income and Labour Dynamics in Australia survey. The sample comprised 424 carers and 424 propensity score-matched non-carers. Health was self-assessed, measured with the SF-36 Health Survey Mental Health (MH) and Physical Functioning (PF) scales. Care-giving was classified as non-carer, low (<5 hours/week), moderate (5-19 hours/week) and high (20 or more hours/week). PF and MH change scores were regressed on baseline scores, care-giving, covariates (including work, family and socio-demographic characteristics) and interactions to identify impacts for subgroups. The physical and mental health impacts differed by gender, and care-giving hours and carer work hours were important contextual factors. Deterioration in both PF and MH was worse for females after 2 years and deterioration in MH was worse for males after 4 years. Among carers aged 40-64 years, there was a 17-point decline in PF (P = 0.009) and a 14-point decline in MH (P < 0.0001) after 2 years for female high caregivers working full-time and 9.3 point improvement (P = 0.02) for non-working male high caregivers. Change was not significant for non-carers. The study found that not all carers suffer adverse health impacts; however, the combination of high levels of care-giving with workforce participation can increase the risk of negative physical and mental health effects (particularly in female carers). Working carers providing high levels of care represent a vulnerable subgroup where supportive and preventive servic...
Laba, T, Hayes, A, Lo, S, Peiris, DP, Usherwood, T, Hillis, GS, Rafter, N, Reid, CM, Tonkin, AM, Webster, R, Neal, BC, Cass, A, Patel, A, Rodgers, A & Jan, S 2014, 'An economic case for a cardiovascular polypill? A cost analysis of the Kanyini GAP trial', Medical Journal of Australia, vol. 201, no. 11, pp. 671-673.
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Laba, T-L 2014, 'Using Discrete Choice Experiment to elicit patient preferences for osteoporosis drug treatments: where to from here?', Arthritis Research & Therapy, vol. 16, no. 2, pp. 106-106.
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Osteoporosis is a disease that increases skeletal fracture risk and places a significant health and economic burden on patients, families, and health systems. Many treatment options exist, but patient use is suboptimal, thus undermining the potential cost-effectiveness of treatments. In the previous issue of Arthritis Research & Therapy, Hiligsmann and colleagues expanded the findings of previous studies to report, from a sample of 257 patients with osteoporosis, the preference to trade off clinical outcomes for the amenity provided by convenient dosing regimens. This editorial critiques the strengths and limitations of the methods, discusses the potential utility of patient treatment preferences, and suggests avenues for further research. © 2014 BioMed Central Ltd.
Langton, JM, Blanch, B, Drew, AK, Haas, M, Ingham, JM & Pearson, S-A 2014, 'Retrospective studies of end-of-life resource utilization and costs in cancer care using health administrative data: A systematic review', Palliative Medicine, vol. 28, no. 10, pp. 1167-1196.
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Background: There has been an increase in observational studies using health administrative data to examine the nature, quality, and costs of care at life’s end, particularly in cancer care. Aim: To synthesize retrospective observational studies on resource utilization and/or costs at the end of life in cancer patients. We also examine the methods and outcomes of studies assessing the quality of end-of-life care. Design: A systematic review according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and AMSTAR (A Measurement Tool to Assess Systematic Reviews) methodology. Data sources: We searched MEDLINE, Embase, CINAHL, and York Centre for Research and Dissemination (1990–2011). Independent reviewers screened abstracts of 14,424 articles, and 835 full-text manuscripts were further reviewed. Inclusion criteria were English-language; at least one resource utilization or cost outcome in adult cancer decedents with solid tumors; outcomes derived from health administrative data; and an exclusive end-of-life focus. Results: We reviewed 78 studies examining end-of-life care in over 3.7 million cancer decedents; 33 were published since 2008. We observed exponential increases in service use and costs as death approached; hospital services being the main cost driver. Palliative services were relatively underutilized and associated with lower expenditures than hospital-based care. The 15 studies using quality indicators demonstrated that up to 38% of patients receive chemotherapy or life-sustaining treatments in the last month of life and up to 66% do not receive hospice/palliative services. Conclusion:...
Liu, H, Massi, L, Laba, T & Jan, S 2014, 'PM282 Understanding adherence to a cardiovascular polypill strategy- a process evaluation of a pragmatic clinical trial', Global Heart, vol. 9, no. 1, pp. e118-e118.
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Longworth, L, Yang, Y, Young, T, Mulhern, B, Hernández Alava, M, Mukuria, C, Rowen, D, Tosh, J, Tsuchiya, A, Evans, P, Devianee Keetharuth, A & Brazier, J 2014, 'Use of generic and condition-specific measures of health-related quality of life in NICE decision-making: a systematic review, statistical modelling and survey', Health Technology Assessment, vol. 18, no. 9, pp. 1-224.
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Background: The National Institute for Health and Care Excellence recommends the use of generic preference-based measures (GPBMs) of health for its Health Technology Assessments (HTAs). However, these data may not be available or appropriate for all health conditions. Objectives: To determine whether GPBMs are appropriate for some key conditions and to explore alternative methods of utility estimation when data from GPBMs are unavailable or inappropriate. Design: The project was conducted in three stages: (1) A systematic review of the psychometric properties of three commonly used GPBMs [EQ-5D, SF-6D and Health Utilities Index Mark 3 (HUI3)] in four broadly defined conditions: visual impairment, hearing impairment, cancer and skin conditions. (2) Potential modelling approaches to 'map' EQ-5D values from condition-specific and clinical measures of health [European Organisation for Research and Treatment of Cancer Quality-of-life Questionnaire Core 30 (EORTC QLQ-C30) and Functional Assessment of Cancer Therapy - General Scale (FACT-G)] are compared for predictive ability and goodness of fit using two separate data sets. (3) Three potential extensions to the EQ-5D are developed as 'bolt-on' items relating to hearing, tiredness and vision. They are valued using the time trade-off method. A second valuation study is conducted to fully value the EQ-5D with and without the vision bolt-on item in an additional sample of 300 people. Setting: The valuation surveys were conducted using face-to-face interviews in the respondents' homes. Participants: Two representative samples of the UK general population from Yorkshire (n = 600). Interventions: None. Main outcome measures: Comparisons of EQ-5D, SF-6D and HUI3 in four conditions with various generic and condition-specific measures. Mapping functions were estimated between EORTC QLQ-C30 and FACT-G with EQ-5D. Three bolt-ons to the EQ-5D were developed: EQ + hearing/vision/tiredness. A full valuation study was condu...
Mays, N, Tan, S, Eastmure, E, Erens, B, Lagarde, M & Wright, M 2014, 'Potential impact of removing general practice boundaries in England: A policy analysis', Health Policy, vol. 118, no. 3, pp. 273-278.
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Milton-Wildey, K, Kenny, P, Parmenter, G & Hall, J 2014, 'Educational preparation for clinical nursing: The satisfaction of students and new graduates from two Australian universities', NURSE EDUCATION TODAY, vol. 34, no. 4, pp. 648-654.
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BACKGROUND: Attrition rates among young and newly registered nurses are high; the capacity of nurse education programmes to prepare nurses for their professional role and the extent to which they are supported during the transition from student to registered nurse may be important factors. OBJECTIVES: This paper examines nursing student and recent graduate satisfaction with their education, focusing on their preparation for work. DESIGN: A descriptive cohort design was used, combining qualitative and quantitative methods to measure and interpret satisfaction. SETTING: Two Australian universities, one urban and one regional. PARTICIPANTS: 530 undergraduate nursing students and recent graduates from the Bachelor of Nursing programmes at the two universities. METHODS: Data were collected via an online survey. Satisfaction with the programmes was measured with closed format questions covering different aspects of the programmes and a single open ended question. Responses were compared between older and younger respondents and between graduates and students at different stages of the programme. RESULTS: Older students were more dissatisfied than younger students with the amount and type of training and their preparation for nursing work. First year students reported the highest levels of satisfaction, and third year students the lowest. The majority of graduates and third year students thought that the programme only partly prepared them for work in nursing. The free text comments particularly highlighted concerns with the amount and quality of clinical education. CONCLUSIONS: Programmes need to take account of the learning requirements of students to maximise the integration of theory and skill development in hospital environments with limited staffing and resources. The clinical environment and support received impact on the quality of learning and satisfaction of student nurses. Students who are dissatisfied with their educational and clinical experiences may choos...
Mulhern, B & Meadows, K 2014, 'The construct validity and responsiveness of the EQ-5D, SF-6D and Diabetes Health Profile-18 in type 2 diabetes', Health and Quality of Life Outcomes, vol. 12, no. 1, pp. 42-42.
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Background: Interest in the measurement of health related quality of life and psychosocial functioning from the patient's perspective in diabetes mellitus has grown in recent years. The aim of this study is to investigate the psychometric performance of and agreement between the generic EQ-5D and SF-6D and diabetes specific DHP-18 in Type 2 diabetes. This will support the future use of the measures by providing further evidence regarding their psychometric properties and the conceptual overlap between the instruments. The results will inform whether the measures can be used with confidence alongside each other to provide a more holistic profile of people with Type 2 diabetes.Methods: A large longitudinal dataset (n = 1,184) of people with Type 2 diabetes was used for the analysis. Convergent validity was tested by examining correlations between the measures. Known group validity was tested across a range of clinical and diabetes severity indicators using ANOVA and effect size statistics. Agreement was examined using Bland-Altman plots. Responsiveness was tested by examining floor and ceiling effects and standardised response means.Results: Correlations between the measures indicates that there is overlap in the constructs assessed (with correlations between 0.1 and 0.7 reported), but there is some level of divergence between the generic and condition specific instruments. Known group validity was generally good but was not consistent across all indicators included (with effect sizes from 0 to 0.74 reported). The EQ-5D and SF-6D displayed a high level of agreement, but there was some disagreement between the generic measures and the DHP-18 dimensions across the severity range. Responsiveness was higher in those who self-reported change in health (SRMs between 0.06 and 0.25).Conclusions: The psychometric assessment of the relationship between the EQ-5D, SF-6D and DHP-18 shows that all have a level of validity for use in Type 2 diabetes. This suggests that...
Mulhern, B & Shah, K 2014, 'Valuing EQ-5D-5L: Does the Ordering of the Health Dimensions Impact on Health State Valuations?', Value in Health, vol. 17, no. 7, pp. A331-A331.
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Mulhern, B, Bansback, N, Brazier, J, Buckingham, K, Cairns, J, Devlin, N, Dolan, P, Hole, AR, Kavetsos, G, Longworth, L, Rowen, D & Tsuchiya, A 2014, 'Preparatory study for the revaluation of the EQ-5D tariff: methodology report', Health Technology Assessment, vol. 18, no. 12, pp. 1-191.
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Background: EQ-5D is a widely used generic measure of health with a 'tariff', or preference weights, obtained from the general population, using time trade-off (TTO). PRET (Preparatory study for the Re-valuation of the EQ-5D Tariff project) contributes towards the methodology for its revaluation. Methods: Stage 1 examined key assumptions typically involved in health-state valuations through a series of binary choice exercises, namely that health-state preferences are independent of (1) duration of the state; (2) whose health it is (i.e. perspective); (3) length of 'lead time' (a mechanism to value all states on the same scale, including those who are worse than being dead); (4) when health events take place (time preference); and (5) satisfaction associated with the state. Further topics addressed were (6) exhaustion of lead time in the worst state; (7) health-state valuation using discrete choice experiments (DCEs) with a duration attribute; and (8) binary choice administration of lead time - time trade-off (LT-TTO). Stage 1 consisted of an online survey with 6000 respondents. Stage 2 compared the results above to those of an identical survey conducted in 200 face-to-face computer-assisted personal interviews (CAPIs), covering topics (1) to (7). Stages 3 and 4 examined - in more detail and depth - issues taken from stage 1. Stage 3 consisted of CAPI surveys of a representative UK sample of 300, using examples of TTO, LT-TTO, and DCE with duration, each followed by extensive feedback questions. Stage 4 was a more intensive exercise involving a qualitative analysis of people's thought processes during both binary choice and iterative health-state valuation exercises. Data were collected through 'think-aloud' methods in 30 interviews of a convenience sample. Results: Stage 1 found that health-state values are not independent of (1) duration of the state but there is no clear pattern; (2) whose health it is; (3) the duration of 'lead time' but there was no...
Mulhern, B, Mukuria, C, Barkham, M, Knapp, M, Byford, S, Soeteman, DR & Brazier, J 2014, 'Using generic preference-based measures in mental health: psychometric validity of the EQ-5D and SF-6D', British Journal of Psychiatry, vol. 205, no. 3, pp. 236-243.
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BackgroundGeneric preference-based measures (EuroQoL-5D (EQ-5D) and SF-6D) are used in the economic evaluation of mental health interventions. However, there are inconsistent findings regarding their psychometric properties.AimsTo investigate the psychometric properties of the EQ-5D and SF-6D in different mental health conditions, using seven existing data-sets.MethodThe construct validity and responsiveness of the measures were assessed in comparison with condition-specific indicators.ResultsEvidence for construct validity and responsiveness in common mental health and personality disorders was found (correlations 0.22–0.64; effect sizes 0.37–1.24; standardised response means 0.45–1.31). There was some evidence for validity in schizophrenia (correlations 0.05–0.43), but responsiveness was unclear.ConclusionsEQ-5D and SF-6D can be used in the economic evaluation of interventions for common mental health problems with some confidence. In schizophrenia, a preference-based measure focused on the impact of mental health should be considered.
Mulhern, B, Rowen, D, Snape, D, Jacoby, A, Marson, T, Hughes, D, Baker, G & Brazier, J 2014, 'Valuations of epilepsy-specific health states: a comparison of patients with epilepsy and the general population', Epilepsy & Behavior, vol. 36, pp. 12-17.
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Aims: Utility values that can be used in the economic evaluation of treatments for epilepsy can be elicited from the general population and the patient population, but it is unclear how the health state values differ. The aim of this study is to compare the preferences of the general population and a sample of people with epilepsy for health states described by the NEWQOL-6D QALY measure. Methods: The Time Trade Off preference elicitation technique was used to value eight NEWQOL-6D health states. The general population sample was recruited and interviewed in their homes, and the sample with epilepsy was recruited and interviewed in an epilepsy service in North West England. Descriptive analysis and regression modeling were used to compare health state values across the populations. Results: A sample of 70 people with epilepsy and a sample of 60 members of the general population were included. The populations differed across a range of background characteristics, but there were limited differences between the health state values. Patients provided significantly higher (better) values for the most severe health state described by the NEWQOL-6D (p < 0.01) and nonsignificant higher values for states with intermediate severity. The general population health state value was only higher for the best health state described by the NEWQOL-6D. Conclusions: The similarities in the patient and general population values for NEWQOL-6D health states suggest that the use of the general population utility weights for the estimation of QALYs in the economic evaluation of epilepsy interventions is appropriate and largely representative of patient preferences. © 2014 Elsevier Inc.
Norman, R & Hall, J 2014, 'Can hospital‐based doctors change their working hours? Evidence from Australia', Internal Medicine Journal, vol. 44, no. 7, pp. 658-664.
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AbstractBackground and AimsTo explore factors predicting hospital‐based doctors’ desire to work less, and then their success in making that change.MethodsConsecutive waves of an Australian longitudinal survey of doctors (Medicine in Australia – Balancing Employment and Life). There were 6285 and 6337 hospital‐based completers in the two waves, consisting of specialists, hospital‐based non‐specialists and specialist registrars.ResultsForty‐eight per cent stated a preference to reduce hours. Predictive characteristics were being female and working more than 40 h/week (both P < 0.01). An inverted U‐shape relationship was observed for age, with younger and older doctors less likely to state the preference. Factors associated with not wanting to reduce working hours were being in excellent health and being satisfied with work (both P < 0.01). Of those who wanted to reduce working hours, only 32% successfully managed to do so in the subsequent year (defined by a reduction of at least 5 h/week). Predictors of successfully reducing hours were being older, female and working more than 40 h/week (all P < 0.01).ConclusionSeveral factors predict the desire of hospital‐base...
Norman, R & Hall, JP 2014, 'The desire and capability of Australian general practitioners to change their working hours', Medical Journal of Australia, vol. 200, no. 7, pp. 399-402.
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Objective: To explore factors associated with general practitioners' desire to work less and their success in making that change. Design, participants and setting: Waves 3 and 4 (conducted in 2010 and 2011) of a national longitudinal survey of Australian doctors in clinical practice (Medicine in Australia: Balancing Employment and Life). Of the broader group of medical practitioners in the survey, there were 3664 and 3436 GP completers in Waves 3 and 4, respectively. Main outcome measures: The association between the desire to reduce hours and doctor, job and geographic characteristics; the association between predictors of the capability to reduce hours and these same doctor, job and geographic characteristics. Results: Over 40% of GPs stated a preference to reduce their working hours. Characteristics that predicted this preference were being middle-aged, being female, working ≥40 hours per week (all P< 0.01), and being on call (P=0.03). Factors associated with not wanting to reduce working hours were being in excellent health, being satisfied or very satisfied with work (both P< 0.01), and not being a partner in a practice (P< 0.01 for a number of alternative options [ie, associates, contractors and locums]). Of those who wanted to reduce working hours, 26.8% successfully managed to do so in the subsequent year (where reduction was defined as reducing hours by at least 5 per week). Predictors of successfully reducing hours were being younger, female and working ≥40 hours per week (all P<0.01). Conclusion: A number of factors appear to determine both the desire of GPs to reduce hours and their subsequent success in doing so. Declining working hours have contributed to the perceived shortage in GPs. Therefore, designing policies that address not just the absolute number of medical graduates but also their subsequent level of work may alleviate some of the pressures on the Australian primary health care system.
Norman, R, Viney, R, Brazier, J, Burgess, L, Cronin, P, King, M, Ratcliffe, J & Street, D 2014, 'Valuing SF-6D Health States Using a Discrete Choice Experiment', Medical Decision Making, vol. 34, no. 6, pp. 773-786.
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Background. SF-6D utility weights are conventionally produced using a standard gamble (SG). SG-derived weights consistently demonstrate a floor effect not observed with other elicitation techniques. Recent advances in discrete choice methods have allowed estimation of utility weights. The objective was to produce Australian utility weights for the SF-6D and to explore the application of discrete choice experiment (DCE) methods in this context. We hypothesized that weights derived using this method would reflect the largely monotonic construction of the SF-6D. Methods. We designed an online DCE and administered it to an Australia-representative online panel ( n = 1017). A range of specifications investigating nonlinear preferences with respect to additional life expectancy were estimated using a random-effects probit model. The preferred model was then used to estimate a preference index such that full health and death were valued at 1 and 0, respectively, to provide an algorithm for Australian cost-utility analyses. Results. Physical functioning, pain, mental health, and vitality were the largest drivers of utility weights. Combining levels to remove illogical orderings did not lead to a poorer model fit. Relative to international SG-derived weights, the range of utility weights was larger with 5% of health states valued below zero. Conclusions. DCEs can be used to investigate preferences for health profiles and to estimate utility weights for multi-attribute utility instruments. Australian cost-utility analyses can now use domestic SF-6D weights. The comparability of DCE results to those using other elicitation methods for estimating utility weights for quality-adjusted life-year calculations should be further investigated.
O'Gorman, H, Mulhern, B, Brazier, J & Rotherham, N 2014, 'Comparing the Equivalence of Eq-5d-5l Across Different Modes of Administration', Value in Health, vol. 17, no. 7, pp. A517-A517.
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Page, K, Barnett, AG, Campbell, M, Brain, D, Martin, E, Fulop, N & Graves, N 2014, 'Costing the Australian National Hand Hygiene Initiative', Journal of Hospital Infection, vol. 88, no. 3, pp. 141-148.
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Parkinson, B, Pearson, S-A & Viney, R 2014, 'Economic evaluations of trastuzumab in HER2-positive metastatic breast cancer: a systematic review and critique', EUROPEAN JOURNAL OF HEALTH ECONOMICS, vol. 15, no. 1, pp. 93-112.
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BACKGROUND: Published economic evaluations of trastuzumab for the treatment of HER2-positive metastatic breast cancer have arrived at different conclusions regarding the cost-effectiveness of trastuzumab, despite comparative efficacy being demonstrated by a small set of randomised controlled trials (RCTs). OBJECTIVES: This article aims to provide insight into the quality of the evaluations and explore the possible drivers of the conflicting conclusions. METHODS: A systematic literature review was conducted to identify all published economic evaluations that compared the incremental costs and outcomes of trastuzumab versus a comparator. RESULTS: Fifteen economic evaluations were identified. In the evaluations that estimated efficacy using an RCT, the key drivers of the conclusions regarding cost-effectiveness were: the approach used to estimate overall survival in the control group given crossover to trastuzumab following progression in the trials; the inclusion of treatment beyond progression; inclusion of wastage due to unused vial portions, adverse events, and the cost of HER2 testing. Four evaluations used non-randomised approaches to estimate efficacy, thus introducing the potential for confounding. As a result these evaluations reported relatively optimistic estimates of comparative effectiveness. Finally the evaluations used different thresholds to determine whether treatment with trastuzumab was cost-effective. CONCLUSION: There were numerous drivers of the different conclusions regarding the cost-effectiveness of trastuzumab, many of which are due to judgements made by the authors when translating data from RCTs. Many of the potential drivers were not identified by the published systematic reviews of economic evaluations and perhaps more remain unidentified because of inconsistent and limited reporting
Pearce, AM, van Gool, K, Haywood, P & Haas, M 2014, 'Delays in access to affordable medicines: putting policy into perspective - authors' response', AUSTRALIAN HEALTH REVIEW, vol. 38, no. 1, pp. 16-17.
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Perkins, N, Coleman, A, Wright, M, Gadsby, E, McDermott, I, Petsoulas, C & Checkland, K 2014, 'The ‘added value’ GPs bring to commissioning: a qualitative study in primary care', British Journal of General Practice, vol. 64, no. 628, pp. e728-e734.
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Prichard, RA, Kershaw, L, Goodall, S, Davidson, PM, Macdonald, P, Newton, P & Hayward, C 2014, 'Abstract 253: Bottom up Costing Ventricular Assist Device Therapy And Optimal Medical Management-first Steps To Establishing Cost Effectiveness.', Circulation: Cardiovascular Quality and Outcomes, vol. 7, no. suppl_1.
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Background:
Since Left Ventricular Assist Devices were approved in the US for destination therapy, there has been a rapid increase in their use. Information on the cost of advanced heart failure management (AHF), transplant (HTX) and VAD programs is variable across health systems, as most cost data is derived from casemix costing, charges or claims against insurers. This weakens comparative studies as eligible AHF patients are cost outliers in the broader heart failure population.
We outline a cost effectiveness study of VAD therapy vs AHF as part of an HTX program, using Time Driven Activity Based Costing of identified models of care in an Australian setting.
Methods:
All patients activated to the HTX waitlist between 07/2009 and 06/2012 (n=101) were screened and 86 included (62 AHF, 24 VAD). Models of care were defined through 13/86 file reviews, clinician interviews and analysis of activity. Detailed costing was undertaken for 5 VAD and 8 AHF patients for 12 months pre and post HTX listing or VAD implant and included medical, allied health, nursing activities, inpatient care and clinic visits (ClinV), consumables, drugs, pathology, medical imaging, and prosthetics.
Results:
Mortality at 1 yr was 12% (3/24) for VADs post implant and 11% (7/62) for AHF post HTX activation. 148 service activities were identified in 13 file reviews ranging from basic documentation to ECMO insertion. The two groups were matched for age, AHF etiology and gender.
In house database interrogation yielded a median pathology cost per patient of $4811 in 17/24 Pre VAD, and $12,294 in 20/24 Post VAD patients,.
Median allied Health cost for 19/24 Pre VAD patients was $545 and ...
Reeve, R, Church, J, Haas, M, Bradford, W & Viney, R 2014, 'Factors that drive the gap in diabetes rates between Aboriginal and non‐Aboriginal people in non‐remote NSW', Australian and New Zealand Journal of Public Health, vol. 38, no. 5, pp. 459-465.
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Objective: To identify factors underpinning the gap in diabetes rates between Aboriginal and non-Aboriginal people in non-remote NSW. This will indicate appropriate target areas for policy and for monitoring progress towards reducing the gap. Methods: Data from the 200405 National Health Survey and National Aboriginal and Torres Strait Islander Health Survey were used to estimate differences in self-reported diabetes rates and risk/prevention factors between Aboriginal and non-Aboriginal people in non-remote NSW. Logistic regression models were used to investigate the contribution of each factor to predicting the probability of diabetes. Results: Risk factors for diabetes are more prevalent and diabetes rates 2.5 to 4 times higher in Aboriginal compared to non-Aboriginal adults in non-remote NSW. The odds of (known) diabetes for both groups are significantly higher for older people, those with low levels of education and those who are overweight or obese. In the Aboriginal sample, the odds of diabetes are significantly higher for people reporting forced removal of their relatives. Conclusions: Differences in BMI and education appear to be driving the diabetes gap, together with onset at younger ages in the Aboriginal population. Psychological distress, indicated by removal of relatives, may contribute to increased risk of diabetes in the Aboriginal population. Implications: The results imply that improved nutrition and exercise, capacity to access and act upon health care information and early intervention are required to reduce the diabetes gap. Current strategies appear to be appropriately aligned with the evidence; however, further research is required to determine whether implementation methods are effective.
Swift, J, Saing, S, Rouet, R, Dudgeon, K, Schofield, P, Sewell, W & Christ, D 2014, 'Identification of aggregation inhibitors of the human antibody light chain repertoire by phage display', Protein Engineering, Design and Selection, vol. 27, no. 10, pp. 405-409.
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van den Berg, B, Fiebig, DG & Hall, J 2014, 'Well-being losses due to care-giving', JOURNAL OF HEALTH ECONOMICS, vol. 35, no. 1, pp. 123-131.
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This paper estimates the impact of informal caregiving on self-reported well-being. It uses a sample of 23,285 respondents of the first eleven waves of the Household, Income and Labour Dynamics in Australia (HILDA).We apply a relatively new analytical method that enables us to estimate fixed effects ordered logit to analyse subjective well-being. The econometric estimates show that providing informal care has a negative effect on subjective well-being.The empirical evidence of our paper could be helpful to inform policy makers to better understand the impact of caregiving and design the appropriate long term care policies and support services. © 2014.
Viney, R, Norman, R, Brazier, J, Cronin, P, King, MT, Ratcliffe, J & Street, D 2014, 'AN AUSTRALIAN DISCRETE CHOICE EXPERIMENT TO VALUE EQ-5D HEALTH STATES', HEALTH ECONOMICS, vol. 23, no. 6, pp. 729-742.
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Conventionally, generic quality-of-life health states, defined within multi-attribute utility instruments, have been valued using a Standard Gamble or a Time Trade-Off. Both are grounded in expected utility theory but impose strong assumptions about the form of the utility function. Preference elicitation tasks for both are complicated, limiting the number of health states that each respondent can value and, therefore, that can be valued overall. The usual approach has been to value a set of the possible health states and impute values for the remainder. Discrete Choice Experiments (DCEs) offer an attractive alternative, allowing investigation of more flexible specifications of the utility function and greater coverage of the response surface. We designed a DCE to obtain values for EQ-5D health states and implemented it in an Australia-representative online panel (n = 1,031). A range of specifications investigating non-linear preferences with respect to time and interactions between EQ-5D levels were estimated using a random-effects probit model. The results provide empirical support for a flexible utility function, including at least some two-factor interactions. We then constructed a preference index such that full health and death were valued at 1 and 0, respectively, to provide a DCE-based algorithm for Australian cost-utility analyses. Copyright © 2013 John Wiley & Sons, Ltd.
Wong, CKH, Mulhern, B, Wan, Y-F & Lam, CLK 2014, 'Responsiveness was similar between direct and mapped SF-6D in colorectal cancer patients who declined', Journal of Clinical Epidemiology, vol. 67, no. 2, pp. 219-227.
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Objectives To evaluate the responsiveness of generic and mapped preference-based measures based on the anchor of global change in health condition of colorectal cancer (CRC) patients. Study Design and Setting A baseline sample of 333 Chinese CRC patients was recruited between September 2009 and July 2010 and was surveyed prospectively at 6-month follow-up. Preference-based indices were derived from the generic SF-6D measure (SF-6D Direct), from the Short Form-12 (SF-6DSF-12), and mapped from the condition-specific Functional Assessment of Cancer Therapy-Colorectal (SF-6DFACT-C). Responsiveness of three measures was assessed using standardized effect size, standardized response mean, responsiveness statistic, and receiver operating characteristic (ROC) curve analysis. Results The SF-6DSF-12 and SF-6DFACT-C indices were significantly more responsive to detect positive changes than the SF-6DDirect index in improved groups. In worsened group, the SF-6DDirect and SF-6D FACT-C indices showed significant decline from baseline to 6-month follow-up. The areas under the ROC curve for SF-6DDirect and SF-6DFACT-C indices were not statistically different from 0.7. The SF-6DFACT-C index was more responsive to changes in health status compared with other indices. Conclusion Direct SF-6D measure was more responsive than mapped preference-based measures in improved group but the direction was reversed in worsened group. The use of a preference-based index mapped from a condition-specific measure captures both negative and positive important changes among CRC. © 2014 Elsevier Inc. All rights reserved.
Yu, S 2014, 'Work–life balance – work intensification and job insecurity as job stressors', Labour & Industry: a journal of the social and economic relations of work, vol. 24, no. 3, pp. 203-216.
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What does it mean to have good work–life balance? Public debate has grown around the importance of work–life balance in contributing to quality of life, yet the debate remains quite narrowly conceived. In particular, ‘work’ is conceived as negative, especially long hours, and ‘life’ is centred around (typically women’s) caring responsibilities, especially childcare. However, a number of studies have challenged these dichotomies and suggested that work–life balance is influenced by other variables. Using Australia at Work survey data on over 4000 individuals, this study considers the factors that determine satisfaction with work–life balance. An ordered probit framework is used to take advantage of a data set that is rich in variables capturing objective and subjective measures of the labour contract and workplace characteristics. The results show that while long hours and caring responsibilities do indeed affect work–life balance outcomes, the presence of job insecurity and work intensification have measurably larger effects. The implications of the analysis are that wider interpretations of work–life balance are needed, which move beyond seeing work–life balance as an issue only of relevance to women with childcaring responsibilities and focus on a broader job quality agenda.
