Addo, R, Agyemang, SA, Tozan, Y & Nonvignon, J 2018, 'Economic burden of caregiving for persons with severe mental illness in sub-Saharan Africa: A systematic review', PLOS ONE, vol. 13, no. 8, pp. e0199830-e0199830.
View/Download from: Publisher's site
View description>>
© 2018 Addo et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Background Over the past two decades, the focus of mental health care has shifted from institutionalisation to community-based programs and short hospital stays. This change means that there is an increased role for caregivers, mostly family members, in managing persons with mental illness. Although there is evidence to support the benefits of deinstitutionalisation of mental health care, there are also indications of substantial burden experienced by caregivers; the evidence of which is limited in sub-Saharan Africa. However, knowledge of the nature and extent of this burden can inform the planning of mental health services that will not only benefit patients, but also caregivers and households. Objective To systematically review the available evidence on the economic burden of severe mental illness on primary family caregivers in sub-Saharan Africa. Methods A comprehensive search was conducted in Pubmed, CINAHL, Econlit and Web of Science with no date limitations up to September 2016 using keywords such as 'burden', 'cost of illness' and 'economic burden' to identify relevant published literature. Articles were appraised using a standardised data extraction tool covering themes such as physical, psychological and socioeconomic burden. Results Seven papers were included in the review. Caregivers were mostly family members with a mean age of 46.34, female and unemployed. Five out of seven studies (71%) estimated the full economic burden of severe mental illness on caregivers. The remainder of studies just described the caregiver burden. All seven papers reported moderate to severe caregiver burden characterised by financial constraint, productivity loss and lost employment. The caregiver’s level of inco...
Addo, R, Goodall, S & Haas, JHM 2018, 'PP02 Cost Effectiveness Of Tamoxifen For Breast Cancer Treatment In Ghana', International Journal of Technology Assessment in Health Care, vol. 34, no. S1, pp. 66-66.
View/Download from: Publisher's site
View description>>
Introduction:In recent years, unlike developing countries, developed countries have seen an increase in the survival of women diagnosed with breast cancer and this has been attributed to early detection through screening and best treatments such as adjuvant systemic therapies with medications like Tamoxifen. The burden of breast cancer in Africa, including Ghana, lies among premenopausal women, with mean age of diagnosis being 46 years. However, survival among these women is low due to reasons such as inability to afford treatment including Tamoxifen, an older but cheaper and effective adjuvant therapy. This study therefore sought to assess the cost effectiveness of Tamoxifen compared to nothing for the adjuvant treatment of early breast cancer among pre- and peri-menopausal women in Ghana to inform funding decisions.Methods:A Markov model was developed using TreeAge pro to incorporate effectiveness, costs and utility data. Effectiveness of Tamoxifen, rate of events and utility weights were derived from published literature. Resource utilization and costs were estimated from Ghanaian clinical expert, national health insurance scheme tariffs and medicines. The analysis was conducted from the perspective of the payer.Results:Patients on Tamoxifen incurred additional costs compared to those who received nothing. The key driver of costs was the cost of Tamoxifen. However, these costs were offset by the QALY gained: 3.51. The incremental cost effectiveness ratio (ICER) was GHC 666.15 (USD 150) per QALY gained. In line with the effective measure commonly used in developing countries, the ICER per DALYs averted was GHC 219.96 (USD 50). The results were sensitive to variations in the utility wei...
Addo, R, Goodall, S, Hall, J & Haas, M 2018, 'Transferring Economic Data from A Developed to Developing Country Setting to Conduct HTA: The Case of Tamoxifen for the Adjuvant Treatment of Advanced Breast Cancer Among Premenopausal Women in Ghana', Value in Health, vol. 21, pp. S23-S23.
View/Download from: Publisher's site
Addo, R, Nonvignon, J & Wang, H 2018, 'VP36 Benefit Cost Analysis Of Electronic Claims Processing System In Ghana', International Journal of Technology Assessment in Health Care, vol. 34, no. S1, pp. 168-169.
View/Download from: Publisher's site
View description>>
Introduction:Since the inception of the Ghana National Health Insurance Scheme (NHIS), it has been pursuing a number of provider payment mechanisms that could not only control the continuous escalating costs of claims payout, but also facilitate the claims processing time. In lieu of this, electronic processing of claims (E-claims) was introduced in 2013 as part of the World Bank supported Health Insurance project that sought to facilitate the financial and operational management of the NHIS. It was piloted in 29 health facilities up to March 2014. They reported cost savings made by the NHIS using E-claims, creating interest in scaling it up. However, the comparative effectiveness and cost effectiveness of E-claims to the health system compared to manual claims processing is unknown. Therefore, to provide decision makers with the appropriate information to choose between manual and E-claims processing, this study sought to evaluate the cost-benefit of E-claims.Methods:A benefit-cost analysis was used to evaluate the efficiency of E-claims from the perspective of the health system. Health providers and the purchaser (NHIS claims processing center) were the study population. Resource use and costs were obtained from the study population. The volumes and values of claims reimbursed and the claims rejection rate were used as the benefits of claims processing. The incremental benefit-cost ratio (IBCR) was estimated for the provider, purchaser and the entire health system. Analysis was conducted in Microsoft Excel.Results:The total cost per claim for providers were USD 1,177.04 and USD 1,240.65 for E-claims and paper claims respectively. The total cost per E-claims and paper claims for the ...
Ager, B, Jansen, J, Porter, D, Phillips, KA, Glassey, R, Butow, P, Rankin, N, Musiello, T, Boyle, F, Zdenkowski, N, Skandarajah, A, Saunders, C, Sundaresan, P & De Abreu Lourenco, R 2018, 'Development and pilot testing of a Decision Aid (DA) for women with early-stage breast cancer considering contralateral prophylactic mastectomy', The Breast, vol. 40, pp. 156-164.
View/Download from: Publisher's site
View description>>
© 2018 Elsevier Ltd Objective: Describe the development, acceptability and feasibility of a Decision Aid (DA) for women with early-stage breast cancer (BC) at average contralateral breast cancer (CBC) risk considering contralateral prophylactic mastectomy (CPM). Methods: The DA was developed using the International Patient Decision Aid Standards (IPDAS) and the Ottawa Decision Support Framework. It provides evidence-based information about CPM in a booklet format combining text, graphs and images of surgical options. Twenty-three women with a history of early-stage breast cancer were interviewed in person or over the phone using a ‘think aloud approach’. Framework analysis was used to code and analyse data. Results: Twenty-three women participated in the study. Mean age of participants was 58.6 years and time since diagnosis ranged from 14 months to 21 years. Five women had CPM and eighteen had not. Women strongly endorsed the DA. Many felt validated by a section on appearance and found information on average risk of recurrence and metastases helpful, however, noted the importance of discussing personal risk with their surgeon. Many requested more information on surgery details (time taken, recovery) and costs of the different options. Conclusion: The DA was acceptable to women, including the format, content and proposed implementation strategies. Practical and financial issues are important to women in considering treatment options. Practice implications: Women appreciate information about CPM at diagnosis and emphasised the importance of discussing potential downsides of the procedure in addition to benefits. The DA was considered acceptable to facilitate such discussions.
Angell, B, Cullen, P, Laba, T, Lung, T, Shanahan, M, Sakashita, C, Eades, S, Ivers, R & Jan, S 2018, 'What is the value of a driver licence? A contingent valuation study of Australian adults', Transportation Research Part A: Policy and Practice, vol. 108, pp. 25-34.
View/Download from: Publisher's site
View description>>
Background Holding a driver licence is a vital part of life for many Australians, facilitating social connections and enabling access to employment, education and health services. There is a lack of evidence, however, about the value the community attaches to driver licences. This study investigates the monetary value that a sample of Australian adults place on holding a driver licence and how such valuations vary on the basis of individual characteristics. Methodology A contingent valuation study of 1054 Australian adult licence holders (with an oversampling of Indigenous Australians) was carried out to derive the sample's willingness to pay (WTP) to avoid losing their driver licence for a period of one year. Interval regression analyses were undertaken to determine the association between a range of demographic and driving-related characteristics of respondents and their WTP valuations. Results The sample was representative of the Australian population in terms of state of residence and gender. Mean WTP based on the base model was $2290 to avoid losing a driver licence for a year (95% CI $2156–$2431). Indigenous participants had a mean WTP higher than other respondents ($2789 as opposed to $2240, p <.001). Once individual characteristics were controlled for, there was no significant difference in the WTP results between Indigenous and non-Indigenous participants. WTP was significantly higher for respondents who drove multiple times a week ($396 higher WTP, p =.012) than those who did not and who required a car for work compared to those who did not ($520 p =.002). WTP increased with higher incomes and was greatest for those earning over $120,000 annually ($1352 higher than those earning under $40,000 per year, p <.001). Those living in urban areas had a significantly lower WTP compared to non-urban residents ($407 lower than other respondents, p =.012) and WTP decreased with age ($14 lower per additional year of age, p =.03). Those who had incurred a ...
Angell, B, Laba, T, Lukaszyk, C, Coombes, J, Eades, S, Keay, L, Ivers, R & Jan, S 2018, 'Participant preferences for an Aboriginal-specific fall prevention program: Measuring the value of culturally-appropriate care', PLOS ONE, vol. 13, no. 8, pp. e0203264-e0203264.
View/Download from: Publisher's site
View description>>
© 2018 Angell et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Background Culturally-specific services are central to efforts to improve the health of Aboriginal Australians. Few empirical studies have demonstrated the value of such services relative to mainstream alternatives. Objective To assess the preferences and willingness to pay (WTP) of participants for attending a class and the relative importance of transport, cost and cultural-appropriateness in the choices made by participants. Design A discrete choice experiment (DCE) was conducted alongside a study of a culturally-specific fall-prevention service. Attributes that were assessed were out-of-pocket costs, whether transport was provided and whether the class was Aboriginal-specific. Choices of participants were modelled using panel-mixed logit methods. Results 60 patients completed the DCE. Attending a service was strongly preferred over no service (selected 99% of the time). Assuming equivalent efficacy of fall-prevention programs, participants indicated a preference for services that were culturally-specific (OR 1.25 95% CI: 1.00–1.55) and incurred lower out-of-pocket participant costs (OR 1.19 95% CI 1.11–1.27). The provision of transport did not have a statistically significant influence on service choice (p = 0.57). Discussion and conclusions This represents the first published DCE in the health field examining preferences amongst an Aboriginal population. The results empirically demonstrate the value of the culturally-specific element of a program has to this cohort and the potential that stated-preference methods can have in incorporating the preferences of Aboriginal Australians and valuing cultural components of health services. Note on terminology As the majority of the NSW Aboriginal and Torr...
Bull, C, Byrnes, J & Mulhern, B 2018, 'We Respect Their Autonomy and Dignity, But How Do We Value Patient-Reported Experiences?', MDM Policy & Practice, vol. 3, no. 2, pp. 238146831880745-238146831880745.
View/Download from: Publisher's site
View description>>
Patients are in a unique position to provide insights regarding their health care management and to assess the quality of health care service delivery. Patient-reported experience measures (PREMs) capture patients’ objective health care experiences of what actually happened, as opposed to satisfaction-based measures that aim to vindicate patients’ expectations. This is in contrast to patient-reported outcome measures, which measure patients’ views of their health status.1 Indeed, it was the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Program that was initiated in the United States in 1995 that highlighted an important transition in assessing health care quality: moving away from measures of patient satisfaction to PREMs for the purposes of obtaining actionable, informed data regarding what actually happens during the provision of health care services.
In recent years, there has been a proliferation of PREMs. While different PREMs across various health care settings and conditions, all with published validation studies, have been identified,2–4 this does not include unpublished PREMs and those developed for specific institutional use.5 The explosion of PREMs is partly due to the increasing focus on patient-centered care, and their adoption as an indicator of health care system quality and performance. For example, the CAHPS program is linked with the US Centers for Medicare and Medicaid to inform hospital benchmarking and pay-for-performance/value-based performance schemes, with the core goal of supporting an objective and meaningful comparison of institutions regarding consumer-based priorities.6 The National Health Service (NHS) of England conducts a similar program called the Overall Patient Experience Scores in partnership with the Care Quality Commission whereby the experiences of NHS consumers can be compared over time.7
Given that PREMs are influential in the assessment of services, it is important to understand what they are measuring...
Butow, P, Shaw, J, Shepherd, HL, Price, M, Masya, L, Kelly, B, Rankin, NM, Girgis, A, Hack, TF, Beale, P, Viney, R, Dhillon, HM, Coll, J, Kelly, P, Lovell, M, Grimison, P, Shaw, T, Luckett, T, Cuddy, J & White, F 2018, 'Comparison of implementation strategies to influence adherence to the clinical pathway for screening, assessment and management of anxiety and depression in adult cancer patients (ADAPT CP): study protocol of a cluster randomised controlled trial', BMC Cancer, vol. 18, no. 1.
View/Download from: Publisher's site
View description>>
© 2018 The Author(s). Background: Health service change is difficult to achieve. One strategy to facilitate such change is the clinical pathway, a guide for clinicians containing a defined set of evidence-based interventions for a specific condition. However, optimal strategies for implementing clinical pathways are not well understood. Building on a strong evidence-base, the Psycho-Oncology Co-operative Research Group (PoCoG) in Australia developed an evidence and consensus-based clinical pathway for screening, assessing and managing cancer-related anxiety and depression (ADAPT CP) and web-based resources to support it - staff training, patient education, cognitive-behavioural therapy and a management system (ADAPT Portal). The ADAPT Portal manages patient screening and prompts staff to follow the recommendations of the ADAPT CP. This study compares the clinical and cost effectiveness of two implementation strategies (varying in resource intensiveness), designed to encourage adherence to the ADAPT CP over a 12-month period. Methods: This cluster randomised controlled trial will recruit 12 cancer service sites, stratified by size (large versus small), and randomised at site level to a standard (Core) versus supported (Enhanced) implementation strategy. After a 3-month period of site engagement, staff training and site tailoring of the ADAPT CP and Portal, each site will 'Go-live', implementing the ADAPT CP for 12 months. During the implementation phase, all eligible patients will be introduced to the ADAPT CP as routine care. Patient participants will be registered on the ADAPT Portal to complete screening for anxiety and depression. Staff will be responsible for responding to prompts to follow the ADAPT CP. The primary outcome will be adherence to the ADAPT CP. Secondary outcomes include staff attitudes to and experiences of following the ADAPT CP, using the ADAPT Portal and being exposed to ADAPT implementation strategies, collected using quantitative...
Carter, DJ, Street, DJ & Bush, S 2018, 'Building Public Confidence in Medical Registration Revalidation: Reform of Medical Registration Law in Australia, a New Risk-based Approach.', J Law Med, vol. 25, no. 4, pp. 1009-1032.
View description>>
This article examines the reform of the Health Practitioner National Law to introduce a form of medical registration revalidation. Revalidation is a regulatory performance management practice designed to confirm the competence of medical practitioners regularly and proactively. Its implementation will shift the law's current contribution to constraining dangerous practice from a largely reactive stance onto a more proactive footing. In aid of advancing the case for registration revalidation, we describe the recent history of the National Law, provide analysis of the proposed revalidation reforms and then apply a novel empirical method of a discrete choice experiment to determine the Australian general public's acceptance of and preferred approach to medical registration revalidation regulation. We argue that the reform represents a potentially effective and, importantly, acceptable reform to existing regulatory performance management and disciplinary systems.
Cavaye, D, Lehnbom, EC, Laba, T-L, El-Boustani, E, Joshi, R & Webster, R 2018, 'Considering pharmacy workflow in the context of Australian community pharmacy: A pilot time and motion study', Research in Social and Administrative Pharmacy, vol. 14, no. 12, pp. 1157-1162.
View/Download from: Publisher's site
View description>>
BACKGROUND: Given time pressures on primary care physicians, utilising pharmacists for chronic disease management is of great interest. However, limited data are available on the current workflow in community pharmacies to guide these discussions. OBJECTIVE: This study aimed to test the feasibility of collecting workflow data from Australian community pharmacies using the Work Observation Method By Activity Timing (WOMBAT) software and provide preliminary data on Australian pharmacy workflow. METHODS: Data were collected from three pharmacies and four variables were recorded: what the pharmacist did, with whom, where and how. All tasks were timed and data were analysed to identify total number of tasks, median time per task, proportion of time per task, and common task combinations. RESULTS: Pharmacists' main tasks consisted of counselling, dispensing and management activities (27%, 21% and 17% respectively of the overall number of tasks) and these tasks also took the majority of their time. Tasks were frequent but short, with the average time per task ranging from 0.55 to 8.46 min and most time was spent in areas without the capacity for patient interaction (51% in the dispensing/compounding area and 6% in the back office). CONCLUSIONS: Pharmacies are dynamic environments with the average task taking 1-2 min. Longer interventions may not be easily integrated into current pharmacy workflow.
Cheung, JMY, Bartlett, DJ, Armour, CL, Laba, T-L & Saini, B 2018, 'To Drug or Not to Drug: A Qualitative Study of Patients’ Decision-Making Processes for Managing Insomnia', Behavioral Sleep Medicine, vol. 16, no. 1, pp. 1-26.
View/Download from: Publisher's site
View description>>
Treatment preferences play a key role in dictating sleep health outcomes. However, patients' treatment beliefs, attitudes, and experiences that inform preference conceptualization remain an unknown phenomenon. Therefore, this study aims to explore patient perceptions toward pharmacotherapy and the nonpharmacological management of insomnia. Fifty-one patients with insomnia were recruited from specialist clinics and general community settings. Participants completed a brief questionnaire followed by an in-depth semistructured interview that was digitally recorded, transcribed verbatim, and subjected to Framework Analysis to identify emergent themes. Three key themes were identified: Resolving Insomnia, Self-Imposed Treatment Boundaries, and Treatment Uptake. Patients' illness, treatment, and psychosocial beliefs and experiences are closely linked to treatment choice. Being attuned to these influences during the clinical encounter can facilitate treatment selection that is meaningful for the patient.
Cheung, JMY, Bartlett, DJ, Armour, CL, Saini, B & Laba, T-L 2018, 'Patient Preferences for Managing Insomnia: A Discrete Choice Experiment', The Patient - Patient-Centered Outcomes Research, vol. 11, no. 5, pp. 503-514.
View/Download from: Publisher's site
View description>>
BACKGROUND: Despite the rapid development of effective treatments, both pharmacological and non-pharmacological, insomnia management remains suboptimal at the practice interface. Patient preferences play a critical role in influencing treatment outcomes. However, there is currently a mismatch between patient preferences and clinician recommendations, partly perpetuated by a limited understanding of the patients' decision-making process. OBJECTIVES: The aim of our study was to empirically quantify patient preferences for treatment attributes common to both pharmacological and non-pharmacological insomnia treatments. METHOD: An efficient dual-response discrete choice experiment was conducted to evaluate patient treatment preferences for managing insomnia. The sample included 205 patients with self-reported insomnia and an Insomnia Severity Index ≥ 14. Participants were presented with two unlabelled hypothetical scenarios with an opt-out option across 12 choice sets. Data were analyzed using a mixed multinomial logit model to investigate the influence of five attributes (i.e. time, onset of action, maintainability of improved sleep, length of treatment, and monthly cost) on treatment preferences. RESULTS: Treatments were preferentially viewed if they conferred long-term sleep benefits (p < 0.05); had an ongoing, as opposed to a predefined, duration of treatment course (p < 0.05); required some, as opposed to no, additional time commitment (p < 0.05); and had lower monthly out-of-pocket treatment costs (p < 0.001). However, treatment onset of action had no influence on preference. Age, help-seeking status, concession card status and fatigue severity significantly influenced treatment preference. CONCLUSION: Participants' prioritization of investing time in treatment and valuing the maintainability of therapeutic gains suggests a stronger inclination towards non-pharmacological treatment, defying current assumptions that patients prefer 'quick-fixes' for man...
Church, J, Goodall, S, Mulhern, B, van Gool, K & Haas, M 2018, 'Informing the Design of Weight Loss Programs Using a Discrete Choice Experiment', Value in Health, vol. 21, pp. S109-S109.
View/Download from: Publisher's site
Cole, A, Shah, K, Mulhern, B, Feng, Y & Devlin, N 2018, 'Valuing EQ-5D-5L health states ‘in context’ using a discrete choice experiment', The European Journal of Health Economics, vol. 19, no. 4, pp. 595-605.
View/Download from: Publisher's site
View description>>
© 2017, Springer-Verlag Berlin Heidelberg. Background: In health state valuation studies, health states are typically presented as a series of sentences, each describing a health dimension and severity ‘level’. Differences in the severity levels can be subtle, and confusion about which is ‘worse’ can lead to logically inconsistent valuation data. A solution could be to mimic the way patients self-report health, where the ordinal structure of levels is clear. We develop and test the feasibility of presenting EQ-5D-5L health states in the ‘context’ of the entire EQ-5D-5L descriptive system. Methods: An online two-arm discrete choice experiment was conducted in the UK (n = 993). Respondents were randomly allocated to a control (standard presentation) or ‘context’ arm. Each respondent completed 16 paired comparison tasks and feedback questions about the tasks. Differences across arms were assessed using regression analyses. Results: Presenting health states ‘in context’ can significantly reduce the selection of logically dominated health states, particularly for labels ‘severe’ and ‘extreme’ (χ2 = 46.02, p < 0.001). Preferences differ significantly between arms (likelihood ratio statistic = 42.00, p < 0.05). Comparing conditional logit modeling results, coefficients are ordered as expected for both arms, but the magnitude of decrements between levels is larger for the context arm. Conclusions: Health state presentation is a key consideration in the design of valuation studies. Presenting health states ‘in context’ affects valuation data and reduces logical inconsistencies. Our results could have implications for other valuation tasks such as time trade-off, and for the valuation of other preference-based measures.
Comans, TA, Nguyen, K-H, Mulhern, B, Corlis, M, Li, L, Welch, A, Kurrle, SE, Rowen, D, Moyle, W, Kularatna, S & Ratcliffe, J 2018, 'Developing a dementia-specific preference-based quality of life measure (AD-5D) in Australia: a valuation study protocol', BMJ Open, vol. 8, no. 1, pp. e018996-e018996.
View/Download from: Publisher's site
View description>>
IntroductionGeneric instruments for assessing health-related quality of life may lack the sensitivity to detect changes in health specific to certain conditions, such as dementia. The Quality of Life in Alzheimer’s Disease (QOL-AD) is a widely used and well-validated condition-specific instrument for assessing health-related quality of life for people living with dementia, but it does not enable the calculation of quality-adjusted life years, the basis of cost utility analysis. This study will generate a preference-based scoring algorithm for a health state classification system -the Alzheimer’s Disease Five Dimensions (AD-5D) derived from the QOL-AD.Methods and analysisDiscrete choice experiments with duration (DCETTO) and best–worst scaling health state valuation tasks will be administered to a representative sample of 2000 members of the Australian general population via an online survey and to 250 dementia dyads (250 people with dementia and their carers) via face-to-face interview. A multinomial (conditional) logistic framework will be used to analyse responses and produce the utility algorithm for the AD-5D.Ethics and disseminationThe algorithms developed will enable prospective and retrospective economic evaluation of any treatment or intervention targeting people with dementia where the QOL-AD has been administered and will be available online. Results will be disseminated through journals that publish health economics articles and through professional conferences. This study has ethical approval.
De Abreu Lourenco, R & Williams, SG 2018, 'Building an Understanding of the Value of Docetaxel Plus Hormone Therapy in Prostate Cancer: An Ever-growing Evidence Base', European Urology Oncology, vol. 1, no. 6, pp. 459-460.
View/Download from: Publisher's site
Devlin, NJ, Shah, KK, Feng, Y, Mulhern, B & van Hout, B 2018, 'Valuing health-related quality of life: An EQ-5D-5L value set for England', Health Economics, vol. 27, no. 1, pp. 7-22.
View/Download from: Publisher's site
View description>>
© 2017 The Authors. Health Economics Published by John Wiley & Sons Ltd. A new version of the EQ-5D, the EQ-5D-5L, is available. The aim of this study is to produce a value set to support use of EQ-5D-5L data in decision-making. The study design followed an international research protocol. Randomly selected members of the English general public completed 10 time trade-off and 7 discrete choice experiment tasks in face-to-face interviews. A 20-parameter hybrid model was used to combine time trade-off and discrete choice experiment data to generate values for the 3,125 EQ-5D-5L health states. Valuation data are available for 996 respondents. Face validity of the data has been demonstrated, with more severe health states generally given lower values. Problems with pain/discomfort and anxiety/depression received the greatest weight. Compared to the existing EQ-5D-3L value set, there are considerably fewer “worse than dead” states (5.1%, compared with over one third), and the minimum value is higher. Values range from −0.285 (extreme problems on all dimensions) to 0.950 (for health states 11211 and 21111). Results have important implications for users of the EQ-5D-5L both in England and internationally. Quality-adjusted life year gains from interventions seeking to improve very poor health may be smaller using this value set and may previously have been overestimated.
Disalvo, D, Luckett, T, Luscombe, G, Bennett, A, Davidson, P, Chenoweth, L, Mitchell, G, Pond, D, Phillips, J, Beattie, E, Goodall, S & Agar, M 2018, 'Potentially Inappropriate Prescribing in Australian Nursing Home Residents with Advanced Dementia: A Substudy of the IDEAL Study', Journal of Palliative Medicine, vol. 21, no. 10, pp. 1472-1479.
View/Download from: Publisher's site
View description>>
© 2018, Mary Ann Liebert, Inc. Background: Prescribing medications for nursing home residents with advanced dementia should focus on optimizing function and comfort, reducing unnecessary harms and aligning care goals with a palliative approach. Objective: The aim of the study was to estimate the proportion of Australian nursing home residents with advanced dementia receiving potentially inappropriate medications, and identify those most commonly prescribed and factors associated with their use. Design: Data were collected through retrospective audit of medication charts. Setting/Subjects: Two hundred eighteen nursing home residents with advanced dementia from 20 nursing homes participated in a cluster-randomized controlled trial of case conferencing (the IDEAL Study) from June 2013 to December 2014. Measurements: Inappropriate drug use was defined as medications classified as 'never appropriate' by the Palliative Excellence in Alzheimer Care Efforts (PEACE) program criteria. Generalized linear mixed models were used to identify variables predicting use of 'never' appropriate medications. Results: Over a quarter (n = 65, 30%) of residents received at least one medication classed as 'never' appropriate, the most common being lipid-lowering agents (n = 38, 17.4%), antiplatelet agents (n = 18, 8.3%), and acetylcholinesterase inhibitors (n = 16, 7.3%). Residents who had been at the nursing home for ≤10 months (odds ratio [OR] 5.60, 95% confidence interval [CI] 1.74-18.06) and 11-21 months (OR 5.41, 95% CI 1.67-17.75) had significantly greater odds of receiving a never appropriate medication compared with residents who had been at the nursing home for >5 years. Conclusions: Use of potentially inappropriate medications in Australian nursing home residents with advanced dementia is common. A greater understanding of the rationale that underpins prescribing of medications is required.
Feng, Y, Devlin, NJ, Shah, KK, Mulhern, B & van Hout, B 2018, 'New methods for modelling EQ-5D-5L value sets: An application to English data', Health Economics, vol. 27, no. 1, pp. 23-38.
View/Download from: Publisher's site
View description>>
© 2017 The Authors Health Economics Published by John Wiley & Sons Ltd. Value sets for the EQ-5D-5L are required to facilitate its use in estimating quality-adjusted life years. An international protocol has been developed to guide the collection of stated preference data for this purpose and has been used to generate EQ-5D-5L valuation data for England. The aim of this paper is report the innovative methods used for modelling those data to obtain a value set. Nine hundred and ninety-six members of the English general public completed time trade-off (TTO) and discrete choice experiment (DCE) tasks. We estimate models, with and without interactions, using DCE data only, TTO data only, and TTO/DCE data combined. TTO data are interpreted as both left and right censored. Heteroskedasticity and preference heterogeneity between individuals are accounted for. We use Bayesian methods in the econometric analysis. The final model is chosen based on the deviance information criterion (DIC). Censoring and taking account of heteroskedasticity have important effects on parameter estimation. For DCE data only, TTO data only, and DCE/TTO data combined, models with parameters for all dimensions and levels perform best, as judged by the DIC. Taking account of heterogeneity improves fit, and the multinomial model reports the lowest DIC. This paper presents approaches that suit observed characteristics of EQ-5D-5L valuation data and recognise respondents' preference heterogeneity. The methods described are potentially relevant to other value set studies.
Gamper, E-M, Holzner, B, King, MT, Norman, R, Viney, R, Nerich, V & Kemmler, G 2018, 'Test-Retest Reliability of Discrete Choice Experiment for Valuations of QLU-C10D Health States', Value in Health, vol. 21, no. 8, pp. 958-966.
View/Download from: Publisher's site
Gardner, T, Refshauge, K, McAuley, J, Hübscher, M, Goodall, S & Smith, L 2018, 'Goal setting practice in chronic low back pain. What is current practice and is it affected by beliefs and attitudes?', Physiotherapy Theory and Practice, vol. 34, no. 10, pp. 795-805.
View/Download from: Publisher's site
View description>>
© 2018, © 2018 Taylor & Francis. Introduction: Goal setting, led by the patient, is promising as an effective treatment for the management of chronic low back pain (CLBP); however, little is known about current practice. The aims of the study were to explore (1) current goal setting practice in CLBP among physiotherapists; (2) perceived barriers to goal setting in CLBP; and (3) relationship between clinician’s attitudes and beliefs and goal setting practice. Method: A cross-sectional observational survey. Results: The majority of respondents used goal setting with the main aim of facilitating self-management. The greatest number of goals were set with 50% therapist/50% patient involvement. The most common perceived barriers to goal setting related to time constraints and lack of skill and confidence. A higher biomedical score for treatment orientation of the therapist was associated with a lower patient involvement score. Conclusion: Goal setting is common practice for CLBP and is perceived as a high priority. It is more often a collaboration between therapist and patient rather than patient-led with treatment orientation of the physiotherapist a predictor of patient involvement. Education of healthcare professionals needs to include better understanding of chronic pain to orient them away from a biomedical treatment approach, as well as to enhance skills in facilitating patient involvement in goal setting.
Gilbert, C, Keay, L, Palagyi, A, Do, VQ, Mccluskey, P, White, A, Carnt, N, Stapleton, F & Laba, T 2018, 'Investigation of attributes which guide choice in cataract surgery services in urban Sydney, Australia', Clinical and Experimental Optometry, vol. 101, no. 3, pp. 363-371.
View/Download from: Publisher's site
View description>>
BACKGROUND: It is critical to consult patients to develop patient-centred cataract surgery care. We aimed to identify attributes patients consider when making decisions about cataract surgery in an Australian context, where both publicly and privately funded surgery are available. This is the first step in investigating how decisions are made about cataract surgery services. METHODS: This observational qualitative study was undertaken in two public hospitals and one private practice in Sydney, Australia. The study involved 19 women and men with age-related cataracts and no previous cataract surgery, aged > 18 years, able to speak conversational English or Mandarin. A multi-stage attribute development process was followed, including: literature review, semi-structured interviews with surgery candidates in three eye clinics, and review by an expert panel. The main outcome measures were primary attributes for making choices about cataract surgery. RESULTS: Wait time, cost, institutional reputation, surgeon experience and travel time were identified as principal attributes; lower value was placed on consultation length and accessibility. Non-English speaking participants indicated greater interest in pre-operative information than English speakers, but expressed trust in the Australian healthcare system. CONCLUSIONS: Findings suggest individuals prioritise attributes which consume time or incur costs when accessing care (wait time, cost and travel time). They also consider factors associated with the outcome of their cataract surgery (surgeon experience and institutional reputation). Similar to other decision-making processes, patients are likely to trade between these different attributes depending on their personal preferences and circumstances.
Gravelle, H, Liu, D, Propper, C & Santos, R 2018, 'Spatial Competition and Quality: Evidence from the English Family Doctor Market', Journal of health economics, vol. 68.
View/Download from: Publisher's site
View description>>
We examine whether family doctor firms in England respond to local competition by increasing their quality. We measure quality in terms of clinical performance and patient-reported satisfaction to capture its multi-dimensional nature. We use a panel covering 8 years for over 8000 English general practices. We measure competition as the number of rival doctors within a small distance and control for a large number of potential confounders. We find that increases in local competition are associated with increases in patient satisfaction and to a lesser extent in clinical quality. However, the magnitude of the effect is small.
Haeusler, GM, Thursky, KA, Slavin, MA, Mechinaud, F, Babl, FE, Bryant, P, De Abreu Lourenco, R & Phillips, R 2018, 'External Validation of Six Pediatric Fever and Neutropenia Clinical Decision Rules', Pediatric Infectious Disease Journal, vol. 37, no. 4, pp. 329-335.
View/Download from: Publisher's site
View description>>
Background: Fever and neutropenia (FN) clinical decision rules (CDRs) are recommended to help distinguish children with cancer at high and low risk of severe infection. The aim of this study was to validate existing pediatric FN CDRs designed to stratify children with cancer at high or low risk of serious infection or medical complication. Methods: Pediatric CDRs suitable for validation were identified from a literature search. Relevant data were extracted from an existing data set of 650 retrospective FN episodes in children with cancer. The sensitivity and specificity of each of the CDR were compared with the derivation studies to assess reproducibility. Results: Six CDRs were identified for validation: 2 were designed to predict bacteremia and 4 to predict adverse events. Five CDRs exhibited reproducibility in our cohort. A rule predicting bacteremia had the highest sensitivity (100%; 95% confidence interval (CI): 93%–100%) although poor specificity (17%), with only 15% identified as low risk. For adverse events, the highest sensitivity achieved was 84% (95% CI: 75%–90%), with specificity of 29% and 27% identified as low risk. A rule intended for application after a 24-hour period of inpatient observation yielded a sensitivity of 80% (95% CI: 73–86) and specificity of 46%, with 44% identified as low risk. Conclusions: Five CDRs were reproducible, although not all can be recommended for implementation because of either inadequate sensitivity or failure to identify a clinically meaningful number of low-risk patients. The 24-hour rule arguably exhibits the best bala...
Haywood, P, Viney, R & Haas, M 2018, 'Real-World Costs of Increasing Complexity of Cancer Care', Value in Health, vol. 21, pp. S13-S14.
View/Download from: Publisher's site
Hewitt, J, Goodall, S, Clemson, L, Henwood, T & Refshauge, K 2018, 'Progressive Resistance and Balance Training for Falls Prevention in Long-Term Residential Aged Care: A Cluster Randomized Trial of the Sunbeam Program', Journal of the American Medical Directors Association, vol. 19, no. 4, pp. 361-369.
View/Download from: Publisher's site
View description>>
© 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine Background: Falls prevention is an international priority, and residents of long-term aged care fall approximately 3 times more often than community dwellers. There is a relative scarcity of published trials in this setting. Objectives: Our objective was to undertake a randomized controlled trial to test the effect of published best practice exercise in long-term residential aged care. The trial was designed to determine if combined high level balance and moderate intensity progressive resistance training (the Sunbeam Program) is effective in reducing the rate of falls in residents of aged care facilities. Method: A cluster randomized controlled trial of 16 residential aged care facilities and 221 participants was conducted. The broad inclusion criterion was permanent residents of aged care. Exclusions were diagnosed terminal illness, no medical clearance, permanent bed- or wheelchair-bound status, advanced Parkinson's disease, or insufficient cognition to participate in group exercise. Assessments were taken at baseline, after intervention, and at 12 months. Randomization was performed by computer-generated sequence to receive either the Sunbeam program or usual care. A cluster refers to an aged care facility. Intervention: The program consisted of individually prescribed progressive resistance training plus balance exercise performed in a group setting for 50 hours over a 25-week period, followed by a maintenance period for 6 months. Outcome Measures: The primary outcome measure was the rate of falls (number of falls and days followed up). Secondary outcomes included physical performance (Short Physical Performance Battery), quality of life (36-item Short-Form Health Survey), functional mobility (University of Alabama Life Space Assessment), fear of falling (Falls Efficacy Scale International), and cognition (Addenbrooke's Cognitive Evaluation–revised). Results: The rate of falls was...
Heyeres, M, Kinchin, I, Whatley, E, Brophy, L, Jago, J, Wintzloff, T, Morton, S, Mosby, V, Gopalkrishnan, N & Tsey, K 2018, 'Evaluation of a Residential Mental Health Recovery Service in North Queensland', Frontiers in Public Health, vol. 6, pp. 123-123.
View/Download from: Publisher's site
View description>>
Evidence shows that subacute mental health recovery occurs best when a person remains active within the community and fulfils meaningful and satisfying roles of their choosing. Several residential care services that incorporate these values have been established in Australia and overseas.This study describes (a) the development of an evaluation framework for a new subacute residential mental health recovery service in regional Australia and (b) reports on the formative evaluation outcomes.Continuous quality improvement and participatory research approaches informed all stages of the development of the evaluation framework. A program logic was established and subsequently tested for practicability. The resultant logic utilizes the Scottish Recovery Indicator 2 (SRI 2) service development tool, Individual Recovery Plans (IRPs), and the impact assessment of the service on psychiatric inpatient admissions (reported separately).Service strengths included a recovery-focused practice that identifies and addresses the basic needs of residents (consumers). The consumers of the service were encouraged to develop their own goals and self-manage their recovery plans. The staff of the service were identified as working effectively in the context of the recovery process; the staff were seen as supported and valued. Areas for improvement included more opportunities for self-management for residents and more feedback from residents and carers.
Hofman, MS, Murphy, DG, Williams, SG, Nzenza, T, Herschtal, A, Lourenco, RDA, Bailey, DL, Budd, R, Hicks, RJ, Francis, RJ & Lawrentschuk, N 2018, 'A prospective randomized multicentre study of the impact of gallium‐68 prostate‐specific membrane antigen (PSMA) PET/CT imaging for staging high‐risk prostate cancer prior to curative‐intent surgery or radiotherapy (proPSMA study): clinical trial protocol', BJU International, vol. 122, no. 5, pp. 783-793.
View/Download from: Publisher's site
View description>>
BackgroundAccurate staging of patients with prostate cancer (PCa) is important for therapeutic decision‐making. Relapse after surgery or radiotherapy of curative intent is not uncommon and, in part, represents a failure of staging with current diagnostic imaging techniques to detect disease spread. Prostate‐specific membrane antigen (PSMA) positron‐emission tomography (PET)/computed tomography (CT) is a new whole‐body scanning technique that enables visualization of PCa with high contrast. The hypotheses of this study are that: (i) PSMA‐PET/CT has improved diagnostic performance compared with conventional imaging; (ii) PSMA‐PET/CT should be used as a first‐line diagnostic test for staging; (iii) the improved diagnostic performance of PSMA‐PET/CT will result in significant management impact; and (iv) there are economic benefits if PSMA‐PET/CT is incorporated into the management ...
Hossain, LN, Tudball, J, Franco-Trigo, L, Durks, D, Benrimoj, SI & Sabater-Hernández, D 2018, 'A multilevel stakeholder approach for identifying the determinants of implementation of government-funded community pharmacy services at the primary care level', Research in Social and Administrative Pharmacy, vol. 14, no. 8, pp. 765-775.
View/Download from: Publisher's site
View description>>
A key early step to enhance the integration of community pharmacy services (CPSs) into primary care practice is identifying key determinants of practice (i.e., critical circumstances that influence the implementation of such services). Involving relevant stakeholders in identifying key determinants enables findings to be more relevant to the context in which CPSs will be implemented.To identify key determinants of practice that can influence the implementation of government-funded CPSs in a primary health network in Australia.A stakeholder collaborative approach was used, encompassing two phases. In the first phase, semi-structured interviews were conducted with ground-level stakeholders in Western Sydney between August 2016 to October 2016. Framework analysis was used to code and analyse the data from the interviews into determinants of pharmacy practice. In the second phase, a workshop was conducted with a mixed-group of ground-level and system-level stakeholders from the primary health network to identify key determinants. A four-quadrant prioritization matrix was employed in the workshop to classify determinants based on their importance and feasibility.Sixty-five determinants of practice that can influence CPS implementation were identified in Phase 1. These determinants were allocated at different levels of the healthcare system, and can exist as a barrier or facilitator or both. Twenty-two key determinants were selected in Phase 2, of which three were agreed to be addressed initially: (1) Patient understanding of the aims of the service; (2) Commitment of the organization and its leaders to provide services; (3) Coordination of the healthcare system to prompt collaboration between pharmacists and GPs.This collaborative stakeholder approach identified a set of key determinants of pharmacy practice in this Australian primary care setting. To enhance the implementation of CPSs in this region, initial efforts should be aimed at developing implementation strate...
Jacups, S, Rogerson, B & Kinchin, I 2018, 'An innovative approach to address homelessness in regional Australia: Participant evaluation of a co-payment model', Public Health, vol. 156, pp. 26-33.
View/Download from: Publisher's site
View description>>
Homelessness is not only about lack of secure housing, it is sometimes caused by simple reasons such as lack of money to travel home. The purpose of this study was to investigate whether the participant co-funded assistance program ('Return to Country' [R2C]), when offered to low socio-economic individuals experiencing homelessness, represented an effective use of scarce resources.In northern Australia, a remote and sparsely populated area, Indigenous persons who travel to regional centres cannot always afford airfares home; they therefore become stranded away from their 'country' leading to rapidly deteriorating health, isolation and separation from family and kin. The R2C program was designed to facilitate travel for persons who were temporarily stranded and were voluntarily seeking to return home. The program provided operational support and funding (participants co-funded AU$99) to participants to return home.Using a descriptive, case series research design, university researchers independently evaluated the R2C program using semi-structured interviews with 37 participants.An investment of AU$970 per participant in the program with partial co-payment was associated with high participant acceptability and satisfaction in-line with harms reduction around substance and criminal abuse, which is suggestive of long-term success for the model.Findings from this study can contribute to the development of best practice guidelines and policies that specifically address the needs of this unique population of stranded persons, who are seeking to return home. The acceptance of the co-payment model can be adopted by policy makers involved in homelessness prevention in other locations in Australia or internationally as an add-on service provision to mainstream housing support.
Jacups, SP, Kinchin, I & McConnon, KM 2018, 'Ear, nose, and throat surgical access for remote living Indigenous children: What is the least costly model?', Journal of Evaluation in Clinical Practice, vol. 24, no. 6, pp. 1330-1338.
View/Download from: Publisher's site
View description>>
AbstractRationale, aims, and objectivesThis costing evaluation compares three service delivery models for ear, nose, and throat (ENT) surgery for remote living Indigenous children to improve their hearing outcomes, with the aim to identify the least costly model.MethodsThe main outcome measure presented was the incremental cost difference between the base case (Model 1) and two alternative models (Model 2, 3). The costs in 2017 Australian dollars are assessed from two viewpoints: (1) health system perspective, and (2) patients and their families including travel out‐of‐pocket expenses, presented separately according to the funding source.ResultsFindings indicate that the least costly model offered low‐risk ENT surgery from a state funded hospital in a remote setting, with high use of videoconference technology: TeleHealth (Model 3) could save $3626 to $5067 per patient, compared with patients travelling to a regional centre public hospital (Model 1). A federally funded scheme which allowed groups of patients to access a direct flight charter transfer to the private hospital in regional centre (Model 2) reduced the cost by $2178 to $2711 per patient when compared with standard care (Model 1). From a societal perspective, Model 1 required out‐of‐pocket patient expenses, with greater time away from home, and hence appears the least preferred option.ConclusionsThe sensitivity analyses also demonstrate that Model 3 would be the more economical model for providing ENT surgery for remote living children. By proving an accurate assessment of the true costs of delivering these important ear and hearing health services, strategic health service planners may be better informed and sufficient budgets can be alloc...
Jan, S, Laba, T-L, Essue, BM, Gheorghe, A, Muhunthan, J, Engelgau, M, Mahal, A, Griffiths, U, McIntyre, D, Meng, Q, Nugent, R & Atun, R 2018, 'Action to address the household economic burden of non-communicable diseases', The Lancet, vol. 391, no. 10134, pp. 2047-2058.
View/Download from: Publisher's site
View description>>
The economic burden on households of non-communicable diseases (NCDs), including cardiovascular diseases, cancer, respiratory diseases, and diabetes, poses major challenges to global poverty alleviation efforts. For patients with NCDs, being uninsured is associated with 2-7-fold higher odds of catastrophic levels of out-of-pocket costs; however, the protection offered by health insurance is often incomplete. To enable coverage of the predictable and long-term costs of treatment, national programmes to extend financial protection should be based on schemes that entail compulsory enrolment or be financed through taxation. Priority should be given to eliminating financial barriers to the uptake of and adherence to interventions that are cost-effective and are designed to help the poor. In concert with programmes to strengthen national health systems and governance arrangements, comprehensive financial protection against the growing burden of NCDs is crucial in meeting the UN's Sustainable Development Goals.
Janda, M, Armfield, NR, Kerr, G, Kurz, S, Jackson, G, Currie, J, Page, K, Weaver, E, Yazdani, A & Obermair, A 2018, 'Surgical approach to hysterectomy and barriers to using minimally invasive methods', Australian and New Zealand Journal of Obstetrics and Gynaecology, vol. 58, no. 6, pp. 690-695.
View/Download from: Publisher's site
View description>>
Minimally invasive approaches to hysterectomy have been shown to be safe, effective and have recovery advantages over open hysterectomy, yet in Australia 36% of hysterectomies are still conducted by open surgery. In 2006, a survey of Australian gynaecological specialists found the main impediment to increasing laparoscopic hysterectomy to be a lack of surgical skills training opportunities. We resurveyed specialists to explore contemporary factors influencing surgeons’ approaches to hysterectomy; 258 (estimated ~19%) provided analysable responses. Despite >50% of surveyed specialists wishing to practise laparoscopic hysterectomy in the future, lack of surgical skills, arising from the lack of training opportunities, remains the main impediment.
Janda, M, Armfield, NR, Page, K, Kerr, G, Kurz, S, Jackson, G, Currie, J, Weaver, E, Yazdani, A & Obermair, A 2018, 'Factors influencing women’s decision making in hysterectomy', Patient Education and Counseling, vol. 101, no. 3, pp. 504-510.
View/Download from: Publisher's site
Jehu, LM, Visram, S, Marks, L, Hunter, DJ, Davis, H, Mason, A, Liu, D & Smithson, J 2018, 'Directors of public health as ‘a protected species’: qualitative study of the changing role of public health professionals in England following the 2013 reforms', Journal of Public Health, vol. 40, no. 3, pp. e203-e210.
View/Download from: Publisher's site
Kasparian, NA, De Abreu Lourenco, R, Winlaw, DS, Sholler, GF, Viney, R & Kirk, EPE 2018, 'Tell me once, tell me soon: parents’ preferences for clinical genetics services for congenital heart disease', Genetics in Medicine, vol. 20, no. 11, pp. 1387-1395.
View/Download from: Publisher's site
View description>>
© 2018, American College of Medical Genetics and Genomics. Purpose: As the molecular basis of congenital heart disease (CHD) comes into sharper focus, cardiac genetics services are likely to play an increasingly important role. This study aimed to identify parents’ preferences for, and willingness to participate in, clinical genetics services for CHD. Methods: A discrete choice experiment was developed to assess parents’ preferences for pediatric cardiogenetics services based on four attributes: appointment format, health professionals involved, waiting time, and information format. Data were analyzed using a mixed logit model. Results: One hundred parents with a living child diagnosed with CHD requiring surgical intervention between 2000 and 2009 completed the discrete choice experiment. Parents expressed a clear preference for cardiac genetics services featuring (i) a single appointment, (ii) the presence of a clinical geneticist and a genetic counselor, (iii) both verbal (oral) and Web-based information about CHD and genetics, and (iv) availability of an appointment within 2 weeks. If offered such conditions, 93% of respondents indicated that they would attend. The choice of service was most strongly influenced by the presence of both a clinical geneticist and a genetic counselor. Conclusion: Parents of children with CHD favor a single, timely genetics appointment with both a geneticist and a genetic counselor present. If appointments offered match these preferences, uptake is likely to be high.
Kinchin, I & Doran, C 2018, 'The Cost of Youth Suicide in Australia', International Journal of Environmental Research and Public Health, vol. 15, no. 4, pp. 672-672.
View/Download from: Publisher's site
View description>>
© 2018 by the authors. Licensee MDPI, Basel, Switzerland. Suicide is the leading cause of death among Australians between 15 and 24 years of age. This study seeks to estimate the economic cost of youth suicide (15-24 years old) for Australia using 2014 as a reference year. The main outcome measure is monetized burden of youth suicide. Costs, in 2014 AU$, are measured and valued as direct costs, such as coronial inquiry, police, ambulance, and funeral expenses; indirect costs, such as lost economic productivity; and intangible costs, such as bereavement. In 2014, 307 young Australians lost their lives to suicide (82 females and 225 males). The average age at time of death was 20.4 years, representing an average loss of 62 years of life and close to 46 years of productive capacity. The average cost per youth suicide is valued at $2,884,426, including $9721 in direct costs, $2,788,245 as the value of lost productivity, and $86,460 as the cost of bereavement. The total economic loss of youth suicide in Australia is estimated at $22 billion a year (equivalent to US$ 17 billion), ranging from $20 to $25 billion. These findings can assist decision-makers understand the magnitude of adverse outcomes associated with youth suicide and the potential benefits to be achieved by investing in effective suicide prevention strategies.
Kinchin, I, Jacups, S, Mann, J, Quigley, R, Harvey, D, Doran, CM & Strivens, E 2018, 'Efficacy and cost-effectiveness of a community-based model of care for older patients with complex needs: a study protocol for a multicentre randomised controlled trial using a stepped wedge cluster design', Trials, vol. 19, no. 1, pp. 668-668.
View/Download from: Publisher's site
View description>>
BACKGROUND:Community-dwelling older persons with complex care needs may deteriorate rapidly and require hospitalisation if they receive inadequate support for their conditions in the community. INTERVENTION:A comprehensive, multidimensional geriatric assessment with care coordination was performed in a community setting-Older Persons ENablement And Rehabilitation for Complex Health conditions (OPEN ARCH). OBJECTIVES:This study will assess the acceptability and determine the impact of the OPEN ARCH intervention on the health and quality of life outcomes, health and social services utilisation of older people with multiple chronic conditions and emerging complex care needs. An economic evaluation will determine whether OPEN ARCH is cost-effective when compared to the standard care. METHODS/DESIGN:This multicentre randomised controlled trial uses a stepped wedge cluster design with repeated cross-sectional samples. General practitioners (GPs; n ≥ 10) will be randomised as 'clusters' at baseline using simple randomisation. Each GP cluster will recruit 10-12 participants. Data will be collected on each participant at 3-month intervals (- 3, 0, 3, 6 and 9 months). The primary outcome is health and social service utilisation as measured by Emergency Department presentations, hospital admissions, in-patient bed days, allied health and community support services. Secondary outcomes include functional status, quality of life and participants' satisfaction. Cost-effectiveness of the intervention will be assessed as the change to cost outcomes, including the cost of implementing the intervention and subsequent use of services, and the change to health benefits represented by quality adjusted life years. DISCUSSION:The results will have direct implications for the design and wider implementation of this new model of care for community-dwelling older persons with complex care needs. Additionally, it will contribute to the evidence base on acceptability, efficacy and cost-effec...
King, MT, Norman, R, Kemmler, G, McTaggart-Cowan, H, Rowen, D, Pickard, AS & Viney, R 2018, 'Cross-Country Comparison Of Cancer-Specific Multi-Attribute Utility Instruments (Mauis): Relative Weighting And Ranking Of Health-Related Quality Of Life (Hrql) Domains In Country-Specific Utility Algorithms', Value in Health, vol. 21, pp. S2-S3.
View/Download from: Publisher's site
King, MT, Viney, R, Simon Pickard, A, Rowen, D, Aaronson, NK, Brazier, JE, Cella, D, Costa, DSJ, Fayers, PM, Kemmler, G, McTaggart-Cowen, H, Mercieca-Bebber, R, Peacock, S, Street, DJ, Young, TA & Norman, R 2018, 'Australian Utility Weights for the EORTC QLU-C10D, a Multi-Attribute Utility Instrument Derived from the Cancer-Specific Quality of Life Questionnaire, EORTC QLQ-C30', PharmacoEconomics, vol. 36, no. 2, pp. 225-238.
View/Download from: Publisher's site
View description>>
© 2017, The Author(s). Background: The EORTC QLU-C10D is a new multi-attribute utility instrument derived from the widely used cancer-specific quality-of-life (QOL) questionnaire, EORTC QLQ-C30. The QLU-C10D contains ten dimensions (Physical, Role, Social and Emotional Functioning; Pain, Fatigue, Sleep, Appetite, Nausea, Bowel Problems), each with four levels. To be used in cost-utility analysis, country-specific valuation sets are required. Objective: The aim of this study was to provide Australian utility weights for the QLU-C10D. Methods: An Australian online panel was quota-sampled to ensure population representativeness by sex and age (≥ 18 years). Participants completed a discrete choice experiment (DCE) consisting of 16 choice-pairs. Each pair comprised two QLU-C10D health states plus life expectancy. Data were analysed using conditional logistic regression, parameterised to fit the quality-adjusted life-year framework. Utility weights were calculated as the ratio of each QOL dimension-level coefficient to the coefficient on life expectancy. Results: A total of 1979 panel members opted in, 1904 (96%) completed at least one choice-pair, and 1846 (93%) completed all 16 choice-pairs. Dimension weights were generally monotonic: poorer levels within each dimension were generally associated with greater utility decrements. The dimensions that impacted most on choice were, in order, Physical Functioning, Pain, Role Functioning and Emotional Functioning. Oncology-relevant dimensions with moderate impact were Nausea and Bowel Problems. Fatigue, Trouble Sleeping and Appetite had relatively small impact. The value of the worst health state was -0.096, somewhat worse than death. Conclusions: This study provides the first country-specific value set for the QLU-C10D, which can facilitate cost-utility analyses when applied to data collected with the EORTC QLQ-C30, prospectively and retrospectively.
Kreimeier, S, Oppe, M, Ramos-Goñi, JM, Cole, A, Devlin, N, Herdman, M, Mulhern, B, Shah, KK, Stolk, E, Rivero-Arias, O & Greiner, W 2018, 'Valuation of EuroQol Five-Dimensional Questionnaire, Youth Version (EQ-5D-Y) and EuroQol Five-Dimensional Questionnaire, Three-Level Version (EQ-5D-3L) Health States: The Impact of Wording and Perspective', Value in Health, vol. 21, no. 11, pp. 1291-1298.
View/Download from: Publisher's site
Laba, T-L, Lung, T, Jan, S, Scaria, A, Usherwood, T, Brien, J-A, Plant, NA & Leeder, S 2018, 'Medication non-adherence in a cohort of chronically ill Australians: A case of missed opportunities', Australian Journal of General Practice, vol. 47, no. 8, pp. 556-562.
View/Download from: Publisher's site
View description>>
BACKGROUND AND OBJECTIVES: This study investigated the effect of management - including home medicines reviews and chronic disease management plans funded through the Medicare Benefits Schedule - on self-reported medication non-adherence. METHOD: An observational cohort study including 244 individuals with an exacerbation of chronic illness enrolled into the Care Navigation randomised controlled trial of integrated care. Non-adherence was measured using the Morisky-Greene-Levine self-reported adherence tool. RESULTS: The cohort comprised an equal number of older men and women with, on average, three chronic diseases, receiving between five and 10 unique medications each month and visiting a general practitioner (GP) more than 50 times in the year prior to completing the questionnaire. Forty per cent reported non-adherence, which was greater in males (relative risk [RR]: 1.73; 95% confidence interval [CI]: 1.25, 2.54) and in patients reporting a recent fall (RR 1.40; 95% CI: 1.02, 1.89). GP-initiated chronic disease management programs did not influence adherence. DISCUSSION: Despite almost weekly contact with GPs, two in five patients were non-adherent. Better methods of encouraging adherence are needed.
Lasen, M, Evans, S, Tsey, K, Campbell, C & Kinchin, I 2018, 'Quality of WIL assessment design in higher education: a systematic literature review', Higher Education Research & Development, vol. 37, no. 4, pp. 788-804.
View/Download from: Publisher's site
View description>>
© 2018 HERDSA. We investigated the quality of work-integrated learning (WIL) assessment design in higher education programmes, through review of peer-reviewed studies published internationally and in English, 1990–2015. Such a review is timely in light of vested interests from a range of WIL stakeholders; high-level endorsement of WIL across university programmes; a regulatory environment requiring development and assurance of higher-order learning outcomes; and a WIL assessment literature that identifies a number of challenges and opportunities. We searched six electronic databases, yielding 20 intervention studies that met inclusion criteria. Findings reveal high-quality assessment design, albeit a need for greater involvement of industry/professional partners in assessment practices and stronger alignment between reflective assessment tasks and students' WIL experiences. The evidence base under review largely comprised qualitative and mixed methods studies, with the indication that the quality of the study design had improved over time, although variably across disciplinary fields. The key recommendation from this review is that resources are needed to support research-active WIL academics, partners and students to: (a) design and participate in assessment practices, which promote integration of student learning, across university and work settings, and achievement of higher-order learning outcomes and (b) pursue a collaborative research agenda involving robust evaluation research, inclusive of quantitative studies.
Longden, T, Hall, J & van Gool, K 2018, 'Supplier‐induced demand for urgent after‐hours primary care services', Health Economics, vol. 27, no. 10, pp. 1594-1608.
View/Download from: Publisher's site
View description>>
AbstractAustralia is one of nine Organisation for Economic Co‐operation and Development (OECD) countries that utilise deputising services to provide after‐hours primary care. While the provision of this service is supposed to be on behalf of regular general practitioners, businesses have adapted to the financial incentives on offer and are directly advertising their services to consumers emphasising patient convenience and no copayments. The introduction of corporate entities has changed the way that deputising services operate. We use a difference‐in‐difference approach to estimate the amount of growth in urgent after‐hours services that was not warranted by urgent medical need. These estimates are calculated by comparing the growth in urgent attendances that occurred during times of the day that are classified as “after‐hours” (e.g., 6 pm–11 pm Monday to Friday) with those that are classified as “unsociable‐hours” (e.g., 11 pm–7 am Monday to Friday). For the national level, we estimate that 593,141 unwarranted attendances were induced as urgent after‐hours consultations in a single year. This corresponds to a national estimate of the total benefits paid for unwarranted demand of approximately $77 million. While deputising services have filled a short‐fall in after‐hours services, the overuse of urgent items has meant that that this has been achieved at a considerable cost to the Australian Government.
Longden, T, Wong, CY, Haywood, P, Hall, J & van Gool, K 2018, 'The prevalence of persistence and related health status: An analysis of persistently high healthcare costs in the short term and medium term', Social Science & Medicine, vol. 211, pp. 147-156.
View/Download from: Publisher's site
View description>>
© 2018 Elsevier Ltd Understanding whether high healthcare costs for individuals persist over time is critical for the development of policies that aim to reduce the prevalence of high cost patients. And while high healthcare costs will occur in any given year based on the prevalence of certain morbidities and acute conditions, a large random component of the distribution means that it is rarely the same people driving the bulk of healthcare expenditures. Using administrative data for over 250,000 Australian residents for the years between 2006 and 2011, we analyse the persistence of high annual healthcare costs. We examine the prevalence of high cost persistence in this sample, and then, we use endogenous switching models to identify the morbidity groups that are related with high cost persistence. These models also measure cases of cost amplification that are associated with a history of high cost healthcare. This analysis uses data from multiple categories of healthcare, specifically medical services, pharmaceuticals and admitted patient care. While there is a relatively low number of patients with persistent high cost (approximately 3% of the sample), this group accounted for 19% of aggregate expenditure. Pharmaceuticals were the most persistently high cost category of healthcare with 5% of the sample accounting for 32% of aggregate pharmaceutical expenditure. The morbidities associated with notable cost amplifications are morbidities that are hard to prevent or involve escalations of adverse health states that are difficult to avert. This casts doubt on whether broad policies can reduce the prevalence of individuals with persistently high healthcare costs.
Lum, EPM, Page, K, Whitty, JA, Doust, J & Graves, N 2018, 'Antibiotic prescribing in primary healthcare: Dominant factors and trade-offs in decision-making', Infection, Disease & Health, vol. 23, no. 2, pp. 74-86.
View/Download from: Publisher's site
View description>>
Background: This study aims to establish dominant factors influencing general practitioner (GP) decision-making on antibiotic prescribing in the Australian primary healthcare sector. Two research questions were posed: What influences antibiotic prescribing from the perspective of GPs? How do GPs trade-off on factors influencing antibiotic prescribing? Methods: An exploratory sequential mixed methods design was used, comprising semi-structured interviews followed by a discrete choice experiment (DCE). Ten GPs practising in Brisbane and Greater Brisbane, Queensland were interviewed in September/October 2015. Interview data were used to develop the DCE, which was conducted online from July–October 2016. Twenty-three GPs participated in the DCE. Results: Three main themes influencing antibiotic prescribing emerged from the semi-structured interviews: prescribing challenges, delayed antibiotic prescriptions, and patient expectations. From the DCE, “Duration of symptoms” and “Patient expectations” exerted the most influence on antibiotic prescribing. Taken together, these results suggest that key challenges to prudent antibiotic prescribing are: patient expectations, an important barrier which is surmountable; prescribing practices of medical colleagues, cultural memes and professional etiquette; and uncertainty of diagnosis coupled with patient expectations for antibiotics exert prescribing pressure on GPs. Conclusion: Patient expectation for antibiotics is the dominant modifiable factor influencing GP antibiotic prescribing behaviours. Key challenges to prudent antibiotic prescribing can be overcome through upskilling GPs to manage patient expectations efficaciously, and through two new emphases for public health campaigns—consumers have the power to reduce the use of antibiotics and the GP as a wise advocate for the patient.
Manipis, K, Mulhern, B, Pearce, A, Haywood, P, Viney, R & Goodall, S 2018, 'Estimating the Willingness to Pay to Avoid the Impacts of Foodborne Illnesses: A Discrete Choice Experiment', Value in Health, vol. 21, pp. S92-S93.
View/Download from: Publisher's site
Mason, A, Liu, D, Kasteridis, P, Goddard, M, Jacobs, R, Wittenberg, R & McGonigal, G 2018, 'Investigating the impact of primary care payments on underdiagnosis in dementia: A difference‐in‐differences analysis', International Journal of Geriatric Psychiatry, vol. 33, no. 8, pp. 1090-1097.
View/Download from: Publisher's site
View description>>
ObjectiveIn England, two primary care incentive schemes were introduced to increase dementia diagnosis rates to two‐thirds of expected levels. This study assesses the effectiveness of these schemes.MethodsWe used a difference‐in‐differences framework to analyse the individual and collective impacts of the incentive schemes: (1) Directed Enhanced Service 18 (DES18: facilitating timely diagnosis of and support for dementia) and (2) the Dementia Identification Scheme (DIS). The dataset included 7529 English general practices, of which 7142 were active throughout the 10‐year study period (April 2006 to March 2016). We controlled for a range of factors, including a contemporaneous hospital incentive scheme for dementia. Our dependent variable was the percentage of expected cases that was recorded on practice dementia registers (the “rate”).ResultsFrom March 2013 to March 2016, the mean rate rose from 51.8% to 68.6%. Both DES18 and DIS had positive and significant effects. In practices participating in the DES18 scheme, the rate increased by 1.44 percentage points more than the rate for non‐participants; DIS had a larger effect, with an increase of 3.59 percentage points. These combined effects increased dementia registers nationally by an estimated 40 767 individuals. Had all practices fully participated in both schemes, the corresponding number would have been 48 685.ConclusionThe primary care incentive schemes appear to have been effective in closing the gap between recorded and expected prevalence of dementia, but the hospital scheme had no additional discernible effect. This study contributes additional evidence that financial incentives can motivate improved performance in primary care.
Mason, A, Liu, D, Marks, L, Davis, H, Hunter, D, Jehu, LM, Visram, S & Smithson, J 2018, 'Local authority commissioning of NHS Health Checks: A regression analysis of the first three years', Health Policy, vol. 122, no. 9, pp. 1035-1042.
View/Download from: Publisher's site
Morgan, A, Joshy, G, Schaffer, A, Laba, T-L, Litchfield, M, Pearson, S & Banks, E 2018, 'Rapid and substantial increases in anticoagulant use and expenditure in Australia following the introduction of new types of oral anticoagulants', PLOS ONE, vol. 13, no. 12, pp. e0208824-e0208824.
View/Download from: Publisher's site
View description>>
© 2018 Morgan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Objectives To quantify changes in anticoagulant use in Australia since the introduction of Non-vitamin K antagonist anticoagulants (NOACs) and to estimate government expenditure. Design Interrupted-time-series analysis quantifying anticoagulant dispensing, before and after first Pharmaceutical Benefits Scheme (PBS) NOAC listing in August 2009 for venous thromboembolism prevention; and expanded listing for stroke prevention in non-valvular atrial fibrillation (AF) in August 2013, up to June 2016. Estimated government expenditure on PBS-listed anticoagulants. Setting and participants PBS dispensing in 10% random sample of Australians, restricted to continuous concessional beneficiaries dispensed oral anticoagulants from July 2005 to June 2016. Total PBS anticoagulant expenditure was calculated using Medicare Australia statistics. Main outcome measures Monthly dispensing and initiation of oral anticoagulants (warfarin, rivaroxaban, dabigatran or apixaban). Annual PBS anticoagulant expenditure. Results An estimated 149,180 concessional beneficiaries were dispensed anticoagulants (100% warfarin) during July 2005. This increased to 292,550 during June 2016, of whom 47.0%, 27.1%, 18.7% and 7.2% were dispensed warfarin, rivaroxaban, apixaban and dabigatran, respectively. Of 16,500 initiated on anticoagulants in June 2016, 24.3%, 38.2%, 30.0% and 7.5% were initiated on warfarin, rivaroxaban, apixaban, and dabigatran, respectively. Compared to July 2005-July 2013, from August 2013-June 2016, dispensings for all anticoagulants increased by 2,303 dispensings/month (p<0.001, 95%CI = [1,229 3,376]); warfarin dispensing decreased by 1,803 dispensings/month (p<0.001, 95%CI = [–2,606, –1,000]). Total PBS anticoagulant...
Morton, K, Voss, S, Adamson, J, Baxter, H, Bloor, K, Brandling, J, Cowlishaw, S, Doran, T, Gibson, A, Gutacker, N, Liu, D, Purdy, S, Roy, P, Salisbury, C, Scantlebury, A, Vaittinen, A, Watson, R & Benger, JR 2018, 'General practitioners and emergency departments (GPED)—efficient models of care: a mixed-methods study protocol', BMJ Open, vol. 8, no. 10, pp. e024012-e024012.
View/Download from: Publisher's site
View description>>
IntroductionPressure continues to grow on emergency departments in the UK and throughout the world, with declining performance and adverse effects on patient outcome, safety and experience. One proposed solution is to locate general practitioners to work in or alongside the emergency department (GPED). Several GPED models have been introduced, however, evidence of effectiveness is weak. This study aims to evaluate the impact of GPED on patient care, the primary care and acute hospital team and the wider urgent care system.Methods and analysisThe study will be divided into three work packages (WPs). WP-A; Mapping and Taxonomy: mapping, description and classification of current models of GPED in all emergency departments in England and interviews with key informants to examine the hypotheses that underpin GPED. WP-B; Quantitative Analysis of National Data: measurement of the effectiveness, costs and consequences of the GPED models identified in WP-A, compared with a no-GPED model, using retrospective analysis of Hospital Episode Statistics Data. WP-C; Case Studies: detailed case studies of different GPED models using a mixture of qualitative and quantitative methods including: non-participant observation of clinical care, semistructured interviews with staff, patients and carers; workforce surveys with emergency department staff and analysis of available local routinely collected hospital data. Prospective case study sites will be identified by completing telephone interviews with sites awarded capital funding by the UK government to implement GPED initiatives. The study has a strong patient and public involvement group that has contributed to study design and materials, and which will be closely involved in data interpretation and dissemination.Ethics and disseminationThe study has been a...
Mu, C, De Abreu Lourenco, R, van Gool, K & Hall, J 2018, 'Is low-priced primary care bad for quality? Evidence from Australian general practice', Applied Economics, vol. 50, no. 5, pp. 475-491.
View/Download from: Publisher's site
View description>>
© 2017 Informa UK Limited, trading as Taylor & Francis Group. We examine whether patients’ perceptions of general practitioner (GP) care varies by the price paid for consultations. Australian consumer survey data from 2275 individuals were used to analyse the relationship between price and patient experience of GP care. Using both standard models for count data and a latent class model that distinguishes between patients with high- and low-quality experiences, we find no evidence that lower prices have a negative impact on patients’ perceptions of GP quality. Nevertheless, some patient characteristics such as age, gender and health status play a significant role in quality-of-care perceptions. The results show that Australian patients have not had to compromise GP quality, as expressed in terms of patient experience, when seeking low-priced care. This supports the view that there are sufficient checks and balances on the GP sector in Australia to ensure positive patient experiences even for low-cost GP consultations.
Mulhern, B, Feng, Y, Shah, K, Janssen, MF, Herdman, M, van Hout, B & Devlin, N 2018, 'Comparing the UK EQ-5D-3L and English EQ-5D-5L Value Sets', PharmacoEconomics, vol. 36, no. 6, pp. 699-713.
View/Download from: Publisher's site
Mulhern, B, Feng, Y, Shah, K, Janssen, MF, Herdman, M, van Hout, B & Devlin, N 2018, 'Correction to: Comparing the UK EQ-5D-3L and English EQ-5D-5L Value Sets', PharmacoEconomics, vol. 36, no. 6, pp. 727-727.
View/Download from: Publisher's site
Mulhern, B, Norman, R, Shah, K, Bansback, N, Longworth, L & Viney, R 2018, 'How Should Discrete Choice Experiments with Duration Choice Sets Be Presented for the Valuation of Health States?', Medical Decision Making, vol. 38, no. 3, pp. 306-318.
View/Download from: Publisher's site
View description>>
© 2017, © The Author(s) 2017. Background. Discrete Choice Experiments including duration (DCETTO) can be used to generate utility values for health states from measures such as EQ-5D-5L. However, methodological issues concerning the optimum way to present choice sets remain. The aim of the present study was to test a range of task presentation approaches designed to support the DCETTO completion process. Methods. Four separate presentation approaches were developed to examine different task features including dimension level highlighting, and health state severity and duration level presentation. Choice sets included 2 EQ-5D-5L states paired with 1 of 4 duration levels, and a third “immediate death” option. The same design, including 120 choice sets (developed using optimal methods), was employed across all approaches. The online survey was administered to a sample of the Australian population who completed 20 choice sets across 2 approaches. Conditional logit regression was used to assess model consistency, and scale parameter testing investigated poolability. Results. Overall 1,565 respondents completed the survey. Three approaches, using different dimension level highlighting techniques, produced mainly monotonic coefficients that resulted in a larger disutility as the severity level increased (excepting usual activities levels 2/3). The fourth approach, using a level indicator to present the severity levels, has slightly more non-monotonicity and produced larger ordered differences for the more severe dimension levels. Scale parameter testing suggested that the data cannot be pooled. Conclusions. The results provide information regarding how to present DCE tasks for health state valuation. The findings improve our understanding of the impact of different presentation approaches on valuation, and how DCE questions could be presented to be amenable to completion. However, it is unclear if the task presentation impacts online respondent engagement.
Oliver, D & Yu, S 2018, 'The Australian labour market in 2017', Journal of Industrial Relations, vol. 60, no. 3, pp. 298-316.
View/Download from: Publisher's site
View description>>
Low wage growth consistently featured as the main underlying characteristic of the Australian labour market in 2017. Overall economic conditions remained weak, although unemployment was fairly static. All indicators of average wage growth declined: average weekly earnings, the wage price index and the average annual wage increase in enterprise agreements. Collective bargaining coverage continued to decline. Although the 3.3% minimum wage increase represents a modest increase in real wages for low-paid workers, the Fair Work Commission decision to reduce Sunday and public holiday penalty rates for some award-reliant workers would put further downward pressure on workers’ incomes. There were more successful applications to terminate expired enterprise agreements, including those where wage rates were thought to be uncompetitive and unsustainable. The underlying causes of low wage growth remain contested. Despite some agreement that the regulatory framework is a contributing factor, firm proposals for regulatory change are yet to emerge.
Pearce, A, Manipis, K, Haywood, P, Hanly, P & Goodall, S 2018, 'Local Inputs for A Societal Perspective: Estimating the Friction Period in Australia', Value in Health, vol. 21, pp. S88-S88.
View/Download from: Publisher's site
Phan, YHL, De Abreu Lourenco, R, Haas, M & van der Linden, N 2018, 'Key considerations in reimbursement decision-making for multiple sclerosis drugs in Australia', Multiple Sclerosis and Related Disorders, vol. 25, pp. 144-149.
View/Download from: Publisher's site
Prichard, R, Goodall, S, Davidson, P, MacDonald, P, McDonagh, J & Hayward, C 2018, 'Frailty and Quality of Life in Advanced Heart Failure and Transplant Medicine: Do We Need to Screen?', Heart, Lung and Circulation, vol. 27, pp. S101-S101.
View/Download from: Publisher's site
Prichard, R, Goodall, S, Davidson, P, Macdonald, P, Mcdonagh, J, Newton, P & Hayward, C 2018, 'Estimating Quality of Life Among Advanced Heart Failure Patients: What Could Formal Screening Add to Clinical Assessments', Heart, Lung and Circulation, vol. 27, pp. S384-S384.
View/Download from: Publisher's site
Prichard, R, Kershaw, L, Davidson, PM, Newton, PJ, Goodall, S & Hayward, C 2018, 'COMBINING INSTITUTIONAL AND ADMINISTRATIVE DATA TO ASSESS HOSPITAL COSTS FOR PATIENTS RECEIVING VENTRICULAR ASSIST DEVICES', International Journal of Technology Assessment in Health Care, vol. 34, no. 6, pp. 555-566.
View/Download from: Publisher's site
View description>>
Objectives:The aim of this study was to describe patient level costing methods and develop a database of healthcare resource use and cost in patients with AHF receiving ventricular assist device (VAD) therapy.Methods:Patient level micro-costing was used to identify documented activity in the years preceding and following VAD implantation, and preceding heart transplant for a cohort of seventy-seven consecutive patients listed for heart transplantation (2009–12). Clinician interviews verified activity, established time resource required for each activity, and added additional undocumented activities. Costs were sourced from the general ledger, salary, stock price, pharmacy formulary data, and from national medical benefits and prostheses lists. Linked administrative data analyses of activity external to the implanting institution, used National Weighted Activity Units (NWAU), 2014 efficient price, and admission complexity cost weights and were compared with micro-costed data for the implanting admission.Results:The database produced includes patient level activity and costs associated with the seventy-seven patients across thirteen resource areas including hospital activity external to the implanting center. The median cost of the implanting admission using linked administrative data was $246,839 (interquartile range [IQR] $246,839–$271,743), versus $270,716 (IQR $211,740–$378,482) for the institutional micro-costing (p = .08).Conclusions:Linked administrative data provides a useful alternative for imputing costs external to the implanting center, and combined with institutional dat...
Prichard, R, Kershaw, L, Goodall, S, Davidson, P, Newton, P, McNeil, F, Homer, T & Hayward, C 2018, 'Left Ventricular Device Implantation Impacts on Hospitalisation Rates, Length of Stay and Out of Hospital Time', Heart, Lung and Circulation, vol. 27, no. 6, pp. 708-715.
View/Download from: Publisher's site
View description>>
Background Widespread application of left ventricular assist devices (LVADs) in advanced heart failure, is limited by
costs, and access to technical expertise. Hospitalisation drives both cost and inversely, quality of life but
cross institutional and pre-surgical inpatient length of stay data is missing in the Australian literature. We
describe changes in hospitalisation rates, in the year before and after bridge to transplant LVAD therapy and
preceding heart transplant (HTX).
Methods Hospitalisation, Australian refined diagnosis group (ArDRG), and clinical data were assessed for 77/100
consecutive patients listed for heart transplant between July of 2009 and June of 2012. Twenty-five of the
patients required ventricular assist device (VAD) therapy whilst waitlisted. Hospitalisation was defined as
the proportion of ‘‘days at risk” that were spent in hospital and included all public and private admissions
identified in the year before and after VAD implant, or before HTX, in a linked administrative dataset of
admissions across New South Wales.
Results Patients requiring VADs were clinically more unstable and spent proportionally more time in hospital than
pre-HTX patients, (13% (IQR 10-20%) vs 4% (IQR1-10%), p < 0.01). During the index admission, they spent
22 days (IQR 10-33) in hospital before implantation, including 13 days in non-transplant centres (IQR 7-20).
Following implantation, median inpatient stay was 31(IQR 26-70) – including rehabilitation in 8 of the 25
patients.
The number of admissions per patientreduced in the year after VAD-implant to two (IQR1-3), from five preimplant
(IQR 3-7) p = 0.002. This was similar to the pre-HTX group’s three admissions (IQR1-6), p = 0.33.
Overall hospitalisation decreased in VAD patients beyond the first year from 14% (IQR 10-20%) at 1-year
to 0.5% (IQR 0-10%) at 2-year (p = 0.002). A high percentage of hospitalisation prior to VAD (41%) and HTX
(66%) occurred outside the transplant centre.
Conclusions A high prop...
Reeve, R, Srasuebkul, P, Langton, JM, Haas, M, Viney, R & Pearson, S-A 2018, 'Health care use and costs at the end of life: a comparison of elderly Australian decedents with and without a cancer history', BMC Palliative Care, vol. 17, no. 1, pp. 1-10.
View/Download from: Publisher's site
View description>>
© 2017 Commonwealth of Australia. Background: There is limited population-level research on end-of-life care in Australia that considers health care use and costs across hospital and community sectors. The aim of this study was to quantify health care use and costs in the last 6 months of life in a cohort of elderly Australian decedents and to examine the factors associated with end-of-life resource use and costs. Methods: A retrospective cohort study using routinely collected health data from Australian Government Department of Veterans' Affairs clients. The study included two cohorts of elderly Australians who died between 2005 and 2009; one cohort with a recorded cancer diagnosis and a comparison cohort with no evidence of a cancer history. We examined hospitalisations, emergency department (ED) visits, prescription drugs, clinician visits, pathology, and procedures and associated costs in the last 6 months of life. We used negative binominal regression to explore factors associated with health service use and costs. Results: The cancer cohort had significantly higher rates of health service use and 27% higher total health care costs than the comparison cohort; in both cohorts, costs were driven primarily by hospitalisations. Older age was associated with lower costs and those who died in residential aged care incurred half the costs of those who died in hospital. Conclusions: The results suggest differences in end-of-life care pathways dependent on patient factors, with younger, community-dwelling patients and those with a history of cancer incurring significantly greater costs. There is a need to examine whether the investment in end-of-life care meets patient and societal needs.
Rowen, D, Labeit, A, Stevens, K, Elliott, J, Mulhern, B, Carlton, J, Basarir, H & Brazier, J 2018, 'Estimating a Preference-Based Single Index Measuring the Quality-of-Life Impact of Self-Management for Diabetes', Medical Decision Making, vol. 38, no. 6, pp. 699-707.
View/Download from: Publisher's site
View description>>
Objective. Self-management is becoming increasingly important in diabetes but is neglected in conventional preference-based measures. The objective of this paper was to generate health state utility values for a novel classification system measuring the quality-of-life impact of self-management for diabetes, which can be used to generate quality-adjusted life years (QALYs). Methods. A large online survey was conducted using a discrete choice experiment (DCE), with duration as an additional attribute, on members of the UK general population ( n = 1,493) to elicit values for health (social limitations, mood, vitality, hypoglycaemia) and non-health (stress, hassle, control, support) aspects of self-management in diabetes. The data were modelled using a conditional fixed-effects logit model and utility estimates were anchored on the one to zero (full health to dead) scale. Results. The model produced significant and consistent coefficients, with one logical inconsistency and 3 insignificant coefficients for the milder levels of some attributes. The anchored utilities ranged from 1 for the best state to −0.029 for the worst state (meaning worse than dead) defined by the classification system. Conclusion. The results presented here can potentially be used to generate utility values capturing the day to day impact of interventions in diabetes on both health and self-management. These utility values can potentially be used to generate QALYs for economic models of the cost-effectiveness of interventions in diabetes.
Rowen, D, Stevens, K, Labeit, A, Elliott, J, Mulhern, B, Carlton, J, Basarir, H, Ratcliffe, J & Brazier, J 2018, 'Using a Discrete-Choice Experiment Involving Cost to Value a Classification System Measuring the Quality-of-Life Impact of Self-Management for Diabetes', Value in Health, vol. 21, no. 1, pp. 69-77.
View/Download from: Publisher's site
View description>>
Objectives
To describe the use of a novel approach in health valuation of a discrete-choice experiment (DCE) including a cost attribute to value a recently developed classification system for measuring the quality-of-life impact (both health and treatment experience) of self-management for diabetes.
Methods
A large online survey was conducted using DCE with cost on UK respondents from the general population (n = 1497) and individuals with diabetes (n = 405). The data were modeled using a conditional logit model with robust standard errors. The marginal rate of substitution was used to generate willingness-to-pay (WTP) estimates for every state defined by the classification system. Robustness of results was assessed by including interaction effects for household income.
Results
There were some logical inconsistencies and insignificant coefficients for the milder levels of some attributes. There were some differences in the rank ordering of different attributes for the general population and diabetic patients. The WTP to avoid the most severe state was £1118.53 per month for the general population and £2356.02 per month for the diabetic patient population. The results were largely robust.
Conclusions
Health and self-management can be valued in a single classification system using DCE with cost. The marginal rate of substitution for key attributes can be used to inform cost-benefit analysis of self-management interventions in diabetes using results from clinical studies in which this new classification system has been applied. The method shows promise, but found large WTP estimates exceeding the cost levels used in the survey.
Sabater-Hernández, D, Tudball, J, Ferguson, C, Franco-Trigo, L, Hossain, LN & Benrimoj, SI 2018, 'A stakeholder co-design approach for developing a community pharmacy service to enhance screening and management of atrial fibrillation', BMC Health Services Research, vol. 18, no. 1.
View/Download from: Publisher's site
Saing, S, Haywood, P, Duncan, JK, Ma, N, Cameron, AL & Goodall, S 2018, 'Cost‐effective imaging for resectability of liver lesions in colorectal cancer: an economic decision model', ANZ Journal of Surgery, vol. 88, no. 6, pp. E507-E511.
View/Download from: Publisher's site
View description>>
BackgroundThis study aimed to determine the cost‐effectiveness of contrast‐enhanced magnetic resonance imaging (CE‐MRI) compared with multiphase CE computed tomography (CE‐CT) scan to characterize suspected liver lesions in patients with known colorectal carcinoma.MethodsA decision analytic model linking diagnostic accuracy to health outcomes in patients with colorectal carcinoma was constructed. The model assumed that CE‐MRI has superior sensitivity and equivalent specificity to CE‐CT, and patients with a colorectal liver metastasis could be eligible for curative surgery or chemotherapy and palliation. Delayed diagnosis or misdiagnosis was associated with worse health outcomes (disutility). Cost‐effectiveness was calculated as the incremental cost relative to the incremental benefit, the benefit was estimated using quality‐adjusted life years. Sensitivity analyses were conducted to test the robustness of the results.ResultsThe clinical evidence supports increased sensitivity of CE‐MRI compared with CE‐CT (0.943 versus 0.768). CE‐MRI was more effective and more costly than CE‐CT. The incremental cost‐effectiveness ratio was estimated to be $40 548 per quality‐adjusted life year gained. The model is most sensitive to the cost of
Saing, S, Parkinson, B, Church, J & Goodall, S 2018, 'Cost Effectiveness of a Community-Delivered Consultation to Improve Infant Sleep Problems and Maternal Well-Being', Value in Health Regional Issues, vol. 15, no. 15, pp. 91-98.
View/Download from: Publisher's site
View description>>
© 2018 Objectives: To evaluate the cost effectiveness of a community-delivered consultation aimed at improving infant sleep and maternal well-being. Methods: A decision-analytic model was developed that compared the costs and benefits of an infant sleep consultation with usual care. The effectiveness of the consultation was based on clinical evidence, and improvements in maternal quality of life were estimated by mapping the Edinburgh Postnatal Depression Scale scores to published utility scores. Cost effectiveness was calculated as the incremental cost per quality-adjusted life-year gained (QALY). Results: The statistically significant improvements in mean Edinburgh Postnatal Depression Scale scores at 4- and 16-month follow-ups were used to estimate the benefit in terms of QALYs. The modeled results demonstrated that the infant sleep consultation is low-cost (A$ 436), more effective in terms of QALYs gained (0.017), and cost-effective. The estimated incremental cost-effectiveness ratio was A$ 4031/QALY gained. The main drivers of the model were the use of early parenting centers and nurse training costs. Conclusions: Community-based nurse-delivered infant sleep consultations aid infant sleep, improve maternal quality of life, and are cost-effective compared with usual care and lead to improvements in quality of life through a reduction in postnatal depression.
Salam, A, Webster, R, Patel, A, Godamunne, P, Pathmeswaran, A, de Silva, HA, Rogers, A, Jan, S & Laba, T-L 2018, 'Process evaluation of a randomised controlled trial of a pharmacological strategy to improve hypertension control: protocol for a qualitative study', BMJ Open, vol. 8, no. 8, pp. e022317-e022317.
View/Download from: Publisher's site
View description>>
IntroductionGlobally, the prevalence of uncontrolled hypertension is high, particularly in low- and middle-income countries. There is a critical need for strategies to improve hypertension control. The early use of a fixed low-dose combination of three antihypertensive drugs (triple pill) has the potential to significantly improve hypertension control. TheTRIple Pill vs.Usual careManagement forPatients with mild-to- moderateHypertension (TRIUMPH) randomised controlled trial (RCT) is designed to test the effects of this strategy compared with usual care in patients with mild-to-moderate hypertension. This paper reports the protocol of a process evaluation of the TRIUMPH RCT. The objectives are to understand factors related to implementation of the intervention, mechanisms of effect, contextual factors that underpin the effectiveness of the triple pill strategy and the potential barriers and facilitators to implementing the strategy in clinical practice.Methods and analysisFace-to-face semistructured in-depth interviews with a purposive sample of TRIUMPH RCT participants and healthcare professionals in Sri Lanka will be conducted. Healthcare professionals will include physicians and their staff who were involved in conducting the TRIUMPH RCT. Interviewees will be recruited sequentially until thematic saturation is achieved. Interviews will be audio recorded, transcribed verbatim and analysed in NVivo using framework analysis methods.Ethics and disseminationThe TRIUMPH RCT and process evaluation have received approval from the relevant Ethics Review Committee. All participants will be asked to provide written consent before participation. Findings from the study will be dissemi...
Singh, K, Crossan, C, Laba, T-L, Roy, A, Hayes, A, Salam, A, Jan, S, Lord, J, Tandon, N, Rodgers, A, Patel, A, Thom, S & Prabhakaran, D 2018, 'Cost-effectiveness of a fixed dose combination (polypill) in secondary prevention of cardiovascular diseases in India: Within-trial cost-effectiveness analysis of the UMPIRE trial', International Journal of Cardiology, vol. 262, pp. 71-78.
View/Download from: Publisher's site
View description>>
BACKGROUND: The Use of Multidrug Pill In Reducing cardiovascular Events (UMPIRE) trial, showed that access to a cardiovascular polypill (aspirin, statin and two blood pressure lowering drugs) significantly improved adherence, lowered systolic blood pressure (SBP) and low-density lipoprotein cholesterol (LDLc) in patients with or at high risk of cardiovascular disease (CVD). We aimed to analyze the within-trial cost-effectiveness of the polypill strategy versus usual care in India. METHODS: Relative effectiveness and costs of polypill versus usual care groups in UMPIRE were estimated from the health sector perspective. Only direct medical costs were considered. The effectiveness of the polypill was reported as a percentage increase in adherence and mean reductions in SBP, and LDL-c, over the 15-month trial period. Healthcare resource utilization and costs were collected for each patient during the trial. Polypill price was constructed using a range of scenarios: $0.06-$0.94/day. The cost-effectiveness of the polypill was measured as the additional cost for 10% increase in adherence, and per unit reduction in SBP and LDL-c. RESULTS: Overall, the mean cost per patient was significantly lower with the polypill strategy (-$203 per person, (95% CI: -286, -119, p < 0.01). In scenario analyses that varied polypill price assumptions, incremental cost-effectiveness ratios for a polypill strategy ranged between cost-saving to $75 per 10% increase in adherence for polypill price of $0.94 per day. CONCLUSIONS: The polypill strategy was cost-saving compared to usual care among patients with or at high risk of CVD in India.
Siva, S, Chesson, B, Bressel, M, Pryor, D, Higgs, B, Reynolds, HM, Hardcastle, N, Montgomery, R, Vanneste, B, Khoo, V, Ruben, J, Lau, E, Hofman, MS, De Abreu Lourenco, R, Sridharan, S, Brook, NR, Martin, J, Lawrentschuk, N, Kron, T & Foroudi, F 2018, 'TROG 15.03 phase II clinical trial of Focal Ablative STereotactic Radiosurgery for Cancers of the Kidney - FASTRACK II', BMC Cancer, vol. 18, no. 1.
View/Download from: Publisher's site
View description>>
© 2018 The Author(s). Background: Stereotactic ablative body radiotherapy (SABR) is a non-invasive alternative to surgery to control primary renal cell cancer (RCC) in patients that are medically inoperable or at high-risk of post-surgical dialysis. The objective of the FASTRACK II clinical trial is to investigate the efficacy of SABR for primary RCC. Methods: FASTRACK II is a single arm, multi-institutional phase II study. Seventy patients will be recruited over 3 years and followed for a total of 5 years. Eligible patients must have a biopsy confirmed diagnosis of primary RCC with a single lesion within a kidney, have ECOG performance ≤2 and be medically inoperable, high risk or decline surgery. Radiotherapy treatment planning is undertaken using four dimensional CT scanning to incorporate the impact of respiratory motion. Treatment must be delivered using a conformal or intensity modulated technique including IMRT, VMAT, Cyberknife or Tomotherapy. The trial includes two alternate fractionation schedules based on tumour size: for tumours ≤4 cm in maximum diameter a single fraction of 26Gy is delivered; and for tumours > 4 cm in maximum diameter 42Gy in three fractions is delivered. The primary outcome of the study is to estimate the efficacy of SABR for primary RCC. Secondary objectives include estimating tolerability, characterising overall survival and cancer specific survival, estimating the distant failure rate, describing toxicity and renal function changes after SABR, and assessment of cost-effectiveness of SABR compared with current therapies. Discussion: The present study design allows for multicentre prospective validation of the efficacy of SABR for primary RCC that has been observed from prior single institutional and retrospective series. The study also allows assessment of treatment related toxicity, overall survival, cancer specific survival, freedom from distant failure and renal function post therapy.
Street, DJ & Bird, EM 2018, 'D-optimal orthogonal array minus t run designs', Journal of Statistical Theory and Practice, vol. 12, no. 3, pp. 575-594.
View/Download from: Publisher's site
View description>>
© 2018, © 2018 Grace Scientific Publishing, LLC. This article considers the design performance of orthogonal arrays in which one or more runs are missing at random. We focus on orthogonal arrays of index unity and on the 18 run ternary arrays.
Teague, SJ, Newman, LK, Tonge, BJ & Gray, KM 2018, 'Caregiver Mental Health, Parenting Practices, and Perceptions of Child Attachment in Children with Autism Spectrum Disorder', Journal of Autism and Developmental Disorders, vol. 48, no. 8, pp. 2642-2652.
View/Download from: Publisher's site
View description>>
© 2018, Springer Science+Business Media, LLC, part of Springer Nature. This paper investigates the role of caregiver mental health and parenting practices as predictors of attachment in children with intellectual disability/developmental delay, comparing between children with ASD (n = 29) and children with other developmental disabilities (n = 20). Parents reported that children with ASD had high levels of anxiety and stress, and attachment insecurity in children (less closeness and more conflict in attachment relationships, and more inhibited attachment behaviours) compared with children with other developmental disabilities. Children’s attachment quality was associated with parenting practices and the presence of an ASD diagnosis. These results highlight the bidirectional nature of the quality of caregiving environments and attachment in children with ASD, and also provide a strong rationale for targeting children’s attachment quality in early interventions.
Thiboonboon, K, Kulpeng, W & Teerawattananon, Y 2018, 'An economic analysis of chromosome testing in couples with children who have structural chromosome abnormalities', PLOS ONE, vol. 13, no. 6, pp. e0199318-e0199318.
View/Download from: Publisher's site
View description>>
© 2018 Thiboonboon et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Background Structural chromosome abnormalities can cause significant negative reproductive outcomes as they typically result in morbidity and mortality of newborns. The prevalence of structural chromosomal abnormalities in live births is at least 0.05%, of which many of them have parental origins. It is uncommon to predict structural chromosome abnormalities at birth in the first child but it is possible to prevent repeated abnormalities through screening and diagnostic programmes. This study will provide an economic analysis of the prenatal detection of these abnormalities. Methods A cost-benefit analysis using a decision analytic model was employed to compare the status quo (doing nothing) with two interventional strategies. The first strategy (Strategy I) is preconceptional screening plus amniocentesis, and the second strategy (Strategy II) is amniocentesis alone. The monetary values in Thai baht (THB) were adjusted to international dollars (I$) using purchasing power parity (PPP) (I$1 = THB 17.60 for the year 2013). The robustness of the results was tested by applying a probabilistic sensitivity analysis. Results Both diagnostic strategies can reduce approximately 10.7–11.1 births with abnormal chromosomes per 1,000 diagnosed couples. The benefit cost ratios were 1.62 for Strategy I and 1.24 for Strategy II. Net present values per 1,000 diagnoses in couples were I$464,000 for Strategy I and I$267,000 for Strategy II. The probabilistic sensitivity analysis suggested that the cost-benefit analysis was sufficiently robust, confirming that both strategies provided higher benefits than costs. Conclusions Since the benefits of both diagnostic strategies exceeded their costs, both strategies are eco...
van der Linden, N, van Gool, K, Gardner, K, Dickinson, H, Agostino, J, Regan, DG, Dowden, M & Viney, R 2018, 'A systematic review of scabies transmission models and data to evaluate the cost-effectiveness of scabies interventions', PLOS Neglected Tropical Diseases, vol. 13, no. 3, pp. e0007182-e0007182.
View/Download from: Publisher's site
View description>>
© 2019 van der Linden et al. Background: Scabies is a common dermatological condition, affecting more than 130 million people at any time. To evaluate and/or predict the effectiveness and cost-effectiveness of scabies interventions, disease transmission modelling can be used. Objective: To review published scabies models and data to inform the design of a comprehensive scabies transmission modelling framework to evaluate the cost-effectiveness of scabies interventions. Methods: Systematic literature search in PubMed, Medline, Embase, CINAHL, and the Cochrane Library identified scabies studies published since the year 2000. Selected papers included modelling studies and studies on the life cycle of scabies mites, patient quality of life and resource use. Reference lists of reviews were used to identify any papers missed through the search strategy. Strengths and limitations of identified scabies models were evaluated and used to design a modelling framework. Potential model inputs were identified and discussed. Findings: Four scabies models were published: a Markov decision tree, two compartmental models, and an agent-based, network-dependent Monte Carlo model. None of the models specifically addressed crusted scabies, which is associated with high morbidity, mortality, and increased transmission. There is a lack of reliable, comprehensive information about scabies biology and the impact this disease has on patients and society. Discussion: Clinicians and health economists working in the field of scabies are encouraged to use the current review to inform disease transmission modelling and economic evaluations on interventions against scabies.
van Sambeek, B, Flattery, M, Mitchell, R & De Abreu Lourenco, R 2018, 'Comparing the cost of preparing matched unrelated donor and TCR α+β+/CD19+ depleted donor material for pediatric hematopoietic stem cell transplants in Australia', Pediatric Transplantation, vol. 22, no. 7, pp. e13279-e13279.
View/Download from: Publisher's site
View description>>
AbstractUse of TCR α+β+/CD19+ depletion in a pediatric setting has improved the utility of haploidentical donor material, resulting in better rates of engraftment, lower rates of graft vs host disease (GVHD), and improved transplant‐related mortality. There are currently no data available on the costs of TCR α+β+/CD19+ depletion. This study assessed the costs of acquiring and preparing TCR α+β+/CD19+ depleted haploidentical donor cells in comparison with matched unrelated donor (MUD) products for use in pediatric patients in Australia. Data from four pediatric transplant centers were used to estimate the resources required for donor work‐up, graft acquisition, and laboratory procedures for graft preparation. Information on MUD work‐up and graft acquisition was also acquired from these sites and from the national coordinating donor center in Australia. Australian‐specific prices and fees were used to estimate total average costs for each transplant type, converted to USD. Preparation of graft material (including work‐up, acquisition, and laboratory processes) costs USD
Vargas, C, Bilbeny, N, Balmaceda, C, Rodríguez, MF, Zitko, P, Rojas, R, Eberhard, ME, Ahumada, M & Espinoza, MA 2018, 'Costs and consequences of chronic pain due to musculoskeletal disorders from a health system perspective in Chile', PAIN Reports, vol. 3, no. 5, pp. e656-e656.
View/Download from: Publisher's site
View description>>
Abstract Background: Chronic pain is a prevalent and distressing condition caused by an unceasing pain lasting more than 3 months or a pain that persists beyond the normal healing time. There is evidence of inadequate management partly explained by the unawareness regarding the magnitude of the problem. Objectives: To estimate the annual expected costs and consequences of chronic pain caused by musculoskeletal diseases from the health system perspective in Chile. Methods: A Markov cohort model was built to represent chronic pain and estimate expected costs and consequences over 1-year time horizon. Transition probabilities were obtained through expert elicitation. Consequences examined were: years lost to disability (YLD), depression, anxiety, and productivity losses. Direct health care costs were estimated using local sources. Probabilistic sensitivity analysis was performed to characterize second-order uncertainty. Results: The annual expected cost due to musculoskeletal chronic pain was estimated in USD $1387.2 million, equivalent to 0.417% of the national GDP. Lower back pain and osteoarthritis of the knee explained the larger proportion of the total cost, 31.8% and 27.1%, respectively. Depression attributed to chronic pain is another important consequence accounting for USD $94 million (Bayesian credibility interval 95% $49.1–$156.26). Productivity losses were also important cost, although early retirement and presenteeism were not measured. Chronic pain causes 137,037 YLDs. ...
Vincent, G, Kinchin, I, Ferguson, S & Jay, S 2018, 'The Cost of Inadequate Sleep among On-Call Workers in Australia: A Workplace Perspective', International Journal of Environmental Research and Public Health, vol. 15, no. 3, pp. 398-398.
View/Download from: Publisher's site
View description>>
On-call or stand-by is becoming an increasingly prevalent form of work scheduling. However, on-call arrangements are typically utilised when workloads are low, for example at night, which can result in inadequate sleep. It is a matter of concern that on-call work is associated with an increased risk of workplace injury. This study sought to determine the economic cost of injury due to inadequate sleep in Australian on-call workers. The prevalence of inadequate sleep among on-call workers was determined using an online survey, and economic costs were estimated using a previously validated costing methodology. Two-thirds of the sample (66%) reported obtaining inadequate sleep on weekdays (work days) and over 80% reported inadequate sleep while on-call. The resulting cost of injury is estimated at $2.25 billion per year ($1.71-2.73 billion). This equates to $1222 per person per incident involving a short-term absence from work; $2.53 million per incident classified as full incapacity, and $1.78 million for each fatality. To the best of our knowledge this is the first study to quantify the economic cost of workplace injury due to inadequate sleep in on-call workers. Well-rested employees are critical to safe and productive workplace operations. Therefore, it is in the interest of both employers and governments to prioritise and invest far more into the management of inadequate sleep in industries which utilise on-call work arrangements.
Walker, JG, Macrae, F, Winship, I, Oberoi, J, Saya, S, Milton, S, Bickerstaffe, A, Dowty, JG, De Abreu Lourenço, R, Clark, M, Galloway, L, Fishman, G, Walter, FM, Flander, L, Chondros, P, Ait Ouakrim, D, Pirotta, M, Trevena, L, Jenkins, MA & Emery, JD 2018, 'The use of a risk assessment and decision support tool (CRISP) compared with usual care in general practice to increase risk-stratified colorectal cancer screening: study protocol for a randomised controlled trial', Trials, vol. 19, no. 1, pp. 397-397.
View/Download from: Publisher's site
View description>>
© 2018 The Author(s). Background: Australia and New Zealand have the highest incidence rates of colorectal cancer worldwide. In Australia there is significant unwarranted variation in colorectal cancer screening due to low uptake of the immunochemical faecal occult blood test, poor identification of individuals at increased risk of colorectal cancer, and over-referral of individuals at average risk for colonoscopy. Our pre-trial research has developed a novel Colorectal cancer RISk Prediction (CRISP) tool, which could be used to implement precision screening in primary care. This paper describes the protocol for a phase II multi-site individually randomised controlled trial of the CRISP tool in primary care. Methods: This trial aims to test whether a standardised consultation using the CRISP tool in general practice (the CRISP intervention) increases risk-appropriate colorectal cancer screening compared to control participants who receive standardised information on cancer prevention. Patients between 50 and 74 years old, attending an appointment with their general practitioner for any reason, will be invited into the trial. A total of 732 participants will be randomised to intervention or control arms using a computer-generated allocation sequence stratified by general practice. The primary outcome (risk-appropriate screening at 12 months) will be measured using baseline data for colorectal cancer risk and objective health service data to measure screening behaviour. Secondary outcomes will include participant cancer risk perception, anxiety, cancer worry, screening intentions and health service utilisation measured at 1, 6 and 12 months post randomisation. Discussion: This trial tests a systematic approach to implementing risk-stratified colorectal cancer screening in primary care, based on an individual's absolute risk, using a state-of-the-art risk assessment tool.
Wong, CKH, Mulhern, B, Cheng, GHL & Lam, CLK 2018, 'SF-6D population norms for the Hong Kong Chinese general population', Quality of Life Research, vol. 27, no. 9, pp. 2349-2359.
View/Download from: Publisher's site
View description>>
To estimate population norms for the SF-6D health preference (utility) scores derived from the MOS SF-36 version 1 (SF-36v1), SF-36 version 2 (SF-36v2), and (SF-12v2) health surveys collected from a representative adult sample in Hong Kong, and to assess differences in SF-6D scores across sociodemographic subgroups.A random telephone survey of 2410 Chinese adults was conducted. All respondents completed questionnaires on sociodemographics and presence of chronic diseases (hypertension, diabetes, chronic rheumatism, chronic lung diseases, stroke, and mental illness), and the short-form 36-item health survey (SF-36) version 1, and selected items of the SF-36v2 that were different from those of SF-36v1. Responses of short-form 12-item health survey (SF-12) were extracted from responses of the SF-36 items. SF-6D health utility scores were derived from SF-36 version 1 (SF-6DSF-36v1), SF-36 version 2 (SF-6DSF-36v2), and SF-12 version 2 (SF-6DSF-12v2) using Hong Kong SF-6D value set.Population norms of SF-6DSF-36v1, SF-6DSF-36v2, and SF-6DSF-12v2 for the Hong Kong Chinese were 0.7947 (± 0.0048), 0.7862 (± 0.0049), and 0.8147 (± 0.0050), respectively. Three SF-6D scores were highly correlated (0.861-0.954), and had a high degree of reliability and absolute agreement. Males had higher health utility scores (SF-6DSF-36v1: 0.0025; SF-6DSF-36v2: 0.025; SF-6DSF-12v2: 0.018) but reported less problems in all the dimensions than women. Respondents with a higher number of chronic diseases had lower SF-6D scores. Among all respondents with one or more chronic diseases, those with hypertension scored the highest whereby those with mental illness scored the least.The SF-6D utility scores derived from different SF-36 or SF-12 health surveys were different. The population norms based on these three health surveys enable the normative comparisons of health utility scores from specific population or patient groups, and provide estimates of age-gender adjusted health utility scores for ...
Wong, CY & Hall, J 2018, 'Does patients’ experience of general practice affect the use of emergency departments? Evidence from Australia', Health Policy, vol. 122, no. 2, pp. 126-133.
View/Download from: Publisher's site
View description>>
© 2017 Elsevier B.V. AS Emergency Department (ED) attendances have been growing rapidly, various strategies have been employed in Australia to improve access to General Practitioner (GP) care, particularly after normal working hours, in order to reduce the demand for ED. However, there has been little attention paid to the quality of GP care and whether that influences ED attendances. This paper investigates whether ED use is affected by patients’ experience of GP care, using the logit model to analyse data from a survey of Australian consumers (1758 individuals). Not surprisingly, we find that people with poor health status and a greater number of chronic conditions are more likely to visit the ED. We also find that, after correcting for health status and sociodemographic factors, patients with a better GP experience are less likely to visit the ED. This suggests that policies aimed at improving the quality of primary care are also important in reducing unplanned hospital use.
Wright, M 2018, 'Continuity of care is in the eye of the beholder', Australian Journal of General Practice, vol. 47, no. 10, pp. 661-661.
View/Download from: Publisher's site
Wright, M & Mainous III, AG 2018, 'Can continuity of care in primary care be sustained in the modern health system?', Australian Journal of General Practice, vol. 47, no. 10, pp. 667-669.
View/Download from: Publisher's site
Wright, M, Hall, J, van Gool, K & Haas, M 2018, 'How common is multiple general practice attendance in Australia?', Australian Journal of General Practice, vol. 47, no. 5, pp. 289-296.
View/Download from: Publisher's site
View description>>
BACKGROUND AND OBJECTIVES: Australians can seek general practice care from multiple general practitioners (GPs) in multiple locations. This provides high levels of patient choice but may reduce continuity of care. The aim of this study was to estimate the prevalence of attendance at multiple general practices in Australia, and identify patient characteristics associated with multiple practice attendances. METHOD: A cross-sectional survey of 2477 Australian adults was conducted online in July 2013. Respondents reported whether they had attended more than one general practice in the past year, and whether they had a usual general practice and GP. Demographic information, health service use and practice characteristics were also obtained from the survey. RESULTS: Over one-quarter of the sample reported attending more than one practice in the previous year. Multiple practice attendance is less common with increasing age, and less likely for survey respondents from regional Australia, compared with respondents from metropolitan areas. Multiple practice attenders are just as likely as single practice attenders to have a usual GP. DISCUSSION: A significant proportion of general practice care is delivered away from usual practices. This may have implications for health policy, in terms of continuity and quality of primary care.
Yinghong, Y, Yan, L, Lui, SM, Kinchin, I, Heyeres, M & Tsey, K 2018, 'County development and sustainability in China: A systematic scoping of the literature', OIDA International Journal of Sustainable Development, vol. 11:02.
View description>>
Despite the importance of research and innovation in facilitating sustainable county development in China, little evidence is available concerning the output and characteristics of that research. This scoping review assesses key features or characteristics of the research output, the extent to which researchers engage with concepts of sustainability and the potential impact of the research. Publications were identified and classified using a process consistent with Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA). The R programming packages igraph and wordcloud respectively were used to analyse and graphically depict the strength of authorship networks and keyword frequency. Findings revealed that this field of research is an evolving one with a widely-dispersed network of researchers increasingly using new keywords. The implications of the review findings for improving the value and impact of sustainable county development research are explored.
Yu, S, van Gool, K, Edwards, K, Kirby, S, Gardner, K, Robinson, L, Linehan, T, Harris, M & Hall, J 2018, 'The business of integrated care: implementing new models of care in a fee-for-service setting', Journal of Integrated Care, vol. 26, no. 1, pp. 16-28.
View/Download from: Publisher's site
View description>>
PurposeThe Western New South Wales Integrated Care Strategy (ICS) was rolled out from November 2014 across three rural sites. The purpose of this paper is to assess its impact on general practices, and examine the feasibility of implementing an ICS, within a predominantly fee-for-service delivery model.Design/methodology/approachMixed methods were used to analyse the implementation of the ICS, including practice-level patient data on changes in service provision. This includes unit-record data on 130 enroled patients across three rural sites, as well as qualitative data collection from providers.FindingsThere were significant increases in both revenue-generating and non-revenue-generating activities (primarily care coordination activities) associated with implementing the ICS. Each occasion of service involved greater contact time with practice staff other than GPs, as well as greater administration time. There is evidence that ICS activities such as case conferencing and team care planning substitute for traditional GP consultations. Overall, the study found that a significant investment of resources – namely staff time devoted to a range of activities – was required to support the implementation of the ICS. Such an investment was supported both externally and through revenue-generating practice-level activities.Research limitations/implicationsThe data collection and evaluation project is ongoing, with analysis based on the first wave of data from three sites.Practical implications...
