Arora, S, Goodall, S, Viney, R & Einfeld, S 2019, 'Using Discrete-Choice Experiment Methods to Estimate the Value of Informal Care: The Case of Children with Intellectual Disability', PharmacoEconomics, vol. 37, no. 4, pp. 501-511.
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© 2018, Springer International Publishing AG, part of Springer Nature. Objectives: This research produces a preference-based monetary valuation of informal care provided to children with intellectual disability (ID) that can be directly applied in economic evaluations. Methods: A discrete-choice experiment (DCE) was designed to elicit an individual’s willingness to accept compensation for different care tasks. Respondents were presented choice sets that included a care package comprising different amounts and types of care and asked to choose between the care package provided free of charge or providing that care themselves and receiving cash compensation. The care package included personal care, social support, household errands and housework, with the value of compensation, number of care hours provided and types of care varied across the choice sets. Choices were analysed using a generalised multinomial logit model and latent class model. Results: A representative sample of 198 caregivers completed the survey (response rate 52%). Participants were recruited in Australia. Overall, caregivers would accept a minimum of Australian dollars ($A)20.61 to provide 1 h of care. The preferences for assistance varied significantly with different types of care tasks. Individuals placed the highest value on receiving assistance with social support ($A35.96) and the least value on receiving assistance with household errands ($A-0.92) Conclusions: This study produces a value of informal care provided to children with ID that can be directly applied in economic evaluations. The study shows that informal care tasks are not valued equally. Caregivers placed the most value on receiving assistance with social support, which may reflect the time spent by caregivers on these tasks.
Barakat-Johnson, M, Lai, M, Wand, T, White, K & De Abreu Lourenco, R 2019, 'Costs and consequences of an intervention-based program to reduce hospital-acquired pressure injuries in one health district in Australia', Australian Health Review, vol. 43, no. 5, pp. 516-525.
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Objectives The aims of this study were to determine the costs of hospital-acquired pressure injuries (HAPIs) in one local health district in Australia and compare the costs and consequences of an intervention-based program with current practice to reduce HAPI incidence and prevalence. Methods A retrospective cost–consequence analysis was conducted using HAPI incidence rate per occupied bed days, point prevalence rates, Australian Refined-Diagnosis Related Group (AR-DRG) costs and the costs of the program to reduce the HAPI rate. Data were analysed for two phases: preprogram implementation (1 June 2015–1 June 2016) and postprogram implementation (1 August 2016–31 July 2017). Results The HAPI intervention-based program resulted in a 51.4% reduction in the incidence of HAPI (from 1.46 per occupied bed day in 2014 to 0.71 per occupied bed day in 2017) and a 71.6% reduction in the prevalence of HAPI (from 6.7% in 2014 to 1.9% in 2017). The occurrence of HAPI added an average cost of A$3332 per episode, such that the overall program, including implementation, reduced costs by A$837 387. The greatest cost reduction was due to the cessation of washable and disposable underpads. The largest contributor to the cost of HAPI prevention was for education and training regarding HAPI prevention initiatives. Conclusions The HAPI intervention-based program halved the incidence and substantially reduced the prevalence of HAPI, with a 23.1% cost saving compared with the previous approach to preventing HAPIs. What is known about the topic? HAPIs are costly to the individual, the organisation and health system. The prevention of HAPIs is a priority in Australia. There is limited research on the economic effect of HAPIs and the costs and consequences for hospitals of implementation strategies to reduce their incidence. What does this paper add? This paper informs health policy and decision makers about the costs and consequences for a local...
Bussabawalai, T, Thiboonboon, K & Teerawattananon, Y 2019, 'Cost-utility analysis of adjuvant imatinib treatment in patients with high risk of recurrence after gastrointestinal stromal tumour (GIST) resection in Thailand', Cost Effectiveness and Resource Allocation, vol. 17, no. 1.
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© 2019 The Author(s). Background: Many patients develop tumour recurrence within a few years after undergoing surgical resection of gastrointestinal stromal tumours (GIST). Adjuvant imatinib treatment is recommended for patients with high risk of GIST recurrence as it can improve recurrence-free survival and overall survival of patients. This study aims to assess the cost-utility of adjuvant imatinib in patients with high risk of GIST recurrence after surgery compared with no adjuvant therapy in Thailand. Methods: A Markov model was developed to estimate lifetime costs and outcomes of using adjuvant imatinib treatment and other treatment alternatives if recurrence occurred compared with the current situation of no adjuvant therapy in high-risk patients after surgery. A 1-month cycle length was deployed in the model. Transition probabilities were derived from literature review. Costs were collected and calculated for the year 2014 from a societal perspective. Future costs and outcomes were discounted at 3% per year. One-way and probabilistic sensitivity analyses were conducted to assess parameter uncertainties. Results: Three years of adjuvant imatinib treatment followed by imatinib treatment and best supportive care if recurrence occurred after or during adjuvant therapy, respectively, was the best option as it produced more health outcomes (1.23 life years (LYs) and 1.16 quality-adjusted life years (QALYs)) compared to no adjuvant therapy while yielding the lowest incremental cost-effectiveness ratio (ICER) of 1,648,801 Thai Baht (THB) per QALY gained. Three years of adjuvant imatinib treatment followed by sunitinib treatment if recurrence occurred had an ICER of 2,608,264 THB per QALY gained compared to the best option, while other options were dominated. A one-way sensitivity analysis showed that the utility of patients receiving adjuvant imatinib had the greatest effect on the model, followed by the discount rate and probability of GIST recurrence. ...
Carrington, A, Dewar, S, Kinchin, I, Cadet-James, Y & Tsey, K 2019, 'A police-led community response to Child abuse and Youth Sexual Violence and Abuse in Indigenous communities in Far North Queensland: “Speak Up. Be strong. Be Heard.”', Child Abuse & Neglect, vol. 98, pp. 104228-104228.
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Cheung, JMY, Bartlett, DJ, Armour, CL, Laba, T-L & Saini, B 2019, 'Patient Perceptions of Treatment Delivery Platforms for Cognitive Behavioral Therapy for Insomnia', Behavioral Sleep Medicine, vol. 17, no. 1, pp. 81-97.
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© 2018, © 2018 Taylor & Francis Group, LLC. Objective: Stepped care has given rise to the proliferation of abbreviated CBT-I programs and delivery formats. This includes interventions delivered by allied health professionals and those delivered electronically through the Internet. This article aims to explore patient perceptions between electronic and face-to-face (FTF) delivery platforms for (abbreviated) CBT-I. Participants: Patients with insomnia from specialist sleep or psychology clinics and those from the general community in Sydney, Australia. Method: Semistructured interviews were conducted with patients with insomnia, guided by a schedule of questions and a choice task to explore patient perceptions of the different CBT-I treatment delivery platforms (e.g., perceived advantages and disadvantages or willingness to engage with either platform). Interviews were transcribed verbatim and analyzed using Framework Analysis. Participants also completed a battery of clinical mood and insomnia measures. Results: Fifty-one interviews were conducted with patients with insomnia from specialist sleep or psychology clinics (n = 22) and the general community (n = 29). Synthesis of the qualitative data set revealed three themes pertinent to the patients’ perspective toward electronic and FTF CBT-I delivery: Concepts of Efficacy, Concerns About Treatment, and Treatment on My Terms. Participants’ choice to engage with either platform was also informed by diverse factors including perceived efficacy of treatment, personal commitments, lifestyle, and beliefs about sleep and insomnia. Conclusion: Clarifying patient treatment priorities and allaying potential concerns about engaging with an electronic treatment platform represent important steps for disseminating eCBT-I into mainstream practice.
Cumming, TB, Churilov, L, Collier, J, Donnan, G, Ellery, F, Dewey, H, Langhorne, P, Lindley, RI, Moodie, M, Thrift, AG & Bernhardt, J 2019, 'Early mobilization and quality of life after stroke', Neurology, vol. 93, no. 7, pp. e717-e728.
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ObjectiveTo determine whether early and more frequent mobilization after stroke affects health-related quality of life.MethodsA Very Early Rehabilitation Trial (AVERT) was an international, multicenter (56 sites), phase 3 randomized controlled trial, spanning 2006–2015. People were included if they were aged ≥18 years, presented within 24 hours of a first or recurrent stroke (ischemic or hemorrhagic), and satisfied preordained physiologic criteria. Participants were randomized to usual care alone or very early and more frequent mobilization in addition to usual care. Quality of life at 12 months was a prespecified secondary outcome, evaluated using the Assessment of Quality of Life 4D (AQoL-4D). This utility-weighted scale has scores ranging from −0.04 (worse than death) to 1 (perfect health). Participants who died were assigned an AQoL-4D score of 0.ResultsNo significant difference in quality of life at 12 months between intervention (median 0.47, interquartile range [IQR] 0.07–0.81) and usual care (median 0.49, IQR 0.08–0.81) groups was identified (p = 0.86), nor were there any group differences across the 4 AQoL-4D domains. The same lack of group difference in quality of life was observed at 3 months. When cohort data were analyzed (both groups together), quality of life was strongly associated with acute length of stay, independence in activities of daily living, cognitive function, depressive symptoms, and anxiety symptoms (all p < 0.001). Quality of life in AVERT participants was substantially lower than population norms, and the gap increased with age.ConclusionsEarlier and more frequent mobilization after stroke did not influence quality of life.
De Abreu Lourenco, R & Williams, S 2019, 'Health Technology Assessment and Health Care Utilisation in the Management of Early Prostate Cancer', European Urology Focus, vol. 5, no. 2, pp. 134-136.
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© 2018 European Association of Urology Health technology assessment (HTA) is a key tool used to allocate health care funding. A critical aspect of HTA is the performance of economic evaluations that compare the costs and outcomes for competing therapies; these typically rely on data from clinical trials. For early prostate cancer, this represents a challenge, as long-term survival and quality-of-life effects—key outcomes in such evaluations—may require a decade or more of follow-up. Thus, identification of early or intermediate measures of benefit is critical. Systematic reviews of economic evaluations in prostate cancer show that understanding the links between intermediate and final outcomes is important for confidence in assessments of what represents value for money. This highlights the importance of efforts to identify and validate intermediate clinical endpoints for use in determining clinical benefit, and hence value for money, in early prostate cancer. Patient summary: As the costs of providing care rise, the challenge is to ensure that we achieve value for money. In this brief review, we note the importance of clinical trial data in understanding what represents value for money and we highlight current efforts to identify measures that can be used to make decisions on treatment funding sooner.
De Abreu Lourenço, R, Haas, M, Hall, J, Parish, K, Stuart, D & Viney, R 2019, 'My mind is made up: Cancer concern and women’s preferences for contralateral prophylactic mastectomy', European Journal of Cancer Care, vol. 28, no. 4, pp. e13058-e13058.
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© 2019 John Wiley & Sons Ltd The fear of cancer recurrence is cited as a motivator of women's preferences between routine monitoring and contralateral prophylactic mastectomy (CPM) as methods of managing ongoing breast cancer risk. We conducted a discrete choice experiment among a general community sample of women who completed 12 hypothetical choices between routine monitoring and CPM described by aspects of treatment efficacy, safety, cost and involvement in decision-making. Respondents also completed a modified cancer worry question to assess cancer concern. Approximately 57.5% of 464 women always chose one option, typically routine monitoring. The majority (71.5%) reported being concerned about cancer recurrence when completing choice tasks. Latent class analysis identified three groups: preferred routine monitoring; preferred CPM; and “traders” (willing to swap between options). Among traders, women were less likely to choose an option associated with higher risk of recurrence. Women were more likely to choose options associated with less-intrusive monitoring methods and where they were involved in decision-making. Women concerned about cancer recurrence were more likely to choose CPM over monitoring. This study shows that women's preferences about how to manage breast cancer recurrence risk reflect the importance of the associated health effects, experience of care and attitudes to cancer recurrence.
Devlin, NJ, Shah, KK, Mulhern, BJ, Pantiri, K & van Hout, B 2019, 'A new method for valuing health: directly eliciting personal utility functions', The European Journal of Health Economics, vol. 20, no. 2, pp. 257-270.
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© 2018, The Author(s). Background: Standard methods for eliciting the preference data upon which ‘value sets’ are based generally have in common an aim to ‘uncover’ people’s preferences by asking them to evaluate a subset of health states, then using their responses to infer their preferences over all dimensions and levels. An alternative approach is to ask people directly about the relative importance to them of the dimensions, levels and interactions between them. This paper describes a new stated preference approach for directly eliciting personal utility functions (PUFs), and reports a pilot study to test its feasibility for valuing the EQ-5D. Methods: A questionnaire was developed, designed to directly elicit PUFs from general public respondents via computer-assisted personal interviews, with a focus on helping respondents to reflect and deliberate on their preferences. The questionnaire was piloted in England. Results: Seventy-six interviews were conducted in December 2015. Overall, pain/discomfort and mobility were found to be the most important of the EQ-5D dimensions. The ratings for intermediate improvements in each dimension show heterogeneity, both within and between respondents. Almost a quarter of respondents indicated that no EQ-5D health states are worse than dead. Discussion: The PUF approach appears to be feasible, and has the potential to yield meaningful, well-informed preference data from respondents that can be aggregated to yield a value set for the EQ-5D. A deliberative approach to health state valuation also has the potential to complement and develop existing valuation methods. Further refinement of some elements of the approach is required.
Doran, CM & Kinchin, I 2019, 'A review of the economic impact of mental illness', Australian Health Review, vol. 43, no. 1, pp. 43-43.
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ObjectiveTo examine the impact and cost associated with mental illness.MethodsA rapid review of the literature from Australia, New Zealand, UK and Canada was undertaken. The review included literature pertaining to the cost-of-illness and impact of mental illness as well as any modelling studies. Included studies were categorised according to impact on education, labour force engagement, earlier retirement or welfare dependency. The well-accepted Drummond 10-point economic appraisal checklist was used to assess the quality of the studies.ResultsA total of 45 methodologically diverse studies were included. The studies highlight the significant burden mental illness places on all facets of society, including individuals, families, workplaces and the wider economy. Mental illness results in a greater chance of leaving school early, a lower probability of gaining full-time employment and a reduced quality of life. Research from Canada suggests that the total economic costs associated with mental illness will increase six-fold over the next 30 years with costs likely to exceed A$2.8 trillion (based on 2015 Australian dollars).ConclusionsMental illness is associated with a high economic burden. Further research is required to develop a better understanding of the trajectory and burden of mental illness so that resources can be directed towards cost-effective interventions.What is known about the topic?Although mental illness continues to be one of the leading contributors to the burden of disease, there is limited information on the economic impact that mental illness imposes on individuals, families, workplaces and the wider economy.What does this paper add?This review provides a summary of the economic impact and cost of mental illness. The included literature highlights the significant burden mental illness places on individuals, families, workplaces, society and the economy in general. The review identified several areas for impr...
Du, W, Gnjidic, D, Pearson, S-A, Hilmer, SN, McLachlan, AJ, Blyth, F, Viney, R, Joshy, G, Day, C & Banks, E 2019, 'Patterns of high-risk prescribing and other factors in relation to receipt of a home medicines review: a prospective cohort investigation among adults aged 45 years and over in Australia', BMJ Open, vol. 9, no. 2, pp. e027305-e027305.
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ObjectivesTo quantify the relationship between home medicines review (HMR) receipt in older adults and sociodemographic, medication-related and health factors.DesignProspective cohort analysis.Settings, participants, measurementsQuestionnaire data from a population-based cohort study of individuals aged ≥45 years, Sydney, Australia were linked with primary healthcare data, medication and hospitalisation data, to ascertain factors associated with HMR receipt during the period July 2009–June 2014. Medication-related factors included exposure to five and more medications (polypharmacy), narrow therapeutic index medicines, potentially inappropriate prescribing defined using Beers Criteria medicines, and anticholinergic and sedative drugs, defined using the Drug Burden Index (DBI). Poisson and Cox regression models were used to evaluate HMR receipt in relation to sociodemographic, behavioural and health characteristics, and time-varying factors including medication use and hospitalisations.Primary outcomeHMR receipt during the 5-year study period.ResultsOver 5 years of follow-up, 4.7% (n=6115) of 131 483 participants received at least one HMR. Five-year HMR receipt was: 1.5% in people using <5 medications at baseline, 6.8% with 5–9 medications, 12.7% with ≥10 medications, 8.8% using Narrow Therapeutic Index medicines, 6.8% using Beers Criteria potentially inappropriate medicines and 7.4% using DBI medicines. Age-sex stratified HRs for HMR receipt were 6.07 (95% CI: 5.58 to 6.59) and 12.46 (11.42 to 13.59) for concurrent use of 5–9 and ≥10 versus <5 medications, respectively. The age-sex adjusted rate ratio for HMR receipt was 2.65 (2.51 to 2.80) with poor versus ...
Duffield, C, Gardner, G, Doubrovsky, A & Wise, S 2019, 'Manager, clinician or both? Nurse managers' engagement in clinical care activities', Journal of Nursing Management, vol. 27, no. 7, pp. 1538-1545.
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© 2019 John Wiley & Sons Ltd Aim: To explore the extent of Australian nurse managers' engagement in clinical care activities. Background: Hybrid nurse manager roles lack clarity in the optimal balance between the clinical and other activities, resulting in stress and challenges in recruiting and retaining nurse managers. Methods: In a national survey using the Advanced Practice Role Delineation tool, Australian nurses self-assessed their level of engagement in activities across five domains of nursing practice. The subset sample analysed comprised 2,758 registered nurses, 390 clinical (front-line) nurse managers and 43 organisational (middle) nurse managers. Median domain scores were compared with non-parametric tests of difference. Results: Clinical nurse managers were in a hybrid role, reporting high levels of engagement across the domains. Lower scores observed for organisational nurse managers highlight the shift to strategy-focussed activities that occurs as nurses up the management hierarchy. Conclusions: By indicating their engagement in the clinical care domain, respondents demonstrated that clinically focused activities were not entirely lost from either front-line or middle-management roles. Implications for Nursing Management: Nurse managers equipped with clinical and management skills, and allowed time to remain engage in clinical care activities are critical for patient-centred and cost-effective care in today's complex health care environments.
Duffield, C, Twigg, D, Roche, M, Williams, A & Wise, S 2019, 'Uncovering the Disconnect Between Nursing Workforce Policy Intentions, Implementation, and Outcomes: Lessons Learned From the Addition of a Nursing Assistant Role', Policy, Politics, & Nursing Practice, vol. 20, no. 4, pp. 228-238.
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The use of nursing assistants has increased across health systems in the past 20 years, to alleviate licensed nurses' workload and to meet rising health care demands at lower costs. Evidence suggests that, when used as a substitute for licensed nurses, assistants are associated with poorer patient and nurse outcomes. Our multimethods study evaluated the impact of a policy to add nursing assistants to existing nurse staffing in Western Australia's public hospitals, on a range of outcomes. In this article, we draw the metainferences from previously published quantitative data and unpublished qualitative interview data. A longitudinal analysis of patient records found significantly higher rates adverse patient outcomes on wards that introduced nursing assistants compared with wards that did not. These findings are explained with ward-level data that show nursing assistants were added to wards with preexisting workload and staffing problems and that those problems persisted despite the additional resources. There were also problems integrating assistants into the nursing team, due to ad hoc role assignments and variability in assistants' knowledge and skills. The disconnect between policy intention and outcomes reflects a top-down approach to role implementation where assistants were presented as a solution to nurses' workload problems, without an understanding of the causes of those problems. We conclude that policy makers and managers must better understand individual care environments to ensure any new roles are properly tailored to patient and staff needs. Further, standardized training and accreditation for nursing assistant roles would reduce the supervisory burden on licensed nurses.
Emery, JD, Murray, SR, Walter, FM, Martin, A, Goodall, S, Mazza, D, Habgood, E, Kutzer, Y, Barnes, DJ & Murchie, P 2019, 'The Chest Australia Trial: a randomised controlled trial of an intervention to increase consultation rates in smokers at risk of lung cancer', Thorax, vol. 74, no. 4, pp. 362-370.
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BackgroundInternational research has focused on screening and mass media campaigns to promote earlier patient presentation and detect lung cancer earlier. This trial tested the effect of a behavioural intervention in people at increased risk of lung cancer on help-seeking for respiratory symptoms.MethodsParallel, individually randomised controlled trial. Eligible participants were long-term smokers with at least 20 pack-years, aged 55 and above. The CHEST intervention entailed a consultation to discuss and implement a self-help manual, followed by self-monitoring reminders to encourage help-seeking for respiratory symptoms. The control group received a brief discussion about lung health. Both groups had baseline spirometry. Telephone randomisation was conducted, 1:1, stratified Medical Research Council (MRC) dyspnoea score and general practice. Participants could not be blinded; data extraction and statistical analyses were performed blinded to group assignment. The primary outcome was respiratory consultation rates.ResultsWe randomised 551 participants (274 intervention, 277 control) from whom the primary outcome was determined for 542 (269 intervention, 273 control). There was a 40% relative increase in respiratory consultations in the intervention group: (adjusted rates (95% CI) intervention 0.57 (0.47 to 0.70), control 0.41 (0.32 to 0.52), relative rate 1.40 (1.08 to 1.82); p=0.0123). There were no significant differences in time to first respiratory consultation, total consultation rates or measures of psychological harm. The incremental cost-effectiveness ratio was $A1289 per additional respiratory consultation.ConclusionsA behavioural intervention can significantly increase consulting for respiratory symptoms in patien...
Franklin, M, Mukuria, C, Mulhern, B, Tran, I, Brazier, J & Watson, S 2019, 'Measuring the Burden of Schizophrenia Using Clinician and Patient-Reported Measures: An Exploratory Analysis of Construct Validity', The Patient - Patient-Centered Outcomes Research, vol. 12, no. 4, pp. 405-417.
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Gardner, T, Refshauge, K, McAuley, J, Hübscher, M, Goodall, S & Smith, L 2019, 'Combined education and patient-led goal setting intervention reduced chronic low back pain disability and intensity at 12 months: a randomised controlled trial', British Journal of Sports Medicine, vol. 53, no. 22, pp. 1424-1431.
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BackgroundOne model of care that has not been tested for chronic low back pain (LBP) is patient-led goal setting. We aimed to compare the clinical effectiveness and healthcare use of a patient-led goal setting approach (intervention) with simple advice to exercise (control) over 12 months.MethodsAn assessor-blinded randomised controlled trial. Intervention was education combined with patient-led goal setting compared with a control group receiving a standardised exercise programme. The primary outcomes were back pain disability and pain intensity. Secondary outcomes were quality of life, kinesiophobia, self-efficacy, depression, anxiety and stress. Outcomes and healthcare use were assessed immediately post-treatment (2 months) and after 4 and 12 months. Analysis was by intention to treat.ResultsSeventy-five patients were randomly assigned to either the intervention (n=37) or the control (n=38) group. Using linear mixed model analyses, adjusted mean changes in primary outcomes of disability and pain intensity were greater in the intervention group than in the control group (disability post-treatment: p<0.05). These differences were clinically meaningful. Mean differences in all secondary measures were greater in the intervention group than in the control group (p<0.05). There was no difference in healthcare use between groups over 12 months.ConclusionA patient-led goal setting intervention was significantly more effective than advice to exercise for improving outcomes in disability, pain intensity, quality of life, self-efficacy and kinesiophobia in chronic LBP. These improvements were maintained at 12 months. Smaller effects were seen in measures of depression, anxiety and stress.
Hewitt, J, Saing, S, Goodall, S, Henwood, T, Clemson, L & Refshauge, K 2019, 'An economic evaluation of the SUNBEAM programme: a falls-prevention randomized controlled trial in residential aged care', Clinical Rehabilitation, vol. 33, no. 3, pp. 524-534.
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Objective: To estimate the cost-effectiveness of a strength and balance exercise programme (SUNBEAM) which has been shown to be clinically effective in reducing the rate of falls in residents of aged care facilities. Design: An economic evaluation was conducted alongside a pragmatic cluster randomized controlled trial that included 16 residential care facilities and 221 participants. Mean participant age was 86 years, 65% were female and 78% relied on a mobility aide. A cost-effectiveness analysis examined the costs of providing the exercise programme and costs of health service use arising from falls in each arm (intervention and usual care) over 12 months. Main measures: Incremental cost-effectiveness ratios were calculated for the cost per fall avoided. Costs were bootstrapped to obtain adjusted confidence intervals for the incremental cost-effectiveness ratios. Results: Of 63 facilities contacted, 16 met the eligibility criteria and were randomized to the intervention or usual care (1:1). There were 142 falls in the intervention group and 277 in the usual care group. 72 injurious falls occurred in the intervention group versus 157 with usual care. Delivery of the SUNBEAM programme cost $463 per participant. The mean total cost of each fall (regardless of group) was $400.09 and the mean cost of each injurious fall was $708.27. The incremental cost-effectiveness ratio was $22 per fall per person avoided with the mean bootstrapped incremental cost-effectiveness ratio $18 per fall avoided (95% CI: −$380.34 to $417.85). Conclusion: The SUNBEAM programme can be considered cost-effective, relative to other fall-prevention interventions in older adults.
Holleman, MS, Uyl-de Groot, CA, Goodall, S & van der Linden, N 2019, 'Determining the Comparative Value of Pharmaceutical Risk-Sharing Policies in Non–Small Cell Lung Cancer Using Real-World Data', Value in Health, vol. 22, no. 3, pp. 322-331.
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Kemmler, G, Gamper, E, Nerich, V, Norman, R, Viney, R, Holzner, B & King, M 2019, 'German value sets for the EORTC QLU-C10D, a cancer-specific utility instrument based on the EORTC QLQ-C30', Quality of Life Research, vol. 28, no. 12, pp. 3197-3211.
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© 2019, The Author(s). Purpose: The EORTC QLU-C10D is a new multi-attribute utility instrument derived from the EORTC QLQ-C30, a widely used cancer-specific quality of life questionnaire. It covers ten dimensions: physical, role, social, emotional functioning, pain, fatigue, sleep, appetite, nausea, and bowel problems. To allow national health attitudes to be reflected, country-specific valuations are being performed by collaboration of the Multi-Attribute Utility Cancer (MAUCa) Consortium and the EORTC. The purpose of this paper is to provide German value sets (utility weights) for the QLU-C10D. Methods: Valuations were run in a web-based setting in two general population samples of approximately 2000 adults in total. As the German version of the QLQ-C30 is presently undergoing a revision of the wording of one response category, valuations for both the current and the new version were performed (Germany 1 and 2). Utilities were elicited using a discrete choice experiment (DCE). Data were analyzed by conditional logistic regression and mixed logits. Results: Completion rates were 88.3% (1002/1135) and 90.4% (1016/1124) for Germany 1 and Germany 2 valuations, respectively. Dimensions with the largest impact on utility weights were, in this order: physical functioning, pain, role functioning, social functioning and nausea (same ordering for both German versions). Several violations of the logical ordering of levels were observed for Germany 1; this was largely improved for Germany 2. Conclusion: This study established German utility weights for the cancer-specific utility instrument QLU-C10D.
Kim, H, Goodall, S & Liew, D 2019, 'Health Technology Assessment Challenges in Oncology: 20 Years of Value in Health', Value in Health, vol. 22, no. 5, pp. 593-600.
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Kinchin, I, Russell, AMT, Tsey, K, Jago, J, Wintzloff, T, Meurk, C & Doran, CM 2019, 'Psychiatric inpatient cost of care before and after admission at a residential subacute step-up/step-down mental health facility', Journal of Medical Economics, vol. 22, no. 5, pp. 491-498.
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BACKGROUND:Residential step-up/step-down services provide transitional care and reintegration into the community for individuals experiencing episodes of subacute mental illness. This study aims to examine psychiatric inpatient admissions, length of stay, and per capita cost of care following the establishment of a step-up/step-down Prevention And Recovery Care (PARC) facility in regional Australia. METHODS:This was a pragmatic before and after study set within a participatory action research methodology. The target sample comprised patients at a PARC facility over 15 months. Six-month individual level data prior to study entry, during, and over 6-months from study exit were examined using patient activity records. Costs were expressed in 2015-2016AU$. RESULTS:An audit included 192 people experiencing 243 episodes of care represented by males (58%), mean age = 39.3 years (SD = 12.7), primarily diagnosed with schizophrenia (48%) or mood disorders (30%). The cost of 1 day in a psychiatric inpatient unit was found to be comparable to an average of 5 treatment days in PARC; the mean cost difference per-bed day (AU$1,167) was associated with fewer and shorter inpatient stays. Reduced use of inpatient facility translated into an opportunity cost of improved patient flow equivalent to AU$12,555 per resident (bootstrapped 95% CI = $5,680-$19,280). More noticeable outcomes were observed among those who stayed in PARC for longer during index admission (rs = 0.16, p = 0.024), who have had more and lengthy inpatient stays (rs = 0.52, p < 0.001 and rs = 0.69, p < 0.001), and those who stepped-down from the hospital (p < 0.001). This information could be proactively used within step-up/step-down services to target care to patients most likely to benefit. Despite early evidence of positive association, the results warrant further investigation using an experimental study design with alongside economic evaluation. CONCLUSION:Efforts should be directed toward the adoption of cost...
Laba, T-L, Jan, S, Zwar, NA, Roughead, E, Marks, GB, Flynn, AW, Goldman, MD, Heaney, A, Lembke, KA & Reddel, HK 2019, 'Cost-Related Underuse of Medicines for Asthma—Opportunities for Improving Adherence', The Journal of Allergy and Clinical Immunology: In Practice, vol. 7, no. 7, pp. 2298-2306.e12.
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BACKGROUND:In asthma, underuse of cost-effective preventive treatments increases morbidity and mortality. The cost of medicines contributes to underuse ("nonadherence"), but the extent to which people with asthma skip or reduce doses or let prescriptions go unfilled when faced with cost pressures is unknown. OBJECTIVE:To estimate the extent of cost-related underuse behaviors and associated factors. METHODS:Using previously validated summary indicators, we conducted an online cross-sectional survey of adults and parents of children 5 to 17 years with asthma in Australia (a high-income country) and developed logistic regression models for adults and children with asthma, controlling for key clinical and demographic factors. RESULTS:The survey was completed by n = 792 adults (mean age, 47 [standard deviation, 17] years, male 47%, concession 60%) and n = 609 parents of children (5-10 years 51%, male 60%, concession 59%) with asthma. Cost-related underuse was reported by 52.9% adults and 34.3% parents, predominantly decreasing or skipping doses to make medicines last longer. Higher odds of cost-related underuse were observed with younger adults (adults: odds ratio [OR]: 1.19; 95% confidence interval [CI]: 1.12, 1.27), males (adults: OR: 1.49; 95% CI: 1.06, 2.08), having concerns about medicines (adults: OR: 3.12; 95% CI: 2.17, 4.35; parents: OR: 2.63; 95% CI: 1.56, 4.55), less comfortable talking to prescribers about cost (parents: OR: 1.22; 95% CI: 1.12, 1.33) or changing medicines (adults: OR: 1.12; 95% CI: 1.03, 1.22), feeling less engaged with prescribers about medicine decisions (parents: OR: 1.11; 95% CI: 1.01, 1.23), and with poorer asthma control (adults, poor control: OR: 1.87; 95% CI: 1.13, 3.09; parents, poor control: OR: 3.87; 95% CI: 1.99, 7.54), and requiring specialist (parents: OR: 1.83; 95% CI: 1.16, 2.87) or urgent health care visits (adults: OR: 1.54; 95% CI: 1.06, 2.23). Income and concession card status were not associated with cost-related underu...
Laba, T-L, Reddel, HK, Zwar, NJ, Marks, GB, Roughead, E, Flynn, A, Goldman, M, Heaney, A, Lembke, K & Jan, S 2019, 'Does a Patient-Directed Financial Incentive Affect Patient Choices About Controller Medicines for Asthma? A Discrete Choice Experiment and Financial Impact Analysis', PharmacoEconomics, vol. 37, no. 2, pp. 227-238.
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Law, MR, Cheng, L, Worthington, H, Majumdar, SR, McGrail, KM, Chan, F, Laba, T-L & Mamdani, M 2019, 'Impact of a household-level deductible on prescription drug use among lower-income adults: a quasi-experimental study', CMAJ Open, vol. 7, no. 1, pp. E167-E173.
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BACKGROUND: Several Canadian public drug plans have income-based deductibles, but we have limited data on their impact, particularly for vulnerable populations. Therefore, we studied the impact of deductibles in British Columbia's Fair PharmaCare program on drug use among lower-income adults. METHODS: We used a quasi-experimental regression discontinuity design to study the impact of BC rules that impose no deductible before receiving public coverage on households with incomes less than $15 000, a deductible of 2% of household income on those with incomes between $15 000 and $30 000, and a deductible of 3% of household income on those with incomes above $30 000. We studied the impact of these thresholds on public and total drug expenditures between 2003 and 2015 using 24 million person-years of data. RESULTS: Both thresholds decreased the proportion of beneficiaries receiving benefits, by 0.33 (95% confidence interval [CI] -0.34 to -0.30) and 0.05 (95% CI -0.064 to -0.032) respectively. There were also substantial reductions in the extent of public drug plan expenditures ($59.94 [95% CI -74.74 to -45.14] and $26.12 [95% CI -39.78 to -12.46], respectively). The change at the $15 000 threshold reduced patient drug expenditures by $26.00 (95% CI -45.48 to -6.51), or 7.2%. In contrast, we found no statistically significant change in total expenditures when households moved from a deductible of 2% to 3% at the $30 000 threshold. INTERPRETATION: Income-based deductibles considerably affected the extent of public subsidy for prescription drugs. For lower-income households making around $15 000, the deductible led to a reduction of 7.2% in overall drug use and costs. Although deductibles are a useful tool to limit public expenditures, policy-makers should be cautious in their use among vulnerable populations.
Liu, D, Green, E, Kasteridis, P, Goddard, M, Jacobs, R, Wittenberg, R & Mason, A 2019, 'Incentive schemes to increase dementia diagnoses in primary care in England: a retrospective cohort study of unintended consequences', British Journal of General Practice, vol. 69, no. 680, pp. e154-e163.
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BackgroundThe UK government introduced two financial incentive schemes for primary care to tackle underdiagnosis in dementia: the 3-year Directed Enhanced Service 18 (DES18) and the 6-month Dementia Identification Scheme (DIS). The schemes appear to have been effective in boosting dementia diagnosis rates, but their unintended effects are unknown.AimTo identify and quantify unintended consequences associated with the DES18 and DIS schemes.Design and settingA retrospective cohort quantitative study of 7079 English primary care practices.MethodPotential unintended effects of financial incentive schemes, both positive and negative, were identified from a literature review. A practice-level dataset covering the period 2006/2007 to 2015/2016 was constructed. Difference-in-differences analysis was employed to test the effects of the incentive schemes on quality measures from the Quality and Outcomes Framework (QOF); and four measures of patient experience from the GP Patient Survey (GPPS): patient-centred care, access to care, continuity of care, and the doctor–patient relationship. The researchers controlled for effects of the contemporaneous hospital incentive scheme for dementia and for practice characteristics.ResultsNational practice participation rates in DES18 and DIS were 98.5% and 76% respectively. Both schemes were associated not only with a positive impact on QOF quality outcomes, but also with negative impacts on some patient experience indicators.ConclusionThe primary care incentive schemes for dementia appear to have enhanced QOF performance for the dementia review, and have had beneficial spil...
Liu, D, Mason, A, Marks, L, Davis, H, Hunter, DJ, Jehu, LM, Smithson, J & Visram, S 2019, 'Effects of local authority expenditure on childhood obesity', European Journal of Public Health, vol. 29, no. 4, pp. 785-790.
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Abstract Background Under the 2013 reforms introduced by the Health and Social Care Act (2012), public health responsibilities in England were transferred from the National Health Service to local authorities (LAs). Ring-fenced grants were introduced to support the new responsibilities. The aim of our study was to test whether the level of expenditure in 2013/14 affected the prevalence of childhood obesity in 2016/17. Methods We used National Child Measurement Programme definitions of childhood obesity and datasets. We used LA revenue returns data to derive three measures of per capita expenditure: childhood obesity (<19); physical activity (<19) and the Children’s 5–19 Public Health Programme. We ran separate negative binomial models for two age groups of children (4–5 year olds; 10–11 year olds) and conducted sensitivity analyses. Results With few exceptions, the level of spend in 2013/14 was not significantly associated with the level of childhood obesity in 2016/17. We identified some positive associations between spend on physical activity and the Children’s Public Health Programme at baseline (2013/14) and the level of childhood obesity in children aged 4–5 in 2016/17, but the effect was not evident in children aged 10–11. In both age groups, LA levels of childhood obesity in 2016/17 were significantly and positively associated with obesity levels in 2013/14. As these four cohorts comprise entirely different pupils, this underlines the importance of local drivers of childhood obesity.
Liu, H, Mohammed, A, Shanthosh, J, News, M, Laba, T-L, Hackett, ML, Peiris, D & Jan, S 2019, 'Process evaluations of primary care interventions addressing chronic disease: a systematic review', BMJ Open, vol. 9, no. 8, pp. e025127-e025127.
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ObjectiveProcess evaluations (PEs) alongside randomised controlled trials of complex interventions are valuable because they address questions of for whom, how and why interventions had an impact. We synthesised the methods used in PEs of primary care interventions, and their main findings on implementation barriers and facilitators.DesignSystematic review using the UK Medical Research Council guidance for PE as a guide.Data sourcesAcademic databases (MEDLINE, SCOPUS, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, EMBASE and Global Health) were searched from 1998 until June 2018.Eligibility criteriaWe included PE alongside randomised controlled trials of primary care interventions which aimed to improve outcomes for patients with non-communicable diseases.Data extraction and synthesisTwo independent reviewers screened and conducted the data extraction and synthesis, with a third reviewer checking a sample for quality assurance.Results69 studies were included. There was an overall lack of consistency in how PEs were conducted and reported. The main weakness is that only 30 studies were underpinned by a clear intervention theory often facilitated by the use of existing theoretical frameworks. The main strengths were robust sampling strategies, and the triangulation of qualitative and quantitative data to understand an intervention’s mechanisms. Findings were synthesised into three key themes: (1) a fundamental mismatch between what the intervention was designed to achieve and local needs; (2) the required roles and responsibilities of key actors were often not clearly understood; and...
Lung, T, Jan, S, de Silva, HA, Guggilla, R, Maulik, PK, Naik, N, Patel, A, de Silva, AP, Rajapakse, S, Ranasinghe, G, Prabhakaran, D, Rodgers, A, Salam, A, Selak, V, Stepien, S, Thom, S, Webster, R & Lea-Laba, T 2019, 'Fixed-combination, low-dose, triple-pill antihypertensive medication versus usual care in patients with mild-to-moderate hypertension in Sri Lanka: a within-trial and modelled economic evaluation of the TRIUMPH trial', The Lancet Global Health, vol. 7, no. 10, pp. e1359-e1366.
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© 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license Background: Elevated blood pressure incurs a major health and economic burden, particularly in low-income and middle-income countries. The Triple Pill versus Usual Care Management for Patients with Mild-to-Moderate Hypertension (TRIUMPH) trial showed a greater reduction in blood pressure in patients using fixed-combination, low-dose, triple-pill antihypertensive therapy (consisting of amlodipine, telmisartan, and chlorthalidone) than in those receiving usual care in Sri Lanka. We aimed to assess the cost-effectiveness of the triple-pill strategy. Methods: We did a within-trial (6-month) and modelled (10-year) economic evaluation of the TRIUMPH trial, using the health system perspective. Health-care costs, reported in 2017 US dollars, were determined from trial records and published literature. A discrete-time simulation model was developed, extrapolating trial findings of reduced systolic blood pressure to 10-year health-care costs, cardiovascular disease events, and mortality. The primary outcomes were the proportion of people reaching blood pressure targets (at 6 months from baseline) and disability-adjusted life-years (DALYs) averted (at 10 years from baseline). Incremental cost-effectiveness ratios were calculated to estimate the cost per additional participant achieving target blood pressure at 6 months and cost per DALY averted over 10 years. Findings: The triple-pill strategy, compared with usual care, cost an additional US$9·63 (95% CI 5·29 to 13·97) per person in the within-trial analysis and $347·75 (285·55 to 412·54) per person in the modelled analysis. Incremental cost-effectiveness ratios were estimated at $7·93 (95% CI 6·59 to 11·84) per participant reaching blood pressure targets at 6 months and $2842·79 (−28·67 to 5714·24) per DALY averted over a 10-year period. Interpretation: Compared with usual care, the triple-pill strate...
Lynch, M, De Abreu Lourenco, R, Flattery, M & Haas, M 2019, 'Reviewing the cost‐effectiveness of long‐acting reversible contraceptive methods in an Australian context', Australian and New Zealand Journal of Obstetrics and Gynaecology, vol. 59, no. 1, pp. 21-35.
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BackgroundRelative to the oral contraceptive pill, uptake of long‐acting reversible contraceptive methods (LARCs) in Australia continues to be lower than might be suggested by the evidence on their clinical and economic benefits.AimTo undertake a critical appraisal of published economic evaluations of LARCs to assess the generalisability of their results to the Australian healthcare context.Materials and MethodsA search of the literature was conducted to identify studies of economic evaluations of LARCs using the Medline, Embase and PubMed databases. The quality of the studies was evaluated using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist.ResultsA total of 1009 citations were screened, from which 20 papers, typically reporting the cost per pregnancy avoided, were reviewed. The overall quality of the studies varied but was generally poor (average score of 62/100). To aid comparisons, results have been grouped under the headings IUS (all hormonal intrauterine systems), IUDs (all non‐hormonal intrauterine devices), injectables (all contraceptive injections) and implants (all subdermal contraceptive implants). Overall, the results indicated that LARCs were more effective and less costly than oral contraceptives.Conclusions<...
MacManus, M, De Abreu Lourenco, R & Hegi-Johnson, F 2019, 'Helping patients with lung cancer choose between surgery or stereotactic body radiotherapy: the importance of the patient experience', Journal of Thoracic Disease, vol. 11, no. 11, pp. 4404-4407.
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Martin, A, Mulhern, B, Shaikh, A, Asghar, S, O'Hara, J, Pedra, G, Sawyer, EK & Li, NN 2019, 'Disease State Adaptation Experienced By Patients with Hemophilia: Literature Review and Expert Consensus', Blood, vol. 134, no. Supplement_1, pp. 5801-5801.
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Introduction Hemophilia is an inherited disorder that causes a deficiency of a blood clotting factor resulting in a lifelong bleeding diathesis. People with hemophilia (PWH) may experience significant morbidity including potentially life-threatening hemorrhages and accumulation of joint damage and require burdensome and costly chronic treatment with factor replacement therapies. Gene therapies aimed at providing endogenous production of the missing clotting factor have the potential to yield significant health benefits for PWH. Economic evaluation is an important component for the commissioning and funding of new treatments like gene therapies. In economic evaluation, quality-of-life (QoL) is measured using health state utility valuations (HSUV). However, people with inherited and long-term health conditions may adapt to their given health state and adjust their expectations, therefore biasing the estimates of QoL/HSUV (i.e., disease state adaptation (DSA) or 'disability paradox'; Albrecht and Devlieger, 1999). Here, we describe the first stages of research to evaluate DSA experienced by PWH. Methods To facilitate the selection of research methodology, a systematic litearure review (SLR) was performed to examine existing studies on QoL/HSUVs for PWH. A SLR was conducted to identify full-text studies by searching electronic databases (e.g. MEDLINE, Web of Science, Cochrane Library). Studies were included in the review using predefined inclusion/exclusion criteria for population, study type, language (English). Additionally, a manual search (last three years) for conferences abstracts was performed to capture the most up-to-date research. Findings from the SLR informed the conceptualisation of a study framework. The proposed research approach was then discussed with an expert panel consisting of clinicians, patient advoca...
McTaggart-Cowan, H, King, MT, Norman, R, Costa, DSJ, Pickard, AS, Regier, DA, Viney, R & Peacock, SJ 2019, 'The EORTC QLU-C10D: The Canadian Valuation Study and Algorithm to Derive Cancer-Specific Utilities From the EORTC QLQ-C30', MDM Policy & Practice, vol. 4, no. 1, pp. 238146831984253-238146831984253.
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Objective. The EORTC QLQ-C30 is widely used for assessing quality of life in cancer. However, QLQ-C30 responses cannot be incorporated in cost-utility analysis because they are not based on general population’s preferences, or utilities. To overcome this limitation, the QLU-C10D, a cancer-specific utility algorithm, was derived from the QLQ-C30. The aim of this study was to obtain Canadian population utility weights for the QLU-C10D. Methods. Respondents from a Canadian research panel expressed their preferences for 16 choice sets in an online discrete choice experiment. Each choice set consisted of two health states described by the 10 QLU-C10D domains plus an attribute representing duration of survival. Using a conditional logit model, responses were converted into utility decrements by evaluating the marginal rate of substitution between each QLU-C10D domain level with respect to duration. Results. A total of 3,363 individuals were recruited. A total of 2,345 completed at least one choice set and 2,271 completed all choice sets. The largest utility decrements were associated with the worse levels of Physical Functioning (−0.24), Pain (−0.18), Role Functioning (−0.15), Emotional Functioning (−0.12), and Nausea (−0.12). The remaining domains and levels had decrements of −0.05 to −0.09. The utility of the worst possible health state was −0.15. Conclusion. Respondents from the general population were most concerned with generic health domains, but Nausea and Bowel Problems also had an impact on the individual’s utility. It is unclear as to whether cancer-specific domains will affect cost-utility analysis when evaluating cancer treatments; this will be tested in the next phase of the study.
Mitchell, BG, Hall, L, White, N, Barnett, AG, Halton, K, Paterson, DL, Riley, TV, Gardner, A, Page, K, Farrington, A, Gericke, CA & Graves, N 2019, 'An environmental cleaning bundle and health-care-associated infections in hospitals (REACH): a multicentre, randomised trial', The Lancet Infectious Diseases, vol. 19, no. 4, pp. 410-418.
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© 2019 Elsevier Ltd Background: The hospital environment is a reservoir for the transmission of microorganisms. The effect of improved cleaning on patient-centred outcomes remains unclear. We aimed to evaluate the effectiveness of an environmental cleaning bundle to reduce health care-associated infections in hospitals. Methods: The REACH study was a pragmatic, multicentre, randomised trial done in 11 acute care hospitals in Australia. Eligible hospitals had an intensive care unit, were classified by the National Health Performance Authority as a major hospital (public hospitals) or having more than 200 inpatient beds (private hospitals), and had a health-care-associated infection surveillance programme. The stepped-wedge design meant intervention periods varied from 20 weeks to 50 weeks. We introduced the REACH cleaning bundle, a multimodal intervention, focusing on optimising product use, technique, staff training, auditing with feedback, and communication, for routine cleaning. The primary outcomes were incidences of health-care-associated Staphylococcus aureus bacteraemia, Clostridium difficile infection, and vancomycin-resistant enterococci infection. The secondary outcome was the thoroughness of cleaning of frequent touch points, assessed by a fluorescent marking gel. This study is registered with the Australian and New Zealand Clinical Trial Registry, number ACTRN12615000325505. Findings: Between May 9, 2016, and July 30, 2017, we implemented the cleaning bundle in 11 hospitals. In the pre-intervention phase, there were 230 cases of vancomycin-resistant enterococci infection, 362 of S aureus bacteraemia, and 968 C difficile infections, for 3 534 439 occupied bed-days. During intervention, there were 50 cases of vancomycin-resistant enterococci infection, 109 of S aureus bacteraemia, and 278 C difficile infections, for 1 267 134 occupied bed-days. After the intervention, vancomycin-resistant enterococci infections reduced from 0·35 to 0·22 per 10 000 occupi...
Mulhern, B, Norman, R, De Abreu Lourenco, R, Street, D, Malley, J & Viney, R 2019, 'Investigating the relative value of health and social care related quality of life using a discrete choice experiment', Social Science and Medicine, vol. 233, pp. 28-37.
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Mulhern, B, Norman, R, Street, DJ & Viney, R 2019, 'One Method, Many Methodological Choices: A Structured Review of Discrete-Choice Experiments for Health State Valuation', PharmacoEconomics, vol. 37, no. 1, pp. 29-43.
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© 2018, Springer Nature Switzerland AG. Background: Discrete-choice experiments (DCEs) are used in the development of preference-based measure (PBM) value sets. There is considerable variation in the methodological approaches used to elicit preferences. Objective: Our objective was to carry out a structured review of DCE methods used for health state valuation. Methods: PubMed was searched until 31 May 2018 for published literature using DCEs for health state valuation. Search terms to describe DCEs, the process of valuation and preference-based instruments were developed. English language papers with any study population were included if they used DCEs to develop or directly inform the production of value sets for generic or condition-specific PBMs. Assessment of paper quality was guided by the recently developed Checklist for Reporting Valuation Studies. Data were extracted under six categories: general study information, choice task and study design, type of designed experiment, modelling and analysis methods, results and discussion. Results: The literature search identified 1132 published papers, and 63 papers were included in the review. Paper quality was generally high. The study design and choice task formats varied considerably, and a wide range of modelling methods were employed to estimate value sets. Conclusions: This review of DCE methods used for developing value sets suggests some recurring limitations, areas of consensus and areas where further research is required. Methodological diversity means that the values should be seen as experimental, and users should understand the features of the value sets produced before applying them in decision making.
Norman, R, Craig, BM, Hansen, P, Jonker, MF, Rose, J, Street, DJ & Mulhern, B 2019, 'Issues in the Design of Discrete Choice Experiments', The Patient - Patient-Centered Outcomes Research, vol. 12, no. 3, pp. 281-285.
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Norman, R, Mercieca‐Bebber, R, Rowen, D, Brazier, JE, Cella, D, Pickard, AS, Street, DJ, Viney, R, Revicki, D & King, MT 2019, 'U.K. utility weights for the EORTC QLU‐C10D', Health Economics, vol. 28, no. 12, pp. 1385-1401.
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AbstractThe EORTC QLU‐C10D is a new multi‐attribute utility instrument derived from the widely used cancer‐specific quality of life questionnaire, EORTC QLQ‐C30. It contains 10 dimensions (physical functioning, role functioning, social functioning, emotional functioning, pain, fatigue, sleep, appetite, nausea, bowel problems), each with four levels. The aim of this study was to provide U.K. general population utility weights for the QLU‐C10D.A U.K. online panel was quota‐sampled to align the sample to the general population proportions of sex and age (≥18 years). The online valuation survey included a discrete choice experiment (DCE). Each participant was asked to complete 16 choice‐pairs, each comprising two QLU‐C10D health states plus duration. DCE data were analysed using conditional logistic regression to generate utility weights.Data from 2,187 respondents who completed at least one choice set were included in the DCE analysis. The final U.K. QLU‐C10D utility weights comprised decrements for each level of each health dimension. For nine of the 10 dimensions (all except appetite), the expected monotonic pattern was observed across levels: Utility decreased as severity increased. For the final model, consistent monotonicity was achieved by merging inconsistent adjacent levels for appetite. The largest utility decrements were associated with physical functioning and pain. The worst possible health state (the worst level of each dimension) is −0.083, which is considered slightly worse than being dead.The U.K.‐specific utility weights will enable cost–utility analysis (CUA) for the economic evaluation of new oncology therapies and technologies in the United Kingdom, where CUA is commonly used to inform resource allocation.
Oliver, D & Yu, S 2019, 'The Australian labour market in 2018', Journal of Industrial Relations, vol. 61, no. 3, pp. 326-341.
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In 2018, the Australian labour market continued to see only very moderate wages growth despite strong employment growth and low unemployment. This remains an international phenomenon with underlying economic and legal structural causes. Employment growth was concentrated in part-time jobs for both males and females, and in both manufacturing and white-collar industries. The Fair Work Commission increased the National Minimum Wage by 3.5%, a higher percentage increase than previous years but one that reflected higher growth in average earnings and inflation. The climate surrounding agreement making was less febrile than in recent years, with fewer high-profile attempts to terminate existing enterprise agreements. However, collective bargaining coverage in the private sector continues to decline to historic lows. Changes to skilled migration were the most significant shift in labour market policy in 2018, with a significant reduction in the number of permanent skilled migrants and a new temporary skilled migrant visa category with much stricter eligibility requirements. If sustained, this reduction may contribute to increasing pressure on wages in the years to come.
Patel, AB, Kuhite, PN, Alam, A, Pusdekar, Y, Puranik, A, Khan, SS, Kelly, P, Muthayya, S, Laba, T, Almeida, MD & Dibley, MJ 2019, 'M‐SAKHI—Mobile health solutions to help community providers promote maternal and infant nutrition and health using a community‐based cluster randomized controlled trial in rural India: A study protocol', Maternal & Child Nutrition, vol. 15, no. 4, pp. e12850-e12850.
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AbstractReduction of childhood stunting is difficult to achieve by interventions that focus only on improving nutrition during infancy. Comprehensive interventions that extend through the continuum of care from pregnancy to infancy are needed. Mobile phones are now successfully being used for behaviour change communication to improve health. We present the methodology of an mHealth intervention “Mobile Solutions Aiding Knowledge for Health Improvement” (M‐SAKHI) to be delivered by rural community health workers or Accredited Social Health Activists (ASHAs) for rural women, below or up to 20 weeks of pregnancy through delivery until their infant is 12 months of age. This protocol paper describes the cluster randomized controlled trial to evaluate the effectiveness of M‐SAKHI. The primary objective of the trial is to reduce the prevalence of stunting (height‐for‐age < −2 z‐score) in children at 18 months of age by 8% in the intervention as compared with control. The secondary objectives include evaluating the impact on maternal dietary diversity, birth weight, infant and young child feeding practices, infant development, and child morbidity, along with a range of intermediate outcomes for maternal, neonatal, and infant health. A total of 297 ASHAs, five trained counsellors, and 2,501 participants from 244 villages are participating in this study. The outcome data are being collected by 51 field research officers. This study will provide evidence regarding the efficacy of M‐SAKHI to reduce stunting in young children in rural India, and if effective, the cost‐effectiveness of M‐SAKHI.
Prichard, R, Davidson, P, Goodall, S & Hayward, C 2019, 'Mind the Gap: Clinician Perceptions of Quality of Life in Advanced Heart Failure. What are We Missing?', Heart, Lung and Circulation, vol. 28, pp. S182-S182.
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Saing, S, Haywood, P, van der Linden, N, Manipis, K, Meshcheriakova, E & Goodall, S 2019, 'Real-World Cost Effectiveness of Mandatory Folic Acid Fortification of Bread-Making Flour in Australia', Applied Health Economics and Health Policy, vol. 17, no. 2, pp. 243-254.
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© 2019, Springer Nature Switzerland AG. Background: In 2009, mandatory folic acid fortification of bread-making flour was introduced in Australia to reduce the birth prevalence of preventable neural tube defects (NTDs) such as spina bifida. Before the introduction of the policy, modelling predicted a reduction of 14–49 NTDs each year. Objective: Using real-world data, this study provides the first ex-post evaluation of the cost effectiveness of mandatory folic acid fortification of bread-making flour in Australia. Methods: We developed a decision tree model to compare different fortification strategies and used registry data to quantify the change in NTD rates due to the policy. We adopted a societal perspective that included costs to industry and government as well as healthcare and broader societal costs. Results: We found 32 fewer NTDs per year in the post-mandatory folic acid fortification period. Mandatory folic acid fortification improved health outcomes and was highly cost effective because of the low intervention cost. The policy demonstrated improved equity in outcomes, particularly in birth prevalence of NTDs in births from teenage and indigenous mothers. Conclusions: This study calculated the value of mandatory folic acid fortification using real-world registry data and demonstrated that the attained benefit was comparable to the modelled expected benefits. Mandatory folic acid fortification (in addition to policies including advice on supplementation and education) improved equity in certain populations and was effective and highly cost effective for the Australian population.
Scarf, VL, Viney, R, Yu, S, Foureur, M, Rossiter, C, Dahlen, H, Thornton, C, Cheah, SL & Homer, CSE 2019, 'Mapping the trajectories for women and their babies from births planned at home, in a birth centre or in a hospital in New South Wales, Australia, between 2000 and 2012', BMC Pregnancy and Childbirth, vol. 19, no. 1, p. 513.
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Abstract Background In New South Wales (NSW) Australia, women at low risk of complications can choose from three birth settings: home, birth centre and hospital. Between 2000 and 2012, around 6.4% of pregnant women planned to give birth in a birth centre (6%) or at home (0.4%) and 93.6% of women planned to birth in a hospital. A proportion of the woman in the home and birth centre groups transferred to hospital. However, their pathways or trajectories are largely unknown. Aim The aim was to map the trajectories and interventions experienced by women and their babies from births planned at home, in a birth centre or in a hospital over a 13-year period in NSW. Methods Using population-based linked datasets from NSW, women at low risk of complications, with singleton pregnancies, gestation 37–41 completed weeks and spontaneous onset of labour were included. We used a decision tree framework to depict the trajectories of these women and estimate the probabilities of the following: giving birth in their planned setting; being transferred; requiring interventions and neonatal admission to higher level hospital care. The trajectories were analysed by parity. Results Over a 13-year period, 23% of nulliparous and 0.8% of multiparous women planning a home birth were transferred to hospital. In the birth centre group, 34% of nulliparae and 12% of multiparas were transferred to a hospital. Normal vaginal birth rates were higher in multiparous women compared to nulliparous women in all settings. Neonatal admission to SCN/NICU was highest in the...
Selak, V, Webster, R, Stepien, S, Bullen, C, Patel, A, Thom, S, Arroll, B, Bots, ML, Brown, A, Crengle, S, Dorairaj, P, Elley, CR, Grobbee, DE, Harwood, M, Hillis, GS, Laba, T-L, Neal, B, Peiris, D, Rafter, N, Reid, C, Stanton, A, Tonkin, A, Usherwood, T, Wadham, A & Rodgers, A 2019, 'Reaching cardiovascular prevention guideline targets with a polypill-based approach: a meta-analysis of randomised clinical trials', Heart, vol. 105, no. 1, pp. 42-48.
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ObjectiveThe aim of this study was to determine the effect of polypill-based care on the achievement of 2016 European Society of Cardiology (ESC) guideline targets for blood pressure (BP), low-density lipoprotein (LDL) cholesterol and antiplatelet therapy.MethodsWe conducted an individual participant data meta-analysis of three randomised clinical trials that compared a strategy using a polypill containing aspirin, statin and antihypertensive therapy with usual care in patients with a prior cardiovascular disease (CVD) event or who were at high risk of their first event. Overall, the trials included 3140 patients from Australia, England, India, Ireland, the Netherlands and New Zealand (75% male, mean age 62 years and 76% with a prior CVD event). The primary outcome for this study was the proportion of people achieving ESC guideline targets for BP, LDL and antiplatelet therapy.ResultsThose randomised to polypill-based care were more likely than those receiving usual care to achieve recommended targets for BP (62% vs 58%, risk ratio (RR) 1.08, 95% CI 1.02 to 1.15), LDL (39% vs 34%, RR 1.13, 95% CI 1.02 to 1.25) and all three targets for BP, LDL and adherence to antiplatelet therapy (the latter only applicable to those with a prior CVD event) simultaneously (24% vs 19%, RR 1.27, 95% CI 1.10 to 1.47) at 12 months. There was no difference between groups in antiplatelet adherence (96% vs 96%, RR 1.00, 95% CI 0.98 to 1.01). There was heterogeneity by baseline treatment intensity such that treatment effects increased with the fewer the number of treatments being taken at baseline: for patients taking 3, 2 and 0–1 treatment modalities the RRs for reaching all three guideline goals simultaneously were 1.10 (95% CI 0.94 to 1.30, 22% vs 20%), 1.62 (95% CI 1.09 to 2.42, 27% vs 17%) and 3.07 (95% CI 1...
Shepherd, HL, Geerligs, L, Butow, P, Masya, L, Shaw, J, Price, M, Dhillon, HM, Hack, TF, Girgis, A, Luckett, T, Lovell, M, Kelly, B, Beale, P, Grimison, P, Shaw, T, Viney, R & Rankin, NM 2019, 'The Elusive Search for Success: Defining and Measuring Implementation Outcomes in a Real-World Hospital Trial', Frontiers in Public Health, vol. 7.
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© Copyright © 2019 Shepherd, Geerligs, Butow, Masya, Shaw, Price, Dhillon, Hack, Girgis, Luckett, Lovell, Kelly, Beale, Grimison, Shaw, Viney and Rankin. Objective and Study Setting: Research efforts to identify factors that influence successful implementation are growing. This paper describes methods of defining and measuring outcomes of implementation success, using a cluster randomized controlled trial with 12 cancer services in Australia comparing the effectiveness of implementation strategies to support adherence to the Australian Clinical Pathway for the Screening, Assessment and Management of Anxiety and Depression in Adult Cancer Patients (ADAPT CP). Study Design and Methods: Using the StaRI guidelines, a process evaluation was planned to explore participant experience of the ADAPT CP, resources and implementation strategies according to the Implementation Outcomes Framework. This study focused on identifying measurable outcome criteria, prior to data collection for the trial, which is currently in progress. Principal Findings: We translated each implementation outcome into clearly defined and measurable criteria, noting whether each addressed the ADAPT CP, resources or implementation strategies, or a combination of the three. A consensus process defined measures for the primary outcome (adherence) and secondary (implementation) outcomes; this process included literature review, discussion and clear measurement parameters. Based on our experience, we present an approach that could be used as a guide for other researchers and clinicians seeking to define success in their work. Conclusions: Defining and operationalizing success in real-world implementation yields a range of methodological challenges and complexities that may be overcome by iterative review and engagement with end users. A clear understanding of how outcomes are defined and measured, based on a strong theoretical framework, is crucial to meaningful measurement and outcomes. The con...
Sommer, J, Gill, KH, Stein-Parbury, J, Cronin, P & Katsifis, V 2019, 'The role of recovery colleges in supporting personal goal achievement.', Psychiatric Rehabilitation Journal, vol. 42, no. 4, pp. 394-400.
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OBJECTIVE: This study examined the types of goals set, the degree to which goals were achieved, and the factors influencing goal attainment for participants in a Recovery College, a recovery-based mental health education program that uses peer learning advisors to facilitate individual student learning plans. METHOD: Students of the Recovery College set baseline goals that were rated in terms of importance and difficulty in line with the Goal Attainment Scale (GAS) framework and reviewed at follow-up points. Goals were reviewed to determine areas of priority and an analysis of goal attainment was conducted using multinomial logit regression analysis. RESULTS: Sixty-four students recorded their goals. The most common goal areas identified related to education, socialization, physical health, mental health, and employment. Seventy percent of goals were fully or partially achieved with goals rated as having a lower difficulty more likely to be achieved. CONCLUSION AND IMPLICATIONS FOR PRACTICE: Recovery College is a program model that can effectively support personal goal achievement, a recommended indicator of personal recovery and program success. The GAS proved to be a useful instrument for measuring goal setting and attainment in students' recovery journeys and peer learning advisors were effective in facilitating this process. The setting and achievement of physical health goals is of clinical significance. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Sweeney, CJ, De Abreu Lourenco, R, Hamid, AA & Buyse, M 2019, 'What Does Metastasis-Free Survival Actually Mean?', Journal of Clinical Oncology, vol. 37, no. 19, pp. 1679-1680.
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Toh, S-L, Lee, BB, Ryan, S, Simpson, JM, Clezy, K, Bossa, L, Rice, SA, Marial, O, Weber, GH, Kaur, J, Boswell-Ruys, CL, Goodall, S, Middleton, JW, Tuderhope, M & Kotsiou, G 2019, 'Probiotics [LGG-BB12 or RC14-GR1] versus placebo as prophylaxis for urinary tract infection in persons with spinal cord injury [ProSCIUTTU]: a randomised controlled trial', Spinal Cord, vol. 57, no. 7, pp. 550-561.
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© 2019, The Author(s). Study design: Randomised double-blind factorial-design placebo-controlled trial. Objective: Urinary tract infections (UTIs) are common in people with spinal cord injury (SCI). UTIs are increasingly difficult to treat due to emergence of multi-resistant organisms. Probiotics are efficacious in preventing UTIs in post-menopausal women. We aimed to determine whether probiotic therapy with Lactobacillus reuteri RC-14+Lactobacillus GR-1 (RC14-GR1) and/or Lactobacillus rhamnosus GG+Bifidobacterium BB-12 (LGG-BB12) are effective in preventing UTI in people with SCI. Setting: Spinal units in New South Wales, Australia with their rural affiliations. Methods: We recruited 207 eligible participants with SCI and stable neurogenic bladder management. They were randomised to one of four arms: RC14-GR1+LGG-BB12, RC14-GR1+placebo, LGG-BB12+ placebo or double placebos for 6 months. Randomisation was stratified by bladder management type and inpatient or outpatient status. The primary outcome was time to occurrence of symptomatic UTI. Results: Analysis was based on intention to treat. Participants randomised to RC14-GR1 had a similar risk of UTI as those not on RC14-GR1 (HR 0.67; 95% CI: 0.39–1.18; P = 0.17) after allowing for pre-specified covariates. Participants randomised to LGG-BB12 also had a similar risk of UTI as those not on LGG-BB12 (HR 1.29; 95% CI: 0.74–2.25; P = 0.37). Multivariable post hoc survival analysis for RC14-GR1 only vs. the other three groups showed a potential protective effect (HR 0.46; 95% CI: 0.21–0.99; P = 0.03), but this result would need to be confirmed before clinical application. Conclusion: In this RCT, there was no effect of RC14-GR1 or LGG-BB12 in preventing UTI in people with SCI.
Tonmukayakul, U, Le, LK-D, Mudiyanselage, SB, Engel, L, Bucholc, J, Mulhern, B, Carter, R & Mihalopoulos, C 2019, 'A systematic review of utility values in children with cerebral palsy', Quality of Life Research, vol. 28, no. 1, pp. 1-12.
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Project aims include the following: (i) to identify reported utility values associated with CP in children aged ≤ 18 years; (ii) to explore utility value elicitation techniques in published studies; and (iii) to examine performance of the measures and/or elicitation approaches.Peer-reviewed studies published prior to March 2017 were identified from six electronic databases. Construct validity, convergent validity, responsiveness, and reliability of instruments were assessed.Five studies met the inclusion criteria. Utility values of hypothetical general CP states obtained from a general population of parents ranged from 0.55 to 0.88 using time trade off (TTO) and 0.60-0.87 using standard gamble (SG) techniques. Utility values reported by clinicians of three hypothetical spastic quadriplegic CP states, using the Health Utility Index Mark 2 (HUI-2), ranged from 0.40 to 0.13. Other sources of utilities identified were based on both proxy and child ratings using Health Utility Index Mark 3 (HUI-3) (values ranged from - 0.013 to 0.84 depending on the valuation source) and the Assessment of Quality of Life 4 Dimension instrument, with values ranging from 0.01 to 0.58. Construct validity of the HUI-3 varied from moderate to strong, whereas mixed results were found for convergent validity. Responsiveness and reliability were not reported.There was substantial variation in reported utilities. Indirect techniques (i.e. via multi-attribute utility instruments) were more frequently used than direct techniques (e.g. TTO, SG). Further research is required to improve the robustness of utility valuation of health-related quality of life in children with CP for use in economic evaluation.
Tsey, K, Onnis, L-A, Whiteside, M, McCalman, J, Williams, M, Heyeres, M, Lui, SMC, Klieve, H, Cadet-James, Y, Baird, L, Brown, C, Watkin Lui, F, Grainger, D, Gabriel, Z, Millgate, N, Cheniart, B, Hunter, T, Liu, H-B, Yinghong, Y, Yan, L, Lovett, R, Chong, A & Kinchin, I 2019, 'Assessing research impact: Australian Research Council criteria and the case of Family Wellbeing research', Evaluation and Program Planning, vol. 73, pp. 176-186.
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© 2019 Researchers worldwide are increasingly reporting the societal impact of their research as part of national research productivity assessments. However, the challenges they encounter in developing their impact case studies against specified government assessment criteria and how pitfalls can be mitigated are not reported. This paper examines the key steps taken to develop an Aboriginal Family Wellbeing (FWB) empowerment research impact case study in the context of an Australian Research Council (ARC) pilot research impact assessment exercise and the challenges involved in applying the ARC criteria. The requirement that researchers demonstrate how their institutions support them to conduct impactful research has the potential to create supportive environments for researchers to be more responsive to the needs of users outside academia. However, the 15-year reference period for the associated research underpinning the reported impact and the focus on researcher's current institutional affiliation constitute potential constraints to demonstrating the true impact of research. For researchers working with Indigenous people, relationships that build over long periods of time, irrespective of university affiliation, are critical to conducting impactful research. A more open-ended time-frame, with no institutional restrictions for the ‘associated research’ provides the best opportunity to demonstrate the true benefits of research not only for Indigenous people but for Australian society more broadly.
Tsuchiya, A, Bansback, N, Hole, AR & Mulhern, B 2019, 'Manipulating the 5 Dimensions of the EuroQol Instrument: The Effects on Self-Reporting Actual Health and Valuing Hypothetical Health States', Medical Decision Making, vol. 39, no. 4, pp. 380-392.
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Background. The EQ-5D instrument has 5 dimensions. This article reports on the effects of manipulating a) the order in which the 5 dimensions are presented (appearing first v. last), b) splitting of the composite dimensions (“pain or discomfort” and “anxiety or depression”), and c) removing or “bolting off” 1 of the 5 EQ-5D dimensions at a time. The effects were examined in 2 contexts: 1) self-reporting health and 2) health state valuations. Methods. Three different types of discrete choice experiments (DCE) including a duration attribute were designed. An online survey with 12 subtypes, each with 10 DCE tasks, was designed and completed by 2494 members of the UK general public. Results. Of the 3 manipulations in the self-reporting context, only b) splitting anxiety or depression had a significant effect. In the health state valuation context, b) splitting level 5 pain or discomfort (relative to pain) and splitting level 5 anxiety or depression (relative to anxiety) had significant effects as did c) bolting off dimensions. Conclusions. We find that the values given to certain health dimensions are sensitive to the way in which it is described and the other health dimensions presented. Of particular interest is the effect of splitting composite dimensions: a given EQ-5D(-5L) profile may mean different things depending on whether the profile is used to self-report one’s health or to value hypothetical states, so that the health state values of EQ-5D(-5L) in population tariffs may not correspond to the states that patients self-report themselves in.
Tudball, J, Reddel, HK, Laba, T-L, Jan, S, Flynn, A, Goldman, M, Lembke, K, Roughead, E, Marks, GB & Zwar, N 2019, 'General practitioners' views on the influence of cost on the prescribing of asthma preventer medicines: a qualitative study', Australian Health Review, vol. 43, no. 3, pp. 246-246.
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Objective Out-of-pocket costs strongly affect patient adherence with medicines. For asthma, guidelines recommend that most patients should be prescribed regular low-dose inhaled corticosteroids (ICS) alone, but in Australia most are prescribed combination ICS–long-acting β2-agonists (LABA), which cost more to patients and government. The present qualitative study among general practitioners (GPs) explored the acceptability, and likely effect on prescribing, of lower patient copayments for ICS alone. Methods Semistructured telephone interviews were conducted with 15 GPs from the greater Sydney area; the interviews were transcribed and thematically analysed. Results GPs reported that their main criteria for selecting medicines were appropriateness and effectiveness. They did not usually discuss costs with patients, had low awareness of out-of-pocket costs and considered that these were seldom prohibitive for asthma patients. GPs strongly believed that patient care should not be compromised to reduce cost to government. They favoured ICS–LABA combinations over ICS alone because they perceived that ICS–LABA combinations enhanced adherence and reduced costs for patients. GPs did not consider that lower patient copayments for ICS alone would affect their prescribing. Conclusion The results suggest that financial incentives, such as lower patient copayments, would be unlikely to encourage GPs to preferentially prescribe ICS alone, unless accompanied by other strategies, including evidence for clinical effectiveness. GPs should be encouraged to discuss cost barriers to treatment with patients when considering treatment choices. What is known about the topic? Australian guidelines recommend that most patients with asthma should be treated with low-dose ICS alone to minimise symptom burden and risk of flare ups. However, most patients in Australian general practice are instead prescribed combination ICS–LABA preventers, which are indicated if asthma remai...
Vargas, C, Balmaceda, C, Rodríguez, F, Rojas, R, Giglio, A & Espinoza, MA 2019, 'Economic evaluation of sunitinib versus pazopanib and best supportive care for the treatment of metastatic renal cell carcinoma in Chile: cost-effectiveness analysis and a mixed treatment comparison', Expert Review of Pharmacoeconomics & Outcomes Research, vol. 19, no. 5, pp. 609-617.
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Wise, S & Duffield, C 2019, 'Has the search for better leadership come at the expense of management?', International Journal of Nursing Studies, vol. 97, pp. A1-A2.
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Yu, S & Peetz, D 2019, 'Non‐Standard Time Wage Premiums and Employment Effects: Evidence from an Australian Natural Experiment', British Journal of Industrial Relations, vol. 57, no. 1, pp. 33-61.
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AbstractWe examine the effect of increasing Sunday wage premiums on retail industry employment in Australia, exploiting a quasi‐experimental policy change across two neighbouring states. Using both aggregate and individual‐level data, we adopt a difference‐in‐difference regression framework to estimate the causal impact of the policy change on employment outcomes. We find no evidence of changes in the total number of employees, and no effect on hours per employee in the years following the policy implementation. However, there appeared to be a decline in hours per employee in the announcement year of the policy change. Overall, it appears that in an industry dominated by part‐time and casual employment, any adjustment to the new Sunday wage rates occurred principally through flexibility in hours, rather than in the number of employees.
Yu, S, van Gool, K, Hall, J & Fiebig, DG 2019, 'Physician pricing behavior: Evidence from an Australian experiment', Journal of Economic Behavior & Organization, vol. 161, pp. 20-34.
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© 2019 Elsevier B.V. We examine the unregulated pricing behavior of physicians in response to an exogenous decrease in patient entitlements under a government scheme providing insurance for high out-of-pocket medical costs. We use survey-linked administrative data to estimate the causal effects of the policy change on consultation fees. Adopting a quasi-experimental difference-in-difference model, we find that in response, physicians with knowledge of the patient's eligibility raised consultation fees by an average 12%. The results show significant unintended consequences of the policy change, indicating that a physician's knowledge of patient eligibility for healthcare benefits may allow them to affect demand for their services.
Abiona, O, Van Gool, K, Hall, J, Haywood, P, Yu, S & Fiebig, D 1970, 'Provider Responses to Insurance Benefit Restrictions: The Case of Ophthalmology', Emerging Health Policy Conference, Menzies Centre for Health Policy, University of Sydney.
Abiona, O, Van Gool, K, Hall, J, Haywood, P, Yu, S & Fiebig, D 1970, 'Provider responses to insurance benefit restrictions: The case of ophthalmology', 41st Annual Australian Health Economics Society (AHES) Conference, Melbourne.
Addo, R 1970, 'What are quality of life measures used for cognitive disorders actually measuring? A review', 11th Health Servcies and Policy Research Conference, Auckland, New Zealand.
Arora, S 1970, 'Using DCE methods to estimate informal care', International Society for Pharmacoeconomics and Outcomes Research Women in Health Economics and Outcomes Research, Sydney.
Chen, G, Mihalopoulos, C, Richardson, J, Viney, R, Scott, J, Brazier, J, Ratcliffe, J, Norman, R, Jenkins, P, Allen, C, Stathis, S, Coghill, D, Patton, G, Bucholc, J & Au, T 1970, 'A Comparison of Multi-Attribute Utility Measures to Routine Used Outcome Measures in Children and Adolescents with Mental Disorders', iHEA 2019 Congress: New Heights in Healh Economics, Basel, Switzerland.
Church, J 1970, 'Weight perception drives choices of weight loss programs', 11th Health Servcies and Policy Research Conference, Auckland, New Zealand.
Craig, BM, De Abreu Lourenco, R & Huynh, E 1970, 'Good practices in health preference research', 11th Meeting of the International Academy of Health Preference Research, Auckland, New Zealand.
De Abreu Lourenco, R 1970, 'Grappling with the health, economics and health economics of immunotherapies', Immunotherapy Symptoms Clinical Trials: a new paradigm, Melbourne.
De Abreu Lourenco, R 1970, 'Health Economics, Drug Funding and Consumers', ANZGOG ASM, Sydney.
De Abreu Lourenco, R 1970, 'More than a fraction of value. Incorporating health economics into radiotherapy research', TROG ASM, Melbourne.
De Abreu Lourenco, R, Hegi-Johnson, F, Ball, D, Wright, G & Haas, M 1970, 'Factors influencing participation in curative intent treatment for lung cancer: A discrete choice experiment', TROG ASM, Melbourne.
Haas, M 1970, 'An Introduction to Health Economics', SPHERE ECRs, Melbourne.
Haas, M 1970, 'Health Economics: what’s it all about?', TCRN Consumer Forum, Lowy Centre UNSW.
Haas, M 1970, 'The Health Economics Stream of SPHERE', SPHERE Launch, Melbourne.
Hegi-Johnson, F, Haas, M, Ball, D, Wright, G & De Abreu Lourenco, R 1970, 'P2.16-33 What Influences Patient Decision-Making About Lung-Cancer Treatment? A Discrete Choice Experiment', Journal of Thoracic Oncology, IASLC 2019 World Conference on Lung Cancer Conquering Thoracic Cancers Worldwide, Elsevier BV, Barcelona, Spain, pp. S878-S878.
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Despite major advances in radiotherapy, surgery remains the treatment of choice for patients with stage I non-small cell
lung cancer. We sought to investigate what influenced preferences
for surgery or SABR among cancer patients.
Hofman, M, Murphy, DG, Williams, S, Nzenza, T, Herschtal, A, Matera, A, Marusic, P, De Abreu Lourenco, R, Bailey, DL, Iravani, A, Hicks, RJ, Francis, RJ & Lawrentschuk, N 1970, 'The “ProPSMA Study” clinical trial protocol: A prospective randomized multi-center study of the impact of Ga-68 PSMA PET/CT imaging for staging high-risk prostate cancer prior to curative-intent surgery or radiotherapy.', Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), pp. TPS138-TPS138.
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TPS138 Background: Disease persistence or relapse following curative-intent surgery or radiotherapy of high-risk prostate cancer is not uncommon. This is attributable, in part, to a failure of accurate staging with diagnostic imaging being insensitive for detection of small volume metastatic disease. Prostate-specific-membrane-antigen (PSMA) positron emission tomography/computed tomography (PET/CT) is a new whole body scanning technique that enables visualisation of prostate cancer with high sensitivity. The hypotheses of this study are that PSMA-PET/CT (a) has improved diagnostic accuracy compared to conventional imaging, (b) should be used as a first-line diagnostic test for staging, (c) the improved diagnostic accuracy will result in significant management impact and (d) provides economic benefits when incorporated into the management algorithm. Methods: This is a 300 patient phase III multi-centre randomized study of patients with untreated high-risk prostate cancer defined by Gleason grade group 3-5, PSA ≥ 20ng/ml or clinical stage ≥ T3. Patients are randomized to Gallium-68-PSMA11 PET/CT or conventional imaging, consisting of computer tomography of the abdomen/pelvis and bone scintigraphy with SPECT/CT. Patients with negative, equivocal or oligometastatic disease cross-over to receive the other imaging arm. The primary objective is to compare the accuracy of PSMA-PET/CT to conventional imaging for detecting nodal or distant metastatic disease. Accuracy is defined by a pre-defined “ground truth” scoring system incorporating histopathologic, imaging and clinical follow-up at six months post randomisation. Secondary objectives include comparing management impact, the number of equivocal studies, the incremental value of second-line imaging in patients who cross-over, health economics, radiation exposure, inter-observer agreement and safety of PSMA-PET/CT. Longer term follow-up will also assess the prognostic value of a nega...
King, M, Norman, R, Kemmler, G, McTaggart-Cowan, H, Rowan, D, Pickard, AS & Viney, R 1970, 'Cross-country comparisons for two cancer-specific multi-attribute utility instruments (MAUIs)', ISPOR Australian Chapter Encore of Presentations Given at ISPOR Conferences in 2018, Sydney.
Laba, T-L 1970, 'How does the cost of medicines to patients influence the use of guidelines-based medicines for asthma in Australia?', HSRAANZ Webinar Series, Sydney.
Laba, T-L 1970, 'The role of the Drug Utilisation Sub-committee (DUSC) and budget impact analysis in the submission process', ISPOR Australian chapter: Budget impact modelling for PBAC submissions, Sydney.
Lewandowska, M 1970, 'Economic Evaluation of the Australian Contraceptive ChOice pRoject (ACCORd)', 11th Health Services and Policy Research Conference, Auckland, New Zealand.
Manipis, K 1970, 'Estimation of the friction period in Australia', 11th Health Services and Policy Conference, Auckland, New Zealand.
McCarthy, M, Lorenco, RDA, Gillam, L, McMillan, L, Sullivan, M & Downie, P 1970, 'Personalised Medicine in Paediatric Cancer Care: What Matters in Decision-Making?', PEDIATRIC BLOOD & CANCER, 51st Congress of the International Society of Paediatric Oncology, WILEY, Lyon, France, pp. S11-S12.
Meshcheriakova, O, Goodall, S, Street, D & Viney, R 1970, 'Does the price premium for branded medicines reflect preferences? A case study from Australia', 11th Meeting of the International Academy of Health Preference Research, Auckland, New Zealand.
Mulhern, B, Norman, R, De Abreu Lourenco, R, Malley, J, Street, D & Viney, R 1970, 'Investigating the relative value of health and social care related quality of life using a discrete choice experiment', Social Science & Medicine, 38th Annual Australian Health Economics Society Conference, Elsevier BV, Perth, pp. 28-37.
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Mulhern, B, Norman, R, Oppe, M, Viney, R & Street, D 1970, 'Comparing DCE designs that can be used to value EQ-5D-5L', International Conference for the Design of Experiments, Memphis, USA.
Mulhern, B, Norman, R, Street, D, Lancsar, E, Ratcliffe, J, Shah, K, Devlin, N, Meshcheriakova, O, Saing, S, Manipis, K, Addo, R, Nolasco, V, Brazier, J & Viney, R 1970, 'Valuing EQ-5D-5L: comparing the time trade off and discrete choice experiment valuation methods', 11th Meeting of the International Academy of Health Presference Research, Auckland, New Zealand.
Naghsh Nejad, M 1970, 'The Effects of a Universal Health Coverage Program on Newly Insured Households', 11th Health Services and Policy Research Conference, Auckland, New Zealand.
Peasgood, T, Mukuria, C, Brazier, J, Marten, O, Kreimeier, S, Luo, N, Mulhern, B, Greiner, W, Pickard, S, Augustovski, F, Engel, L, Belizan, M, Yang, Z & Monteiro, A 1970, 'Developing a new generic classifier of quality of life: initial results from the Extending the QALY (EQALY) psychometric surveys', 35th EuroQol Plenary Meeting, Brussels, Belgium.
Peasgood, T, Mukuria, C, Brazier, J, Marten, O, Kreimeier, S, Luo, N, Mulhern, B, Greiner, W, Pickard, S, Augustovski, F, Engel, L, Belizan, M, Yang, Z & Monteiro, A 1970, 'Developing a new generic classifier of quality of life: initial results from the Extending the QALY (EQALY) psychometric surveys', ISOQOL 26th Annual Conference, San Diego, USA.
Roche, M, Duffield, C, Wise, S & Debono, D 1970, 'The impact of ward reconfiguration on nursing workload: Integrating administrative data with expert knowledge', International Council of Nurses 2019 Congress, Singapore.
Saing, S, Haywood, P, Van Der Linden, N, Manipis, K, Meshcheriakova, O & Goodall, S 1970, 'Real world cost-effectiveness of mandatory folic acid fortification of bread making flour in Australia', 11th Health Services and Policy Research Conference, Auckland, New Zealand.
Saing, S, Van Der Linden, N, Hayward, C & Goodall, S 1970, 'Cost-effectiveness analysis of ventricular assist devices used as a bridge to transplant in patients with end-stage heart failure', 11th Health Services and Policy Research Conference, Auckland, New Zealand.
Sampson, C, Addo, R, Haywood, P, Herdman, M, Janssen, B, Mulhern, B, Page, K, Reardon, O, Rodes Sanchez, M, Schneider, J, Shah, K & Thetford, C 1970, 'PMU141 DEVELOPMENT OF EQ-5D-5L BOLT-ONS FOR COGNITION AND VISION', Value in Health, ISPOR Europe 2019, Elsevier BV, Copenhagen, Denmark, pp. S733-S733.
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Street, D, Mulhern, B, Norman, R, Viney, R & Oppe, M 1970, 'Is the total number of responses all that matters?', 35th EuroQol Plenary Meeting, Brussels, Belgium.
Thiboonboon, K, Butchon, R & Vijitsoonthornkul, K 1970, 'Characterising the Pattern of Recent Changes in the Body Mass Index Distribution', Australian Health Economics Society Conference 2019, Melbourne.
Van Gool, K, Abiona, O, Hall, J, Haywood, P & Fiebig, DG 1970, 'Provider Responses to Insurance Benefit Restrictions: The Case of Ophthalmology', iHEA 2019 Congress: New Heights in Health Economics, Basel, Switzerland.
Van Gool, K, Longden, T & Hall, J 1970, 'Worried about Children: Multi-Level Modelling of Supplier-Induced Demand for Urgent After-Hours Care', iHEA 2019 Congress: New Heights in Health Economics, Basel, Switzerland.
Viney, R 1970, 'NHMRC Funding Experience', ISPOR Australian Chapter Women in Health Economics and Outcomes Research, Sydney.
Viney, R, Mulhern, B, Norman, R, Shah, K & Devlin, N 1970, 'Quality control vs. ‘data curation’: where should we draw the line in researcher judgements about the stated preference data used to value EQ-5D?', 35th EuroQol Plenary Meeting, Brussels, Belgium.
Viney, R, Mulhern, B, Norman, R, Street, D, Feng, Y, Shah, K, Lorgelly, P & Ratcliffe, J 1970, 'Are Results from Discrete Choice Experiments Similar to Time Trade-Off? Comparison of Health State Valuation Methods Using the EQ-5D-5L in an Australian General Population Sample', iHEA 2019 Congress, Basel, Switzerland.
White, K, De Abreu Lourenco, R, Kenny, P, Lehane, L & King, T 1970, 'Understanding the financial impact of cancer: Examining the ‘COST’ Measure in the Australian context.', Clinical Lymphoma Myeloma and Leukemia, Elsevier BV, pp. e340-e340.
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Wise, S 1970, 'The flexibility of stable healthcare teams: a mixed methods study of emergency doctors and nurses', 11th Health Services and Policy Research Conference, Auckland, New Zealand.
Woods, M 1970, 'The role of health economics in improving care for older Australians', Research Australia Health Economics Roundtable, Sydney.
Woods, M 1970, 'Unpacking the progress of the Royal Commission & the Interim Report (Panel)', The Future of Aged Care: Beyond the Interim Report of the Royal Commission, Melbourne.
Woods, M & Dickinson, S 1970, 'Improving the availability of palliative care – identifying unmet need at the local level', CHARM Canberra Health Annual Research Meeting, Canberra.
Wright, M & Sharma, R 1970, 'RACGP Vision for General Practice and a Sustainable Health System', GP19 – RACGP National Conference, Adelaide.
Wright, M, Hall, J, Haas, M, Van Gool, K & Yu, S 1970, 'The relationship between continuity of care and cervical cancer screening', North American Primary Care Research Conference, Toronto, Canada.
Wright, M, Morgan, M & Hoskings, R 1970, 'The Practice Incentives Program Quality Improvement – Quality Incentive (PIP-QI) Incentive', GP19 – RACGP National Conference, Adelaide.
Yu, S, Fiebig, DG, Viney, R, Scarf, V & Homer, C 1970, 'Private Provider Incentives in Health Care: The Case of Birth Interventions', iHEA 2019 Congress: New Heights in Health Economics, Basel, Switzerland.
Yu, WS, Mulhern, B, Norman, R, Viney, R, Stolk, E, Gudex, C, Augustovski, F, Tejada, RA, Jensen, CE, Jonker, M & Street, D 1970, 'A developmental perspective on DCE with duration for the valuation of health', 35th EuroQol Plenary Meeting, Brusells, Belgium.
