Abiona, O, Yu, S, Woods, M & van Gool, K 2020, 'Accommodation payment plans in residential aged care: The impact of consumer choice', Australasian Journal on Ageing, vol. 39, no. 1, pp. e103-e109.
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AbstractObjectiveTo examine changes in accommodation payments to residential aged care facilities following the introduction of consumer choice reforms in 2014. These reforms have allowed residents to choose between making lump sum refundable deposits and/or rental‐style payments.MethodsQuantitative analysis was undertaken for facility‐level quarterly data of 136 separate facilities, which were operated by six providers over the period under study.ResultsWhile the total pool of payments has grown strongly, consumers have increasingly favoured rental‐style payments over lump sum refundable deposits.ConclusionConsumer choice has changed the landscape of accommodation payment receipts in the provision of residential aged care services. Greater understanding is needed on how consumer preferences impact on the financial risk borne by providers and their ability to invest in future capacity.
Addo, R 2020, 'The knowledge and attitude of Ghanaian decision-makers and researchers towards health technology assessment [published online ahead of print', Soc Sci Med..
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Addo, R, Goodall, S, Hall, J & Haas, M 2020, 'Assessing the capacity of Ghana to introduce health technology assessment: a systematic review of economic evaluations conducted in Ghana', International Journal of Technology Assessment in Health Care, vol. 36, no. 5, pp. 500-507.
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ObjectivesGhana is in the process of formally introducing health technology assessment (HTA) for health decision making. Similar to other low- and middle-income countries, evidence suggests that the lack of data and human capacity is a major barrier to the conduct and use of HTA. This study assessed the current human and data capacity available in Ghana to undertake HTA.MethodsAs economic evaluation (EE) forms an integral part of HTA, a systematic review of EE studies undertaken in Ghana was conducted to identify the quality and number of studies available, methods and source of data used, and local persons involved. The literature search was undertaken in EMBASE (including MEDLINE), PUBMED, and Google Scholar. The quality of studies was evaluated using the Consolidated Health Economics Evaluation Reporting Standards. The number of local Ghanaians who contributed to authorship were used as a proxy for assessing human capacity for HTA.ResultsThirty-one studies were included in the final review. Overall, studies were of good quality. Studies derived their effectiveness, resource utilization and cost data mainly from Ghana. The most common source of cost data was from the National Health Insurance Scheme pricing list for medicines and tariffs. Effectiveness data were mostly derived from either single study or intervention programs. Sixty out of 199 authors were Ghanaians (30 percent); these authors were mostly involved in data collection and study conceptualization.ConclusionsHuman capacity for HTA in Ghana is limited. To introduce HTA successfully in...
Addo, R, Hall, J, Haas, M & Goodall, S 2020, 'The knowledge and attitude of Ghanaian decision-makers and researchers towards health technology assessment', Social Science & Medicine, vol. 250, pp. 112889-112889.
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Although health technology assessment (HTA) is intended to provide policymakers with objective information, the likelihood that a health decision-maker (HDM) will use this information is associated with their knowledge, role and perception of the HTA process. In Ghana, policymakers are working towards formalising the use of HTA, but HDM knowledge of and attitude towards HTA are not known. Between March and May 2016, we conducted in-depth interviews and used inductive thematic analysis to explore Ghanaian HDMs (n = 23) and researchers' (n = 4) perceptions of and barriers to HTA and identify ways to promote HTA. We compare our findings with those reported in previous studies conducted in low-and-middle-income countries. Common themes were that resources, political and cultural factors act as barriers to HTA use. Recommendations made in previous studies which were also identified in this study included the need for the development of both human and data capacity, allocating funds to HTA and stakeholder involvement in HTA processes. Specific recommendations made by Ghanaian HDMs and researchers in this study focused on the establishment of an HTA body: its location, the constitution of the appraisal team, the type of evidence to appraise and who makes the final decision. The findings provide important information in the context of current planning to institutionalise HTA in Ghana. Addressing the identified barriers will enable policymakers to maximise the chances of realising the expected benefits of HTA, as participants who are potential producers and end-users are likely to use what they have contributed to.
Arora, S, Goodall, S, Viney, R & Einfeld, S 2020, 'Health‐related quality of life amongst primary caregivers of children with intellectual disability', Journal of Intellectual Disability Research, vol. 64, no. 2, pp. 103-116.
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AbstractBackgroundChildren with intellectual disability (ID) frequently have significant educational, social and health care needs, resulting in caregivers often experiencing a wide range of negative effects. This paper aims to determine the impact of childhood ID on caregivers' health‐related quality of life (HRQoL) across co‐morbid diagnostic groups. The second aim of this study is to determine the risk factors associated with lower HRQoL in this population.MethodsCaregivers of a child with ID aged between 2 and 12 years old completed an online survey to determine their HRQoL using the EQ‐5D‐5L measure. They were also asked demographic questions and about their dependent child's level of behavioural and emotional difficulties.ResultsOf the total sample of 634 caregivers, 604 caregivers completed all five questions of the EQ‐5D‐5L. The mean age of caregivers was 39.1 years and 91% were women. Caregivers spent on average 66.6 h per week caring for their child related to their child's disability. The mean EQ‐5D‐5L score of caregivers was 0.80 (95% confidence interval: 0.79, 0.82), which is below the estimated Australian population norms (mean utility score of 0.92) for the age‐equivalent population.Caregivers of children with autism spectrum disorders reported the lowest HRQoL (0.77, 95% confidence interval: 0.74, 0.79) of the five included co‐morbid diagnostic groups. Caregivers with a lower income, a perceived low level of social support and children with higher degree of behavioural and emotional problems were likely to have a statistically lower HRQoL.ConclusionsThis is the first study to produce utility values for caregivers of children with ID. The utility values can be used to c...
Arora, S, Goodall, S, Viney, R & Einfeld, S 2020, 'Societal cost of childhood intellectual disability in Australia', Journal of Intellectual Disability Research, vol. 64, no. 7, pp. 524-537.
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AbstractBackgroundThere is limited research quantifying the direct and indirect economic costs associated with intellectual disability (ID) in Australia. Costs incurred by families, governments and broader society include time spent providing care, absenteeism and increased healthcare utilisation. The purpose of this research is to quantify the costs associated with ID in childhood using a range of methods to collect cost data.MethodsCosts included healthcare service utilisation, pharmaceutical use, caregiver productivity losses and time spent providing care because of the child's disability. The sample comprised caregivers with a child with ID aged between 2 and 10 years old recruited in Australia. Healthcare service utilisation and pharmaceutical use were obtained from routinely collected administrative claims data. Healthcare utilisation not captured in the routinely collected administrative data and absenteeism data were obtained from a retrospective recall‐based questionnaire. Time spent providing care because of the child's disability was obtained using a time‐use diary.ResultsThe total cost of ID in Australia was estimated to be AUD 72 027 per year per child, and the total cost of ID in childhood was estimated to be AUD 12.5 billion per year. The cost to governments of ID in childhood was estimated to be AUD 6385 per child per year, resulting in a total cost to government of AUD 1.1 billion per year.ConclusionsThis is the first study to estimate the direct and indirect costs associated with ID in childhood. The results of this research demonstrate the considerable economic impact of ID in childhood on families, governments and broader society in terms of both direct and indirect costs. An under...
Brazier, JE, Mulhern, BJ, Bjorner, JB, Gandek, B, Rowen, D, Alonso, J, Vilagut, G & Ware, JE 2020, 'Developing a New Version of the SF-6D Health State Classification System From the SF-36v2: SF-6Dv2', Medical Care, vol. 58, no. 6, pp. 557-565.
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Objective: The objective of this study was to develop the classification system for version of the SF-6D (SF-6Dv2) from the SF-36v2. SF-6Dv2 is an improved version of SF-6D, one of the most widely used generic measures of health for the calculation of quality-adjusted life years. Study Design and Setting: A 3-step process was undertaken to generate a new classification system: (1) factor analysis to establish dimensionality; (2) Rasch analysis to understand item performance; and (3) tests of differential item function. To evaluate robustness, Rasch analyses were performed in multiple subsets of 2 large cross-sectional datasets from recently discharged hospital patients and online patient samples. Results: On the basis of factor analysis, other psychometric evidence, cross-cultural considerations, and amenability to valuation, the 6-dimension classification used in SF-6D was maintained. SF-6Dv2 resulted in the following modifications to SF-6D: a simpler classification of physical function with clearer separation between levels; a more detailed 5-level description of role limitations; using negative wording to describe vitality; and using pain severity rather than pain interference. Conclusions: The SF-6Dv2 classification system describes more distinct levels of health than SF-6D, changes the descriptions used for a number of dimensions and provides clearer wording for health state valuation. The second stage of the study has developed a utility value set using discrete choice methods so that the measure can be used in health technology assessment. Further work should...
Bull, C, Crilly, J, Chaboyer, W, Spain, D, Mulhern, B, Fitzgerald, G, Scuffham, P & Byrnes, J 2020, 'Does facility type and location impact upon patient experiences in emergency departments? Secondary analysis of a state‐wide, cross‐sectional survey', Emergency Medicine Australasia, vol. 32, no. 4, pp. 562-569.
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AbstractObjectiveTo identify the extent to which patient experiences in the ED differ depending on facility type (based on bed numbers, services available and annual separations), and location (level of remoteness).MethodsData from a 2015 state‐wide (Queensland, Australia) public ED patient experience survey were linked to sociodemographic and presentation‐related characteristics data. Survey items were individually scored (from 0 to 100), and averaged across 13 pre‐determined patient experience topic areas. Descriptive statistics were used to report on patient sociodemographic and presentation‐related characteristics. One‐way analysis of variance tests were used to identify associations between patient‐reported experience scores, facility types and location.ResultsA total of 10 553 patients over the age of 16 years completed the survey. All patients reported scores above 75 for 7 of the 13 patient experience topic areas (0 = lowest score, 100 = highest score). Patients from very remote and outer regional EDs reported the highest scores for the topic Environment and facilities, and remote facility patients reported the highest scores for the topic Leaving the ED – Delays. The same two topic areas were scored most highly by patients from smaller facilities in comparison to principal referral hospital EDs.ConclusionsPatients attending smaller and more rurally located EDs reported more positive experiences than those attending larger, metropolitan EDs on two of the 13 topic areas. However, these differences were marginal. Future research should aim to determine what constitutes clinically meaningful differences between groups when comparing patient‐re...
Campbell, JA, Jelinek, GA, Weiland, TJ, Nag, N, Neate, SL, Palmer, AJ, Mulhern, B, De Livera, A & Simpson-Yap, S 2020, 'SF-6D health state utilities for lifestyle, sociodemographic and clinical characteristics of a large international cohort of people with multiple sclerosis', Quality of Life Research, vol. 29, no. 9, pp. 2509-2527.
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Comans, TA, Nguyen, K-H, Ratcliffe, J, Rowen, D & Mulhern, B 2020, 'Valuing the AD-5D Dementia Utility Instrument: An Estimation of a General Population Tariff', PharmacoEconomics, vol. 38, no. 8, pp. 871-881.
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Objective
This paper reports on the valuation of quality-of-life states in the Alzheimer's Disease Five Dimensions (AD-5D) instrument in a representative sample of the general population in Australia using the discrete-choice experiment with duration (DCE
TTO) elicitation technique.
Method
A DCE with 200 choice sets of two quality-of-life (QoL) state-duration combinations blocked into 20 survey versions, with ten choice sets in each version, was designed and administered online to a sample representative of the Australian population. Two additional choice sets comprising internal consistency and dominance checks were included in each survey version. A range of model specifications investigating preferences with respect to duration and interactions between AD-5D dimension levels were estimated. Utility weights were developed, with estimated coefficients transformed to the 0 (being dead) to 1 (full health) scale, suitable for the calculation of quality-adjusted life-year (QALY) weights for use in economic evaluation.
Results
In total, 1999 respondents completed the choice experiment. Overall, respondents were slightly better educated and had higher annual incomes than the Australian general population. The estimation results from different specifications and models were broadly consistent with the monotonic nature of the AD-5D: utility increased with increased life expectancy and decreased as the severity level for each dimension worsened. A utility value set was generated for the calculation of utilities for all QoL states defined by the AD-5D descriptive system.
Conclusion
The DCE-based utility value set is now available to use to generate QALYs for the economic evaluation of treatments and interventions targeting people with dementia and/or their family caregivers.
Cronin, P, Reeve, R, McCabe, P, Viney, R & Goodall, S 2020, 'Academic achievement and productivity losses associated with speech, language and communication needs', International Journal of Language & Communication Disorders, vol. 55, no. 5, pp. 734-750.
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AbstractBackgroundChildhood speech, language and communication needs (SLCN) impose a significant burden on individuals, families and society. There are explicit costs related to increased health utilization and expenditure. Additionally, there may be indirect costs associated with a child's employment prospects in the long term because of the child's low literacy and numeracy, which in turn affects adult labour force participation (LFP). Several reviews have identified that there is paucity of published evidence on the costs of SLCN. Motivated by broad policy implications, and the lack of prior research in this area, this paper calculates the indirect costs and workplace productivity losses of children with SLCN.AimsTo estimate the indirect costs of SLCN associated with a child's reduced long‐term productivity.Methods & ProceduresUsing 12 years of data from a longitudinal study of Australian children, we employed a panel fixed‐effects model to estimate academic achievement at 14–15 years of age. Using these estimates, we employed a human capital approach (HCA) to estimate the projected LFP for children with SLCN, measured by workforce participation and foregone wages. LFP is estimated by extrapolating a child's academic achievement at 14–15 years of age to adulthood outcomes.Outcomes & ResultsThe results showed that a 1 SD (standard deviation) decrease in SLCN is equivalent to 0.19 (95% confidence interval (CI) = 0.09, 0.30) SD decrease in academic achievement at 14–15 years, 0.79% (95% CI = 0.37, 1.21) decrease in work participation and A$453 (95% CI = A$207, A$674) per annum in lost wages. The average work participation penalty across all level of SLCN (–3, –2, –1) is A$628 (95% CI = A$236, ...
Currow, DC, Chang, S, Grande, ED, Ferreira, DH, Kochovska, S, Kinchin, I, Johnson, MJ & Ekstrom, M 2020, 'Quality of Life Changes With Duration of Chronic Breathlessness: A Random Sample of Community-Dwelling People', Journal of Pain and Symptom Management, vol. 60, no. 4, pp. 818-827.e4.
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INTRODUCTION:Chronic breathlessness is associated with poorer quality of life (QoL). This population study aimed to define dimensions of QoL and duration and dominant causes of breathlessness that most diminished QoL. METHODS:This cross-sectional, population-based, and randomized survey of adults (n = 2977) in South Australia collected data on demographics, modified Medical Research Council (mMRC) breathlessness, and QoL (EuroQoL five-dimension five-level [EQ-5D-5L] measure; Short Form 12 quality-of-life measure). Data weighted to the census were analyzed for relationships between EQ-5D-5L and its dimensions with mMRC. Regression models controlled for age, sex, education, rurality, and body mass index. RESULTS:About 2883 responses were analyzed: 49% were males; mean age was 48 years (SD 19). As mMRC worsened, EQ-5D-5L and its dimensions worsened. More severe chronic breathlessness was iteratively associated with lower mobility, daily activities, and worse pain/discomfort. For self-care and anxiety/depression, impairment was only with the most severe breathlessness. Respondents who had chronic breathlessness for two to six years had the worst QoL scores. People who attributed their breathlessness to cardiac failure had poorer QoL. Respondents who reported a cardiac cause for their breathlessness had worse mobility, poorer usual activities, and more pain than the other causes. The regression analyses showed that worse chronic breathlessness was associated with worsening QoL in each dimension of EQ-5D-5L, with the exception of the self-care, which only worsened with the most severe breathlessness. CONCLUSIONS:This is the first study to report on chronic breathlessness and impairment across dimensions of QoL and differences by its duration. Mobility, usual activity, and pain drive these reductions.
Currow, DC, Chang, S, Reddel, HK, Kochovska, S, Ferreira, D, Kinchin, I, Johnson, M & Ekström, M 2020, 'Breathlessness, Anxiety, Depression, and Function–The BAD-F Study: A Cross-Sectional and Population Prevalence Study in Adults', Journal of Pain and Symptom Management, vol. 59, no. 2, pp. 197-205.e2.
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CONTEXT:Breathlessness is associated with depression, but its relationship to anxiety or impaired function is less clear. OBJECTIVES:This study evaluated associations between chronic breathlessness and anxiety, depression, and functional status in the general population. METHODS:This cross-sectional study of consenting adults (18 years and older) used an online survey. Quota sampling (n = 3000) was used reflecting the 2016 national census for sex, age, and place of residence. Other data included Four-Item Patient Health Questionnaire for depression and anxiety, the modified Medical Research Council (mMRC) Breathlessness Scale, and the Australia-modified Karnofsky Performance Scale. Multinomial logistic regression assessed predictors. RESULTS:About 2977 respondents had all relevant scores (female 51.2%; median age 45.0 [range 18-92]). Prevalence of breathlessness (mMRC ≥2) was 2.4%, anxiety 6.0%, depression 2.7%, coexisting anxiety/depression 6.1%, and poorer functional status (Australia-modified Karnofsky Performance Scale ≤60) 1.6%. In multinomial regression, depression, anxiety, and coexisting anxiety/depression were predicted by younger age, longer duration of breathlessness, and poorer functional status. The highest proportions of people with breathlessness were found in the coexisting anxiety/depression group (10.6%) and depression only group (8.8%). Poorest function was in the coexisting anxiety/depression group with 11.6%. The relationship between poorer functional status and coexisting anxiety/depression was significant (odds ratio 0.90; 95% CI 0.89, 0.92). Adjusted odds ratio for breathlessness and depression only was 3.0 (95% CI 1.2, 7.8). CONCLUSION:Clinically important breathlessness (mMRC ≥2) was associated with depression, anxiety, and coexisting anxiety/depression. Poorer function that is associated with psychological morbidity in the general population requires further research.
Dawson, CP, Aryeetey, GC, Agyemang, SA, Mensah, K, Addo, R & Nonvignon, J 2020, 'Costs, burden and quality of life associated with informal caregiving for children with Lymphoma attending a tertiary hospital in Ghana', International Journal of Care Coordination, vol. 23, no. 4, pp. 165-172.
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IntroductionPrimary family caregivers provide substantial support in the management of lymphoma, potentially affecting their quality of life and increasing household health care costs. Our aim was thus to determine the economic costs and quality of life of primary caregivers of children with lymphoma.MethodsThis cross-sectional study involved primary informal caregivers of children with lymphoma attending the pediatric cancer unit at Komfo Anokye Teaching Hospital. The study adopted a cost-of-illness approach to estimate the direct costs (medical and non- medical) incurred and indirect cost (productive losses) to caregivers over the one-month period preceding the data collection. Zarit Burden Interview was used to determine caregiver burden and EUROHIS-QoL tool was used to determine the quality of life of primary caregivers.ResultsThe average cost of managing lymphoma in children was estimated to be US$440.32, 97% of which were direct costs. On average, caregiver burden was 26.3 on the scale of 0 to 48. About 94% of caregivers reported high burden, with more males reporting high burden. Overall, average quality of life among caregivers was 2.20 on the 1 to 5 range. Approximately 85% of respondents reported low quality of life, with females reporting lower quality of life than males.DiscussionThis study shows that lymphoma is associated with substantial cost and increased burden, and affects quality of life of family caregivers. Future studies can explore the impact of social protection interventions (in the form of health insurance) to reduce the household economic burden of managing lymphoma in children.
Dineen-Griffin, S, Vargas, C, Williams, KA, Benrimoj, SI & Garcia-Cardenas, V 2020, 'Cost utility of a pharmacist-led minor ailment service compared with usual pharmacist care', Cost Effectiveness and Resource Allocation, vol. 18, no. 1.
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AbstractBackgroundA cluster randomised controlled trial (cRCT) performed from July 2018 to March 2019 demonstrated the clinical impact of a community pharmacist delivered minor ailment service (MAS) compared with usual pharmacist care (UC). MAS consisted of a technology-based face-to-face consultation delivered by trained community pharmacists. The consultation was guided by clinical pathways for assessment and management, and communication systems, collaboratively agreed with general practitioners. MAS pharmacists were trained and provided monthly practice support by a practice change facilitator. The objective of this study was to assess the cost utility of MAS, compared to UC.MethodsParticipants recruited were adult patients with symptoms suggestive of a minor ailment condition, from community pharmacies located in Western Sydney. Patients received MAS (intervention) or UC (control) and were followed-up by telephone 14-days following consultation with the pharmacist. A cost utility analysis was conducted alongside the cRCT. Transition probabilities and costs were directly derived from cRCT study data. Utility values were not available from the cRCT, hence we relied on utility values reported in the published literature which were used to calculate quality adjusted life years (QALYs), using the area under the curve method. A decision tree model was used to capture the decision problem, considering a societal perspective and a 14-day time horizon. Deterministic and probabilistic sensitivity analyses assessed robustness and uncertainty of results, respectively.ResultsPatients (n = 894) were recruited from 30 pharmacies and 82% (n = 732) responded to follow-up. On average, MAS was more costly but also more effective (in terms of symptom resolution and QALY...
Doran, CM & Kinchin, I 2020, 'Economic and epidemiological impact of youth suicide in countries with the highest human development index', PLOS ONE, vol. 15, no. 5, pp. e0232940-e0232940.
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This research estimates the economic and epidemiological impact of youth suicide in countries with the highest human development index. The study relied on secondary analysis of suicide mortality data for youth aged between 15-24 years in countries with the highest human development index-Norway, Australia, Switzerland, Germany, Denmark, Singapore, Netherlands, Ireland, Canada and the United States. The impact of youth suicide is measured using years of life lost, years of productive life lost and present economic value of lost productivity. Costs are expressed in 2014 International dollars. Future earning potential is estimated using adjusted gross domestic product per capita, employment potential and historical trends in productivity and real interest rates. In 2014, an estimated 6,912 young people living in the most developed countries in the world lost their lives to suicide. These preventable deaths resulted in a loss of 406,730 years of life at a cost of $5.53 billion in lost economic income with the average cost of suicide estimated at $802,939. The United States stands out as a country with the most significant youth suicide problem accounting for 77% of total costs. Reducing youth suicide requires a multifaceted approach and significant investment by governments.
Doran, CM & Kinchin, I 2020, 'Economics of Mental Health: Providing a Platform for Efficient Mental Health Policy', Applied Health Economics and Health Policy, vol. 18, no. 2, pp. 143-145.
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Duffield, C, Roche, MA, Wise, S & Debono, D 2020, 'Harnessing ward‐level administrative data and expert knowledge to improve staffing decisions: A multi‐method case study', Journal of Advanced Nursing, vol. 76, no. 1, pp. 287-296.
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AbstractAimThe aim of this study was to investigate the impact of changes to bed configuration and patient mix on nurses’ workload in a single ward.DesignMulti‐method case study.MethodThe study was undertaken in an acute 28‐bed ward in a tertiary referral public hospital in Queensland, Australia. Ward‐level administrative data were obtained for a 2‐year period, 12 months before bed configuration changes in October 2015 and 12 months after. These data included patient activity (bed occupancy, transfers, length of stay and casemix) and nurse staffing (budgeted and actual staffing levels, employment status and skillmix). Semi‐structured interviews were conducted with ward nurses (N = 17) to explore the impact of the bed configuration changes on their workload.ResultsAdministrative data showed that the bed configuration changes resulted in more complex and dependent patients, increased patient transfers and greater variability in casemix. The interview data found these changes to patient complexity and activity intensified workloads, which were further increased by staffing decisions that resulted in greater reliance on temporary staff.ConclusionHospitals already possess the data and expert knowledge needed to improve staffing and bed management decisions without the need for additional, costly workload systems.ImpactDetermining appropriate nurse staffing in light of the complexities and variation of patient needs at the ward level remains a challenge. This study identified increases in patient complexity, dependency, variability and churn that increased ...
Eakin, EG, Reeves, MM, Goode, AD, Winkler, EAH, Vardy, JL, Boyle, F, Haas, MR, Hiller, JE, Mishra, GD, Jefford, M, Koczwara, B, Saunders, CM, Chapman, K, Hing, L, Boltong, AG, Lane, K, Baldwin, P, Millar, L, McKiernan, S, Demark-Wahnefried, W, Courneya, KS, Job, J, Reid, N, Robson, E, Moretto, N, Gordon, L & Hayes, SC 2020, 'Translating research into practice: outcomes from the Healthy Living after Cancer partnership project', BMC Cancer, vol. 20, no. 1.
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Abstract Background Healthy Living after Cancer (HLaC) was a national dissemination and implementation study of an evidence-based lifestyle intervention for cancer survivors. The program was imbedded into existing telephone cancer information and support services delivered by Australian state-based Cancer Councils (CC). We report here the reach, effectiveness, adoption, implementation, and maintenance of the program. Methods In this phase IV study (single-group, pre-post design) participants - survivors of any type of cancer, following treatment with curative intent - received up to 12 nurse/allied health professional-led telephone health coaching calls over 6 months. Intervention delivery was grounded in motivational interviewing, with emphasis on evidence-based behaviour change strategies. Using the RE-AIM evaluation framework, primary outcomes were reach, indicators of program adoption, implementation, costs and maintenance. Secondary (effectiveness) outcomes were participant-reported anthropometric, behavioural and psychosocial variables including: weight; physical activity; dietary intake; quality-of-life; treatment side-effects; distress; and fear of cancer recurrence and participant satisfaction. Changes were evaluated using linear mixed models, including terms for timepoint (0/6 months), strata (Cancer Council), and timepoint x strata. Results Four of 5 CCs approached participated in the study. In total, 1183 cancer survivors were referred (mostly via calls to the Cancer Council telephone information service). Of these, 90.4% were eligible and 88.7% (n = 791) of those eligible consented to participate. Re...
Engel, L, Bucholc, J, Mihalopoulos, C, Mulhern, B, Ratcliffe, J, Yates, M & Hanna, L 2020, 'A qualitative exploration of the content and face validity of preference-based measures within the context of dementia', Health and Quality of Life Outcomes, vol. 18, no. 1, pp. 1-19.
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Abstract Background Assessing the cost-effectiveness of interventions for people with dementia, based on cost per quality-adjusted life years (QALYs) gained, requires that the measures used to derive QALYs are preference-based whilst also being valid, feasible to use, comprehensible and acceptable for people with dementia. The aim of this study was to assess the content and face validity of six preference-based measures (PBMs) within the context of dementia. Methods Qualitative focus groups and interviews were conducted with community-dwelling individuals with mild dementia and carers of people with dementia. After exploring participants’ understanding of ‘quality of life’ (QoL), six PBMs were assessed for content and face validity: two measures assessing health-related QoL (EQ-5D-5L and AQoL-8D); two covering broader aspects of capability wellbeing and social care-related QoL (ICECAP-O and ASCOT); and two dementia-specific QoL measures (DEMQOL-U and AD-5D). A random mix of one health-related QoL measure, one wellbeing measure, and one dementia-specific measure was explored in each session. All sessions were audiotaped and transcribed verbatim. Data were analysed thematically. Results Nine individuals with mild dementia and 17 carers of people with dementia participated across 4 focus groups and 10 interviews. Participants perceived 9 broad QoL domains as relevant to them: Activity, Autonomy, Cognition, Communication, Coping, Emotions, End-of-Life, Physical Functioning, and Relationships. These domains had limited overlap with the content of the six PBMs. Assessment of face validity was summarized into eight themes: (1) ambiguous questions...
Farrar, MA, Carey, KA, Paguinto, S-G, Kasparian, NA & De Abreu Lourenço, R 2020, '“The Whole Game is Changing and You’ve Got Hope”: Australian Perspectives on Treatment Decision Making in Spinal Muscular Atrophy', The Patient - Patient-Centered Outcomes Research, vol. 13, no. 4, pp. 389-400.
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INTRODUCTION:The natural history and treatment of spinal muscular atrophy (SMA) is currently being transformed by the development and availability of novel therapies, with significant related changes in practice. This not only has important implications for the health and wellbeing of patients with SMA and their families, as well as improves the quality of care. OBJECTIVE:The present study aimed to investigate the processes and factors that influence treatment and healthcare decisions for children and adults with SMA and their families and healthcare providers. METHODS:Four focus groups comprising adults, or parents of children and adolescents, with SMA and an expert panel of healthcare providers (N = 25) explored experiences of SMA, its treatment and related decision making and expectations for future care. Group discussions were recorded and transcribed verbatim for thematic analysis using NVivo12.0. RESULTS:People with SMA, their families and healthcare providers described confronting complex healthcare decisions in the context of a rapidly changing SMA treatment environment. Across all groups, five key themes were identified: hope, yearning and searching, patient-centred care and support, community and a sense of connectedness and weighing up potential treatment benefits and costs. Essential to these themes was the notion of what it means to live with SMA and complexities relating to 'quality of life'. CONCLUSION:Identifying and more deeply understanding the factors that influence patient, family and healthcare providers' decision making regarding SMA treatment is an important first step in improving the quality of patient- and family-centred care and in informing clinical practice and future health policy incorporating personalized medicine and optimal supportive and mental health care.
Findlay, M, Brown, C, De Abreu Lourenço, R, White, K & Bauer, J 2020, 'Sarcopenia and myosteatosis in patients undergoing curative radiotherapy for head and neck cancer: Impact on survival, treatment completion, hospital admission and cost', Journal of Human Nutrition and Dietetics, vol. 33, no. 6, pp. 811-821.
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AbstractBackgroundComputed tomography (CT) is the gold standard of body composition analysis at the tissue‐organ level. The present study aimed to determine the impact of CT‐defined sarcopenia and myosteatosis on outcomes, including overall survival, unplanned hospital admissions and related costs, in patients who had completed treatment of curative intent for head and neck cancer (HNC).MethodsRetrospective observational study of patients undergoing radiotherapy of curative intent ± other treatment modalities for HNC. Tissue density data derived at the third lumbar vertebra (L3) were evaluated with sarcopenia defined per sex‐specific published threshold values for skeletal muscle index, stratified by body mass index and mean skeletal muscle attenuation in HU (Hounsfield units).ResultsPre‐ or post‐treatment images were available for 79/98 patients (80.6%) and 61/98 patients (62.2%), respectively. Sarcopenia was present in 42/79 patients pre‐treatment and 36/61 patients post‐treatment, whereas myosteatosis was present in 63/79 patients pre‐treatment and 48/61 patients post‐treatment. In patients with pre‐ and post‐treatment images (n = 60), the median (range) percentage weight change was −8.5% (−29.9 to +11.7). On multivariable analysis, a post‐treatment sarcopenia hazard ratio of 3.87 (95% confidence interval = 1.22–12.24, P = 0.021) and a pre‐treatment myosteatosis hazard ratio of 8.86 (95% confidence interval = 1.12–69.88, P = 0.038) were independent predictors of reduced overall survival. There was no difference in radiotherapy or chemotherapy treatment completion based on pre‐treatment sarcopenia status. The mean (SD) difference unplanned hospital admission cost was $15 846 ($17 7...
Findlay, M, Rankin, NM, Shaw, T, White, K, Boyer, M, Milross, C, De Abreu Lourenço, R, Brown, C, Collett, G, Beale, P & Bauer, JD 2020, 'Best Evidence to Best Practice: Implementing an Innovative Model of Nutrition Care for Patients with Head and Neck Cancer Improves Outcomes', Nutrients, vol. 12, no. 5, pp. 1465-1465.
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Malnutrition is prevalent in patients with head and neck cancer (HNC), impacting outcomes. Despite publication of nutrition care evidence-based guidelines (EBGs), evidence–practice gaps exist. This study aimed to implement and evaluate the integration of a patient-centred, best-practice dietetic model of care into an HNC multidisciplinary team (MDT) to minimise the detrimental sequelae of malnutrition. A mixed-methods, pre–post study design was used to deliver key interventions underpinned by evidence-based implementation strategies to address identified barriers and facilitators to change at individual, team and system levels. A data audit of medical records established baseline adherence to EBGs and clinical parameters prior to implementation in a prospective cohort. Key interventions included a weekly Supportive Care-Led Pre-Treatment Clinic and a Nutrition Care Dashboard highlighting nutrition outcome data integrated into MDT meetings. Focus groups provided team-level evaluation of the new model of care. Economic analysis determined system-level impact. The baseline clinical audit (n = 98) revealed barriers including reactive nutrition care, lack of familiarity with EBGs or awareness of intensive nutrition care needs as well as infrastructure and dietetic resource limitations. Post-implementation data (n = 34) demonstrated improved process and clinical outcomes: pre-treatment dietitian assessment; use of a validated nutrition assessment tool before, during and after treatment. Patients receiving the new model of care were significantly more likely to complete prescribed radiotherapy and systemic therapy. Differences in mean percentage weight change were clinically relevant. At the system level, the new model of care avoided 3.92 unplanned admissions and related costs of $AUD121K per annum. Focus groups confirmed clear support at the multidisciplinary team level for continuing the new model of care. Implementing an evidence-based nutrition mo...
Geerligs, L, Shepherd, HL, Rankin, NM, Masya, L, Shaw, JM, Price, MA, Dhillon, H, Dolan, C, Prest, G, Andrews, G, Baychek, K, Beale, P, Allison, K, Clayton, J, Coll, J, Cuddy, J, Girgis, A, Grimison, P, Hack, T, Kelly, B, Kirsten, L, Lindsay, T, Lovell, M, Luckett, T, Murphy, M, Newby, J, Orr, F, Pearce, A, Piro, D, Shaw, T, Stubbs, J, Viney, R, White, F, Yim, J & Butow, P 2020, 'The value of real-world testing: a qualitative feasibility study to explore staff and organisational barriers and strategies to support implementation of a clinical pathway for the management of anxiety and depression in adult cancer patients', Pilot and Feasibility Studies, vol. 6, no. 1.
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AbstractBackgroundEffective translation of evidence-based research into clinical practice requires assessment of the many factors that can impact implementation success. Research methods that draw on recognised implementation frameworks, such as the Promoting Action Research in Health Services (PARiHS) framework, and that test feasibility to gain information prior to full-scale roll-out, can support a more structured approach to implementation.ObjectiveThis paper presents qualitative findings from a feasibility study in one cancer service of an online portal to operationalise a clinical pathway for the screening, assessment and management of anxiety and depression in adult cancer patients. The aim of this study was to explore staff perspectives on the feasibility and acceptance of a range of strategies to support implementation in order to inform the full-scale roll-out.MethodsSemi-structured interviews were conducted with fifteen hospital staff holding a range of clinical, administrative and managerial roles, and with differing levels of exposure to the pathway. Qualitative data were analysed thematically, and themes were subsequently organised within the constructs of the PARiHS framework.ResultsBarriers and facilitators that affected the feasibility of the online portal and implementation strategies were organised across eight key themes: staff perceptions, culture, external influences, attitudes to psychosocial care, intervention fit, familiarity, burden and engagement. These themes mapped to the PARiHS framework’s three domains of evidence, context and facilitation.ConclusionsImplementation success may be threatened by a...
Haeusler, GM, Phillips, R, Slavin, MA, Babl, FE, De Abreu Lourenco, R, Mechinaud, F & Thursky, KA 2020, 'Re-evaluating and recalibrating predictors of bacterial infection in children with cancer and febrile neutropenia', EClinicalMedicine, vol. 23, pp. 100394-100394.
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BackgroundNumerous paediatric febrile neutropenia (FN) clinical decision rules (CDRs) have been derived. Validation studies show reduced performance in external settings. We evaluated the association between variables common across published FN CDRs and bacterial infection and recalibrated existing CDRs using these data.MethodsProspective data from the Australian-PICNICC study which enrolled 858 FN episodes in children with cancer were used. Variables shown to be significant predictors of infection or adverse outcome in >1 CDR were analysed using multivariable logistic regression. Recalibration included re-evaluation of beta-coefficients (logistic model) or recursive-partition analysis (tree-based models).FindingsTwenty-five unique variables were identified across 17 FN CDRs. Fourteen were included in >1 CDR and 10 were analysed in our dataset. On univariate analysis, location, temperature, hypotension, rigors, severely unwell and decreasing platelets, white cell count, neutrophil count and monocyte count were significantly associated with bacterial infection. On multivariable analysis, decreasing platelets, increasing temperature and the appearance of being clinically unwell remained significantly associated. Five rules were recalibrated. Across all rules, recalibration increased the AUC-ROC and low-risk yield as compared to non-recalibrated data. For the SPOG-adverse event CDR, recalibration also increased sensitivity and specificity and external validation showed reproducibility.InterpretationDegree of marrow suppression (low platelets), features of inflammation (temperature) and clinical judgement (severely unwell) have been consistently shown to predict infection in children with FN. Recalibration of existing CDRs is a novel way to improve diagnostic performance of CDRs and maintain relevance over time.
Haeusler, GM, Thursky, KA, Slavin, MA, Babl, FE, De Abreu Lourenco, R, Allaway, Z, Mechinaud, F & Phillips, R 2020, 'Risk stratification in children with cancer and febrile neutropenia: A national, prospective, multicentre validation of nine clinical decision rules', eClinicalMedicine, vol. 18, pp. 100220-100220.
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© 2019 Background: Reduced intensity treatment of low-risk febrile neutropenia (FN) in children with cancer is safe and improves quality of life. Identifying children with low-risk FN using a validated risk stratification strategy is recommended. This study prospectively validated nine FN clinical decision rules (CDRs) designed to predict infection or adverse outcome. Methods: Data were collected on consecutive FN episodes in this multicentre, prospective validation study. The reproducibility and discriminatory ability of each CDR in the validation cohort was compared to the derivation dataset and details of missed outcomes were reported. Findings: There were 858 FN episodes in 462 patients from eight hospitals included. Bacteraemia occurred in 111 (12·9%) and a non-bacteraemia microbiological documented infection in 185 (21·6%). Eight CDRs exhibited reproducibility and sensitivity ranged from 64% to 96%. Rules that had >85% sensitivity in predicting outcomes classified few patients (<20%) as low risk. For three CDRs predicting a composite outcome of any bacterial or viral infection, the sensitivity and discriminatory ability improved for prediction of bacterial infection alone. Across all CDRs designed to be implemented at FN presentation, the sensitivity improved at day 2 assessment. Interpretation: While reproducibility was observed in eight out of the nine CDRs, no rule perfectly differentiated between children with FN at high or low risk of infection. This is in keeping with other validation studies and highlights the need for additional safeguards against missed infections or adverse outcomes before implementation can be considered.
Hettiarachchi, R, Kularatna, S, Byrnes, J, Mulhern, B, Chen, G & Scuffham, PA 2020, 'Valuation study for a preference-based quality of life measure for dental caries (Dental Caries Utility Index - DCUI) among Australian adolescents - study protocol', BMJ Open, vol. 10, no. 10, pp. e038626-e038626.
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IntroductionA new health state classification system has been developed for dental caries - Dental Caries Utility Index (DCUI) to facilitate the assessment of oral health interventions in the cost-utility analysis (CUA). This paper reports the protocol for a valuation study, which aims to generate a preference-based algorithm for the classification system for the DCUI.Methods and analysisDiscrete choice experiments (DCEs) will be conducted to value health states generated by the DCUI classification system and preferences for these health states will be modelled to develop a utility algorithm. DCEs produce utility values on a latent scale and these values will be anchored into the full health-dead scale to calculate the quality-adjusted life years in CUA. There is no previous evidence for the most suitable anchoring method for dental caries health state valuation. Hence, we will first conduct pilot studies with two anchoring approaches; DCE including duration attribute and DCE anchoring to worst heath state in Visual Analogue Scale. Based on the pilot studies, the most suitable anchoring method among two approaches will be used in the main valuation survey, which will be conducted as an online survey among a representative sample of 2000 adults from the Australian general population. Participants will be asked to complete a set of DCE choice tasks along with anchoring tasks, basic social-demographic questions, DCUI, a generic preference-based measure and oral health quality of life instrument.Ethics and disseminationEthical approval for this study was obtained from the Human Research Ethics Committee, Griffith University (reference number HREC/2019/550). The generated algorithm will facilitate the use of the new dental caries preference-based measure in economic eva...
Howard, K, Anderson, K, Cunningham, J, Cass, A, Ratcliffe, J, Whop, LJ, Dickson, M, Viney, R, Mulhern, B, Tong, A & Garvey, G 2020, 'What Matters 2 Adults: a study protocol to develop a new preference-based wellbeing measure with Aboriginal and Torres Strait Islander adults (WM2Adults)', BMC Public Health, vol. 20, no. 1.
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AbstractBackgroundUnderstandings of health and wellbeing are culturally bound. Many Aboriginal and Torres Strait Islander people perceive wellbeing and quality of life (QOL) differently from the Western biomedical models of health underpinning existing QOL instruments. Any instrument to measure the wellbeing of Aboriginal and Torres Strait Islander people should be culturally appropriate and safe, include relevant dimensions, and be informed by their own values and preferences. Existing QOL instruments do not meet these standards. This study will generate a new preference-based wellbeing measure, WM2Adults, for Aboriginal and Torres Strait Islander adults, underpinned by their values and preferences.MethodsA mixed methods approach will be used; we will employ decolonising methodologies, privilege Aboriginal and Torres Strait Islander voices and perspectives, and adopt a strengths-based approach rather than a deficit lens. Yarning Circles will be conducted with Aboriginal and Torres Strait Islander people across Australia. A candidate item pool will be developed from these data, on which psychometric analysis and validity testing will be undertaken to develop a descriptive system. Following finalisation of the descriptive system, wellbeing states will be valued using a quantitative preference-based approach (best-worst scaling) with a diverse sample of Aboriginal and Torres Strait Islander adults (n = 1000). A multinomial (conditional) logit framework will be used to analyse responses and generate a scoring algorithm for the new preference-based WM2Adults measure.DiscussionThe new wellbeing measure will have wide applicability in assessing the effectiveness and cost-effectiveness of new programs and services for Aboriginal and Torres Str...
Huda, TM, Alam, A, Tahsina, T, Hasan, MM, Iqbal, A, Khan, J, Ara, G, Ali, NB, Al Amin, SU, Kirkwood, EK, Laba, T-L, Goodwin, N, Muthayya, S, Islam, M, Agho, KE, Hoddinott, J, El Arifeen, S & Dibley, MJ 2020, 'Shonjibon cash and counselling: a community-based cluster randomised controlled trial to measure the effectiveness of unconditional cash transfers and mobile behaviour change communications to reduce child undernutrition in rural Bangladesh', BMC Public Health, vol. 20, no. 1, p. 1776.
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AbstractBackgroundUndernutrition is strongly associated with poverty - levels of undernutrition are higher in poor countries than in better-off countries. Social protection especially cash transfer is increasingly recognized as an important strategy to accelerate progress in improving maternal and child nutrition. A critical method to improve nutrition knowledge and influence feeding practices is through behaviour change communication intervention. The Shonjibon Cash and Counselling study aims to assess the effectiveness of unconditional cash transfers combined with a mobile application on nutrition counselling and direct counselling through mobile phone in reducing the prevalence of stunting in children at 18 months.MethodThe study is a longitudinal cluster randomised controlled trial, with two parallel groups, and cluster assignment by groups of villages. The cohort of mother-child dyads will be followed-up over the intervention period of approximately 24 months, starting from recruitment to 18 months of the child’s age. The study will take place in north-central Bangladesh. The primary trial outcome will be the percentage of stunted children at 18 m as measured in follow up assessments starting from birth. The secondary trial outcomes will include differences between treatment arms in (1) Mean birthweight, percentage with low birthweight and small for gestational age (2) Mean child length-for age, weight for age and weight-for-length Z scores (3) Prevalence of child wasting (4) Percentage of women exclusively breastfeeding and mean duration of exclusive breastfeeding (5) Percentage of children consuming > 4 food groups (6) Mean child intake of energy, protein, carbohydrate, fat and micronutrients (7) Percentage of women at risk of inadequate nutrient intakes in all three trimesters (8) Maternal weight gain (9) Hou...
Karia, AM, Balane, C, Norman, R, Robinson, S, Lehnbom, E, Durakovic, I, Laba, T-L, Joshi, R & Webster, R 2020, 'Community pharmacist workflow: Space for Pharmacy-based Interventions and Consultation TimE study protocol', International Journal of Pharmacy Practice, vol. 28, no. 5, pp. 441-448.
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Abstract Background Pharmacists’ roles are expanding to delivering a wider set of professional services including medication management optimisation, vaccinations and screening services. Robust research determining whether pharmacists have the capacity to offer such services in the Australian community pharmacy setting is lacking. This protocol details a mixed methods study that investigates the variation in pharmacists’ daily tasks and the workspace they work in as a measure of their workload capacity for expanding pharmacy services. Methods An observational time and motion study will be conducted in up to twenty community pharmacies in metropolitan and rural regions of Australia. A trained observer will follow a pharmacist and record the type, location and duration of tasks undertaken over the course of their working day. Data will be collected and analysed using the electronic Work Observation Method By Activity Timing (WOMBAT) tool. Pharmacists’ work patterns will be described as time for each task, and by proportionating multitasking and interruptions. This information will be combined with workspace data collected using floor plans, photographs and a qualitative assessment of the working environment completed by the observer. Analysis will include heat-mapped floor plans visually highlighting pharmacist movements. Discussion Pharmacists may provide solutions to the strained health workforce and system. There is limited quantitative evidence on whether pharmacists have the time or work setting to support such needs. The use of time and motion methodology is novel to Austral...
Kelada, L, Wakefield, CE, Vetsch, J, Schofield, D, Sansom‐Daly, UM, Hetherington, K, O'Brien, T, Cohn, RJ, Anazodo, A, Viney, R & Zeppel, MJB 2020, 'Financial toxicity of childhood cancer and changes to parents’ employment after treatment completion', Pediatric Blood & Cancer, vol. 67, no. 7, p. e28345.
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AbstractObjectiveChildhood cancer can have short‐ and long‐term impacts on parents’ finances and employment. It is important to understand how families adjust to the financial and employment changes caused by childhood cancer, the ongoing impacts after treatment completion, and which families need more targeted support. Qualitative research is necessary to facilitate an in‐depth understanding of the employment and financial impacts on families and to capture parents’ complex and nuanced experiences and perspectives.MethodsWe interviewed 56 parents of childhood cancer survivors (M = 2.13 years after treatment completion; 89% mothers) using the vocational and financial impact section of the Psychosocial Adjustment to Illness Scale–Carer Interview Form. We analyzed interviews using content analysis.ResultsParents reported multiple sources of financial toxicity including travel to and from the hospital and needing to reduce their working hours during their child's cancer treatment. Workplace flexibility was an important factor to protect against unwanted vocational changes. After treatment completion, families living in low socioeconomic areas commonly reported ongoing financial difficulties. Mothers, particularly those who were on maternity leave when their child was diagnosed with cancer, reported ongoing employment impacts including unemployment.ConclusionsClinical staff including social workers could more consistently assess families’ financial distress and refer to professional services who can offer guidance for financial decision‐making as standard care. Flexible workplace agreements appear important for parents of children with cancer. Our findings can assist organizatio...
Kim, H, Goodall, S & Liew, D 2020, 'The Potential for Early Health Economic Modelling in Health Technology Assessment and Reimbursement DecisionMaking Comment on 'Problems and Promises of Health Technologies: The Role of Early Health Economic Modeling'', International Journal of Health Policy and Management.
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Grutters et al recently investigated the role of early health economic modelling of health technologies by undertaking a secondary analysis of health economic modelling assessments performed by their group. Our commentary offers a broad perspective on the potential utility of early health economic modelling to inform health technology assessment (HTA) and decision-making around reimbursement of new health technologies. Further we provide several examples to compliment Grutters and colleagues’ observations.
Kim, H, Liew, D & Goodall, S 2020, 'Cost‐effectiveness and financial risks associated with immune checkpoint inhibitor therapy', British Journal of Clinical Pharmacology, vol. 86, no. 9, pp. 1703-1710.
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The reimbursement of immune checkpoint inhibitors is challenging. Funding these technologies involves the careful balance between awarding innovation and ensuring affordability as increases in drug spending compete directly with other health care and social expenditure. This narrative review examines the recommendations of 2 health technology assessment agencies—the Australian Pharmaceutical Benefits Advisory Committee and the British National Institute of Clinical Excellence—to determine the factors that contribute to the approval and rejection of immune checkpoint inhibitors as well as the use of manage entry schemes and risk management strategies to control expenditure. Reimbursement decisions from 6 immune checkpoint inhibitor drugs (ipilimumab, pembrolizumab, nivolumab, durvalumab, atezolizumab, avelumab) covering 10 different cancers were examined. The extrapolation of survival beyond the clinical trial and lack of head‐to‐head evidence are some of the main issues relating to cost...
Kinchin, I, Russell, AMT, Byrnes, J, McCalman, J, Doran, CM & Hunter, E 2020, 'The cost of hospitalisation for youth self-harm: differences across age groups, sex, Indigenous and non-Indigenous populations', Social Psychiatry and Psychiatric Epidemiology, vol. 55, no. 4, pp. 425-434.
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Objective
To report the comparative rates, average length of stay and cost per episode of hospital management for self-harm in three age cohorts: 15–19 years, 20–24 years and 25–29 years; by sex and indigeneity.
Design, setting, participants
A secondary data analysis of the Australian Institute of Health and Welfare (AIHW) dataset between 1st January 2014 and 31st December 2014 inclusive.
Main outcome measures
Cost per episode of hospitalised self-harm and rates by age group, sex and Indigenous status.
Results
The rate of hospitalised self-harm among Australian youth was 254.0 per 100,000 population. This rate resulted in an annual cost to the healthcare system of AU$55 million or an average cost per episode of $4649 (95% CI $4488:$4810). Hospitalised self-harm was 21 times higher than the rate of suicide (11,820 episodes of hospitalised self-harm/564 suicides). Indigenous youth had on average a 1.4 times higher rate of hospitalised self-harm and 2.2 times higher rate of suicide than non-Indigenous counterparts. When controlling for age and sex, the average cost per episode was significantly lower for Indigenous youth compared to non-Indigenous youth, estimated marginal means $4538 and $4954, respectively (p < 0.001).
Conclusions
Hospitalised self-harm among Australian youth resulted in a substantial cost to the healthcare system. This cost is only part of the overall burden associated with self-harm. The rate of hospitalised self-harm was significantly higher in Indigenous youth, but the associated cost per episode was significantly lower.
Kinchin, I, Russell, AMT, Petrie, D, Mifsud, A, Manning, L & Doran, CM 2020, 'Program Evaluation and Decision Analytic Modelling of Universal Suicide Prevention Training (safeTALK) in Secondary Schools', Applied Health Economics and Health Policy, vol. 18, no. 2, pp. 311-324.
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BACKGROUND:Universal suicide education and awareness training in schools are promising suicide prevention initiatives. This study aims to evaluate a suicide awareness training (safeTALK) and to model potential return on investment (ROI) on a population basis. SafeTALK, comprises a 3-h education session, and has been delivered to secondary school students (aged 15-16 years) in Mackay, located in the Australian state of Queensland. METHODS:Evaluation consisted of two phases, ex-post and ex-ante. Phase I was a pre-post, follow-up analysis using a mixed-method questionnaire administered immediately prior (Time 1), immediately after (Time 2), and 4 weeks after training (Time 3). Phase II involved decision analytic modelling comparing safeTALK to the status quo. ROI was modelled using Markov chains for a hypothetical population of students aged 15-19 years in Mackay (n = 2561; suicide rate 78.1 per 100,000), Queensland (n = 296,287; 10.2) and Australia (n = 1,421,595; 8.3). Model parameters, including rates of hospitalised self-harm and suicide, cost implications and effectiveness of safeTALK were drawn from published literature. The baseline model adapted a health and justice system's perspective, with an alternative model incorporating a societal perspective. All costs were adjusted to reflect AU$2017-2018. RESULTS:Students reported seeking help mostly from friends (79%) or parents (68%); in the last 6 months 61% considered another student's behaviour as suicidal, but only 21% reported asking about this. The main barriers to help-seeking were (i) being too embarrassed, (ii) shy or (iii) being judged. Students who attended safeTALK gained suicide-related knowledge (p < 0.001), confidence (p < 0.001), willingness (p = 0.006), and likelihood of seeking help (p = 0.044) and retained these up until follow-up assessment 4 weeks later with the exception of seeking help. From a health and justice system's perspective, the model estimated a cumulative return of AU$1.45 per AU...
Laba, T-L, Cheng, L, Kolhatkar, A & Law, MR 2020, 'Cost-related nonadherence to medicines in people with multiple chronic conditions', Research in Social and Administrative Pharmacy, vol. 16, no. 3, pp. 415-421.
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BACKGROUND:Multimorbidity is common and frequently associated with medicine nonadherence. Although cost is a common reason for nonadherence, very little research has quantified cost-related nonadherence (CRNA) to medicines specifically in people with multimorbidity, the prevalence of CRNA for different conditions nor the impact of cost when prioritising treatment between conditions. OBJECTIVE:To determine the extent of CRNA in people with multimorbidity and the patient characteristics associated with these behaviours. DESIGN AND SETTING:People reporting two or more chronic conditions responding to a rapid response module regarding prescription drug affordability fielded between January 1 and June 30 2016 in the Canadian Community Health Survey, a cross-sectional household survey. METHODS:Ordinal logistic regression, adjusted for key sociodemographic, clinical and treatment related variables, of weighted population estimates of self-reported CRNA within one group of conditions, across multiple groups of conditions, or no CRNA. RESULTS:10.2% of 8420 Canadians with multimorbidity reported CRNA. The majority (61%) reported CRNA within one group of conditions, especially respiratory (16%) and mental health disorders (17%). CRNA was more common in younger adults, people without employer or association drug insurance plans, poorer health status, more chronic conditions, and increased out-of-pocket prescription costs. Having no prescription insurance was associated with a higher probability of CRNA across multiple groups of conditions. CONCLUSIONS:People with multimorbidity primarily forego medicines because of cost within one group of conditions. However, those without drug insurance extended these behaviours to multiple condition groups. Further work is needed to determine how people prioritise the conditions and treatments that are foregone because of cost, and how to best incorporate this information into treatment plans.
Laba, T-L, Cheng, L, Worthington, HC, McGrail, KM, Chan, FKI, Mamdani, M & Law, MR 2020, 'What happens to drug use and expenditure when cost sharing is completely removed? Evidence from a Canadian provincial public drug plan', Health Policy, vol. 124, no. 9, pp. 977-983.
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ObjectivesThe role of cost-sharing for medicines is under active policy discussion, including in proposals for value-based insurance design. To inform this debate, we estimated the impact of completely removing cost-sharing on medication use and expenditure using a quasi-experimental approach.MethodsFair PharmaCare, British Columbia’s income-based public drug plan, includes a household out-of-pocket limit. Therefore, when one household member starts a long-term high-cost drug surpassing this maximum, cost-sharing is completely removed for other family members. We used an interrupted time series design to estimate monthly prescriptions and expenditures of other household members, 24 months before and after cost-sharing removal.ResultsWe studied 2191 household members newly free of cost-sharing requirements, most of whom had lower incomes. R emoving cost-sharing increased the level of drug expenditure and prescription numbers by 16 and 19%, respectively (i.e. $2659.43 (95%$1507.27–$3811.59, p < 0.001); 50.0 (95%CI 25.1–74.9, p < 0.001)) relative to prior expenditures and utilization without changing pre-existing trends. Much of this change was driven by 533 individuals initiating medication for the first time after cost-sharing removal. This initiation substantially increased average expenditure, especially for antiviral agents.ConclusionsCompletely removing cost-sharing, independent of health status, significantly increased medication use and expenditure particularly due to medicine initiation by new users. While costs may be preventing use, the appropriateness of additional use, especially among new users, is unclear.
Laba, T-L, Jiwani, B, Crossland, R & Mitton, C 2020, 'Can multi-criteria decision analysis (MCDA) be implemented into real-world drug decision-making processes? A Canadian provincial experience', International Journal of Technology Assessment in Health Care, vol. 36, no. 4, pp. 434-439.
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ObjectiveTo describe the implementation of multi-criteria decision analysis (MCDA) into a Canadian public drug reimbursement decision-making process, identifying the aspects of the MCDA approach, and the context that promoted uptake.MethodsNarrative summary of case study describing the how, when, and why of implementing MCDA.ResultsFaced with a fixed budget, a pipeline of expensive but potentially valuable drugs, and potential delays to drug decision making, the Ministry of Health (i.e., decision makers) and its independent expert advisory committee (IAB) sought alternative values-based decision processes. MCDA was considered highly compatible with current processes, but the ability as a stand-alone intervention to address issues of opportunity cost was unclear. The IAB nevertheless collaboratively voted to implement an externally developed MCDA with support from decision makers. After several months of engagement and piloting, implementation was rapid and leveraged strong pre-existing formal and informal communication networks. The IAB as a whole rates new submissions which serves as an input into the deliberative process.ConclusionsMCDA can be a highly adaptable approach that can be implemented into a functioning drug reimbursement setting when facilitated by (i) a truly limited budget; (ii) a shared vision for change by end-users and decision makers; (iii) using pre-existing deliberative processes; and (iv) viewing the approach as a decision framework rather than the decision (when appropriate). Given the current limitations of MCDA, implementin...
Marten, O, Mulhern, B, Bansback, N & Tsuchiya, A 2020, 'Implausible States: Prevalence of EQ-5D-5L States in the General Population and Its Effect on Health State Valuation', Medical Decision Making, vol. 40, no. 6, pp. 735-745.
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The EQ-5D is made up of health state dimensions and levels, in which some combinations seem less “plausible” than others. If “implausible” states are used in health state valuation exercises, then respondents may have difficulty imagining them, causing measurement error. There is currently no standard solution: some valuation studies exclude such states, whereas others leave them in. This study aims to address 2 gaps in the literature: 1) to propose an evidence-based set of the least prevalent two-way combinations of EQ-5D-5L dimension levels and 2) to quantify the impact of removing perceived implausible states from valuation designs. For the first aim, we use data from 2 waves of the English General Practitioner Patient Survey ( n = 1,639,453). For the second aim, we remodel a secondary data set of a Discrete Choice Experiment (DCE) with duration that valued EQ-5D-5L and compare across models that drop observations involving different health states: 1) implausible states as defined in the literature, 2) the least prevalent states identified in stage 1, and 3) randomly select states, alongside 4) a model that does not drop any observations. The results indicate that two-way combinations previously thought to be implausible actually exist among the general population; there are other combinations that are rarer, and removing implausible states from an experimental design of a DCE with duration leads to value sets with potentially different characteristics depending on the criterion of implausible states. We advise against the routine removal of implausible states from health state valuation studies.
Martin, A, Morgan, G, O'hara, J, Mulhern, B, Sawyer, EK & Li, N 2020, 'PRO120 A Discrete-Choice Experiment with Duration to Compare the Preferences of People with Haemophilia and the General Population', Value in Health, vol. 23, pp. S711-S711.
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Mazza, D, Amos, N, Watson, CJ, McGeechan, K, Haas, M, Peipert, JF, Lucke, J, Taft, A, McNamee, K & Black, KI 2020, 'Increasing the uptake of long-acting reversible contraception in general practice: the Australian Contraceptive ChOice pRoject (ACCORd) cluster randomised controlled trial longitudinal follow-up protocol', BMJ Open, vol. 10, no. 9, pp. e035895-e035895.
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IntroductionThrough addressing main barriers to the uptake of long-acting reversible contraceptives (LARCs) among Australian women, the Australian Contraceptive ChOice pRoject (ACCORd) trialled an educational intervention targeting general practitioners (GPs) and provided those in the intervention group with a rapid referral service for quick insertion. The cluster randomised controlled trial resulted in greater uptake of LARC in the intervention group. This protocol paper describes a longitudinal follow-up to the ACCORd Study to assess the long-term efficacy and cost-effectiveness of the intervention.Methods and analysisWomen participants (patients of ACCORd GPs) completed a baseline, 6-month and 12-month survey. These participants will be invited to complete an additional follow-up survey 3 years post completion of their baseline interview. Based on the original ACCORd Study tools, the online survey will address long-term outcomes including contraceptive continuation rates and reproductive history, any unintended pregnancies, satisfaction and concerns with their current contraceptive method, and an assessment of quality of life. We will analyse data using binary regression models with generalised estimating equations and robust standard errors to account for clustering.DiscussionDemonstration of sustained use, effectiveness at reducing unwanted pregnancies and cost-effectiveness of this strategy among this cohort of Australian primary care patients, will strengthen the policy and programme urgency of addressing wider dissemination of these strategies and replicating the study elsewhere.Ethics and disseminationThe ACCORd Study received approval from the Monash University Human Research Ethics Committee: CF16/188-201000080. A...
Mazza, D, Watson, CJ, Taft, A, Lucke, J, McGeechan, K, Haas, M, McNamee, K, Peipert, JF & Black, KI 2020, 'Increasing long-acting reversible contraceptives: the Australian Contraceptive ChOice pRoject (ACCORd) cluster randomized trial', American Journal of Obstetrics and Gynecology, vol. 222, no. 4, pp. S921.e1-S921.e13.
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BACKGROUND:Long-active reversible contraceptives (LARCs) reduce unintended pregnancy and abortions but uptake is low. Interventions to increase uptake in family medicine settings are untested. OBJECTIVE:The Australian Contraceptive ChOice pRoject (ACCORd), adapted from the successful US Contraceptive CHOICE study, aimed to evaluate whether a complex intervention in family medicine practices resulted in increased LARC uptake by women. STUDY DESIGN:This cluster randomized controlled trial was set in family practices in metropolitan Melbourne, Australia. From April 2016 to January 2017 we recruited 57 family physicians by mail invitation. Each family physician aimed to recruit at least 14 women patients. Eligible family physician worked three or more sessions per week in computerized practices. Eligible women were English speaking, sexually active, not pregnant, not planning a pregnancy in the following year, aged 16-45 years and interested in discussing contraception or in starting a new, reversible method. Using a randomization sequence with permuted bocks stratified by whether the family physician performed LARC insertion or not, family physicians were randomly assigned to a complex intervention involving training to provide structured effectiveness-based contraceptive counselling, and access to rapid referral to LARC insertion clinics. The six-hour, online educational intervention was based on the US Contraceptive CHOICE Project and adapted for the Australian context. The control family physicians received neither the educational intervention nor access to the LARC rapid referral clinics and conducted their usual contraception counselling. We used the χ2 test, adjusted for clustering and stratification by whether the family physician inserted LARCs, and binary regression models with generalized estimating equations and robust standard errors, to compare the proportions of women who had a LARC inserted between the intervention and control groups. The pr...
McCarthy, MC, De Abreu Lourenco, R, McMillan, LJ, Meshcheriakova, E, Cao, A & Gillam, L 2020, 'Finding Out What Matters in Decision-Making Related to Genomics and Personalized Medicine in Pediatric Oncology: Developing Attributes to Include in a Discrete Choice Experiment', The Patient - Patient-Centered Outcomes Research, vol. 13, no. 3, pp. 347-361.
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ackgroundTreatment decision-making in pediatric oncology can be complex. Recent advances in genome sequencing and novel or ‘personalized’ therapies potentially increases the complexity of decision-making and treatment options.ObjectivesThis study explored the views and experiences of healthcare providers (HCPs) and parents with respect to decision-making in difficult-to-treat cancers, including genomic decision-making.MethodsA two-phase qualitative study was undertaken in which oncologists and nurses and parents of children with relapsed and refractory cancers were interviewed using a semi-structured interview guide. Data were analyzed thematically, with a focus on measurable themes relevant to the development of candidate attributes for a discrete choice experiment (DCE). Secondly, a review of studies that utilized stated preference experiments in the fields of genomics, medical decision-making, and pediatrics was undertaken and compared with the candidate attributes identified from interviews.ResultsSix candidate attributes were developed from the interview themes: clinical benefit, quality of life (QoL) including both treatment effects and functionality, likelihood of a target, cost (who pays), recommendation of HCP or extent family supported the decision, and whether a biopsy was needed. Two further candidate attributes were identified from the literature review: severity of illness and cost (dollar amount).ConclusionsThis study identified eight candidate attributes that will be further validated prior to developing a DCE aimed at better understanding factors influencing decision-making related to genomic sequencing and personalized medicine. This study and the proposed DCE will contribute to improving ethical and clinical practices in the application of novel genomic technology in pediatric oncology.
McRae, I, van Gool, K, Hall, J, Yen, L & Wright, M 2020, 'Failure to access prescribed pharmaceuticals by older patients with chronic conditions', Australian Health Review, vol. 44, no. 2, pp. 270-270.
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ObjectiveMedication adherence is a significant public health concern. Australian studies of statins show patients facing the highest copayments are the least likely to be adherent. This study examined whether the association identified between adherence and costs for statins also applies to a wider group of medications prescribed for Australian patients with chronic conditions.MethodsData from 267086 participants in the Sax Institute’s 45 and Up Study linked to data from the Pharmaceutical Benefits Scheme (PBS) provided by the Department of Human Services were used. Patients using angiotensin II receptor blockers, angiotensin-converting enzyme inhibitors, glitazones and bisphosphonates were identified and classified according to concessional status and whether they had access to the PBS ‘safety net’. Data were analysed using mainly descriptive methods to investigate the association of adherence with cost and other selected covariates.ResultsAcross medications, the group facing the highest copayment was least adherent. Speaking a language other than English at home and facing high levels of psychological distress were also associated with lower levels of adherence.ConclusionsAs for statins, the main financial determinant of adherence is cost in the form of prescribed copayments, suggesting that this may apply across many medications.What is known about the topic?Previous studies have shown patients’ concern about the costs of pharmaceuticals, and more detailed studies of statins show that the lowest adherence relates to patients facing the highest copayments.What does this paper add?This paper provides support for the contention that the results found for statins broadly apply across more medications used by people with chronic conditions.What are the implications for practitioners?Although practitioners cannot affect legislated copayments, they can consider the costs of options for medications for patients with chronic condi...
Meshcheriakova, E, Goodall, S, Street, D & Viney, R 2020, 'PNS55 The Effect of Pharmaceutical Policy on Demand for Branded Medicines: A Discrete Choice Experiment from Australia', Value in Health Regional Issues, vol. 22, pp. S91-S91.
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Mu, C & Hall, J 2020, 'What explains the regional variation in the use of general practitioners in Australia?', BMC Health Services Research, vol. 20, no. 1, p. 325.
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AbstractBackgroundRegional variation in the use of health care services is widespread. Identifying and understanding the sources of variation and how much variation is unexplained can inform policy interventions to improve the efficiency and equity of health care delivery.MethodsWe examined the regional variation in the use of general practitioners (GPs) using data from the Social Health Atlas of Australia by Statistical Local Area (SLAs). 756 SLAs were included in the analysis. The outcome variable of GP visits per capita by SLAs was regressed on a series of demand-side factors measuring population health status and demographic characteristics and supply-side factors measuring access to physicians. Each group of variables was entered into the model sequentially to assess their explanatory share on regional differences in GP usage.ResultsBoth demand-side and supply-side factors were found to influence the frequency of GP visits. Specifically, areas in urban regions, areas with a higher percentage of the population who are obese, who have profound or severe disability, and who hold concession cards, and areas with a smaller percentage of the population who reported difficulty in accessing services have higher GP usage. The availability of more GPs led to higher use of GP services while the supply of more specialists reduced use. 30.56% of the variation was explained by medical need. Together, both need-related and supply-side variables accounted for 32.24% of the regional differences as measured by the standard deviation of adjusted GP-consultation rate.ConclusionsThere was substantial variation in GP use across Australian regions with only a small proportion of them being explained by popul...
Mulhern, B 2020, 'PR3 MOVING BEYOND THE HEALTH RELATED QALY: WHERE DOES THE EQ-5D FIT WITHIN A WIDER MEASUREMENT FRAMEWORK?', Value in Health, vol. 23, pp. S328-S328.
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Mulhern, BJ, Bansback, N, Norman, R & Brazier, J 2020, 'Valuing the SF-6Dv2 Classification System in the United Kingdom Using a Discrete-choice Experiment With Duration', Medical Care, vol. 58, no. 6, pp. 566-573.
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Objective: An updated version of the SF-6D Classification System (SF-6Dv2) has been developed, and utility value sets are required. The aim of this study was to test the development of a United Kingdom SF-6Dv2 value set, and address limitations of the existing SF-6D value set (which results in a narrow range of utilities). This was done using 2 discrete-choice experiment (DCE) tasks. Interactions and preference heterogeneity were also investigated. Research Design and Subjects: An online sample of respondents (n=3014) completed 10 DCE with duration choice sets from an efficient design of 300 (Design 1) and 2 DCE with duration choice sets including immediate death from a set of 60 (Design 2). Conditional logit regression was used to estimate value set models with and without interactions. We investigated preference heterogeneity using latent class models. Results: Models including ordered coefficients within each dimension were developed, with the favored model including an additional interaction term when one dimension was at the most severe level. Value sets differed across Designs 1 and 2. Design 1 models had a wider utility range and a higher proportion of negative values. The most important dimensions were pain, mental health, and physical functioning. Preference heterogeneity was apparent, with a 2-class model describing the data. Conclusions: We developed and applied a protocol to value the SF-6Dv2 using DCE. The results provide a provisional value set for use in resource allocation. The protocol can be applied internationally. Further work should investigate ...
Ong, JJ, De Abreu Lourenco, R, Street, D, Smith, K, Jamil, MS, Terris-Prestholt, F, Fairley, CK, McNulty, A, Hynes, A, Johnson, K, Chow, EPF, Bavinton, B, Grulich, A, Stoove, M, Holt, M, Kaldor, J & Guy, R 2020, 'The Preferred Qualities of Human Immunodeficiency Virus Testing and Self-Testing Among Men Who Have Sex With Men: A Discrete Choice Experiment', Value in Health, vol. 23, no. 7, pp. 870-879.
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Onnis, L-A, Kinchin, I, Pryce, J, Ennals, P, Petrucci, J & Tsey, K 2020, 'Evaluating the Implementation of a Mental Health Referral Service “Connect to Wellbeing”: A Quality Improvement Approach', Frontiers in Public Health, vol. 8, p. 585933.
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There is increasing demand for mental health services to be accessible to diverse populations in flexible, yet, cost-effective ways. This article presents the findings from a study that evaluated the process of implementing Connect to Wellbeing (CTW), a new mental health intake, assessment and referral service in regional Australia, to determine how well it improved access to services, and to identify potential measures that could be used to evaluate value for money. The study used a hybrid study design to conduct a process evaluation to better understand: the process of implementing CTW; and the barriers and factors enabling implementation of CTW. In addition, to better understand how to measure the cost-effectiveness of such services, the hybrid study design included an assessment of potential outcome measures suitable for ascertaining both the effectiveness of CTW in client health outcomes, and conducting a value for money analysis. The process evaluation found evidence that by improving processes, and removing waitlists CTW had created an opportunity to broadened the scope and type of psychological services offered which improved accessibility. The assessment of potential outcome measures provided insight into suitable measures for future evaluation into service effectiveness, client health outcomes and value for money.
Pace, J, Laba, T-L, Nisingizwe, M-P & Lipworth, W 2020, 'Formulating an Ethics of Pharmaceutical Disinvestment', Journal of Bioethical Inquiry, vol. 17, no. 1, pp. 75-86.
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There is growing interest among pharmaceutical policymakers in how to “disinvest” from subsidized medicines. This is due to both the rapidly rising costs of healthcare and the increasing use of accelerated and conditional reimbursement pathways which mean that medicines are being subsidized on the basis of less robust evidence of safety and efficacy. It is crucial that disinvestment decisions are morally sound and socially legitimate, but there is currently no framework to facilitate this. We therefore reviewed the bioethics literature in order to identify ethical principles and concepts that might be relevant to pharmaceutical disinvestment decisions. This revealed a number of key ethical considerations—both procedural and substantive—that need to be considered when making pharmaceutical disinvestment decisions. These principles do not, however, provide practical guidance so we present a framework outlining how they might be applied to different types of disinvestment decisions. We also argue that, in this context, even the most rigorous ethical reasoning is likely to be overridden by moral intuitions and psychological biases and that disinvestment decisions will need to strike the right balance between respecting justifiable moral intuitions and overriding unjustifiable psychological impulses.
Pan, T, Mulhern, B, Viney, R, Duy Tran, A, Norman, R & Devlin, N 2020, 'PNS202 COMPARING PROMIS-29 AND EQ-5D-5L: SYNTHESISING EVIDENCE FROM LITERATURE AND COMPARING THE VALUE SETS', Value in Health, vol. 23, pp. S321-S321.
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Pan, T, Mulhern, B, Viney, R, Norman, R, Hanmer, J & Devlin, N 2020, 'PNS234 How Do the Utilities for Promis-29 and EQ-5D-5L Compare? a Comparison of Propr and EQ-5D-5L VALUE SETS, and Implications for Users', Value in Health, vol. 23, pp. S680-S680.
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Patten, N, Brydon, S, Mulhern, B, Peacock, A, White, B, von, BL & Taylor, C 2020, 'PCN42 A Real World Comparison of Utility Values Derived from a Discrete Choice Experiment Versus Patient Reported Outcomes in Clinical Trials', Value in Health Regional Issues, vol. 22, pp. S12-S12.
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Pearce, AM, Mulhern, BJ, Watson, V & Viney, RC 2020, 'How Are Debriefing Questions Used in Health Discrete Choice Experiments? An Online Survey', Value in Health, vol. 23, no. 3, pp. 289-293.
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OBJECTIVES:Debriefing questions can assess if respondents understand discrete choice experiments (DCEs) and are answering in a way consistent with theories of decision making and utility maximization. Nevertheless, there is limited literature about how often debriefing questions are included or how the results are used in health economics. The aim of this study was to conduct a survey of the frequency, type, and analysis of debriefing questions in health DCEs. METHODS:We conducted an online survey of authors of published health DCEs, asking about their use of debriefing questions, including frequency, type, and analysis. We descriptively analyzed the sample characteristics and responses. Free-text questions were analyzed with qualitative thematic analysis. RESULTS:We received 70 responses (43% response rate), of which 50% reported using debriefing questions. They were most commonly designed to assess difficulty (91%), understanding (49%), and attribute nonattendance (31%) rather than learning effects (3%) or monotonicity (11%). On average, 37% of debriefing questions were analyzed (range, 0% to 69%), and the results were used <50% of the time, usually to exclude respondents or interpret overall results. Researcher experience or confidence with DCEs did not affect their use of debriefing questions. CONCLUSIONS:These results suggest that although half of researchers conducting health DCEs use debriefing questions, many do not analyze, use, or report the responses. Given the additional respondent burden, there is a need for reliable and valid debriefing questions. In the meantime, the inclusion, analysis, and reporting of debriefing questions should be carefully considered before DCE implementation.
Podger, A, Woods, M & Su, T 2020, 'The immense and continuing challenge of urban governance: Developments in Australia and across Greater China', Australian Journal of Social Issues, vol. 55, no. 2, pp. 105-124.
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AbstractThe article describes the long history of urbanisation, including developments in four jurisdictions – three in Greater China (the People's Republic of China, Hong Kong and Taiwan) and Australia. While each has its own history, all now face challenges associated with continuing urbanisation and the growth of very large cities. There are broadly similar economic forces at work, but differences in scale and differences in the “growth machines” involved and the institutional arrangements within which urban governance operates. The article explains the growing importance internationally of urban governance and the growing interest in the “performance” of cities. The authors then set out two case studies describing developments in urban governance around Shanghai and around Sydney. In both cases, the scale of big city growth is demanding both horizontal and vertical coordination, and processes that facilitate citizens and civil society participation. While the very different institutional arrangements in these jurisdictions have led to different urban governance arrangements, there are common challenges that have led to some common governance developments such as having a lead government with citywide and comprehensive public service responsibilities, and also having the national government play an increasingly active role in support.
Prichard, R, Kershaw, L, Goodall, S, Davidson, P, Newton, PJ, Saing, S & Hayward, C 2020, 'Costs Before and After Left Ventricular Assist Device Implant and Preceding Heart Transplant: A Cohort Study', Heart, Lung and Circulation, vol. 29, no. 9, pp. 1338-1346.
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Pulok, MH, van Gool, K & Hall, J 2020, 'Horizontal inequity in the utilisation of healthcare services in Australia', Health Policy, vol. 124, no. 11, pp. 1263-1271.
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The Australian universal healthcare system aims to ensure affordable and equitable use of healthcare services based on individual health needs. This paper presents empirical evidence on the extent of horizontal inequity (HI) in healthcare services (unequal utilisation by income for equal need) in Australia during the period of promoting reliance on private healthcare financing. Using data from the most recent Australian National Health Survey of 2011-12 and 2014-15, we examined and measured the extent of HI in eight indicators of out-of-hospital services and hospital-related care. Contrary to earlier studies, our results show a small but pro-rich inequity in the probability of general practitioner visits. Inequity in the distribution of specialist and dentist visits was in favour of richer people, a result that is commonly found in other developed countries and is also consistent with existing Australian evidence. Hospital-related care was equitably distributed compared to the pro-poor pattern found in earlier studies. Despite the universal health insurance system in Australia, there was inequity in the utilisation of needed healthcare services. Our evidence is relevant to similar health systems as governments move to higher out-of-pocket payments and other private sources to reduce pressure on public healthcare expenditure.
Pulok, MH, van Gool, K & Hall, J 2020, 'Inequity in healthcare use among the indigenous population living in non-remote areas of Australia', Public Health, vol. 186, pp. 35-43.
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OBJECTIVES:Although several studies have examined the gap in healthcare use between indigenous and non-indigenous people, empirical evidence on inequity in healthcare use within indigenous populations is limited. This study aims to fill this gap in the literature by investigating income-related inequity (unequal use for equal need) in healthcare use among indigenous Australians living in non-remote areas. STUDY DESIGN:This is a cross-sectional study. METHODS:This study used data from the Australian Aboriginal and Torres Strait Islander Health Survey, 2012-13. Logistic regression analysis was used to determine the association of income with the probability of a general practitioner (GP) visit, a specialist visit and inpatient admission. The horizontal inequity (HI) index and decomposition analysis were also used to quantify and explain inequity in healthcare use. RESULTS:No consistent association was found between income and the probability of GP visit or inpatient admission after controlling for health need. However, the likelihood of visiting a specialist was about three times (odds ratio = 2.96, P = 0.028) higher for the richest compared with the poorest population subgroups. The inequity index was 0.016 (P < 0.001), indicating a pro-rich inequity for the probability of visiting a specialist. Income inequality, unequal distribution of private health insurance and inequality in education were the main factors explaining the pro-rich inequity in specialist utilisation. CONCLUSIONS:Although there was no income-related inequity in GP visits or inpatient admissions, wealthier indigenous Australians had a higher probability of visiting a specialist than their poorer counterparts, after adjusting for need. Specific policies and initiatives are required to address the inequity faced by low-income indigenous people in Australia.
Pulok, MH, van Gool, K & Hall, J 2020, 'Inequity in physician visits: the case of the unregulated fee market in Australia', Social Science & Medicine, vol. 255, pp. 113004-113004.
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Equity is one of the key goals of universal healthcare coverage (UHC). Achieving this goal does not just depend on the presence of UHC, but also on its design and organisation. In Australia, out-of-hospital medical services are provided by private physicians in a market where fees are unregulated. This makes an interesting case to study equity. Using data from the Australian National Health Survey of 2014–15, we distinguish between the probability of any visit and the number of visits conditional on having any visit to analyse income-related inequity in general practitioner (GP) and specialist visits. We apply the horizontal inequity approach to measure the extent of inequity, and the decomposition method to explain the factors accounting for inequity. Our results show a small pro-rich inequity in the probability of any GP visit, but the distribution of conditional GP visits was concentrated among the poor. Inequity in the probability of any specialist visit was pro-rich. However, there was almost no inequity in conditional specialist visits. We find holding a concession card explained pro-poor inequity while income, education, and private health insurance contributed to pro-rich inequity in specialist visits. Although Australia has a universal health insurance system, there is unequal use (adjusted for health need) of physician services by socioeconomic status. This has implications for insurance design in other countries.
Pulok, MH, van Gool, K, Hajizadeh, M, Allin, S & Hall, J 2020, 'Measuring horizontal inequity in healthcare utilisation: a review of methodological developments and debates', The European Journal of Health Economics, vol. 21, no. 2, pp. 171-180.
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Equity in healthcare is an overarching goal of many healthcare systems around the world. Empirical studies of equity in healthcare utilisation primarily rely on the horizontal inequity (HI) approach which measures unequal utilisation of healthcare services by socioeconomic status (SES) for equal medical need. The HI method examines, quantifies, and explains inequity which is based on regression analysis, the concentration index, and the decomposition technique. However, this method is not beyond limitations and criticisms, and it has been subject to several methodological challenges in the past decade. This review presents a summary of the recent developments and debates on various methodological issues and their implications on the assessment of HI in healthcare utilisation. We discuss the key disputes centred on measurement scale of healthcare variables as well as the evolution of the decomposition technique. We also highlight the issues about the choice of variables as the indicator of SES in measuring inequity. This follows a discussion on the application of the longitudinal method and use of administrative data to quantify inequity. Future research could exploit the potential for health administrative data linked to social data to generate more comprehensive estimates of inequity across the healthcare continuum. This review would be helpful to guide future applied research to examine inequity in healthcare utilisation.
Redfern, J, Hafiz, N, Hyun, K, Knight, A, Hespe, C, Chow, CK, Briffa, T, Gallagher, R, Reid, C, Hare, DL, Zwar, N, Woodward, M, Jan, S, Atkins, ER, Laba, T-L, Halcomb, E, Billot, L, Johnson, T & Usherwood, T 2020, 'QUality improvement in primary care to prevent hospitalisations and improve Effectiveness and efficiency of care for people Living with coronary heart disease (QUEL): protocol for a 24-month cluster randomised controlled trial in primary care', BMC Family Practice, vol. 21, no. 1, p. 36.
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AbstractBackgroundCardiovascular disease (CVD), including coronary heart disease (CHD) and stroke, is the leading cause of death and disability globally. A large proportion of mortality occurs in people with prior CHD and effective and scalable strategies are needed to prevent associated deaths and hospitalisations. The aim of this study is to determine if a practice-level collaborative quality improvement program, focused on patients with CHD, reduces the rate of unplanned CVD hospitalisations and major adverse cardiovascular events, and increases the proportion of patients achieving risk factor targets at 24 months.MethodsCluster randomised controlled trial (cRCT) to evaluate the effectiveness of a primary care quality improvement program in 50 primary care practices (n~ 10,000 patients) with 24-month follow-up. Eligible practices will be randomised (1:1) to participate in either the intervention (collaborative quality improvement program) or control (standard care) regimens. Outcomes will be assessed based on randomised allocation, according to intention-to-treat. The primary outcome is the proportion of patients with unplanned CVD hospitalisations at 2 years. Secondary outcomes are proportion of patients with major adverse cardiovascular events, proportion of patients who received prescriptions for guideline-recommended medicines, proportion of patients achieving national risk factor targets and proportion with a chronic disease management plan or review. Differences in the proportion of patients who are hospitalised (as well as binary secondary outcomes) will be analysed using log-binomial regression or robust Poisson regression, if necessary.DiscussionDespite extensive research with surrogate outcomes, to the authors’ knowledge, this is the first randomised...
Scarf, VL, Yu, S, Viney, R, Lavis, L, Dahlen, H, Foureur, M & Homer, C 2020, 'The cost of vaginal birth at home, in a birth centre or in a hospital setting in New South Wales: A micro-costing study', Women and Birth, vol. 33, no. 3, pp. 286-293.
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© 2019 Australian College of Midwives Background: Women want greater choice of place of birth in New South Wales, Australia. It is perceived to be more costly to health services for women with a healthy pregnancy to give birth at home or in a birth centre. It is not known how much it costs the health service to provide care for women planning to give birth in these settings. Aim: The aim of this study was to determine the direct cost of giving birth vaginally at home, in a birth centre or in a hospital for women at low risk of complications, in New South Wales. Methods: A micro-costing design was used. Observational (time and motion) and resource use data collection was undertaken to identify the staff time and resources required to provide care in a public hospital, birth centre or at home for women with a healthy pregnancy. Findings: The median cost of providing care for women who plan to give birth at home, in a birth centre and in a hospital were similar (AUD $2150.07, $2100.59 and $2097.30 respectively). Midwifery time was the largest contributor to the cost of birth at home, and overhead costs accounted for over half of the total cost of BC and hospital birth. The cost of consumables was low in all three settings. Conclusion: In this study, we have found there is little difference in the cost to the health service when a woman has an uncomplicated vaginal birth at home, in a birth centre or in a hospital setting.
Shanahan, M, Seddon, J, Ritter, A & De Abreu Lourenco, R 2020, 'Valuing families' preferences for drug treatment: a discrete choice experiment', Addiction, vol. 115, no. 4, pp. 690-699.
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AbstractBackground and AimsThe burden on family members of those who are dependent on illicit drugs is largely unidentified, despite the presence of significant negative financial, health and social impacts. This makes it difficult to provide appropriate services and support. This study aimed to assess the preferences for treatment attributes for heroin dependence among family members affected by the drug use of a relative and to obtain a measure of the intangible economic benefit.DesignDiscrete choice experiment. Data were analysed using mixed logit which accounted for repeated responses.SettingAustralia.ParticipantsEligible participants were Australian residents aged 18+ years with a relative with problematic drug use. Complete data on 237 respondents were analysed; 21 invalid responses were deleted.MeasurementsParticipant preference for likelihood of staying in treatment, family conflict, own health status, contact with police and monetary contribution to a charitable organization providing treatment.FindingsAll attributes were significant, and the results suggest that there was a preference for longer time in treatment, less family discord, better own health status, less likelihood of their relative encountering police and, while they were willing to contribute to a charity for treatment to be available, they prefer to pay less, not more. In order of relative importance, participants were willing to pay an additional A$4.46 [95% confidence interval (CI) = 3.33–5.60] for treatment which resulted in an additional 1% of heroin users staying in treatment for longer than 3 month...
Siva, S, Bressel, M, Kron, T, Mai, T, Le, HV, Montgomery, R, Hardcastle, N, Rezo, A, Gill, S, Higgs, BG, Pryor, DI, De Abreu Lourenco, R, Awad, R, Chesson, B, Eade, TN, Skala, M, Sasso, G, Wong, W, Vinod, S & Ball, D 2020, 'Stereotactic Ablative Fractionated Radiotherapy versus Radiosurgery for Oligometastatic Neoplasia to the Lung: A Randomized Phase II Trial', International Journal of Radiation Oncology*Biology*Physics, vol. 108, no. 3, pp. S3-S4.
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Teague, SJ, Newman, LK, Tonge, BJ & Gray, KM 2020, 'Attachment and child behaviour and emotional problems in autism spectrum disorder with intellectual disability', Journal of Applied Research in Intellectual Disabilities, vol. 33, no. 3, pp. 475-487.
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AbstractBackgroundBehaviour and emotional problems are highly prevalent in children with autism spectrum disorder (ASD). In typically developing children, attachment quality acts as a risk/protective factor for behavioural outcomes and adjustment, warranting investigation in children with ASD.MethodWe investigated the relationship between attachment and child behaviour and emotional problems in children with ASD and comorbid intellectual disability. Data were collected from parent–child dyads where children were diagnosed with ASD and ID (n = 28) or other developmental disabilities (n = 20).ResultsChildren with ASD had higher levels of behaviour and emotional problems and more attachment difficulties than children with other developmental disabilities. Poorer attachment quality contributed uniquely to the variance in child behaviour and emotional problems.ConclusionsInterventions targeting behaviour and emotional problems in children with ASD may benefit from an attachment model which addresses the child's difficulty in using caregivers as a coregulatory agent of emotions.
Tonmukayakul, U, Imms, C, Mihalopoulos, C, Reddihough, D, Carter, R, Mulhern, B & Chen, G 2020, 'Health‐related quality of life and upper‐limb impairment in children with cerebral palsy: developing a mapping algorithm', Developmental Medicine & Child Neurology, vol. 62, no. 7, pp. 854-860.
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AimTo: (1) investigate the relationship between upper‐limb impairment and health‐related quality of life (HRQoL) for children with cerebral palsy and (2) develop a mapping algorithm from the Cerebral Palsy Quality of Life Questionnaire for Children (CPQoL‐Child) onto the Child Health Utility 9D (CHU9D) measure.MethodThe associations between physical and upper‐limb classifications and HRQoL of 76 children (40 females, 36 males) aged 6 to 15 years (mean age 9 years 7 months [SD 3y]) were assessed. Five statistical techniques were developed and tested, which predicted the CHU9D scores from the CPQoL‐Child total/domain scores, age, and sex.ResultsMost participants had mild impairments. The Manual Ability Classification System (MACS) level was significantly negatively correlated with CHU9D and CPQoL‐Child (r=−0.388 and r=−0.464 respectively). There was a negative correlation between the Neurological Hand Deformity Classification (NHDC) and CPQoL‐Child (r=−0.476, p<0.05). The generalized linear model with participation, pain domain, and age had the highest predictive accuracy.InterpretationThe weak negative correlations between classification levels and HRQoL measures may be explained by the restricted range of impairment levels of the participants. The MACS and NHDC explained the impact of upper‐limb impairment on HRQoL better than the other classifications. The generalized linear model with participation, pain, and age is the suggested mapping algorithm. The suggested mapping algorithm will facilitate the use of CPQoL‐Child for economic evaluation and can be used to conduct cost–utility analyses.
van Gelder, T, Mulhern, B, Schoormans, D, Husson, O & De Abreu Lourenço, R 2020, 'Assessing health-related quality of life in cancer survivors: factors impacting on EORTC QLU-C10D-derived utility values', Quality of Life Research, vol. 29, no. 6, pp. 1483-1494.
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PURPOSE:To investigate the factors influencing EORTC QLQ-C30-derived EORTC QLU-C10D utility values across five cancer types (non-Hodgkin lymphoma, multiple myeloma, colorectal, thyroid, and prostate cancer) and a general population sample. METHODS:Data from the Dutch population-based patient-reported outcomes following initial treatment and long-term evaluation of survivorship (PROFILES) registry collected between 2009 and 2012 were used. EORTC QLQ-C30 data were used to estimate utility values by applying the EORTC QLU-C10D instrument using Australian utility weights. Regression analyses were conducted, within and across cancer type, to examine the factors influencing utility values, including patient- and cancer-specific factors, as well as the EORTC QLQ-C30 scale/item scores. RESULTS:The mean utility value for the total cancer sample was 0.791 (SD 0.201), significantly lower than that from the general population (0.865, SD 0.165). Multiple myeloma patients had the lowest utility value at 0.663 (SD 0.244). Physical functioning, pain and nausea and vomiting were the health-related quality of life (HRQoL) domains with the greatest impact on utility values; cognitive functioning and dyspnea had the lowest impact. Of the demographic and clinical factors, unemployment for reasons other than retirement, age older than 75 years, number of comorbidities, and experience of symptoms all had a statistically significant negative impact on utility values. CONCLUSIONS:This study is one of the first to apply the EORTC QLU-C10D to a heterogeneous group of cancer patients. Results can be used to more efficiently target care towards factors influencing HRQoL. Furthermore, it enhances our understanding of how the EORTC QLU-C10D performs across cancer types, supporting its use in cost-utility analyses.
van Hout, B, Mulhern, B, Feng, Y, Shah, K & Devlin, N 2020, 'The EQ-5D-5L Value Set for England: Response to the “Quality Assurance”', Value in Health, vol. 23, no. 5, pp. 649-655.
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Wang, Y, Castelli, A, Cao, Q & Liu, D 2020, 'Assessing the design of China’s complex health system – Concerns on equity and efficiency', Health Policy OPEN, vol. 1, pp. 100021-100021.
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Whitehurst, DGT, Brazier, JE, Viney, R & Mulhern, BJ 2020, 'The SF-6Dv2: How Does the New Classification System Impact the Distribution of Responses Compared with the Original SF-6D?', PharmacoEconomics, vol. 38, no. 12, pp. 1283-1288.
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Wise, S 2020, 'Staffing policy in aged care must look beyond the numbers', Australian Health Review, vol. 44, no. 6, pp. 829-829.
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The COVID-19 pandemic has highlighted an aged care system struggling to meet the needs of vulnerable Australians. Staffing levels and skill mix in aged care have declined, whereas the health and social needs of an older and more clinically complex population have risen. Increasing staff and improving personal care workers’ skills and education are essential steps to quality aged care in Australia, but it will not be possible without funding models that foster secure employment, development opportunities and long-term career pathways.
Wise, S, Duffield, C, Fry, M & Roche, M 2020, 'Clarifying workforce flexibility from a division of labor perspective: a mixed methods study of an emergency department team', Human Resources for Health, vol. 18, no. 1.
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Abstract Background The need for greater flexibility is often used to justify reforms that redistribute tasks through the workforce. However, “flexibility” is never defined or empirically examined. This study explores the nature of flexibility in a team of emergency doctors, nurse practitioners (NPs), and registered nurses (RNs), with the aim of clarifying the concept of workforce flexibility. Taking a holistic perspective on the team’s division of labor, it measures task distribution to establish the extent of multiskilling and role overlap, and explores the behaviors and organizational conditions that drive flexibly. Methods The explanatory sequential mixed methods study was set in the Fast Track area of a metropolitan emergency department (ED) in Sydney, Australia. In phase 1, an observational time study measured the tasks undertaken by each role (151 h), compared as a proportion of time (Kruskal Wallis, Mann-Whitney U), and frequency (Pearson chi-square). The time study was augmented with qualitative field notes. In phase 2, 19 semi-structured interviews sought to explain the phase 1 observations and were analyzed thematically. Results The roles were occupationally specialized: “Assessment and Diagnosis” tasks consumed the largest proportion of doctors’ (51.1%) and NPs’ (38.1%) time, and “Organization of Care” tasks for RNs (27.6%). However, all three roles were also multiskilled, which created an overlap in the tasks they performed. The team used this role overlap to work flexibly in response to patients’ needs and adapt to changing demands. Flexibility was driven by the urgent and unpredictable workload in ...
Wright, M, Versteeg, R & Hall, J 2020, 'General practice's early response to the COVID-19 pandemic', Australian Health Review, vol. 44, no. 5, pp. 733-733.
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The COVID-19 pandemic has resulted in multiple changes in the delivery of general practice services. In response to the threat of the pandemic and in order to keep their businesses safe and viable, general practices have rapidly moved to new models of care, embraced Medicare-funded telehealth and responded to uncertain availability of personal protective equipment with innovation. These changes have shown the adaptability of general practice, helped keep patients and practice staff safe, and undoubtedly reduced community transmission and mortality. The pandemic, and the response to it, has emphasised the potential dangers of existing fragmentation within the Australian health system, and is affecting the viability of general practice. These impacts on primary care highlight the need for improved integration of health services, should inform future pandemic planning, and guide the development of Australia’s long-term national health plan.
Xie, W, Regan, MM, Buyse, M, Halabi, S, Kantoff, PW, Sartor, O, Soule, H, Berry, D, Clarke, N, Collette, L, D’Amico, A, Lourenco, RDA, Dignam, J, Eisenberger, M, James, N, Fizazi, K, Gillessen, S, Loriot, Y, Mottet, N, Parulekar, W, Sandler, H, Spratt, DE, Sydes, MR, Tombal, B, Williams, S & Sweeney, CJ 2020, 'Event-Free Survival, a Prostate-Specific Antigen–Based Composite End Point, Is Not a Surrogate for Overall Survival in Men With Localized Prostate Cancer Treated With Radiation', Journal of Clinical Oncology, vol. 38, no. 26, pp. 3032-3041.
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PURPOSE Recently, we have shown that metastasis-free survival is a strong surrogate for overall survival (OS) in men with intermediate- and high-risk localized prostate cancer and can accelerate the evaluation of new (neo)adjuvant therapies. Event-free survival (EFS), an earlier prostate-specific antigen (PSA)–based composite end point, may further expedite trial completion. METHODS EFS was defined as the time from random assignment to the date of first evidence of disease recurrence, including biochemical failure, local or regional recurrence, distant metastasis, or death from any cause, or was censored at the date of last PSA assessment. Individual patient data from trials within the Intermediate Clinical Endpoints in Cancer of the Prostate–ICECaP–database with evaluable PSA and disease follow-up data were analyzed. We evaluated the surrogacy of EFS for OS using a 2-stage meta-analytic validation model by determining the correlation of EFS with OS (patient level) and the correlation of treatment effects (hazard ratios [HRs]) on both EFS and OS (trial level). A clinically relevant surrogacy was defined a priori as an R2 ≥ 0.7. RESULTS Data for 10,350 patients were analyzed from 15 radiation therapy–based trials enrolled from 1987 to 2011 with a median follow-up of 10 years. At the patient level, the correlation of EFS with OS was 0.43 (95% CI, 0.42 to 0.44) as measured by Kendall’s tau from a copula model. At the trial level, the R2 was 0.35 (95% CI, 0.01 to 0.60) from the weighted linear regression of log(HR)-OS on log(HR)-EFS. CONCLUSION EFS is a weak surrogate for OS and is not suitable for use as an intermediate clinical end point to substitute for OS to accelerate phase III (neo...
Xie, W, Regan, MM, Buyse, M, Halabi, S, Kantoff, PW, Sartor, O, Soule, H, Berry, D, Clarke, N, Collette, L, D'Amico, A, Lourenco, RDA, Dignam, J, Eisenberger, M, James, N, Fizazi, K, Gillessen, S, Loriot, Y, Mottet, N, Parulekar, W, Sandler, H, Spratt, DE, Sydes, MR, Tombal, B, Williams, S & Sweeney, CJ 2020, 'Event-Free Survival, a Prostate-Specific Antigen-Based Composite End Point, Is Not a Surrogate for Overall Survival in Men With Localized Prostate Cancer Treated With Radiation', JOURNAL OF CLINICAL ONCOLOGY, vol. 38, no. 26, pp. 3032-+.
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Yu, S & Byles, J 2020, 'Waiting times in aged care: What matters?', Australasian Journal on Ageing, vol. 39, no. 1, pp. 48-55.
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AbstractObjectiveTo assess consumer‐level socioeconomic factors associated with waiting times for access to aged care services, specifically community‐based care and permanent residential care.MethodsAdministrative data on assessment outcomes and admissions to services were linked with survey data at the person‐level and were used to implement a competing risks regression model. We estimated the association between health needs, and socioeconomic variables and subsequent waiting periods for individuals with approval for access.ResultsThe main consumer‐level factors driving waiting time were the individual's assessed needs, including health status, whether they lived alone and age. We found no evidence that socioeconomic status was associated with waiting times for community‐based care; however, admission to residential care reflected socioeconomic factors including education levels and geographical isolation.ConclusionThis paper provides baseline evidence for factors affecting wait times in aged care, essential for evaluating subsequent policy reforms aimed at reducing wait times and increasing equity of access and consumer choice.
Yu, S, Fiebig, DG, Scarf, V, Viney, R, Dahlen, HG & Homer, C 2020, 'Birth models of care and intervention rates: The impact of birth centres', Health Policy, vol. 124, no. 12, pp. 1395-1402.
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Birth centres offer a midwifery-led model of care which supports a non-medicalised approach to childbirth. They are often reported as having low rates of birth intervention, however the precise impact is obscured because less disadvantaged mothers with less complex pregnancies, and who prefer and often select little intervention, are more likely to choose a birth centre. In this paper, we use a methodology that purges the impact of these selection effects and provides a causal interpretation of the impact of birth centres on intervention outcomes. Using administrative birth data on over 364,000 births in Australia's most populous state between 2001 and 2012, we implement an instrumental variables framework to address confounding factors influencing choice of birth setting. We find that giving birth in a birth centre results in significantly lower probabilities of intervention, and that critically, this impact has been increasing over time. Our estimates are larger than those in existing studies, reflecting our newer data, diverging intervention rates across birth settings, and our accounting for important selection effects. The results emphasise the greater role of birth centres in delivering on policy priorities which include greater maternal autonomy, lower intervention rates, and lower health system costs.
Zampirolli Dias, C, Godman, B, Gargano, LP, Azevedo, PS, Garcia, MM, Souza Cazarim, M, Pantuzza, LLN, Ribeiro-Junior, NG, Pereira, AL, Borin, MC, de Figueiredo Zuppo, I, Iunes, R, Pippo, T, Hauegen, RC, Vassalo, C, Laba, T-L, Simoens, S, Márquez, S, Gomez, C, Voncina, L, Selke, GW, Garattini, L, Kwon, H-Y, Gulbinovic, J, Lipinska, A, Pomorski, M, McClure, L, Fürst, J, Gambogi, R, Ortiz, CH, Canuto Santos, VC, Araújo, DV, Araujo, VE, Acurcio, FDA, Alvares-Teodoro, J & Guerra-Junior, AA 2020, 'Integrative Review of Managed Entry Agreements: Chances and Limitations', PharmacoEconomics, vol. 38, no. 11, pp. 1165-1185.
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BACKGROUND AND OBJECTIVE:Managed entry agreements (MEAs) consist of a set of instruments to reduce the uncertainty and the budget impact of new high-priced medicines; however, there are concerns. There is a need to critically appraise MEAs with their planned introduction in Brazil. Accordingly, the objective of this article is to identify and appraise key attributes and concerns with MEAs among payers and their advisers, with the findings providing critical considerations for Brazil and other high- and middle-income countries. METHODS:An integrative review approach was adopted. This involved a review of MEAs across countries. The review question was 'What are the health technology MEAs that have been applied around the world?' This review was supplemented with studies not retrieved in the search known to the senior-level co-authors including key South American markets. It also involved senior-level decision makers and advisers providing guidance on the potential advantages and disadvantages of MEAs and ways forward. RESULTS:Twenty-five studies were included in the review. Most MEAs included medicines (96.8%), focused on financial arrangements (43%) and included mostly antineoplastic medicines. Most countries kept key information confidential including discounts or had not published such data. Few details were found in the literature regarding South America. Our findings and inputs resulted in both advantages including reimbursement and disadvantages including concerns with data collection for outcome-based schemes. CONCLUSIONS:We are likely to see a growth in MEAs with the continual launch of new high-priced and often complex treatments, coupled with increasing demands on resources. Whilst outcome-based MEAs could be an important tool to improve access to new innovative medicines, there are critical issues to address. Comparing knowledge, experiences, and practices across countries is crucial to guide high- and middle-income countries when designing the...
