Addo, R, Haas, M & Goodall, S 2021, 'The Cost-Effectiveness of Adjuvant Tamoxifen Treatment of Hormone Receptor–Positive Early Breast Cancer Among Premenopausal and Perimenopausal Ghanaian Women', Value in Health Regional Issues, vol. 25, pp. 196-205.
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Aguiar, M, Harrison, M, Munro, S, Burch, T, Kaal, KJ, Hudson, M, Bansback, N & Laba, T-L 2021, 'Designing Discrete Choice Experiments Using a Patient-Oriented Approach', The Patient - Patient-Centered Outcomes Research, vol. 14, no. 4, pp. 389-397.
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Patient-oriented research is a process whereby patients or caregivers are included as research partners so that research focusses on topics that are priorities and lead to findings that translate into practice. Using a case study of preferences for stem cell transplant in scleroderma, we report on a patient-oriented research approach to developing a discrete choice experiment. Our patient-oriented research application followed the four guiding principles in Canada's Strategy for Patient-Oriented Research: inclusiveness, support, mutual respect and co-build. In this case study, patient partners were involved at different levels of engagement to match individual availability, skillset and roles in the team. They advised, to different degrees, on all aspects of the study from design to analyses. Using a patient-oriented research approach led to the inclusion of attributes that would likely have been excluded (e.g. support from a multidisciplinary team), and realistic framing of patient-relevant and sometimes sensitive attributes (e.g. mortality and cost). Meeting locations and times were adjusted to accommodate all-team circumstances. Institutional constraints on the reimbursement for patient partners influenced the timing and extent of involvement. We found that adopting a patient-oriented research approach to discrete choice experiment design injected unique knowledge and expertise into the team, improved the representativeness of the sample recruited, minimised researcher biases, and ensured appropriate attribute selection and descriptions. The patient-oriented research approach highlighted some constraints of discrete choice experiment designs and, while not a solution, might ensure the methodological trade-offs remain patient relevant. Institutional challenges must be addressed to progress patient-oriented health economics research.
Ahumada-Canale, A, Vargas, C, Balmaceda, C, Martinez-Mardones, F, Plaza-Plaza, JC, Benrimoj, S & Garcia-Cardenas, V 2021, 'Medication review with follow-up for cardiovascular outcomes: a trial based cost–utility analysis', Journal of Comparative Effectiveness Research, vol. 10, no. 3, pp. 229-242.
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Aim: To assess the trial-based cost–effectiveness of medication review with follow-up compared with usual care in primary care. Materials & methods: A cluster randomized controlled trial included patients if they were independent older adults, receiving five or more prescriptions, with moderate or high cardiovascular risk. Costs were estimated from the public healthcare sector perspective, and health benefits were measured as quality-adjusted life years. Both of which were used to calculate the incremental cost–effectiveness ratio. Results: Twelve centers completed the study, six (146 patients) in the intervention group and six (145 patients) in the control group. The base-case analysis showed an incremental cost–effectiveness ratio of US$ (2019) 434.4/quality-adjusted life year (95% CI 64.20–996.03). Conclusion: The intervention was cost-effective in the public primary care setting.
Ahumada-Canale, A, Vargas, C, Martinez-Mardones, F, Plaza-Plaza, JC, Benrimoj, S & Garcia-Cardenas, V 2021, 'Cost-utility analysis of medication review with follow-up for cardiovascular outcomes: A microsimulation model', Health Policy, vol. 125, no. 11, pp. 1406-1414.
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Background: Cardiovascular diseases are the leading cause of death. Pharmacist-led medication review with follow-up might be cost-effective preventing cardiovascular diseases. Objective: To undertake a cost–utility analysis of the addition of pharmacist-led medication review with follow-up to usual care compared to usual care alone for cardiovascular outpatients. Materials and methods: A state-transition microsimulation model was built to project outcomes over a lifetime time horizon. Inputs from a cluster randomized controlled trial conducted in primary health care centers in Chile with full-time pharmacists were used. Probabilities were estimated using patient-level data. Utilities and costs associated with each health state were obtained from the literature, whereas the intervention costs were retrieved from the trial. The public third-party payer perspective was used. Uncertainty was evaluated through one-way and probabilistic sensitivity analyses. Results: For the base case analysis, an incremental cost-effectiveness ratio of $963 per quality-adjusted life-year was observed which was considered cost-effective. The results were robust to sensitivity analyses and were driven by decreased cardiovascular events resulting in lower mortality. Conclusions: Medication review with follow-up was deemed a cost-effective addition to usual care with low uncertainty.
Bagg, MK, Lo, S, Cashin, AG, Herbert, RD, O’Connell, NE, Lee, H, Hübscher, M, Wand, BM, O’Hagan, E, Rizzo, RRN, Moseley, GL, Stanton, TR, Maher, CG, Goodall, S, Saing, S & McAuley, JH 2021, 'The RESOLVE Trial for people with chronic low back pain: statistical analysis plan', Brazilian Journal of Physical Therapy, vol. 25, no. 1, pp. 103-111.
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BackgroundStatistical analysis plans describe the planned data management and analysis for clinical trials. This supports transparent reporting and interpretation of clinical trial results. This paper reports the statistical analysis plan for the RESOLVE clinical trial. The RESOLVE trial assigned participants with chronic low back pain to graded sensory-motor precision training or sham-control.ResultsWe report the planned data management and analysis for the primary and secondary outcomes. The primary outcome is pain intensity at 18-weeks post randomization. We will use mixed-effects models to analyze the primary and secondary outcomes by intention-to-treat. We will report adverse effects in full. We also describe analyses if there is non-adherence to the interventions, data management procedures, and our planned reporting of results.ConclusionThis statistical analysis plan will minimize the potential for bias in the analysis and reporting of results from the RESOLVE trial.Trial registrationACTRN12615000610538 (https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368619).
Black, KI, McGeechan, K, Watson, CJ, Lucke, J, Taft, A, McNamee, K, Haas, M, Peipert, JF & Mazza, D 2021, 'Women’s satisfaction with and ongoing use of hormonal long‐acting methods compared to the oral contraceptive pill: Findings from an Australian general practice cluster randomised trial (ACCORd)', Australian and New Zealand Journal of Obstetrics and Gynaecology, vol. 61, no. 3, pp. 448-453.
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BackgroundThe Australian Contraceptive ChOice pRoject (ACCORd) aimed to assess the impact of a complex general practice intervention on the uptake of long‐acting reversible contraceptives (LARC).AimsUsing survey data from enrolled women, we aimed to compare the ongoing use and satisfaction of women who chose one of the hormonal LARC methods including the levonorgestrel intrauterine system (LNG‐IUS) or levonorgestrel implant compared to the oral contraceptive pill (OCP).Materials and MethodsWe used the data from participants’ baseline, six and 12‐month surveys to identify new users of implants, LNG‐IUS or OCP. We included demographic information, ongoing use of the contraceptive method, reasons for dissatisfaction and discontinuation and experience of side‐effects. Proportions were compared using χ2 tests.ResultsOf the 740 women enrolled in ACCORd, 176 started using a hormonal LARC or OCP in the study’s first six months with 76 using the IUS (43%), 60 the implant (34%) and 40 (23%) the OCP. Twelve‐month continuation rates for the LNG‐IUS, implant and OCP were 93, 83 and 65% respectively (P < 0.001). Satisfaction was highest among the LNG‐IUS users; 86% were very/somewhat satisfied compared to 75% of implant users and 61% of OCP users (P < 0.001). Main reasons for method dissatisfaction were irregular bleeding and mood changes which were similar for all methods.ConclusionsThis study provides further evidence that hormonal LARC methods have higher continuation and satisfaction rates compared to the OCP with similar side‐effects. Since hormonal LARC methods have the highest contraceptive ...
Blankart, CR, van Gool, K, Papanicolas, I, Bernal‐Delgado, E, Bowden, N, Estupiñán‐Romero, F, Gauld, R, Knight, H, Abiona, O, Riley, K, Schoenfeld, AJ, Shatrov, K, Wodchis, WP & Figueroa, JF 2021, 'International comparison of spending and utilization at the end of life for hip fracture patients', Health Services Research, vol. 56, no. S3, pp. 1370-1382.
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AbstractObjectiveTo identify and explore differences in spending and utilization of key health services at the end of life among hip fracture patients across seven developed countries.Data SourcesIndividual‐level claims data from the inpatient and outpatient health care sectors compiled by the International Collaborative on Costs, Outcomes, and Needs in Care (ICCONIC).Study DesignWe retrospectively analyzed utilization and spending from acute hospital care, emergency department, outpatient primary care and specialty physician visits, and outpatient drugs. Patterns of spending and utilization were compared in the last 30, 90, and 180 days across Australia, Canada, England, Germany, New Zealand, Spain, and the United States. We employed linear regression models to measure age‐ and sex‐specific effects within and across countries. In addition, we analyzed hospital‐centricity, that is, the days spent in hospital and site of death.Data Collection/Extraction MethodsWe identified patients who sustained a hip fracture in 2016 and died within 12 months from date of admission.Principal FindingsResource use, costs, and the proportion of deaths in hospital showed large variability being high in England and Spain, while low in New Zealand. Days in hospital significantly decreased with increasing age in Canada, Germany, Spain, and the United States. Hospital spending near date of death was significantly lower for women in Canada, Germany, and the United States. The age gradient and the sex effect were less pronounced in utilization and spending of emergency care, outpatient care, and drugs.Conclusions
Broderick, L, Bjorner, J, Lauher, M, Kosinski, M, White, MK, Mulhern, B & Brazier, JE 2021, 'PNS111 Development of the SF-6DV2 Health Utility Survey: Content Validity and Patient Preference', Value in Health, vol. 24, pp. S193-S193.
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Butow, P, Shepherd, HL, Cuddy, J, Harris, M, He, S, Masya, L, Faris, M, Rankin, NM, Beale, P, Girgis, A, Kelly, B, Grimison, P, Beale, P, Butow, P, Clayton, J, Cuddy, J, Davies, F, Dhillon, H, Faris, M, Geerligs, L, Girgis, A, Grimison, P, Hack, T, Harris, M, He, S, Kelly, B, Kelly, P, Kirsten, L, Lindsay, T, Lovell, M, Luckett, T, Masya, L, Murphy, M, Newby, J, Piro, D, Rankin, N, Shaw, J, Shaw, T, Shepherd, H, Viney, R, Yim, J & Shaw, J 2021, 'Acceptability and appropriateness of a clinical pathway for managing anxiety and depression in cancer patients: a mixed methods study of staff perspectives', BMC Health Services Research, vol. 21, no. 1, p. 1243.
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Abstract Background Clinical pathways (CPs) can improve health outcomes, but to be sustainable, must be deemed acceptable and appropriate by staff. A CP for screening and management of anxiety and depression in cancer patients (the ADAPT CP) was implemented in 12 Australian oncology services for 12 months, within a cluster randomised controlled trial of core versus enhanced implementation strategies. This paper compares staff-perceived acceptability and appropriateness of the ADAPT CP across study arms. Methods Multi-disciplinary lead teams at each service tailored, planned, championed and implemented the CP. Staff at participating services, purposively selected for diversity, completed a survey and participated in an interview prior to implementation (T0), and at midpoint (6 months: T1) and end (12 months: T2) of implementation. Interviews were recorded, transcribed and thematically analysed. Results Seven metropolitan and 5 regional services participated. Questionnaires were completed by 106, 58 and 57 staff at T0, T1 and T2 respectively. Eighty-eight staff consented to be interviewed at T0, with 89 and 76 at T1 and T2 (response rates 70%, 66% and 57%, respectively). Acceptability/appropriateness, on the quantitative measure, was high at T0 (mean of 31/35) and remained at that level throughout the study, with no differences between staff from core versus enhanced services. Perceived burden was relatively low (mean of 11/20) with no change over time. Lowest scores and greatest variability pertained to perceived impact on workload, time and cost. Four major themes were identified: 1) Mental health is an important issue which ADAPT addresse...
Campbell, J, Jelinek, G, Weiland, T, Nag, N, Neate, S, Palmer, A, Mulhern, B, Livera, AD & Simpson-Yap, S 2021, '102Assessing the characteristics of health state utilities among people living with multiple sclerosis', International Journal of Epidemiology, vol. 50, no. Supplement_1.
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Abstract Background While many studies have examined the impacts of multiple sclerosis (MS) on health-related quality-of-life (HRQoL), none have used the SF-6D multi-attribute utility instrument in a large international cohort (>2,000 subjects) of people with MS. Our objective was to derive SF-6D health state utilities (HSUs) for participants of the HOLISM international cohort and to describe the distribution and determinants thereof. Methods HSUs were generated using the SF-6D for the Version-1 United States SF-36 for participants with sufficient SF-36 data (n = 2,185/2,466 (88.6%)). Determinants of HSU were evaluated by linear regression, adjusted for age, sex, MS type, disability (Patient-Determined MS Severity Scale), fatigue (Fatigue Severity Scale), and prescription antidepressant use. Results Mean HSU for the sample was 0.67 (SD = 0.13) and diminished with increasing MS-related disability. These findings were robust to adjustment, supporting the SF-6D’s discriminatory power in people with MS. Severe disability and clinically significant fatigue were each associated with 11%-lower HSU (95%CI=-0.13,-0.10 & -0.12,-0.10), and depression risk (Patient Health Questionnaire-2) with 10%-lower HSU (95%CI=-0.11,-0.08). Employment, higher socioeconomic and married/partnered statuses, larger social-network size, greater physical activity, vitamin D and omega-3 supplementations were associated with significantly higher HSU, and overweight/obese BMI and tobacco smoking with lower HSU. Age, sex, and education were not associated. ...
Cronin, P & Addo, R 2021, 'Interactions with youth justice and associated costs for young people with speech, language and communication needs', International Journal of Language & Communication Disorders, vol. 56, no. 4, pp. 797-811.
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AbstractBackgroundIndividuals with speech, language and communication needs (SLCN) are at greater risk of contact with the criminal justice system. Diagnosis and appropriate treatment of SLCN reduces these risks, leading to better life outcomes for the individual as well as broader social and economic benefits. These youth represent a particularly high‐priority group for research into language deficits, as the juvenile justice system involves situations with a high risk or serious consequences that rely upon the application of effective language skills. Whilst some studies have established some gains in speech and communication from speech pathology (SP) interventions during custody, there is limited evidence on the long‐term impact of these gains following release from custody. Similarly, few studies have directly measured the cost savings associated with early SP on subsequent youth antisocial behaviour and crime.AimsTo estimate the youth antisocial behaviours, youth justice (YJ) contacts and associated costs (from a justice perspective) of childhood SLCN.Methods & ProceduresUsing 12 years of data from a longitudinal study of Australian children and young people, we employ a panel fixed‐effects model to explore the relationship between SLCN and youth antisocial behaviour and youth offending between 12 and 17 years of age. Using these results, we estimate the cost of SLCN and subsequent cost savings associated with identification of SLCN.Outcomes & ResultsThe results showed that the annual cost of SLCN to the YJ system (exchange rate as at 9 December 2020) is A$875 (95% confidence interval (CI) = A$195, A$1916) (US$$649, €536, £485) per person who participates in youth crime, which is due to ...
Crothers, A, Haeusler, GM, Slavin, MA, Babl, FE, Mechinaud, F, Phillips, R, Tapp, H, Padhye, B, Zeigler, D, Clark, J, Walwyn, T, Super, L, Alvaro, F, Thursky, K & De Abreu Lourenco, R 2021, 'Examining health-related quality of life in pediatric cancer patients with febrile neutropenia: Factors predicting poor recovery in children and their parents', EClinicalMedicine, vol. 40, pp. 101095-101095.
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De Abreu Lourenço, R, Devlin, N, Howard, K, Ong, JJ, Ratcliffe, J, Watson, J, Willing, E & Huynh, E 2021, 'Giving a Voice to Marginalised Groups for Health Care Decision Making', The Patient - Patient-Centered Outcomes Research, vol. 14, no. 1, pp. 5-10.
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De Abreu Lourenco, R, McCarthy, MC, McMillan, LJ, Sullivan, M & Gillam, L 2021, 'Understanding decisions to participate in genomic medicine in children's cancer care: A comparison of what influences parents, health care providers, and the general community', Pediatric Blood & Cancer, vol. 68, no. 8.
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AbstractBackgroundThe emerging role of genomically guided precision medicine in pediatric cancer care presents significant clinical, practical, and ethical challenges. We investigated the factors that influence decision‐making in genomic medicine from the perspective of different stakeholders in the context of difficult‐to‐treat childhood cancer.MethodsHealth care providers (HCPs), parents of childhood cancer survivors, and general community members completed an online discrete choice experiment survey. Respondents considered whether to recommend (HCPs) or choose (parents/community) a genomically guided approach to pediatric cancer treatment. Respondents completed eight choice questions varying by survival benefit, prognosis, likelihood of finding a target, quality of life (QoL), HCP/parent preference, need for biopsy, cost, and who pays. Data were analyzed using a probability regression model, with findings expressed as relative importance, stated importance, and marginal willingness to pay (mWTP).ResultsOne hundred twenty‐six HCPs, 130 parents, and 531 community members participated. The probability of recommending/choosing genomically guided treatment increased significantly with better prognosis, survival benefit, improvements in QoL, and decision‐making partner support. It decreased with increasing costs and if parents paid for treatment. HCPs were more responsive to all factors but were most influenced by survival outcomes, and parents and community members by QoL. In contrast to these forced choice preference results, HCPs stated they were most influenced by QoL and community members by survival.ConclusionOur findings support the primacy of QoL in genomic decision‐making, with some differences ...
de Feria Cardet, RE, Hofman, MS, Segard, T, Yim, J, Williams, S, Francis, RJ, Frydenberg, M, Lawrentschuk, N, Murphy, DG & De Abreu Lourenco, R 2021, 'Is Prostate-specific Membrane Antigen Positron Emission Tomography/Computed Tomography Imaging Cost-effective in Prostate Cancer: An Analysis Informed by the proPSMA Trial', European Urology, vol. 79, no. 3, pp. 413-418.
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Background
Before integrating prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) into routine care, it is important to assess if the benefits justify the differences in resource use.Objective
To determine the cost-effectiveness of PSMA-PET/CT when compared with conventional imaging.Design, setting, and participants
A cost-effectiveness analysis was developed using data from the proPSMA study. proPSMA included patients with high-risk prostate cancer assigned to conventional imaging or 68Ga-PSMA-11 PET/CT with planned health economics data collected. The cost-effectiveness analysis was conducted from an Australian societal perspective.Intervention
68Ga-PSMA-11 PET/CT compared with conventional imaging (CT and bone scan).Outcome measurements and statistical analysis
The primary outcome from proPSMA was diagnostic accuracy (nodal and distant metastases). This informed a decision tree analysis of the cost per accurate diagnosis.Results and limitations
The estimated cost per scan for PSMA PET/CT was AUD$1203, which was less than the conventional imaging cost at AUD$1412. PSMA PET/CT was thus dominant, having both better accuracy and a lower cost. This resulted in a cost of AUD$959 saved per additional accurate detection of nodal disease, and AUD$1412 saved for additional accurate detection of distant metastases. The results were most sensitive to variations in the number of men scanned for each 68Ga-PSMA-11 production run. Subsequent research is required to assess the long-term costs and benefits of PSMA PET/CT-directed care.Conclusions
PSMA PET/CT has lower direct comparative costs and greater accuracy compared to conventional imaging for initial staging of men with high-risk prostate cancer. This provides a compelling case for adopting PSMA PET/CT into clinical practice.Patient summary
The proPSMA study demonstrat...
de Zoete, A, de Boer, MR, Rubinstein, SM, van Tulder, MW, Underwood, M, Hayden, JA, Buffart, LM, Ostelo, R & International IPD-SMT group 2021, 'Moderators of the Effect of Spinal Manipulative Therapy on Pain Relief and Function in Patients with Chronic Low Back Pain: An Individual Participant Data Meta-analysis.', Spine (Phila Pa 1976), vol. 46, no. 8, pp. E505-E517.
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STUDY DESIGN: Individual participant data (IPD) meta-analysis. OBJECTIVE: The aim of this study was to identify which participant characteristics moderate the effect of spinal manipulative therapy (SMT) on pain and functioning in chronic LBP. SUMMARY OF BACKGROUND: The effects of SMT are comparable to other interventions recommended in guidelines for chronic low back pain (LBP); however, it is unclear which patients are more likely to benefit from SMT compared to other therapies. METHODS: IPD were requested from randomized controlled trials (RCTs) examining the effect of SMT in adults with chronic LBP for pain and function compared to various other therapies (stratified by comparison). Potential patient moderators (n = 23) were a priori based on their clinical relevance. We investigated each moderator using a one-stage approach with IPD and investigated this interaction with the intervention for each time point (1, 3, 6, and 12 months). RESULTS: We received IPD from 21 of 46 RCTs (n = 4223). The majority (12 RCTs, n = 2249) compared SMT to recommended interventions. The duration of LBP, baseline pain (confirmatory), smoking, and previous exposure to SMT (exploratory) had a small moderating effect across outcomes and follow-up points; these estimates did not represent minimally relevant differences in effects; for example, patients with <1 year of LBP demonstrated more positive point estimates for SMT versus recommended therapy for the outcome pain (mean differences ranged from 4.97 (95% confidence interval, CI: -3.20 to 13.13) at 3 months, 10.76 (95% CI: 1.06 to 20.47) at 6 months to 5.26 (95% CI: -2.92 to 13.44) at 12 months in patients with over a year LBP. No other moderators demonstrated a consistent pattern across time and outcomes. Few moderator analyses were conducted for the other comparisons because of too few data. CONCLUSION: We did not identify any moderators that enable clinicians to identify which patients are likely to benefit more from S...
Desborough, J, Dykgraaf, SH, Phillips, C, Wright, M, Maddox, R, Davis, S & Kidd, M 2021, 'Lessons for the global primary care response to COVID-19: a rapid review of evidence from past epidemics', Family Practice.
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AbstractBackgroundCOVID-19 is the fifth and most significant infectious disease epidemic this century. Primary health care providers, which include those working in primary care and public health roles, have critical responsibilities in the management of health emergencies.ObjectiveTo synthesize accounts of primary care lessons learnt from past epidemics and their relevance to COVID-19.MethodsWe conducted a review of lessons learnt from previous infectious disease epidemics for primary care, and their relevance to COVID-19. We searched PubMed/MEDLINE, PROQUEST and Google Scholar, hand-searched reference lists of included studies, and included research identified through professional contacts.ResultsOf 173 publications identified, 31 publications describing experiences of four epidemics in 11 countries were included. Synthesis of findings identified six key lessons: (i) improve collaboration, communication and integration between public health and primary care; (ii) strengthen the primary health care system; (iii) provide consistent, coordinated and reliable information emanating from a trusted source; (iv) define the role of primary care during pandemics; (v) protect the primary care workforce and the community and (vi) evaluate the effectiveness of interventions.ConclusionsEvidence highlights distinct challenges to integrating and supporting primary care in response to infectious disease epidemics that have persisted over time, emerging again during COVID-19. These insights provide an opportunity for strengthening, and improved preparedness, that cannot be ignored in a world where the frequency, virility and global reach of infectious dis...
Disalvo, D, Agar, M, Caplan, G, Murtagh, FEM, Luckett, T, Heneka, N, Hickman, L, Kinchin, I, Trethewie, S, Sheehan, C, Urban, K, Cohen, J, Harlum, J, Long, B, Parker, T, Schaefer, I & Phillips, J 2021, 'Virtual models of care for people with palliative care needs living in their own home: A systematic meta-review and narrative synthesis', Palliative Medicine, vol. 35, no. 8, pp. 1385-1406.
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Background: Access to palliative care in the community enables people to live in their preferred place of care, which is often home. Community palliative care services struggle to provide timely 24-h services to patients and family. This has resulted in calls for ‘accessible and flexible’ models of care that are ‘responsive’ to peoples’ changing palliative care needs. Digital health technologies provide opportunities to meet these requirements 24-h a day. Aim: To identify digital health technologies that have been evaluated for supporting timely assessment and management of people living at home with palliative care needs and/or their carer(s), and the evidence-base for each. Design: A systematic review of systematic reviews (‘meta-review’). Systematic reviews evaluating evidence for virtual models of palliative or end-of-life care using one or more digital health technologies were included. Systematic reviews were evaluated using the Risk of Bias Tool for Systematic Reviews. A narrative approach was used to synthesise results. Data sources: Medline, Embase, Web of Science, CINAHL and Cochrane Database of systematic reviews were searched for English-language reviews published between 2015 and 2020. Results: The search yielded 2266 articles, of which 12 systematic reviews met criteria. Sixteen reviews were included in total, after four reviews were found via handsearching. Other than scheduled telehealth, video-conferencing, or after-hours telephone support, little evidence was found for digital health technologies used to deliver virtual models of palliative care. Conclusions: There are opportunities t...
Doerflinger, M, Haeusler, GM, Li-Wai-Suen, CSN, Clark, JE, Slavin, M, Babl, FE, Allaway, Z, Mechinaud, F, Smyth, GK, De Abreu Lourenco, R, Phillips, B, Pellegrini, M & Thursky, KA 2021, 'Procalcitonin and Interleukin-10 May Assist in Early Prediction of Bacteraemia in Children With Cancer and Febrile Neutropenia', Frontiers in Immunology, vol. 12.
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ObjectivesFebrile neutropenia (FN) causes treatment disruption and unplanned hospitalization in children with cancer. Serum biomarkers are infrequently used to stratify these patients into high or low risk for serious infection. This study investigated plasma abundance of cytokines in children with FN and their ability to predict bacteraemia.MethodsThirty-three plasma cytokines, C-reactive protein (CRP) and procalcitonin (PCT) were measured using ELISA assays in samples taken at FN presentation (n = 79) and within 8–24 h (Day 2; n = 31). Optimal thresholds for prediction of bacteraemia were identified and the predictive ability of biomarkers in addition to routinely available clinical variables was assessed.ResultsThe median age of included FN episodes was 6.0 years and eight (10%) had a bacteraemia. On presentation, elevated PCT, IL-10 and Mip1-beta were significantly associated with bacteraemia, while CRP, IL-6 and IL-8 were not. The combination of PCT (≥0.425 ng/ml) and IL-10 (≥4.37 pg/ml) had a sensitivity of 100% (95% CI 68.8–100%) and specificity of 89% (95% CI 80.0–95.0%) for prediction of bacteraemia, correctly identifying all eight bacteraemia episodes and classifying 16 FN episodes as high-risk. There was limited additive benefit of incorporating clinical variables to this model. On Day 2, there was an 11-fold increase in PCT in episodes with a bacteraemia which was significantly higher than that observed in the non-bacteraemia episodes.ConclusionElevated PCT and IL-10 accurately identified all bacteraemia episodes in our FN cohort and may enhance the early risk stratification process in this population. Prospective validation and implementation is required to determine the impact on health service utilisation.
Fardell, JE, Wakefield, CE, De Abreu Lourenco, R, Signorelli, C, McCarthy, M, McLoone, J, Osborn, M, Gabriel, M, Anazodo, A, Alvaro, F, Lockwood, L, Walwyn, T, Skeen, J, Tillemans, R & Cohn, RJ 2021, 'Long‐term health‐related quality of life in young childhood cancer survivors and their parents', Pediatric Blood & Cancer, vol. 68, no. 12.
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AbstractPurposeFew studies have investigated the health‐related quality of life (HRQoL) of young childhood cancer survivors and their parents. This study describes parent and child cancer survivor HRQoL compared to population norms and identifies factors influencing child and parent HRQoL.MethodsWe recruited parents of survivors who were currently <16 years, and >5 years postdiagnosis. Parents reported on their child's HRQoL (Kidscreen‐10), and their own HRQoL (EQ‐5D‐5L). Parents rated their resilience and fear of cancer recurrence and listed their child's cancer‐related late effects.ResultsOne hundred eighty‐two parents of survivors (mean age = 12.4 years old and 9.7 years postdiagnosis) participated. Parent‐reported child HRQoL was significantly lower than population norms (48.4 vs. 50.7, p < .009). Parents most commonly reported that their child experienced sadness and loneliness (18.1%). Experiencing more late effects and receiving treatments other than surgery were associated with worse child HRQoL. Parents’ average HRQoL was high (0.90) and no different to population norms. However 38.5% of parents reported HRQoL that was clinically meaningfully different from perfect health, and parents experienced more problems with anxiety/depression (43.4%) than population norms (24.7%, p < .0001). Worse child HRQoL, lower parent resilience, and higher fear of recurrence was associated with worse parent HRQoL.ConclusionsParents report that young survivors experience small but significant ongoing reductions in HRQoL. While overall mean levels of HRQoL were no different to population norms, a subset of parents reported HRQoL that was clinically ...
Fiebig, DG, van Gool, K, Hall, J & Mu, C 2021, 'Health care use in response to health shocks: Does socio‐economic status matter?', Health Economics, vol. 30, no. 12, pp. 3032-3050.
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AbstractWe investigate how utilization of primary care, specialist care, and emergency department (ED) care (and the mix across the three) changes in response to a change in health need. We determine whether any changes in utilization are impacted by socio‐economic status. The use of a unique Australian data set that consists of a large survey linked to multiple years of detailed administrative records enables us to better control for individual heterogeneity and allows us to exploit changes in health that are related to the onset of two health shocks: a new diagnosis of diabetes and heart disease. We extend the analysis by also examining changes to patient out‐of‐pocket costs. We find significant differences in the mix between primary and specialist care use according to income and type of health shock but no evidence of using ED as a substitute for other care. Our results indicate that low‐ and high‐income patients navigate very different pathways for their care following the onset of diabetes and to a lesser extent heart disease. These pathways appear to be chosen on the basis of ability to pay, rather than the most effective or efficient bundle of care delivered through a combination of GP and specialist care.
Figueroa, JF, Horneffer, KE, Riley, K, Abiona, O, Arvin, M, Atsma, F, Bernal‐Delgado, E, Blankart, CR, Bowden, N, Deeny, S, Estupiñán‐Romero, F, Gauld, R, Hansen, TM, Haywood, P, Janlov, N, Knight, H, Lorenzoni, L, Marino, A, Or, Z, Pellet, L, Orlander, D, Penneau, A, Schoenfeld, AJ, Shatrov, K, Skudal, KE, Stafford, M, van de Galien, O, van Gool, K, Wodchis, WP, Tanke, M, Jha, AK & Papanicolas, I 2021, 'A methodology for identifying high‐need, high‐cost patient personas for international comparisons', Health Services Research, vol. 56, no. S3, pp. 1302-1316.
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AbstractObjectiveTo establish a methodological approach to compare two high‐need, high‐cost (HNHC) patient personas internationally.Data sourcesLinked individual‐level administrative data from the inpatient and outpatient sectors compiled by the International Collaborative on Costs, Outcomes, and Needs in Care (ICCONIC) across 11 countries: Australia, Canada, England, France, Germany, the Netherlands, New Zealand, Spain, Sweden, Switzerland, and the United States.Study designWe outline a methodological approach to identify HNHC patient types for international comparisons that reflect complex, priority populations defined by the National Academy of Medicine. We define two patient profiles using accessible patient‐level datasets linked across different domains of care—hospital care, primary care, outpatient specialty care, post‐acute rehabilitative care, long‐term care, home‐health care, and outpatient drugs. The personas include a frail older adult with a hip fracture with subsequent hip replacement and an older person with complex multimorbidity, including heart failure and diabetes. We demonstrate their comparability by examining the characteristics and clinical diagnoses captured across countries.Data collection/extraction methodsData collected by ICCONIC partners.Principal findingsAcross 11 countries, the identification of HNHC patient personas was feasible to examine variations in healthcare utilization, spending, and patient outcomes. The ability of countries to examine linked, individual‐level data varied, with the Netherlands, Canada, and Germany able to comprehensively examine care across all seven domains, whereas other countries ...
Figueroa, JF, Papanicolas, I, Riley, K, Abiona, O, Arvin, M, Atsma, F, Bernal‐Delgado, E, Bowden, N, Blankart, CR, Deeny, S, Estupiñán‐Romero, F, Gauld, R, Haywood, P, Janlov, N, Knight, H, Lorenzoni, L, Marino, A, Or, Z, Penneau, A, Shatrov, K, van de Galien, O, van Gool, K, Wodchis, W & Jha, AK 2021, 'International comparison of health spending and utilization among people with complex multimorbidity', Health Services Research, vol. 56, no. S3, pp. 1317-1334.
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AbstractObjectiveThe objective of this study was to explore cross‐country differences in spending and utilization across different domains of care for a multimorbid persona with heart failure and diabetes.Data SourcesWe used individual‐level administrative claims or registry data from inpatient and outpatient health care sectors compiled by the International Collaborative on Costs, Outcomes, and Needs in Care (ICCONIC) across 11 countries: Australia, Canada, England, France, Germany, the Netherlands, New Zealand, Spain, Sweden, Switzerland, and the United States (US).Data Collection/Extraction MethodsData collected by ICCONIC partners.Study DesignWe retrospectively analyzed age–sex standardized utilization and spending of an older person (65–90 years) hospitalized with a heart failure exacerbation and a secondary diagnosis of diabetes across five domains of care: hospital care, primary care, outpatient specialty care, post–acute rehabilitative care, and outpatient drugs.Principal FindingsSample sizes ranged from n = 1270 in Spain to n = 21,803 in the United States. Mean age (standard deviation [SD]) ranged from 76.2 (5.6) in the Netherlands to 80.3 (6.8) in Sweden. We observed substantial variation in spending and utilization across care settings. On average, England spent $10,956 per person in hospital care while the United States spent $30,877. The United States had a shorter length of stay over the year (18.9 days) compared to France (32.9) and Germany (33.4). The United States spent more days in facility‐based rehabilitative care than other countries. Australia spent $421 per person...
Finch, AP, Gamper, E, Norman, R, Viney, R, Holzner, B, King, M & Kemmler, G 2021, 'Estimation of an EORTC QLU-C10 Value Set for Spain Using a Discrete Choice Experiment', PharmacoEconomics, vol. 39, no. 9, pp. 1085-1098.
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BackgroundThe EORTC QLU-C10D is a preference-based measure derived from the EORTC QLQ-C30. For use in economic evaluations, country-specific value sets are needed. This study aimed to generate an EORTC QLU-C10 value set for Spain.MethodsA sample of the Spanish general population completed an online discrete choice experiment. An attribute-balanced incomplete block design was used to select 960 choice tasks, with a total of 1920 health states. Each participant was randomly assigned 16 choice sets without replacement. Data were modelled using generalized estimating equations and mixed logistic regressions.ResultsA total of 1625 panel members were invited to participate, 1010 of whom were included in the study. Dimension decrements were generally monotonic with larger disutilities at increased severity levels. Dimensions associated with larger decrements were physical functioning and pain, while the dimension with the smallest decrement was sleep disturbances. The PITS state (i.e. worst attainable health) for the Spanish population is − 0.043.ConclusionsThis study generated the first Spanish value set for the QLU-C10D. This can facilitate cost-utility analyses when applied to data collected with the EORTC QLQ-C30.
Geerligs, L, Shepherd, HL, Butow, P, Shaw, J, Masya, L, Cuddy, J & Rankin, NM 2021, 'What factors influence organisational readiness for change? Implementation of the Australian clinical pathway for the screening, assessment and management of anxiety and depression in adult cancer patients (ADAPT CP)', Supportive Care in Cancer, vol. 29, no. 6, pp. 3235-3244.
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AIMS:Translation of evidence-based psycho-oncology interventions into routine care can significantly improve patient outcomes, yet effective implementation remains challenging due to numerous real-world barriers. A key factor that may influence implementation is organisational readiness for change. This mixed method study sought to identify factors associated with organisational readiness for implementing the Australian clinical pathway for the screening, assessment and management of anxiety and depression in adult cancer patients (ADAPT CP). METHODS:We collected data from multidisciplinary staff across six Australian cancer services who were preparing to implement the ADAPT CP. Services were categorised as having 'high' versus 'mid-range' organisational readiness based on a median split on the Organizational Readiness for Implementing Change (ORIC) questionnaire (score range = 12-60). Qualitative data from the semi-structured interviews based on the Promoting Action Research in Health Services (PARiHS) framework were analysed thematically and compared for services with high- versus mid-range organisational readiness. RESULTS:Three services with high- (mean ORIC range, 52.25-56.88), and three with mid-range (range, 38.75-46.39) organisational readiness scores were identified. Staff at services reporting higher readiness described a more collaborative and proactive service culture, strong communication processes and greater role flexibility. They also reported greater confidence in overcoming anticipated barriers and clearer strategies for addressing issues. CONCLUSIONS:Levels of organisational readiness were related to distinct qualitative themes. Targeting these issues in services where readiness is mid-range or low prior to full-scale roll-out may improve staff levels of confidence and efficacy in implementing psycho-oncology-focused interventions.
Girgis, A, Candler, HB, Handley, T, Descallar, J, Hansen, V, Haas, M, Viney, R, Haywood, P, Bellamy, D, Proietto, A & Kelly, BJ 2021, 'The PACT Study: results of a time series study investigating the impact, acceptability and cost of an integrated model for psychosocial screening, care and treatment of patients with urological and head and neck cancers', Journal of Psychosocial Oncology Research & Practice, vol. 3, no. 4, pp. e063-e063.
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Abstract Background: The significant psychosocial morbidity experienced by cancer patients is often undetected and untreated. Despite international priority given to psychosocial care for cancer patients, implementation of psychosocial programs into routine cancer care is limited. We developed, implemented, and assessed the impact, acceptability, and cost of an integrated, patient-centered Psychosocial Assessment, Care and Treatment (PACT) model of care for cancer patients within a general hospital setting. Methods: A time series research design was implemented to test the PACT model of care, newly introduced in an Australian tertiary hospital. System-level impact on systematic distress screening and management was assessed through audit of the medical records of three cross-sectional samples of 141 patients, at baseline and at 12 and 24 months post-baseline. The impact of the model on patient experience and health care professionals’ (HCPs) knowledge and confidence was assessed via surveys. The acceptability of the intervention was assessed through HCP interviews at 24 months. The cost of the intervention was assessed by PACT staff recording the time spent on care provision, training, and intervention administration, and associated costs were calculated using staff payment rates adjusted for superannuation and leave. Results: Across the 24 months of implementation, formal distress screening increased from 0% at baseline to 29% of patients at 12 months and 31% of patients at 24 months, with an associated decrease in informal screening as formal screening increased. There was no notable change in distress management (ie, development of car...
Godman, B, Hill, A, Simoens, S, Selke, G, Selke Krulichová, I, Zampirolli Dias, C, Martin, AP, Oortwijn, W, Timoney, A, Gustafsson, LL, Voncina, L, Kwon, H-Y, Gulbinovic, J, Gotham, D, Wale, J, Cristina Da Silva, W, Bochenek, T, Allocati, E, Kurdi, A, Ogunleye, OO, Meyer, JC, Hoxha, I, Malaj, A, Hierländer, C, Sauermann, R, Hamelinck, W, Petrova, G, Laius, O, Langner, I, Yfantopoulos, J, Joppi, R, Jakupi, A, Greiciute-Kuprijanov, I, Vella Bonanno, P, Piepenbrink, JH, de Valk, V, Wladysiuk, M, Marković-Peković, V, Mardare, I, Fürst, J, Tomek, D, Obach Cortadellas, M, Zara, C, Pontes, C, McTaggart, S, Laba, T-L, Melien, Ø, Wong-Rieger, D, Bae, S & Hill, R 2021, 'Potential approaches for the pricing of cancer medicines across Europe to enhance the sustainability of healthcare systems and the implications', Expert Review of Pharmacoeconomics & Outcomes Research, vol. 21, no. 4, pp. 527-540.
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- CLEAN VERSION Introduction: There are growing concerns among European health authorities regarding increasing prices for new cancer medicines, prices not necessarily linked to health gain and the implications for the sustainability of their healthcare systems. Areas covered: Narrative discussion principally among payers and their advisers regarding potential approaches to the pricing of new cancer medicines. Expert commentary: A number of potential pricing approaches are discussed including minimum effectiveness levels for new cancer medicines, managed entry agreements, multicriteria decision analyses (MCDAs), differential/tiered pricing, fair pricing models, amortization models as well as de-linkage models. We are likely to see a growth in alternative pricing deliberations in view of ongoing challenges including the considerable number of new cancer medicines in development including new gene therapies and being launched with uncertainty regarding their value, continued high prices coupled with the extent of confidential discounts for reimbursement; however, balanced against the need for new cancer medicines. This will lead to greater scrutiny over the prices of patent oncology medicines as more standard medicines lose their patent, calls for greater transparency as well as new models including amortization models. We will be monitoring these developments.
Haeusler, GM, De Abreu Lourenco, R, Bakos, C, O'Brien, T, Slavin, MA, Clark, JE, McMullan, B, Borland, ML, Babl, FE, Krishnasamy, M, Vanevski, M, Thursky, KA & Hall, L 2021, 'Managing low‐risk febrile neutropenia in children in the time of COVID‐19: What matters to parents and clinicians', Journal of Paediatrics and Child Health, vol. 57, no. 6, pp. 826-834.
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AimThe Australian ‘There is no place like home’ project is implementing a paediatric low‐risk febrile neutropenia (FN) programme across eight paediatric hospitals. We sought to identify the impact of the coronavirus disease 2019 (COVID‐19) pandemic on programme implementation.MethodsPaediatric oncology, infectious diseases and emergency medicine health‐care workers and parent/carers were surveyed to explore the impact of the COVID‐19 pandemic on home‐based FN care. Online surveys were distributed nationally to health‐care workers involved in care of children with FN and to parents or carers of children with cancer.ResultsSurveys were completed by 78 health‐care workers and 32 parents/carers. Overall, 95% of health‐care workers had confidence in the safety of home‐based FN care, with 35% reporting changes at their own hospitals in response to the pandemic that made them more comfortable with this model. Compared to pre‐pandemic, >50% of parent/carers were now more worried about attending the hospital with their child and >80% were interested in receiving home‐based FN care. Among both groups, increased telehealth access and acceptance of home‐based care, improved patient quality of life and reduced risk of nosocomial infection were identified as programme enablers, while re‐direction of resources due to COVID‐19 and challenges in implementing change during a crisis were potential barriers.ConclusionThere is strong clinician and parent/carer support for home‐based management of low‐risk FN across Australia. Changes made to the delivery of cancer care in response to the pandemic have generally increased acceptance for home‐based treatments and opportunities exist to leverage these to refine the low‐risk FN programme.
Haeusler, GM, De Abreu Lourenco, R, Clark, H, Thursky, KA, Slavin, MA, Babl, FE, Mechinaud, F, Alvaro, F, Clark, J, Padhye, B, Phillips, M, Super, L, Tapp, H, Walwyn, T, Ziegler, D, Phillips, R & Worth, LJ 2021, 'Diagnostic Yield of Initial and Consecutive Blood Cultures in Children With Cancer and Febrile Neutropenia', Journal of the Pediatric Infectious Diseases Society, vol. 10, no. 2, pp. 125-130.
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Abstract Background The timing and necessity of repeated blood cultures (BCs) in children with cancer and febrile neutropenia (FN) are unknown. We evaluated the diagnostic yield of BCs collected pre- and post-empiric FN antibiotics. Methods Data collected prospectively from the Australian Predicting Infectious ComplicatioNs in Children with Cancer (PICNICC) study were used. Diagnostic yield was calculated as the number of FN episodes with a true bloodstream infection (BSI) detected divided by the number of FN episodes that had a BC taken. Results A BSI was identified in 13% of 858 FN episodes. The diagnostic yield of pre-antibiotic BCs was higher than of post-antibiotic cultures (12.3% vs 4.4%, P < .001). Two-thirds of the post-antibiotic BSIs were associated with a new episode of fever or clinical instability, and only 2 new BSIs were identified after 48 hours of empiric antibiotics and persistent fever. A contaminated BC was identified more frequently in post-antibiotic cultures. Conclusions In the absence of new fever or clinical instability, BCs beyond 48 hours of persistent fever have limited yield. Opportunity exists to optimize BC collection in this population and reduce the burden of unnecessary tests on patients, healthcare workers, and hospitals.
Haeusler, GM, Gaynor, L, Teh, B, Babl, FE, Orme, LM, Segal, A, Mechinaud, F, Bryant, PA, Phillips, B, Lourenco, RDA, Slavin, MA & Thursky, KA 2021, 'Home-based care of low-risk febrile neutropenia in children—an implementation study in a tertiary paediatric hospital', Supportive Care in Cancer, vol. 29, no. 3, pp. 1609-1617.
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Hafiz, N, Hyun, K, Knight, A, Hespe, C, Chow, CK, Briffa, T, Gallagher, R, Reid, CM, Hare, DL, Zwar, N, Woodward, M, Jan, S, Atkins, ER, Laba, T-L, Halcomb, E, Usherwood, T & Redfern, J 2021, 'Gender Comparison of Receipt of Government-Funded Health Services and Medication Prescriptions for the Management of Patients With Cardiovascular Disease in Primary Care', Heart, Lung and Circulation, vol. 30, no. 10, pp. 1516-1524.
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Background
Cardiovascular disease (CVD) and risk factors remains a major burden in terms of disease, disability, and death in the Australian population and mental health is considered as an important risk factor affecting cardiovascular disease. A multidisciplinary collaborative approach in primary care is required to ensure an optimal outcome for managing cardiovascular patients with mental health issues. Medicare introduced numerous primary care health services and medications that are subsidised by the Australian government in order to provide a more structured approach to reduce and manage CVD. However, the utilisation of these services nor gender comparison for CVD management in primary care has been explored. Therefore, the aim is to compare the provision of subsidised chronic disease management plans (CDMPs), mental health care and prescription of guideline-indicated medications to men and women with CVD in primary care practices for secondary prevention.Methods
De-identified data for all active patients with CVD were extracted from 50 Australian primary care practices. Outcomes included the frequency of receipt of CDMPs, mental health care and prescription of evidence-based medications. Analyses adjusted for demography and clinical characteristics, stratified by gender, were performed using logistic regression and accounted for clustering effects by practices.Results
Data for 14,601 patients with CVD (39.4% women) were collected. The odds of receiving the CDMPs was significantly greater amongst women than men (preparation of general practice management plan [GPMP]: (46% vs 43%; adjusted OR [95% CI]: 1.22 [1.12, 1.34]). Women were more likely to have diagnosed with mental health issues (32% vs 20%, p<0.0001), however, the adjusted odds of men and women receiving any government-subsidised mental health care were similar. Women were less often prescribed blood pressure, lipid-lowering and antiplatelet medications. After adju...
Hall, J & Viney, R 2021, 'Quality adjusted life years in the time of COVID-19', Australian Health Review, vol. 45, no. 1, pp. 12-12.
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The quality adjusted life year (QALY) as a basis of valuing additional expenditure on health is widely accepted. Although early in the COVID-19 pandemic, several commentators called for a similar approach in resolving trade-offs between economic activity and reducing the burden of COVID-19, this has not occurred. The value of a QALY has not been used to deny all intervention, as the rule of rescue attests. Further, while there was no other way of managing the pandemic, there were other means available to mitigate the economic losses. Now that vaccine programs have commenced in several countries, it is interesting to consider whether economic evaluation should now be applied. However, the recognised complexities of the evaluation of vaccines, plus the challenge of measuring opportunity costs in the face of an economic recession and the severity of the consequences of an outbreak even though the probability of transmission is exceedingly low, mean its use will be restricted. COVID-19 has changed everything, even the way we should think about economic evaluation.
Jacups, S & Kinchin, I 2021, 'A rapid review of evidence to inform an ear, nose and throat service delivery model in remote Australia', Rural and Remote Health, vol. 21, no. 1.
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Introduction
This rapid literature review aimed to inform the development of a new sustainable, evidence-based service delivery model for ear, nose and throat (ENT) services across Cape York, Australia. This work seeks to investigate the research question: 'What are the characteristics of successful outreach services which can be applied to remote living Indigenous children?'Methods
A comprehensive search of three major electronic databases (PubMed, CINAHL and MEDLINE) and two websites (HealthInfo Net and Google Scholar) was conducted for peer-reviewed and grey literature, to elicit characteristics of ENT and hearing services in rural and remote Australia, Canada, New Zealand and the USA. The search strategy was divided into four sections: outreach services for rural and remote communities; services for Indigenous children and families; telehealth service provision; and remote ear and hearing health service models. A narrative synthesis was used to summarise the key features of the identified service characteristics.Results
In total, 71 studies met the inclusion criteria and were included in the review, which identified a number of success and sustainability traits, including employment of a dedicated ear and hearing educator; outreach nursing and audiology services; and telehealth access to ENT services. Ideally, outreach organisations should partner with local services that employ local Indigenous health workers to provide ongoing ear health services in community between outreach visits.Conclusion
The evidence suggests that sound and sustainable ENT outreach models build on existing services; are tailored to local needs; promote cross-agency collaboration; use telehealth; and promote ongoing education of the local workforce.
Jacups, SP, Kinchin, I & Edwards, L 2021, 'Participatory Action Research Applied to an Ear, Nose, and Throat Specialty Service Redesign in Remote Australia: A Mixed-Methods Study of Key Stakeholder Perspectives', International Journal of Environmental Research and Public Health, vol. 18, no. 1, pp. 167-167.
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This mixed-methods study reports on the key stakeholders’ perspectives on the ear, nose, and throat (ENT) service redesign in remote Australia, using a participatory action research (PAR) approach. A primary health care (PHC) clinician survey was conducted to assess local needs and possible educational gaps in clinical knowledge. This was followed by an internal stakeholder forum and a follow-up survey with Torres and Cape Hospital and Health Service staff to gain their perspectives on current service delivery and table ideas for a new ENT health service model. Qualitative data were analyzed inductively and grouped in emerging themes. Quantitative data were imported into tables and analyzed descriptively. PAR allowed for input from 19 PHC clinicians, 10 face-to-face stakeholders perspectives, and 18 stakeholder follow-up survey respondents. Four themes emerged: 1. Training for health workers in ENT management; 2. Improved local service access; 3. New referral pathways to improve continuity of care; and 4. Introduction of telehealth. PAR engaged key stakeholders, identifying gaps in ENT service delivery, and guided the development of the new service model. The inclusion of stakeholders throughout the service redesign process is likely to create a more sustainable model of care which already has local “buy-in”.
Jones, R, Mulhern, B, McGregor, K, Yip, S, O'Loughlin, R, Devlin, N, Hiscock, H & Dalziel, K 2021, 'Psychometric Performance of HRQoL Measures: An Australian Paediatric Multi-Instrument Comparison Study Protocol (P-MIC)', Children, vol. 8, no. 8, pp. 714-714.
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Background: There is a lack of psychometric evidence about pediatric health-related quality of life (HRQoL) instruments. Evidence on cost effectiveness, involving the measurement of HRQoL, is used in many countries to make decisions about pharmaceuticals, technologies, and health services for children. Additionally, valid instruments are required to facilitate accurate outcome measurement and clinical decision making. A pediatric multi instrument comparison (P-MIC) study is planned to compare the psychometric performance and measurement characteristics of pediatric HRQoL instruments. Methods: The planned P-MIC study will collect data on approximately 6100 Australian children and adolescents aged 2–18 years via The Royal Children’s Hospital Melbourne and online survey panels. Participants will complete an initial survey, involving the concurrent collection of a range of pediatric HRQoL instruments, followed by a shorter survey 2–8 weeks later, involving the collection of a subset of instruments from the initial survey. Children aged ≥7 years will be asked to self-report HRQoL. Psychometric performance will be assessed at the instrument, domain, and item level. Conclusions: This paper describes the methodology of the planned P-MIC study, including benefits, limitations, and likely challenges. Evidence from this study will guide the choice of HRQoL measures used in clinical trials, economic evaluation, and other applications.
Kenny, P, Street, DJ, Hall, J, Agar, M & Phillips, J 2021, 'Valuing End-of-Life Care for Older People with Advanced Cancer: Is Dying at Home Important?', The Patient - Patient-Centered Outcomes Research, vol. 14, no. 6, pp. 803-813.
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Background
Most health care systems are facing the challenge of providing health services to support the increasing numbers of older people with chronic life-limiting conditions at the end of life. Many policies focus primarily on increasing the proportion of deaths at home.
Objectives
This study aims to investigate preferences for care throughout the latter stages of a life-limiting illness, particularly the importance of location of care, location of death, and the use of life-sustaining measures. It focuses on preferences for the care of an older person with advanced cancer in the last 3 weeks of life.
Methods
A survey using discrete choice experiment (DCE) methods was completed online by a general population sample of 1548 Australians aged 45 years and over. The experiment included 12 attributes, and each respondent completed 11 choice sets. Analysis was by a mixed logit model and latent class analysis (LCA).
Results
The most important attributes influencing care preferences were cost, patient anxiety, pain control, and carer stress (relative importance scores 0.21, 0.19, 0.14, and 0.14, respectively), with less importance given to place of care and place of death (relative importance scores 0.03 and 0.01). The model predicted that 42% would consider receiving most care in hospital better than at home (58%) holding the levels of other attributes constant across the alternatives, while 42% would consider death in hospital better than at home (58%). Three population segments with different preferences were identified by the LCA, the largest (46.5%) prioritised how the patient and carer felt as well as the pain control achieved, the next largest (28.1%) prioritised cost, and the smallest segment (25.4%) prioritised a single room when an inpatient.
Conclusions
This study shows that investment in services to support people at the end of life would be better targeted toward programmes that improve patient and carer well...
Kim, H, Byrnes, J & Goodall, S 2021, 'Health Technology Assessment in Australia: The Pharmaceutical Benefits Advisory Committee and Medical Services Advisory Committee', Value in Health Regional Issues, vol. 24, pp. 6-11.
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© 2020 Health technology assessment (HTA) was introduced in Australia for the reimbursement of pharmaceuticals in 1992 and in the following years for procedures, diagnostic tests, and devices. The Australian health system is largely funded by the government. The Pharmaceutical Benefits Scheme is a national list of prescription pharmaceuticals for which the patient pays a small copayment. HTA submissions to the Pharmaceutical Benefits Scheme are assessed by the Pharmaceutical Benefits Advisory Committee. The Medical Benefits Scheme provides ambulatory medical services and HTA submissions are assessed by the Medical Services Advisory Committee. This article describes the processes of reimbursement in Australia as well as the special case of codependent technologies (eg, diagnostic test and a therapeutic drug) where a combined Medical Services Advisory Committee and Pharmaceutical Benefits Advisory Committee application is required. There are many future challenges for HTA in Australia, with growing pressure to provide early access to promising treatments and high cost personalized medicines looming on the horizon. However, Australia is well placed to deal with these issues as the early adoption of HTA and coexistence between industry, academia and the payer has proven to be a fertile environment for developing capacity to undertake and evaluate HTA.
Kim, H, Cook, G, Goodall, S & Liew, D 2021, 'Comparison of EQ-5D-3L with QLU-C10D in Metastatic Melanoma Using Cost-Utility Analysis', PharmacoEconomics - Open, vol. 5, no. 3, pp. 459-467.
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Kim, H, Goodall, S & Liew, D 2021, 'Reassessing the cost-effectiveness of nivolumab for the treatment of renal cell carcinoma based on mature survival data, updated safety and lower comparator price', Journal of Medical Economics, vol. 24, no. 1, pp. 893-899.
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Kinchin, I, Mitchell, E, Agar, M & Trépel, D 2021, 'The economic cost of delirium: A systematic review and quality assessment', Alzheimer's & Dementia, vol. 17, no. 6, pp. 1026-1041.
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AbstractIntroductionThis review aims to systematically identify and appraise the methodological quality of claims on the cost of delirium; and discuss challenges and opportunities for improvements in the precision of the estimates.MethodsSearches of scientific papers and gray literature were performed up until June 2020. The Larg and Moss checklist was used to assess the methodological quality of the included studies.ResultsAfter deduplication, the search identified 317 potentially relevant articles, of which 17 articles were eligible for inclusion. After adjusting for inflation and common currency, the cost of delirium ranged between $806 and $24,509 (in 2019 US$).DiscussionThis review found significant variation among the cost estimates and methodological quality. There has been limited focus on dementia as a sequela of delirium in terms of economic implications, but recent evidence suggests cost implications of delirium may be 52% higher when dementia is considered.
King, MT, Norman, R, Mercieca-Bebber, R, Costa, DSJ, McTaggart-Cowan, H, Peacock, S, Janda, M, Müller, F, Viney, R, Pickard, AS, Cella, D, Aaronson, N, Brazier, J, Cella, D, Costa, DSJ, Fayers, P, Grimison, P, Janda, M, Kemmler, G, King, MT, McTaggart-Cowan, H, Mercieca-Bebber, R, Norman, R, Peacock, S, Pickard, AS, Rowen, D, Velikova, G, Viney, R, Street, D & Young, T 2021, 'The Functional Assessment of Cancer Therapy Eight Dimension (FACT-8D), a Multi-Attribute Utility Instrument Derived From the Cancer-Specific FACT-General (FACT-G) Quality of Life Questionnaire: Development and Australian Value Set', Value in Health, vol. 24, no. 6, pp. 862-873.
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ObjectivesTo develop a cancer-specific multi-attribute utility instrument derived from the Functional Assessment of Cancer Therapy - General (FACT-G) health-related quality of life (HRQL) questionnaire.MethodsWe derived a descriptive system based on a subset of the 27-item FACT-G. Item selection was informed by psychometric analyses of existing FACT-G data (n = 6912) and by patient input (n = 82). We then conducted an online valuation survey, with participants recruited via an Australian general population online panel. A discrete choice experiment (DCE) was used, with attributes being the HRQL dimensions of the descriptive system and survival duration, and 16 choice-pairs per participant. Utility decrements were estimated with conditional logit and mixed logit modeling.ResultsEight HRQL dimensions were included in the descriptive system: pain, fatigue, nausea, sleep, work, social support, sadness, and future health worry; each with 5 levels. Of 1737 panel members who accessed the valuation survey, 1644 (95%) completed 1 or more DCE choice-pairs and were included in analyses. Utility decrements were generally monotonic; within each dimension, poorer HRQL levels generally had larger utility decrements. The largest utility decrements were for the highest levels of pain (-0.40) and nausea (-0.28). The worst health state had a utility of -0.54, considerably worse than dead.ConclusionsA descriptive system and preference-based scoring approach were developed for the FACT-8D, a new cancer-specific multi-attribute utility instrument derived from the FACT-G. The Australian value set is the first of a series of country-specific value sets planned that can facilitate cost-utility analyses based on items from the FACT-G and related FACIT questionnaires containing FACT-G items.
Kirby, S, Edwards, K, Yu, S, van Gool, K, Powell‐Davies, G, Harris‐Roxas, B, Gresham, E, Harris, M & Hall, J 2021, 'Improving outcomes for marginalised rural families through a care navigator program', Health Promotion Journal of Australia, vol. 32, no. 2, pp. 285-294.
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AbstractIssues addressedHealth promotion programs are based on the premise that health and well‐being is impacted by a person's living circumstances, not just factors within the health arena. Chronic health issues require integrated services from health and social services. Navigator positions are effective in assisting chronic disease patients to access services. This family program in a small rural town in Western New South Wales targeted marginalised families with children under five years of age with a chronic health issue. The navigator developed a cross‐sectoral care plan to provide services to address family issues. The study aimed to identify navigator factors supporting improved family outcomes.MethodsParticipants included parent/clients (n = 4) and the cross‐sectoral professional team (n = 9) involved in the program. During the interview, participants were asked about their perspective of the program. Interview transcripts were thematically analysed informed by the Chronic Care Model underpinned by Health Promotion Theory.ResultsThe program improved client family's lives in relation to children's health and other family health and social issues. Trust in the care navigator was the most important factor for parents to join and engage with the program. The care navigator role was essential to maintaining client engagement and supporting cooperation between services to support families.ConclusionEssential care navigator skills were commitment, ability to persuade and empower parents and other professionals.So what?This descriptive study demonstrated the positive influence of the care navigator and the program on high risk families i...
Kirkwood, EK, Dibley, MJ, Hoddinott, JF, Huda, T, Laba, TL, Tahsina, T, Hasan, MM, Iqbal, A, Khan, J, Ali, NB, Ullah, S, Goodwin, N, Muthayya, S, Islam, MM, Ara, G, Agho, KE, Arifeen, SE & Alam, A 2021, 'Assessing the impact of a combined nutrition counselling and cash transfer intervention on women’s empowerment in rural Bangladesh: a randomised control trial protocol', BMJ Open, vol. 11, no. 6, pp. e044263-e044263.
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IntroductionThere is growing interest in assessing the impact of health interventions, particularly when women are the focus of the intervention, on women’s empowerment. Globally, research has shown that interventions targeting nutrition, health and economic development can affect women’s empowerment. Evidence suggests that women’s empowerment is also an underlying determinant of nutrition outcomes. Depending on the focus of the intervention, different domains of women’s empowerment will be influenced, for example, an increase in nutritional knowledge, or greater control over income and access to resources.ObjectiveThis study evaluates the impact of the Shonjibon Cash and Counselling (SCC) Trial that combines nutrition counselling and an unconditional cash transfer, delivered on a mobile platform, on women’s empowerment in rural Bangladesh.Methods and analysisWe will use a mixed-methods approach, combining statistical analysis of quantitative data from 2840 women in a cluster randomised controlled trial examining the impact of nutrition behaviour change communications (BCCs) and cash transfers on child undernutrition. Pregnant participants will be given a smartphone with a customised app, delivering nutrition BCC messages, and will receive nutrition counselling via a call centre and an unconditional cash transfer. This study is a component of the SCC Trial and will measure women’s empowerment using a composite indicator based on the Project-Level Women’s Empowerment in Agriculture Index, with quantitative data collection at baseline and endline. Thematic analysis of qualitative data, collected through longitudinal interviews with women, husbands and mothers-in-law, will elicit a local understanding of women’s empowerment and the linkages between the intervention and women’s empowerment o...
Kong, B, Sim, H-W, Amanuel, B, Day, B, Buckland, M, Verhaak, R, Yip, S, Johns, T, Lwin, Z, Rosenthal, M, Nowak, AK, Barnes, EH, Scott, AM, Parkinson, J, Jeffree, R, Lourenco, RDA, Lau, P, Whittle, J, Hovey, E, Cher, L, Kichendasse, G, Hall, M, Robinson, C, Thomas, M, Giardina, T, Tu, E, Khasraw, M, Koh, E-S & Gan, H 2021, 'INNV-08. LOW AND INTERMEDIATE GRADE GLIOMA UMBRELLA STUDY OF MOLECULAR GUIDED THERAPIES (LUMOS) STUDY', Neuro-Oncology, vol. 23, no. Supplement_6, pp. vi106-vi107.
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Abstract BACKGROUND Grade 2 and 3 (G2/3) gliomas are the second largest group of brain tumors in adults. Although the prognosis for G2/3 gliomas at the time of relapse mirror those of glioblastoma, there are few trials in this space. METHODS LUMOS was a national multi-center pilot study for patients with relapsed G2/3 gliomas designed to match contemporaneous tissue obtained at the time of disease progression with subsequent targeted therapies. The objective was to establish the feasibility of a precision oncology, umbrella approach to obtain and type tissue within a useful timeframe. As a key feature of LUMOS, a multidisciplinary Molecular Tumor Advisory Panel (MTAP) with subspecialty neuro-oncology expertise was formed to interpret the complex genomic information and provide a simplified recommendation to the treating physician. RESULTS Ten patients (median age 42: range 32-62; four G2 astrocytoma, one G3 astrocytoma, three G2 oligoendroglioma, one G3 oligodendroglioma, one mixed tumor) were enrolled in the study. Eight patients had biopsies within 6 months of study entry whilst two underwent a biopsy during the study. All patients had potentially targetable alterations (10 IDH, 3 FGFR, 2 PIK3K, CCND3, NRAS, CDK4, PRPRZ1-MET fusion and MET amplification). Matched therapies were delivered for two patients via compassionate access outside the study. The median turnaround time (TAT) of MTAP reports was 6.2 weeks (range 4.2-9.7 weeks) but 4.6 weeks when lag time for shipping was removed. CO...
Kong, BY, Sim, H-W, Nowak, AK, Yip, S, Barnes, EH, Day, BW, Buckland, ME, Verhaak, R, Johns, T, Robinson, C, Thomas, MA, Giardina, T, Lwin, Z, Scott, AM, Parkinson, J, Jeffree, R, Lourenco, RDA, Hovey, EJ, Cher, LM, Kichendasse, G, Khasraw, M, Hall, M, Tu, E, Amanuel, B, Koh, E-S & Gan, HK 2021, 'LUMOS - Low and Intermediate Grade Glioma Umbrella Study of Molecular Guided TherapieS at relapse: Protocol for a pilot study', BMJ Open, vol. 11, no. 12, pp. e054075-e054075.
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IntroductionGrades 2 and 3 gliomas (G2/3 gliomas), when combined, are the second largest group of malignant brain tumours in adults. The outcomes for G2/3 gliomas at progression approach the dismal outcomes for glioblastoma (GBM), yet there is a paucity of trials for Australian patients with relapsed G2/3 gliomas compared with patients with GBM. LUMOS will be a pilot umbrella study for patients with relapsed G2/3 gliomas that aims to match patients to targeted therapies based on molecular screening with contemporaneous tumour tissue. Participants in whom no actionable or no druggable mutation is found, or in whom the matching drug is not available, will form a comparator arm and receive standard of care chemotherapy. The objective of the LUMOS trial is to assess the feasibility of this approach in a multicentre study across five sites in Australia, with a view to establishing a national molecular screening platform for patient treatment guided by the mutational analysis of contemporaneous tissue biopsiesMethods and analysisThis study will be a multicentre pilot study enrolling patients with recurrent grade 2/3 gliomas that have previously been treated with radiotherapy and chemotherapy at diagnosis or at first relapse. Contemporaneous tumour tissue at the time of first relapse, defined as tissue obtained within 6 months of relapse and without subsequent intervening therapy, will be obtained from patients. Molecular screening will be performed by targeted next-generation sequencing at the reference laboratory (PathWest, Perth, Australia). RNA and DNA will be extracted from representative formalin-fixed paraffin embedded tissue scrolls or microdissected from sections on glass slides tissue sections following a review of the histology by pathologists. Extracted nucleic acid will be quantified by Qubit Fluorometric Quantitation (Thermo Fisher Scientific...
Kong, BY, Sim, H-W, Nowak, AK, Yip, S, Barnes, EH, Day, BW, Buckland, ME, Verhaak, R, Johns, T, Robinson, C, Thomas, MA, Giardina, T, Lwin, Z, Scott, AM, Parkinson, J, Jeffree, R, Lourenco, RDA, Hovey, EJ, Cher, LM, Kichendasse, G, Khasraw, M, Hall, M, Tu, E, Amanuel, B, Koh, E-S & Gan, HK 2021, 'LUMOS - Low and Intermediate Grade Glioma Umbrella Study of Molecular Guided TherapieS at relapse: Protocol for a pilot study.', BMJ open, vol. 11, no. 12, p. e054075.
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Introduction
Grades 2 and 3 gliomas (G2/3 gliomas), when combined, are the second largest group of malignant brain tumours in adults. The outcomes for G2/3 gliomas at progression approach the dismal outcomes for glioblastoma (GBM), yet there is a paucity of trials for Australian patients with relapsed G2/3 gliomas compared with patients with GBM. LUMOS will be a pilot umbrella study for patients with relapsed G2/3 gliomas that aims to match patients to targeted therapies based on molecular screening with contemporaneous tumour tissue. Participants in whom no actionable or no druggable mutation is found, or in whom the matching drug is not available, will form a comparator arm and receive standard of care chemotherapy. The objective of the LUMOS trial is to assess the feasibility of this approach in a multicentre study across five sites in Australia, with a view to establishing a national molecular screening platform for patient treatment guided by the mutational analysis of contemporaneous tissue biopsies METHODS AND ANALYSIS: This study will be a multicentre pilot study enrolling patients with recurrent grade 2/3 gliomas that have previously been treated with radiotherapy and chemotherapy at diagnosis or at first relapse. Contemporaneous tumour tissue at the time of first relapse, defined as tissue obtained within 6 months of relapse and without subsequent intervening therapy, will be obtained from patients. Molecular screening will be performed by targeted next-generation sequencing at the reference laboratory (PathWest, Perth, Australia). RNA and DNA will be extracted from representative formalin-fixed paraffin embedded tissue scrolls or microdissected from sections on glass slides tissue sections following a review of the histology by pathologists. Extracted nucleic acid will be quantified by Qubit Fluorometric Quantitation (Thermo Fisher Scientific). Library preparation and targeted capture will be performed using the TruSight Tumor 170 (TS...
Lewandowska, M, De Abreu Lourenco, R, Haas, M, Watson, CJ, Black, KI, Taft, A, Lucke, J, McGeechan, K, McNamee, K, Peipert, JF & Mazza, D 2021, 'Cost-effectiveness of a complex intervention in general practice to increase uptake of long-acting reversible contraceptives in Australia', Australian Health Review, vol. 45, no. 6, pp. 728-734.
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Objective The aim of this study was to evaluate the cost-effectiveness of the Australian Contraceptive ChOice pRoject (ACCORd) intervention. Methods An economic evaluation compared the costs and outcomes of the ACCORd intervention with usual care (UC). Data from the ACCORd trial were used to estimate costs and efficacy in terms of contraceptive uptake and quality of life. Rates of contraceptive failure and pregnancy were sourced from the literature. Using a Markov model, within-trial results were extrapolated over 10 years and subjected to univariate sensitivity analyses. Model outputs were expressed as the cost per quality-adjusted life years (QALY) gained and cost per unintended pregnancy resulting in birth (UPB) avoided. Results Over 10 years, compared with UC, initiating contraception through the ACCORd intervention resulted in 0.02 fewer UPB and higher total costs (A$2505 vs A$1179) per woman. The incremental cost-effectiveness of the ACCORd intervention versus UC was A$1172 per QALY gained and A$7385 per UPB averted. If the start-up cost of the ACCORd intervention was removed, the incremental cost-effectiveness ratio was A$81 per QALY gained and A$511 per UPB averted. The results were most sensitive to the probability of contraceptive failure, the probability of pregnancy-related healthcare service utilisation or the inclusion of the costs of implementing the ACCORd intervention. Conclusions From a health system perspective, if implemented appropriately in terms of uptake and reach, and assuming an implicit willingness to pay threshold of A$50 000 the ACCORd intervention is cost-effective. What is known about the topic? The uptake of long-active reversible contraceptives (LARC) in Australia is low. The ACCORd trial assessed the efficacy of providing structured training to general practitioners (GPs) on LARC counselling, together with access to rapid referral to insertion clinics. What does this paper add? This study is the ...
Li, G, Li, L, Liu, D, Qin, J & Zhu, H 2021, 'Effect of PM2.5 pollution on perinatal mortality in China', Scientific Reports, vol. 11, no. 1.
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AbstractUsing ArcGIS to analyze satellite derived PM2.5estimates, this paper obtains the average concentration and maximum concentration of fine particulate matter (PM2.5) in China's 31 provinces from 2002 to 2015. We adopt fixed effects model and spatial Durbin model to investigate the association between PM2.5and perinatal mortality rates. The results indicate that PM2.5has a significantly positive association with perinatal mortality rates. A 1% increase of log-transformed average concentration and maximum concentrations of PM2.5is associated with 1.76‰ and 2.31‰ increase of perinatal mortality rates, respectively. In spatial econometrics analysis, we find PM2.5has significant spatial autocorrelation characteristics. The concentrations of log-transformed average and maximum PM2.5increase 1% is associated with a 2.49% increase in a 2.49‰ and 2.19‰ increase of perinatal mortality rates, respectively. The potential mechanism is that air pollution has an impact on infant weight to impact perinatal mortality rates.
Luckett, T, Luscombe, G, Phillips, J, Beattie, E, Chenoweth, L, Davidson, PM, Goodall, S, Pond, D, Mitchell, G & Agar, M 2021, 'Australian long-term care personnel’s knowledge and attitudes regarding palliative care for people with advanced dementia', Dementia, vol. 20, no. 2, pp. 427-443.
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This study aimed to describe Australian long-term care (LTC) personnel’s knowledge and attitudes concerning palliative care for residents with advanced dementia, and explore relationships with LTC facility/personnel characteristics. An analysis was undertaken of baseline data from a cluster randomised controlled trial of facilitated family case conferencing for improving palliative care of LTC residents with advanced dementia (the ‘IDEAL Study’). Participants included any LTC personnel directly involved in residents’ care. Knowledge and attitudes concerning palliative care for people with advanced dementia were measured using the questionnaire on Palliative Care for Advanced Dementia. Univariate and multivariate analyses explored relationships between personnel knowledge/attitudes and facility/personnel characteristics. Of 307 personnel in the IDEAL Study, 290 (94.5%) from 19/20 LTCFs provided sufficient data for inclusion. Participants included 9 (2.8%) nurse managers, 59 (20.5%) registered nurses, 25 (8.7%) enrolled nurses, 187 (64.9%) assistants in nursing/personal care assistants and 9 (3.1%) care service employees. In multivariate analyses, a facility policy not to rotate personnel through dementia units was the only variable associated with more favourable overall personnel knowledge and attitudes. Other variables associated with favourable knowledge were a designation of nursing manager or registered or enrolled nurse, and having a preferred language of English. Other variables associated with favourable attitudes were tertiary level of education and greater experience in dementia care. Like previous international research, this study found Australian LTC personnel knowledge and attitudes regarding palliative care for people with advanced dementia to be associated with both facility and personnel characteristics. Future longitudinal research is needed to better understand the relationships between knowledge and attitudes, as well as betw...
Manipis, K, Goodall, S, Hanly, P, Viney, R & Pearce, A 2021, 'Employer survey to estimate the productivity friction period', The European Journal of Health Economics, vol. 22, no. 2, pp. 255-266.
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Objectives
The friction cost approach (FCA) is one way to estimate lost productivity, which considers the time taken to replace an employee, known as the friction period. The friction period may be influenced by local labour market conditions, limiting the relevance of international FCA estimates. The objective was to estimate the time and costs of replacing an employee in Australia.
Methods
Staff responsible for recruitment in businesses across Australia were surveyed about the last management and non-management employee hired, workforce composition, friction period time and costs, and team dynamic effects. Primary analyses were conducted on respondents that recruited in the past 12 months. The friction period was decomposed into three periods: recruitment decision, recruitment period, and training period. Descriptive statistics of the friction period time and costs, and team dynamic effects were calculated.
Results
The sample consisted of Australian businesses (N = 274), primarily micro-organisations (2-4 employees, 44%) in urban locations (75%). The time (12.3 weeks; SD 15.1) and costs ($6230; SD $17,502) to replace a manager were higher than those to replace non-managers (10.0 weeks, SD 13.01; $2666, sd $7849). The training period represented the longest time component in replacing an employee (38-40% of the total friction period). There was an increasing impact on other employees' productivity, particularly for absent managers as time off work increased.
Conclusions
The friction period in Australia was similar to international estimates. Interestingly, the friction period mainly consisted of time outside the recruitment period; the decision to recruit and the training period.
Manipis, K, Street, D, Cronin, P, Viney, R & Goodall, S 2021, 'Exploring the Trade-Off Between Economic and Health Outcomes During a Pandemic: A Discrete Choice Experiment of Lockdown Policies in Australia', The Patient - Patient-Centered Outcomes Research, vol. 14, no. 3, pp. 359-371.
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Mulhern, B, Norman, R & Brazier, J 2021, 'Valuing SF-6Dv2 in Australia Using an International Protocol', PharmacoEconomics, vol. 39, no. 10, pp. 1151-1162.
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Nathan, N, Nguyen, AD, Stocker, S, Laba, T, Baysari, MT & Day, RO 2021, 'Out‐of‐pocket spending among a cohort of Australians living with gout', International Journal of Rheumatic Diseases, vol. 24, no. 3, pp. 327-334.
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AbstractObjectiveTo measure the direct and indirect out‐of‐pocket (OOP) costs borne by Australians with gout.MethodsA cross‐sectional, Australia‐wide, web‐based survey was conducted over 12 months between May 2017 and April 2018. Participants were recruited via advertisements in doctors’ clinics and healthcare organizations’ websites, and social media platforms such as Facebook and Twitter. Survey questions collected information about participants’ OOP spending on direct medical and non‐medical gout‐related healthcare costs. Participant demographics, gout status, healthcare sought, workdays lost to due gout and health‐related quality of life were also collected.ResultsSeventy‐nine patients with gout completed the survey; 70 (89%) were male, and on average were 56 (SD 16) years of age and had gout for 14 (SD 12) years. For this cohort, the median total OOP direct medical cost was AU$200 per year (interquartile range [IQR]: AU$60‐AU$570). Sixty (76%) people with gout reported being affected by gout during work; however, only 0.25 (IQR: 0‐3) days of work (approximately $60) were lost due to gout in a year. Nine percent (n = 7) of participants experienced cost‐related treatment attrition and 33% reported economic hardship (n = 26). Participants who experienced economic hardship or cost‐related treatment attrition had higher median total gout‐related direct costs than those who did not.ConclusionIn Australia, gout has an OOP financial cost and reduces work productivity. The presence of cost‐related treatment attrition among people with gout indicates that financial costs may be a significant barrier to seeking treatment for a subset of patients with gout.
Nerich, V, Gamper, EM, Norman, R, King, M, Holzner, B, Viney, R & Kemmler, G 2021, 'French Value-Set of the QLU-C10D, a Cancer-Specific Utility Measure Derived from the QLQ-C30', Applied Health Economics and Health Policy, vol. 19, no. 2, pp. 191-202.
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Norman, R, Robinson, S, Dickinson, H, Williams, I, Meshcheriakova, E, Manipis, K & Anstey, M 2021, 'Public Preferences for Allocating Ventilators in an Intensive Care Unit: A Discrete Choice Experiment', The Patient - Patient-Centered Outcomes Research, vol. 14, no. 3, pp. 319-330.
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O’Hara, J, Martin, AP, Nugent, D, Witkop, M, Buckner, TW, Skinner, MW, O’Mahony, B, Mulhern, B, Morgan, G, Li, N & Sawyer, EK 2021, 'Evidence of a disability paradox in patient‐reported outcomes in haemophilia', Haemophilia, vol. 27, no. 2, pp. 245-252.
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AbstractIntroductionPeople with inherited and long‐term conditions such as haemophilia have been shown to adapt to their levels of disability, often reporting better quality of life (QoL) than expected from the general population (the disability paradox).AimTo investigate the disability paradox in people with haemophilia in the United States by examining preference differences in health state valuations versus the general population.MethodsWe conducted a discrete choice experiment including duration to capture valuations of health states based on patient‐reported preferences. Participants indicated their preferences for hypothetical health states using the EQ‐5D‐5L, where each participant completed 15 of the 120 choice tasks. Response inconsistencies were evaluated with dominated and repeated scenarios. Conditional‐logit regressions with random sampling of the general population responses were used to match the sample of patients with haemophilia. We compared model estimates and derived preferences associated with EQ‐5D‐5L health states.ResultsAfter removing respondents with response inconsistencies, 1327/2138 (62%) participants remained (177/283 haemophilia; 1150/1900 general population). Patients with haemophilia indicated higher preference value for 99% of EQ‐5D‐5L health states compared to the general population (when matched on age and gender). The mean health state valuation difference of 0.17 indicated a meaningful difference compared to a minimal clinically important difference threshold of 0.07. Results were consistent by haemophilia type and severity.ConclusionOur findings indicated the presence of a disability paradox among pati...
Or, Z, Shatrov, K, Penneau, A, Wodchis, W, Abiona, O, Blankart, CR, Bowden, N, Bernal‐Delgado, E, Knight, H, Lorenzoni, L, Marino, A, Papanicolas, I, Riley, K, Pellet, L, Estupiñán‐Romero, F, van Gool, K & Figueroa, JF 2021, 'Within and across country variations in treatment of patients with heart failure and diabetes', Health Services Research, vol. 56, no. S3, pp. 1358-1369.
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AbstractObjectiveTo compare within‐country variation of health care utilization and spending of patients with chronic heart failure (CHF) and diabetes across countries.Data SourcesPatient‐level linked data sources compiled by the International Collaborative on Costs, Outcomes, and Needs in Care across nine countries: Australia, Canada, England, France, Germany, New Zealand, Spain, Switzerland, and the United States.Data Collection MethodsPatients were identified in routine hospital data with a primary diagnosis of CHF and a secondary diagnosis of diabetes in 2015/2016.Study DesignWe calculated the care consumption of patients after a hospital admission over a year across the care pathway—ranging from primary care to home health nursing care. To compare the distribution of care consumption in each country, we use Gini coefficients, Lorenz curves, and female–male ratios for eight utilization and spending measures.Principal FindingsIn all countries, rehabilitation and home nursing care were highly concentrated in the top decile of patients, while the number of drug prescriptions were more uniformly distributed. On average, the Gini coefficient for drug consumption is about 0.30 (95% confidence interval (CI): 0.27–0.36), while it is, 0.50 (0.45–0.56) for primary care visits, and more than 0.75 (0.81–0.92) for rehabilitation use and nurse visits at home (0.78; 0.62–0.9). Variations in spending were more pronounced than in utilization. Compared to men, women spend more days at initial hospital admission (+5%, 1.01–1.06), have a higher number of prescriptions (+7%, 1.05–1.09), and substantially more rehabilitation and home care (+20% to 35%, 0.79...
Papanicolas, I, Figueroa, JF, Schoenfeld, AJ, Riley, K, Abiona, O, Arvin, M, Atsma, F, Bernal‐Delgado, E, Bowden, N, Blankart, CR, Deeny, S, Estupiñán‐Romero, F, Gauld, R, Haywood, P, Janlov, N, Knight, H, Lorenzoni, L, Marino, A, Or, Z, Penneau, A, Shatrov, K, Stafford, M, van de Galien, O, van Gool, K, Wodchis, W & Jha, AK 2021, 'Differences in health care spending and utilization among older frail adults in high‐income countries: ICCONIC hip fracture persona', Health Services Research, vol. 56, no. S3, pp. 1335-1346.
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AbstractObjectiveThis study explores differences in spending and utilization of health care services for an older person with frailty before and after a hip fracture.Data SourcesWe used individual‐level patient data from five care settings.Study DesignWe compared utilization and spending of an older person aged older than 65 years for 365 days before and after a hip fracture across 11 countries and five domains of care as follows: acute hospital care, primary care, outpatient specialty care, post–acute rehabilitative care, and outpatient drugs. Utilization and spending were age and sex standardized..Data Collection/Extraction MethodsThe data were compiled by the International Collaborative on Costs, Outcomes, and Needs in Care (ICCONIC) across 11 countries as follows: Australia, Canada, England, France, Germany, the Netherlands, New Zealand, Spain, Sweden, Switzerland, and the United States.Principal FindingsThe sample ranged from 1859 patients in Spain to 42,849 in France. Mean age ranged from 81.2 in Switzerland to 84.7 in Australia. The majority of patients across countries were female. Relative to other countries, the United States had the lowest inpatient length of stay (11.3), but the highest number of days were spent in post–acute care rehab (100.7) and, on average, had more visits to specialist providers (6.8 per year) than primary care providers (4.0 per year). Across almost all sectors, the United States spent more per person than other countries per unit ($13,622 per hospitalization, $233 per primary care visit, $386 per MD specialist visit). Patients also had high expenditures in the year prior to the hip fracture, mostly conce...
Papanicolas, I, Riley, K, Abiona, O, Arvin, M, Atsma, F, Bernal‐Delgado, E, Bowden, N, Blankart, CR, Deeny, S, Estupiñán‐Romero, F, Gauld, R, Haywood, P, Janlov, N, Knight, H, Lorenzoni, L, Marino, A, Or, Z, Penneau, A, Schoenfeld, AJ, Shatrov, K, Stafford, M, van de Galien, O, van Gool, K, Wodchis, W, Jha, AK & Figueroa, JF 2021, 'Differences in health outcomes for high‐needhigh‐costpatients across high‐incomecountries', Health Services Research, vol. 56, no. S3, pp. 1347-1357.
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AbstractObjectiveThis study explores variations in outcomes of care for two types of patient personas—an older frail person recovering from a hip fracture and a multimorbid older patient with congestive heart failure (CHF) and diabetes.Data SourcesWe used individual‐level patient data from 11 health systems.Study DesignWe compared inpatient mortality, mortality, and readmission rates at 30, 90, and 365 days. For the hip fracture persona, we also calculated time to surgery. Outcomes were standardized by age and sex.Data Collection/Extraction MethodsData was compiled by the International Collaborative on Costs, Outcomes and Needs in Care across 11 countries for the years 2016–2017 (or nearest): Australia, Canada, England, France, Germany, the Netherlands, New Zealand, Spain, Sweden, Switzerland, and the United States.Principal FindingsThe hip sample across ranged from 1859 patients in Aragon, Spain, to 42,849 in France. Mean age ranged from 81.2 in Switzerland to 84.7 in Australia, and the majority of hip patients across countries were female. The congestive heart failure (CHF) sample ranged from 742 patients in England to 21,803 in the United States. Mean age ranged from 77.2 in the United States to 80.3 in Sweden, and the majority of CHF patients were males. Average in‐hospital mortality across countries was 4.1%. for the hip persona and 6.3% for the CHF persona. At the year mark, the mean mortality across all countries was 25.3% for the hip persona and 32.7% for CHF persona. Across both patient types, England reported the highest mortality at 1 year followed by the United States. Readmission rates for all periods were higher for the CHF p...
Pearson, S-A, Pratt, N, de Oliveira Costa, J, Zoega, H, Laba, T-L, Etherton-Beer, C, Sanfilippo, FM, Morgan, A, Kalisch Ellett, L, Bruno, C, Kelty, E, IJzerman, M, Preen, DB, Vajdic, CM & Henry, D 2021, 'Generating Real-World Evidence on the Quality Use, Benefits and Safety of Medicines in Australia: History, Challenges and a Roadmap for the Future', International Journal of Environmental Research and Public Health, vol. 18, no. 24, pp. 13345-13345.
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Australia spends more than $20 billion annually on medicines, delivering significant health benefits for the population. However, inappropriate prescribing and medicine use also result in harm to individuals and populations, and waste of precious health resources. Medication data linked with other routine collections enable evidence generation in pharmacoepidemiology; the science of quantifying the use, effectiveness and safety of medicines in real-world clinical practice. This review details the history of medicines policy and data access in Australia, the strengths of existing data sources, and the infrastructure and governance enabling and impeding evidence generation in the field. Currently, substantial gaps persist with respect to cohesive, contemporary linked data sources supporting quality use of medicines, effectiveness and safety research; exemplified by Australia’s limited capacity to contribute to the global effort in real-world studies of vaccine and disease-modifying treatments for COVID-19. We propose a roadmap to bolster the discipline, and population health more broadly, underpinned by a distinct capability governing and streamlining access to linked data assets for accredited researchers. Robust real-world evidence generation requires current data roadblocks to be remedied as a matter of urgency to deliver efficient and equitable health care and improve the health and well-being of all Australians.
Pratt, N, Camacho, X, Vajdic, C, Degenhardt, L, Laba, T-L, Hillen, J, Etherton-Beer, C, Preen, D, Jorm, L, Donnolley, N, Havard, A & Pearson, S-A 2021, 'The Medicines Intelligence Centre of Research Excellence: Co-creating real-world evidence to support the evidentiary needs of Australian regulators and payers.', International Journal of Population Data Science, vol. 6, no. 3, p. 1726.
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Regulators and payers play a pivotal role in facilitating timely and affordable access to safe and efficacious medicines. They use evidence generated from randomised clinical trials (RCTs) to support decisions to register and subsidise medicines. However, at the time of registration and subsidy approval, regulators and payers face uncertainty about how RCT outcomes will translate to real-world clinical practice. In response to this situation, medicines policy agencies worldwide have endorsed the use of real-world data (RWD) to derive novel insights on the use and outcomes of prescribed medicines. Recent reforms around data availability and use in Australia are creating unparalleled data access and opportunities for Australian researchers to undertake large-scale research to generate evidence on the safety and effectiveness of medicines in the real world. Highlighting the critical importance of research in this area, Quality Use of Medicines and Medicine Safety was announced as Australia's 10th National Health Priority in 2019. The National Health and Medical Research Council, Medicines Intelligence Centre of Research Excellence (MI-CRE) has been formed to take advantage of the renewed focus on quality use of medicines and the changing data landscape in Australia. It will generate timely research supporting the evidentiary needs of Australian medicines regulators and payers by accelerating the development and translation of real-world evidence on medicines use and outcomes. MI-CRE is developing a coordinated approach to identify, triage and respond to priority questions where there are significant uncertainties about medicines use, (cost)-effectiveness, and/or safety and creating a data ecosystem that will streamline access to Australian data to enable researchers to generate robust evidence in a timely manner. This paper outlines how MI-CRE will partner with policy makers, clinicians, and consumer advocates to leverage real-world data to co-crea...
Prichard, RA, Zhao, F-L, Mcdonagh, J, Goodall, S, Davidson, PM, Newton, PJ, Farr-Wharton, B & Hayward, CS 2021, 'Discrepancies between proxy estimates and patient reported, health related, quality of life: minding the gap between patient and clinician perceptions in heart failure', Quality of Life Research, vol. 30, no. 4, pp. 1049-1059.
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Redman-MacLaren, M, Benveniste, T, McCalman, J, Rutherford, K, Britton, A, Langham, E, Stewart, R, Saunders, P, Kinchin, I & Bainbridge, R 2021, 'Through the eyes of students: the satisfaction of remote Indigenous boarding students’ with a transition support service in Queensland, Australia', The Australian Journal of Indigenous Education, vol. 50, no. 1, pp. 95-106.
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AbstractMore than 4000 Indigenous Australian students enrol and take up a placement at boarding school each year. While reasons for attending boarding school vary, the impetus for many remote and very remote-dwelling students is restricted secondary educational opportunities in their home communities. A large multi-site study is being undertaken across Queensland to understand the conditions required for these students to be resilient while studying away from home. This paper reports on levels of student satisfaction with Queensland Department of Education's Transition Support Service (TSS) that provide assistance to remote-dwelling Indigenous students in the transition to boarding schools. A survey instrument administered to students included 22 close-ended questions to elicit levels of student satisfaction with TSS. Data were collected electronically using SurveyMonkey™ and analysed in SPSS v24. Descriptive statistics were calculated for variables assessing service support, student perceptions and experiences. A total of 294 primary, secondary and re-engaging students across 21 sites responded. Nearly all primary students (97%) anticipated that TSS would assist their move to boarding school. All secondary students identified that TSS had assisted their transition to boarding school. All re-engaging students agreed that TSS support had increased their capacity to cope when things go wrong. Lower scores related to students’ ability to access TSS when needed. Very high levels of satisfaction with TSS were countered by constraints of distance between TSS and students, and resources available to support the work of TSS. Findings point to the need for equitable provision of transition services in Queensland that emphasise the importance of relationship between service provider and student, and can inform the design of similar transition services across Australia.
Revicki, DA, King, MT, Viney, R, Pickard, AS, Mercieca-Bebber, R, Shaw, JW, Müller, F & Norman, R 2021, 'United States Utility Algorithm for the EORTC QLU-C10D, a Multiattribute Utility Instrument Based on a Cancer-Specific Quality-of-Life Instrument', Medical Decision Making, vol. 41, no. 4, pp. 485-501.
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Background The EORTC QLU-C10D is a multiattribute utility measure derived from the cancer-specific quality-of-life questionnaire, the EORTC QLQ-C30. The QLU-C10D contains 10 dimensions (physical, role, social and emotional functioning, pain, fatigue, sleep, appetite, nausea, bowel problems). The objective of this study was to develop a United States value set for the QLU-C10D. Methods A US online panel was quota recruited to achieve a representative sample for sex, age (≥18 y), race, and ethnicity. Respondents undertook a discrete choice experiment, each completing 16 choice-pairs, randomly assigned from a total of 960 choice-pairs. Each pair included 2 QLU-C10D health states and duration. Data were analyzed using conditional logistic regression, parameterized to fit the quality-adjusted life-year framework. Utility weights were calculated as the ratio of each dimension-level coefficient to the coefficient for life expectancy. Results A total of 2480 panel members opted in, 2333 (94%) completed at least 1 choice-pair, and 2273 (92%) completed all choice-pairs. Within dimensions, weights were generally monotonic. Physical functioning, role functioning, and pain were associated with the largest utility weights. Cancer-specific dimensions, such as nausea and bowel problems, were associated with moderate utility decrements, as were general issues such as problems with emotional functioning and social functioning. Sleep problems and fatigue were associated with smaller utility decrements. The value of the worst health state was 0.032, which was slightly greater than 0 (equivalent to being dead). Conclusions This study provides the US-specific value set for the QLU-C10D. These estimated health state scores, based on responses to th...
Sansom-Daly, U, Wakefield, C, Ellis, S, McGill, B, Donoghoe, M, Butow, P, Bryant, R, Sawyer, S, Patterson, P, Anazodo, A, Plaster, M, Thompson, K, Holland, L, Osborn, M, Maguire, F, O’Dwyer, C, De Abreu Lourenco, R & Cohn, R 2021, 'Online, Group-Based Psychological Support for Adolescent and Young Adult Cancer Survivors: Results from the Recapture Life Randomized Trial', Cancers, vol. 13, no. 10, pp. 2460-2460.
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Telehealth interventions offer a practical platform to support adolescent and young adult (AYA) cancer survivors’ mental health needs after treatment, yet efficacy data are lacking. We evaluated an online, group-based, videoconferencing-delivered cognitive-behavioral therapy (CBT) intervention (‘Recapture Life’) in a 3-arm randomized-controlled trial comparing Recapture Life with an online peer-support group, and a waitlist control, with the aim of testing its impact on quality of life, emotional distress and healthcare service use. Forty AYAs (Mage = 20.6 years) within 24-months of completing treatment participated, together with 18 support persons. No groupwise impacts were measured immediately after the six-week intervention. However, Recapture Life participants reported using more CBT skills at the six-week follow-up (OR = 5.58, 95% CI = 2.00–15.56, p = 0.001) than peer-support controls. Recapture Life participants reported higher perceived negative impact of cancer, anxiety and depression at 12-month follow-up, compared to peer-support controls. Post-hoc analyses suggested that AYAs who were further from completing cancer treatment responded better to Recapture Life than those who had completed treatment more recently. While online telehealth interventions hold promise, recruitment to this trial was challenging. As the psychological challenges of cancer survivorship are likely to evolve with time, different support models may prove more or less helpful for different sub-groups of AYA survivors at different times.
Sansom-Daly, UM, Wakefield, CE, Signorelli, C, Donoghoe, MW, Anazodo, A, Sawyer, SM, Osborn, M, Viney, R, Daniell, N, Faasse, K & Cohn, RJ 2021, 'Patterns and Predictors of Healthcare Use among Adolescent and Young Adult Cancer Survivors versus a Community Comparison Group', Cancers, vol. 13, no. 21, pp. 5270-5270.
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Healthcare use (HCU) during survivorship can mitigate adolescent and young adult (AYA) cancer survivors’ (aged 15–39 years) risk of medical and psychosocial late effects, but this is understudied. We surveyed 93 Australian AYA post-treatment cancer survivors (Mage = 22.0 years, SD = 3.5; 55.9% female) and a comparison sample of 183 non-matched AYAs (Mage = 19.7, SD = 3.2; 70.5% female) on their HCU, medication use, depression/anxiety, and general functioning. Relative to our comparison AYAs, a higher proportion of our survivor group reported medical HCU (community-delivered: 65.6% versus 47.0%, p = 0.003; hospital-delivered: 31.2% versus 20.3%, p = 0.044) and mental HCU (53.8% vs. 23.5%; p < 0.0001) in the past six months. A higher proportion of our survivors reported taking medications within the past six months than our comparison AYAs (61.3% vs. 42.1%, p = 0.003) and taking more types (p < 0.001). Vitamin/supplement use was most common followed by psychotropic medications. Our survivor group reported lower depression (p = 0.001) and anxiety symptoms (p = 0.003), but similar work/study participation (p = 0.767) to our comparison AYAs. Across groups, psychological distress was associated with higher mental HCU (p = 0.001). Among survivors, those who were female, diagnosed with brain/solid tumors and who had finished treatment more recently reported greater HCU. Future research should establish whether this level of HCU meets AYAs’ survivorship needs.
Scarf, VL, Yu, S, Viney, R, Cheah, SL, Dahlen, H, Sibbritt, D, Thornton, C, Tracy, S & Homer, C 2021, 'Modelling the cost of place of birth: a pathway analysis', BMC Health Services Research, vol. 21, no. 1, pp. 1-11.
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AbstractBackgroundIn New South Wales (NSW), Australia there are three settings available for women at low risk of complications to give birth: home, birth centre and hospital. Between 2000 and 2012, 93.6% of babies were planned to be born in hospital, 6.0% in a birth centre and 0.4% at home. Availability of alternative birth settings is limited and the cost of providing birth at home or in a birth centre from the perspective of the health system is unknown.ObjectivesThe objective of this study was to model the cost of the trajectories of women who planned to give birth at home, in a birth centre or in a hospital from the public sector perspective.MethodsThis was a population-based study using linked datasets from NSW, Australia. Women included met the following selection criteria: 37-41 completed weeks of pregnancy, spontaneous onset of labour, and singleton pregnancy at low risk of complications. We used a decision tree framework to depict the trajectories of these women and Australian Refined-Diagnosis Related Groups (AR-DRGs) were applied to each trajectory to estimate the cost of birth. A scenario analysis was undertaken to model the cost for 30 000 women in one year.Findings496 387 women were included in the dataset. Twelve potential outcome pathways were identified and each pathway was costed using AR-DRGs. An overall cost was also calculated by place of birth: $AUD4802 for homebirth, $AUD4979 for a birth centre birth and $AUD5463 for a hospital birth.ConclusionThe findings from this study provides some clarity into the financial saving of offering more options to women seeking an alternative to giving birth in hospital. Given the re...
Siva, S, Bressel, M, Mai, T, Le, H, Vinod, S, de Silva, H, Macdonald, S, Skala, M, Hardcastle, N, Rezo, A, Pryor, D, Gill, S, Higgs, B, Wagenfuehr, K, Montgomery, R, Awad, R, Chesson, B, Eade, T, Wong, W, Sasso, G, De Abreu Lourenco, R, Kron, T, Ball, D, Neeson, P, Bettington, C, Cook, O, Foote, M, Gowda, R, Haas, M, Haynes, NM, Hilder, B, Lao, L, Lim, A, Ludbrook, J, Jansen, T, MacManus, M, McCullough, SA, Moore, A, Ritchie, D, Shaw, M, Sia, J, Syed, F, Tang, C & Trapani, J 2021, 'Single-Fraction vs Multifraction Stereotactic Ablative Body Radiotherapy for Pulmonary Oligometastases (SAFRON II)', JAMA Oncology, vol. 7, no. 10, pp. 1476-1476.
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Street, AE, Street, DJ & Flynn, GM 2021, 'Who Gets the Last Bed? A Discrete-Choice Experiment Examining General Population Preferences for Intensive Care Bed Prioritization in a Pandemic', Medical Decision Making, vol. 41, no. 4, pp. 408-418.
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Objective To explore the key patient attributes important to members of the Australian general population when prioritizing patients for the final intensive care unit (ICU) bed in a pandemic over-capacity scenario. Methods A discrete-choice experiment administered online asked respondents ( N = 306) to imagine the COVID-19 caseload had surged and that they were lay members of a panel tasked to allocate the final ICU bed. They had to decide which patient was more deserving for each of 14 patient pairs. Patients were characterized by 5 attributes: age, occupation, caregiver status, health prior to being infected, and prognosis. Respondents were randomly allocated to one of 7 sets of 14 pairs. Multinomial, mixed logit, and latent class models were used to model the observed choice behavior. Results A latent class model with 3 classes was found to be the most informative. Two classes valued active decision making and were slightly more likely to choose patients with caregiving responsibilities over those without. One of these classes valued prognosis most strongly, with a decreasing probability of bed allocation for those 65 y and older. The other valued both prognosis and age highly, with decreasing probability of bed allocation for those 45 y and older and a slight preference in favor of frontline health care workers. The third class preferred more random decision-making strategies. Conclusions For two-thirds of those sampled, prognosis, age, and caregiving responsibilities were the important features when making allocation decisions, although the emphasis varies. The remainder appeared to choose randomly.
Subasinghe, AK, Watson, CJ, Black, KI, Taft, A, Luck, J, McGeechan, K, Haas, M, McNamee, K, Peipert, JF & Mazza, D 2021, 'Current contraceptive use in women with a history of unintended pregnancies: Insights from the Australian Contraceptive ChOice pRoject (ACCORd) trial', Australian Journal of General Practice, vol. 50, no. 6, pp. 422-425.
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van Gool, K, Mu, C & Hall, J 2021, 'Does more investment in primary care improve health system performance?', Health Policy, vol. 125, no. 6, pp. 717-724.
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This study examines the association between primary care investment and performance, in 34 OECD countries for 2005-15. Specifically, we explore whether an increasing investment in primary care is associated with improved performance, and whether particular characteristics of organisation and delivery are associated with a better return on primary care investment. We take advantage of new data sources that provide rich information on health and health systems as well as economic and distributional characteristics. Multilevel modelling was utilised to analyse cross-country variation. The results show that greater investment in primary care does not improve health system performance for complex targets (i.e., no reduction in preventable hospital admissions) though there is modest improvement in breast and cervical cancer screening rates. We also found that those countries in which GPs are more aware of health promotion/preventive activities achieve higher screening rates with the same amount of investment. The findings imply that primary care investment strategies need to look beyond high-level expenditure and characteristics of primary care strength, to institutional and funding arrangements and how these link to policy goals. Despite broad enthusiasm for strengthening primary care in general, we conclude that primary care policy needs to be appropriately targeted to improve health system performance.
Watson, C, McGeechan, K, McNamee, K, Black, KI, Lucke, J, Taft, A, Haas, M, Peipert, JE & Mazza, D 2021, 'Influences on condom use: A secondary analysis of women’s perceptions from the Australian Contraceptive ChOice pRoject (ACCORd) trial', Australian Journal of General Practice, vol. 50, no. 8, pp. 581-587.
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Webster, R, Usherwood, T, Joshi, R, Saini, B, Armour, C, Critchley, S, Di Tanna, GL, Galgey, S, Hespe, CM, Jan, S, Karia, A, Kaur, B, Krass, I, Laba, T, Li, Q, Lo, S, Peiris, DP, Reid, C, Rodgers, A, Shiel, L, Strathdee, J, Zamora, N & Patel, A 2021, 'An electronic decision support‐based complex intervention to improve management of cardiovascular risk in primary health care: a cluster randomised trial (INTEGRATE)', Medical Journal of Australia, vol. 214, no. 9, pp. 420-427.
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ObjectivesTo determine whether a multifaceted primary health care intervention better controlled cardiovascular disease (CVD) risk factors in patients with high risk of CVD than usual care.Design, settingParallel arm, cluster randomised trial in 71 Australian general practices, 5 December 2016 – 13 September 2019.ParticipantsGeneral practices that predominantly used an electronic medical record system compatible with the HealthTracker electronic decision support tool, and willing to implement all components of the INTEGRATE intervention.InterventionElectronic point-of-care decision support for general practices; combination cardiovascular medications (polypills); and a pharmacy-based medication adherence program.Main outcome measuresProportion of patients with high CVD risk not on an optimal preventive medication regimen at baseline who had achieved both blood pressure and low-density lipoprotein (LDL) cholesterol goals at study end.ResultsAfter a median 15 months’ follow-up, primary outcome data were available for 4477 of 7165 patients in the primary outcome cohort (62%). The proportion of patients who achieved both treatment targets was similar in the intervention (423 of 2156; 19.6%) and control groups (466 of 2321; 20.1%; relative risk, 1.06; 95% CI, 0.85–1.32). Further, no statistically significant differences were found for a number of secondary outcomes, including risk factor screening, preventive medication prescribing, and risk factor levels. Use of intervention components was low; it was highest for HealthTracker, used at least once for 347 of 3236 undertreated patients with high CVD risk (10.7%).ConclusionsDespite evidence for the efficacy of its individual components, the INTEGRATE intervention was not broadly implemented and did not improve CVD risk management in participating Australian general practices.
Wise, S, Hall, J, Haywood, P, Khana, N, Hossain, L & van Gool, K 2021, 'Paying for value: options for value-based payment reform in Australia', Australian Health Review, vol. 46, no. 2, pp. 129-133.
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Value-based health care has gained increasing prominence among funders and providers in efforts to improve the outcomes important to patients relative to the resources used to deliver care. In Australia, the value-based healthcare agenda has focused on reducing the use of ‘low-value’ interventions, redesigning models of care to improve integration between providers and increasing the use of patient-reported measures to drive improvement; all have occurred within existing payment structures. In this paper we describe options for value-based payment reform and highlight two challenges critical for success: attributing financial risk fairly and organisational structures. What is known about the topic? ‘Fee for service’ is the dominant payment method in Australia and creates incentives to increase service volume, rewarding inputs rather than improvements in longer-term health outcomes. There is increasing recognition that payment reform is needed to support the shift to value-based health care in Australia. What does this paper add? This paper describes the three main options for value-based payment reform: episode-based bundled payments chronic condition bundled payments and comprehensive capitation payments. Each involves some degree of funds pooling, and the shifting of risk from the funder to provider to stimulate the more efficient use of resources. What are the implications for practitioners? We conclude that local hospital authorities in the states, private health insurers and primary health networks could implement reform as payment holders, but that capacity development in coordination and risk adjustment will be required. Successful implementation of payment reform will also require investment in data collection and information technology to track patients’ care and measure outcomes and costs.
Witkop, M, Morgan, G, O'Hara, J, Recht, M, Buckner, TW, Nugent, D, Curtis, R, O'Mahony, B, Skinner, MW, Mulhern, B, Cawson, M, Ali, TM, Sawyer, EK & Li, N 2021, 'Patient preferences and priorities for haemophilia gene therapy in the US: A discrete choice experiment', Haemophilia, vol. 27, no. 5, pp. 769-782.
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AbstractIntroductionGene therapy has shown promise in clinical trials for patients with haemophilia, but patient preference studies have focused on factor replacement treatments.AimWe conducted a discrete choice experiment (DCE) to investigate the relative importance and differential preferences patients provide for gene therapy attributes.MethodsWe surveyed male adults with haemophilia in the United States recruited from patient panels including the National Hemophilia Foundation Community Voices in Research platform using an online survey over 4 months in 2020/21. Participants indicated preferences for gene therapy attributes including dosing frequency/durability, effect on annual bleeding, uncertainty related to side effects, impact on daily activities, impact on mental health, and post‐treatment requirements. The relative importance of each attribute was analysed overall and for subgroups based on haemophilia type and severity.ResultsA total of 183 males with haemophilia A (n = 120) or B (n = 63) were included. Half (47%) had severe haemophilia; most (75%) were White. Overall, participants gave effect on bleeding rate the greatest relative importance (31%), followed by dose frequency/durability (26%), uncertainty regarding safety issues (17%), and impact on daily activities (11%). Dose frequency/durability had the greatest importance for those with haemophilia B (35%).ConclusionPeople with haemophilia prioritised reduced bleeding and treatment burden; the former was more important in haemophilia A and the latter in haemophilia B, followed by safety and impact on daily life in this DCE of gene therapy attributes. These findings and diff...
Woods, M & Corderoy, G 2021, 'Improving Consumer‐Centred Aged Care: Addressing Issues of Sustainability, Service Integration and Market Incentives', Australian Economic Review, vol. 54, no. 2, pp. 266-274.
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AbstractThe Australian Government is preparing to implement its next tranche of reforms to publicly subsidised aged care services. While prompted by the Royal Commission into Aged Care Quality and Safety, this is also the next step in an ongoing program of improvement. System sustainability should remain a core concern, shared alike by consumers, providers, regulators and taxpayers. Some unfinished business should also be addressed. First, creating an integrated range of client‐centred services; second introducing market‐based incentives that empower residential care consumers to exercise choice and control and encourage competing providers to improve quality, safety and efficiency.
Wright, M, Versteeg, R & van Gool, K 2021, 'How much of Australia’s health expenditure is allocated to general practice and primary healthcare?', Australian Journal of General Practice, vol. 50, no. 9, pp. 673-678.
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ackground and objectivesUnderstanding resource allocation is important to ensure that limited health resources are spent where they bring the greatest benefit. The aim of this study was to explore how much of Australia’s national health expenditure is allocated specifically to general practice services, and more broadly to primary healthcare (PHC) services.MethodsThis study used multiple Australian institutional reports – produced by the Australian Institute of Health and Welfare, Productivity Commission and Services Australia – to classify, compare and quantify general practice and PHC expenditure.ResultsNational statistics report that approximately 34% of Australian health expenditure is spent on PHC. However, less than 20% of PHC expenditure (approximately 6.5% of total health expenditure) is allocated to delivering general practice services. Spending on general practitioners and general practice services varies between 4.2% and 6.8% of total health expenditure (between $7.8 billion and $12.4 billion) depending on the classification used.DiscussionSignificant differences exist in how different institutions classify general practice and PHC spending. Clearer, agreed and more precise methods of classification and reporting of health expenditure are needed.
Xiong, X, Dalziel, K, Huang, L, Mulhern, B & Carvalho, N 2021, 'PIH33 How Do Different Health Conditions IMPACT Dimensions of Pediatric Preference-Based Health-Related Quality of Life Measures?', Value in Health, vol. 24, pp. S104-S104.
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Yim, J, Arora, S, Shaw, J, Street, DJ, Pearce, A & Viney, R 2021, 'Patient Preferences for Anxiety and Depression Screening in Cancer Care: A Discrete Choice Experiment', Value in Health, vol. 24, no. 12, pp. 1835-1844.
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OBJECTIVES: Screening for anxiety and depression in cancer care is recommended, as identification is the first step in managing anxiety and depression. Nevertheless, patient preferences for anxiety and depression screening in cancer care are unknown. The objective of this study was to investigate and identify the aspects of an anxiety and depression screening program cancer patients value most, to inform decision-makers about ways to improve patient uptake and ultimately, the provision of patient-centered care. METHODS: A discrete choice experiment was designed and implemented within an Australian cancer population sample. Participants were presented with a series of hypothetical screening programs labeled as 'screening program 1' and 'screening program 2' and were asked to choose their preferred one. The discrete choice experiment was administered using an online survey platform. A mixed logit and a latent class analysis was conducted. RESULTS: Participants (n = 294) preferred screening to be conducted by a cancer nurse, face-to-face, and at regular intervals (monthly or every 3 months). Participants also preferred follow-up care to be delivered by mental health professionals embedded within the cancer care team. Factors that influenced preferences were the low cost and short waiting times for access to care. CONCLUSIONS: Cancer patients prefer cancer services with integrated mental healthcare services. To maximize patient uptake, anxiety and depression screening programs should be routinely offered, delivered by oncology healthcare staff in a face-to-face format, and, postscreening, to be care for by mental health professionals embedded within the cancer service.
Yim, J, Shaw, J, Viney, R, Arora, S, Ezendam, N & Pearce, A 2021, 'Investigating the Association Between Self-Reported Comorbid Anxiety and Depression and Health Service Use in Cancer Survivors', PharmacoEconomics, vol. 39, no. 6, pp. 681-690.
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BACKGROUND: Anxiety and depression have a higher prevalence in cancer survivors than in the general population and are associated with lower quality of life, poorer survival and an increased risk of suicide. Anxiety and depression are also highly comorbid among cancer survivors and associated with increased health service use. As such, it is important to consider both anxiety and depression and health service use in cancer survivors. OBJECTIVE: Our objective was to explore the association between anxiety and depression and health service utilisation, both cancer-specific and general doctor visits, in cancer survivors. METHODS: Data from a Dutch cancer registry were analysed to determine the association between anxiety and depression (measured using the Hospital Anxiety and Depression Scale) and health service use. Negative binomial regression models, controlling for patient demographics, comorbidities and cancer-related variables were estimated. RESULTS: Cancer survivors (n = 2538), with a mean age of 61.1 years and between 0.7 and 10.9 years since diagnosis, were included in the analysis. Increasing levels of anxiety and depression were associated with increased health service use. Having severe levels of anxiety was associated with more frequent visits to the general practitioner (p < 0.001). Severe depression in cancer survivors was associated with more frequent visits to the specialist (p < 0.001). CONCLUSION: Anxiety and depression in cancer survivors, particularly severe anxiety and depression, were associated with increased health service use. Treatment of anxiety and depression in cancer survivors has the potential to reduce overall health service use and associated costs and improve health outcomes for cancer survivors.
Yu, A, Street, D, Viney, R, Goodall, S, Pearce, A, Haywood, P, Haas, M, Battaglini, E, Goldstein, D, Timmins, H & Park, SB 2021, 'Clinical assessment of chemotherapy-induced peripheral neuropathy: a discrete choice experiment of patient preferences', Supportive Care in Cancer, vol. 29, no. 11, pp. 6379-6387.
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PURPOSE: Up to 40% of cancer patients treated with neurotoxic chemotherapies experience chemotherapy-induced peripheral neuropathy (CIPN). Currently, there is no gold standard assessment tool for CIPN and there is little information in the literature on patient preferences for such assessments. This study aims to address this gap by identifying the features of a CIPN assessment tool that cancer patients value. METHODS: An online discrete choice experiment (DCE) survey of neurotoxic chemotherapy-treated patients was implemented. Respondents completed 8 choice questions each. In each choice question, they chose between two hypothetical CIPN assessment tools, each described by six attributes: impact on quality of life; level of nerve damage detected; questionnaire length; physical tests involved; impact on clinic time; impact on care. RESULTS: The survey was completed by 117 respondents who had a range of cancers of which breast cancer was the most common. Respondents favoured an assessment tool that includes a physical test and that asks about impact on quality of life. Respondents were strongly opposed to clinicians, alone, deciding how the results of a CIPN assessment might influence their care especially their chemotherapy treatment. They were concerned about small changes in their CIPN, independent of clinical relevance. Respondents were willing to add half an hour to the usual clinic time to accommodate the CIPN assessment. CONCLUSION: The findings of this DCE will assist clinicians in choosing an assessment tool for CIPN that is satisfactory to both clinician and patient.
Zitko, P, Bilbeny, N, Vargas, C, Balmaceda, C, Eberhard, ME, Ahumada, M, Rodríguez, MF, Flores, J, Markkula, N & Espinoza, MA 2021, 'Different Alternatives to Assess the Burden of Disease Using Attributable Fraction on a Disability Variable: The Case of Pain and Chronic Musculoskeletal Disorders in Chile', Value in Health Regional Issues, vol. 26, pp. 15-23.
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Objectives: To estimate the burden of disease through 4 complementary procedures to years lived with disability (YLDs) using the concept of attributable fraction and including analysis of subdomains of disability. Methods: We explored the burden on disability for 7 common musculoskeletal disorders (CMD) using the 2009 to 2010 Chilean National Health Survey, which included the Community Oriented Programme for the Control of Rheumatic Disease Core Questionnaire to identify cases with CMD, and an 8-domain questionnaire for health state descriptions. We calculated the proportion of disability attributable to pain in the general population and people with CMD. We also estimated the burden of CMD expressed as YLD and as the proportion of the disability in the general population attributable to people with CMD, with a particular focus in the pain domain of disability. Second order of uncertainty around point estimations was also characterized. Results: Pain domain of disability accounted for 23.4% of the total disability in the general population, and between 20% (fibromyalgia) to 27.1% (osteoarthritis of the hip) in people with some of the selected CMD. People with chronic musculoskeletal pain accounted for 21.2% of total disability from general population, which generated 1.2 million of YLD (6679 YLD/100 000 inhabitants). Chronic low back pain and osteoarthritis of the knee were in the top position of specific CMDs, explaining the highest national burden. Conclusion: Pain is an essential component of disability in people with CMD and also in the general population. The approach used can be easily applied to other health conditions and other domains of disability.
