Abdel Shaheed, C, Ivers, R, Vizza, L, McLachlan, A, Kelly, PJ, Blyth, F, Stanaway, F, Clare, PJ, Thompson, R, Lung, T, Degenhardt, L, Reid, S, Martin, B, Wright, M, Osman, R, French, S, McCaffery, K, Campbell, G, Jenkins, H, Mathieson, S, Boogs, M, McMaugh, J, Bennett, C & Maher, C 2023, 'Clinical Observation, Management and Function Of low back pain Relief Therapies (COMFORT): A cluster randomised controlled trial protocol', BMJ Open, vol. 13, no. 11, pp. e075286-e075286.
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IntroductionLow back pain (LBP) is commonly treated with opioid analgesics despite evidence that these medicines provide minimal or no benefit for LBP and have an established profile of harms. International guidelines discourage or urge caution with the use of opioids for back pain; however, doctors and patients lack practical strategies to help them implement the guidelines. This trial will evaluate a multifaceted intervention to support general practitioners (GPs) and their patients with LBP implement the recommendations in the latest opioid prescribing guidelines.Methods and analysisThis is a cluster randomised controlled trial that will evaluate the effect of educational outreach visits to GPs promoting opioid stewardship alongside non-pharmacological interventions including heat wrap and patient education about the possible harms and benefits of opioids, on GP prescribing of opioids medicines dispensed. At least 40 general practices will be randomised in a 1:1 ratio to either the intervention or control (no outreach visits; GP provides usual care). A total of 410 patient–participants (205 in each arm) who have been prescribed an opioid for LBP will be enrolled via participating general practices. Follow-up of patient–participants will occur over a 1-year period. The primary outcome will be the cumulative dose of opioid dispensed that was prescribed by study GPs over 1 year from the enrolment visit (in morphine milligram equivalent dose). Secondary outcomes include prescription of opioid medicines, benzodiazepines, gabapentinoids, non-steroidal anti-inflammatory drugs by study GPs or any GP, health services utilisation and patient-reported outcomes such as pain, quality of life and adverse events. Analysis will be by intention to treat, with a health economics analysis also planned.Ethics and disseminati...
Baker, EK, Arora, S, Amor, DJ, Date, P, Cross, M, O’Brien, J, Simons, C, Rogers, C, Goodall, S, Slee, J, Cahir, C & Godler, DE 2023, 'The Cost of Raising Individuals with Fragile X or Chromosome 15 Imprinting Disorders in Australia', Journal of Autism and Developmental Disorders, vol. 53, no. 4, pp. 1682-1692.
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The study characterised differences in costs associated with raising a child between four rare disorders and examined the associations between these costs with clinical severity. Caregivers of 108 individuals with Prader-Willi, Angelman (AS), Chromosome 15q Duplication and fragile X (FXS) syndromes completed a modified Client Services Receipt Inventory and participants completed intellectual/developmental functioning and autism assessments. AS incurred the highest yearly costs per individual ($AUD96,994), while FXS had the lowest costs ($AUD33,221). Intellectual functioning negatively predicted total costs, after controlling for diagnosis. The effect of intellectual functioning on total costs for those with AS was significantly different to the other syndromes. The study highlights the significant costs associated with these syndromes, particularly AS, linked with severity of intellectual functioning.
Bates, S, Harris‐Roxas, B & Wright, M 2023, 'Understanding the costs of co‐commissioning: Early experiences with co‐commissioning in Australia', Australian Journal of Public Administration, vol. 82, no. 4, pp. 462-487.
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AbstractPublic services, such as health and other human services, are increasingly being delivered by third‐party providers (providers) under contract to public sector organisations (PSOs). While often advantageous to PSOs, this creates a fragmented service context which is difficult for consumers to navigate. Further, providers often deliver services under multiple contracts to multiple funders, with high reporting requirements, high administrative costs, and low operational sustainability. Policymakers have encouraged co‐commissioning—where PSOs come together to jointly commission services—to increase the efficiency and effectiveness of outsourcing. This article seeks to understand the costs of co‐commissioning in Australia, and consequently the enablers and barriers to co‐commissioning. This qualitative study is based on the early experiences of co‐commissioning by one of 31 Primary Health Networks (PHNs). Using transaction cost economics (TCE) theory, the study explains how the PHN started co‐commissioning services with other PHNs, before co‐commissioning with other types of organisations. The PHN also co‐commissioned relatively simple activities first, before moving on to more complex services. The insights provided using TCE theory help explain why co‐commissioning is initially complicated (and costly), requiring time to understand both the services to be commissioned and the governance requirements of each party involved. While initial transaction costs may be high when co‐commissioning, this may reflect organisational learning and capacity development costs ‐ therefore, costs are expected to reduce over time.Points for practitionersFragmentation in policy and funding also leads to fragmentation of human services and high costs to service providers....
Belay, YB, Mihalopoulos, C, Lee, YY, Mulhern, B & Engel, L 2023, 'Examining the psychometric properties of a split version of the EQ-5D-5L anxiety/depression dimension in patients with anxiety and/or depression.', Qual Life Res, vol. 32, no. 7, pp. 2025-2036.
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PURPOSE: This study explored differences in self-reported responses and the psychometric performance of the composite EQ-5D-5L anxiety/depression (A/D) dimension compared with a split version of the dimension where 'anxiety' and 'depression' are measured separately. METHODS: People with anxiety and/or depression who visited the Amanuel Mental Specialized Hospital in Ethiopia completed the standard EQ-5D-5L with the added subdimensions. Correlation analysis was used to examine convergent validity with validated measures of depression (PHQ-9) and anxiety (GAD-7), while ANOVA was used to assess known-groups' validity. Agreement between ratings for composite and split dimensions was compared using percent agreement and Cohen's Kappa, while the proportion of 'no problems' reports was compared using the chi-square test. Discriminatory power analysis was undertaken using the Shannon index (H') and Shannon Evenness index (J'). Open-ended questions explored participants' preferences. RESULTS: Of the 462 respondents, 30.5% reported no problems with the composite A/D, while 13.2% reported no problems on both subdimensions. Agreement between ratings for composite and split dimensions was highest for respondents with comorbid anxiety and depression. The depression subdimension had higher correlation with PHQ-9 (r = 0.53) and GAD-7 (r = 0.33) than the composite A/D dimension (r = 0.36 and r = 0.28, respectively). The split subdimensions and composite A/D could adequately differentiate respondents based on their severity of anxiety or depression. Slightly better informativity was observed in EQ-4D-5L + anxiety (H' = 5.4; J' = 0.47) and EQ-4D-5L + depression (H' = 5.31; J' = 0.46) than EQ-5D-5L (H' = 5.19; J' = 0.45). CONCLUSIONS: Adopting two subdimensions within the EQ-5D-5L tool appears to perform slightly better than the standard EQ-5D-5L.
Brazier, J, Peasgood, T, Mukuria, C, Luo, N, Mulhern, B, Pickard, AS, Augustovski, F, Greiner, W & Engel, L 2023, 'Author Reply', Value in Health, vol. 26, no. 3, pp. 437-440.
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Brown, A, Yim, J, Jones, S, Tan, A, Callander, E, Watt, K, De Abreu Lourenco, R & Pain, T 2023, 'Men’s perceptions and preferences regarding prostate cancer radiation therapy: A systematic scoping review', Clinical and Translational Radiation Oncology, vol. 38, pp. 28-42.
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PURPOSE: To assess the literature on men's preferences and perceptions regarding prostate cancer radiation therapy. METHODS: A scoping review was undertaken as per JBI guidelines. Searches were conducted in PubMed, CINAHL, Scopus and Science Direct with search terms including 'prostate cancer,' 'radiotherapy,' 'radiation therapy,' 'radiation oncology,' 'patient preferences,' 'patient perceptions' and 'patient experience.' The resultant studies were mapped and grouped according to the emergent themes and pathway stages. RESULTS: A total of 779 titles and abstracts were screened by two independent reviewers. Fifty-two full-text studies were reviewed, with 27 eligible for inclusion. There were 4 pre-treatment, 13 during treatment and 10 post-treatment studies covering broad themes of information needs (n = 3), preferences and decisions (n = 6), general experiences (n = 8), side effects (n = 6), and support (n = 4). There were a mix of methodologies, including 11 qualitative, 14 quantitative (including four preference studies), one mixed methods and one narrative review. CONCLUSION: There were only four preference studies, with the remaining 23 reporting on perceptions. Overall, there is a paucity of literature regarding patient preferences and perceptions of prostate cancer radiation therapy, particularly when considering how many clinical and technical studies are published in the area. This highlights opportunities for future research.
Buteau, JP, Moon, D, Fahey, MT, Roberts, MJ, Thompson, J, Murphy, DG, Papa, N, Mitchell, C, De Abreu Lourenco, R, Dhillon, HM, Kasivisvanathan, V, Francis, RJ, Stricker, P, Agrawal, S, O'Brien, J, McVey, A, Sharma, G, Levy, S, Ayati, N, Nguyen, A, Lee, S-F, Pattison, DA, Sivaratnam, D, Frydenberg, M, Du, Y, Titus, J, Lee, S-T, Ischia, J, Jack, G, Hofman, MS & Emmett, L 2023, 'Clinical Trial Protocol for PRIMARY2: A Multicentre, Phase 3, Randomised Controlled Trial Investigating the Additive Diagnostic Value of [68Ga]Ga-PSMA-11 Positron Emission Tomography/Computed Tomography in Men with Negative or Equivocal Multiparametric Magnetic Resonance Imaging for the Diagnosis of Clinically Significant Prostate Cancer', European Urology Oncology.
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Butow, P, Faris, MM, Shaw, J, Kelly, P, He, S, Harris, M, Cuddy, J, Masya, L, Geerligs, L, Kelly, B, Girgis, A, Rankin, N, Beale, P, Hack, TF, Kirsten, L, Dhillon, H, Grimison, P, Viney, R, Clayton, JM, Schlub, T, Lindsay, T, Lovell, M, Luckett, T, Murphy, M, Newby, J, Piro, D, Price, M, Shaw, T, Yim, J & Shepherd, HL 2023, 'Effect of core versus enhanced implementation strategies on adherence to a clinical pathway for managing anxiety and depression in cancer patients in routine care: a cluster randomised controlled trial', Implementation Science, vol. 18, no. 1, p. 18.
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AbstractBackgroundOptimal strategies to facilitate implementation of evidence-based clinical pathways are unclear. We evaluated two implementation strategies (Core versus Enhanced) to facilitate implementation of a clinical pathway for the management of anxiety and depression in cancer patients (the ADAPT CP).MethodsTwelve cancer services in NSW Australia were cluster randomised, stratified by service size, to the Core versus Enhanced implementation strategy. Each strategy was in place for 12 months, facilitating uptake of the ADAPT CP (the intervention being implemented). The Core strategy included a lead team with champions, staff training and awareness campaigns prior to implementation, plus access to feedback reports and telephone or online support during implementation. The Enhanced strategy included all Core supports plus monthly lead team meetings, and proactive, ongoing advice on managing barriers, staff training and awareness campaigns throughout implementation.All patients at participating sites were offered the ADAPT CP as part of routine care, and if agreeable, completed screening measures. They were allocated a severity step for anxiety/depression from one (minimal) to five (severe) and recommended management appropriate to their severity step. Multi-level mixed-effect regression analyses examined the effect of Core versus Enhanced implementation strategy on adherence to the ADAPT CP (binary primary outcome: adherent ≥ 70% of key ADAPT CP components achieved versus non-adherent < 70%), with continuous adherence as a secondary outcome. Interaction between study arm and anxiety/depression severity step was also explored.ResultsOf 1280 registered patients, 696 (54%) completed at least one screening. As patients were encoura...
Clarke, J, Kinchin, I, Kochovska, S, Johnson, MJ & Currow, DC 2023, 'What If… Caregivers' Subsequent Workforce Participation Was a Measure of Palliative Care Services' Impact? An Hypothesis-Generating Study', Journal of Palliative Medicine, vol. 26, no. 8, pp. 1042-1047.
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Background: Hospice/palliative care emphasizes excellent care for patients, but what about longer-term caregiver outcomes after their caregiving role? What is the role of services in working to ensure that caregivers can re-engage with all aspects of life, including paid employment given that this is an identified stressor for caregivers? Aim: This hypothesis-generating study aimed to explore self-reported, post-care workforce participation, and any association with hospice/palliative care contact. Design: Cross-sectional random population interviews. Setting/Participants: People in the general population were randomly selected for face-to-face interviews about well-being including end-of-life care in South Australia. Questions included experiences of people dying an expected death and whether interviewees provided care. Demographic data included current workforce participation. A regression model explored associations with workforce participation. Results: Of 8945 interviews over three years, 171 participants aged 20-60 years (working age) provided intermittent hands-on care: two in five were men and two in three had qualifications beyond high school; one in two decedents had accessed palliative care services. Reflecting the bivariable analyses, logistic regression models showed associations with workforce participation and: being male (odds ratio [OR] 6.71); use of palliative care services (OR 4.85); and higher levels of education (OR 3.54). Conclusion: An association between workforce participation after caregiving ceased and the use of palliative care services was described, controlling for key factors. Reasons may include continued working, greater rates of return to work, earlier return to work or that people in the workforce are more likely to access services.
Cronin, P, Stein-Parbury, J, Sommer, J & Gill, KH 2023, 'What about value for money? A cost benefit analysis of the South Eastern Sydney Recovery and Wellbeing College', Journal of Mental Health, vol. 32, no. 1, pp. 63-70.
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Background
Recovery Colleges assist people in their personal recovery journeys by offering an approach that transforms conventional mental health care by using an educational framework. While evaluations of these colleges have demonstrated effectiveness in promoting personal recovery, scant research has been published regarding their economic evaluation.
Aims
To conduct a cost-benefit analysis of the South Eastern Sydney Recovery and Wellbeing College in Australia by exploring health utilisation and direct costs.
Method
The overall costs of the Recovery College sample (reported from 2014 to 2017) were used to derive a per person, per year cost, adjusted for inflation to 2020 Australian dollars. Benefits were determined by analysing pre/post health service utilisation by service users, and subsequently calculating a net cost saving.
Results
There was a statistically significant reduction in Emergency Department and inpatient mental health utilisation following participation in the Recovery College. The net cost savings was A$269 per student per year.
Conclusions
This study indicates that the Recovery College can play an important role in decreasing mental health service and ED utilisation. This reflects reduced reliance on traditional mental health services, thus suggesting that students develop improved self-agency and ability to manage their own mental health.
Cunich, M, Barakat-Johnson, M, Lai, M, Arora, S, Church, J, Basjarahil, S, Campbell, JL, Disher, G, Geering, S, Ko, N, Leahy, C, Leong, T, McClure, E, O'Grady, M, Walsh, J, White, K & Coyer, F 2023, 'Corrigendum to “The costs, health outcomes and cost-effectiveness of interventions for the prevention and treatment of incontinence-associated dermatitis: A systematic review” [Int. J. Nurs. Stud. 129 (2022) 104216]', International Journal of Nursing Studies, vol. 139, pp. 104433-104433.
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In the supplementary material to this paper we noted some errors in supplementary Online Resource 4: (a) The title ‘CHEERS checklist’ should be deleted and replaced with ‘CHEERS checklist and adapted scoring criteria’. (b) We should have cited the following two references: Lynch et al., 2019 and Husereau et al., 2013 in the title: • D. Husereau, M. Drummond, S. Petrou, C. Carswell, D. Moher, D. Greenberg, et al. Consolidated Health Economic Evaluation Reporting Standards (CHEERS)–explanation and elaboration: a report of the ISPOR health economic evaluation publication guidelines good reporting practices task force. Value in Health, 16 (2) (2013), pp. 231-250 • M. Lynch, R. De Abreu Lourenco, M. Flattery, M. Haas. Reviewing the cost-effectiveness of long-acting reversible contraceptive methods in an Australian context. Aust. N. Zeal. J. Obstet. Gynaecol., 59 (2019), pp. 21-35 (c) In Row 7 (Comparators), the example offered ‘e.g. IUS is used rather than LNG-IUS20 or Mirena’ should be disregarded because ‘LNG-IUS20 or Mirena’ was included in error and was not relevant to this paper. The authors would like to apologise for any inconvenience caused.
de Oliveira Costa, J, Pearson, S-A, Brieger, D, Lujic, S, Shawon, MSR, Jorm, LR, van Gool, K & Falster, MO 2023, 'In-hospital outcomes by insurance type among patients undergoing percutaneous coronary interventions for acute myocardial infarction in New South Wales public hospitals', International Journal for Equity in Health, vol. 22, no. 1, p. 226.
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Abstract Background International evidence suggests patients receiving cardiac interventions experience differential outcomes by their insurance status. We investigated outcomes of in-hospital care according to insurance status among patients admitted in public hospitals with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI). Methods We conducted a cohort study within the Australian universal health care system with supplemental private insurance. Using linked hospital and mortality data, we included patients aged 18 + years admitted to New South Wales public hospitals with AMI and undergoing their first PCI from 2017–2020. We measured hospital-acquired complications (HACs), length of stay (LOS) and in-hospital mortality among propensity score-matched private and publicly funded patients. Matching was based on socio-demographic, clinical, admission and hospital-related factors. Results Of 18,237 inpatients, 30.0% were privately funded. In the propensity-matched cohort (n = 10,630), private patients had lower rates of in-hospital mortality than public patients (odds ratio: 0.59, 95% CI: 0.45–0.77; approximately 11 deaths avoided per 1,000 people undergoing PCI procedures). Mortality differences were mostly driven by STEMI patients and those from major cities. There were no significant differences in rates of HACs or average LOS in private, compared to public, patients. Conclusion Our findings suggest patients undergoing PCI in Australian public hospitals with private hea...
Dodd, RH, Sharman, AR, McGregor, D, Stone, E, Donnelly, C, Lourenco, RDA, Marshall, H & Rankin, NM 2023, 'Education messages and strategies to inform the public, potential screening candidates and healthcare providers about lung cancer screening: A systematic review', Preventive Medicine, vol. 169, pp. 107459-107459.
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Emery, JD, Jenkins, MA, Saya, S, Chondros, P, Oberoi, J, Milton, S, Novy, K, Habgood, E, Karnchanachari, N, Pirotta, M, Trevena, L, Bickerstaffe, A, De Abreu Lourenço, R, Crothers, A, Ouakrim, DA, Flander, L, Dowty, JG, Walter, FM, Clark, M, Doncovio, S, Etemadmoghadam, D, Fishman, G, Macrae, F, Winship, I & McIntosh, JG 2023, 'The Colorectal cancer RISk Prediction (CRISP) trial: a randomised controlled trial of a decision support tool for risk-stratified colorectal cancer screening', British Journal of General Practice, vol. 73, no. 733, pp. e556-e565.
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BackgroundA risk-stratified approach to colorectal cancer (CRC) screening could result in a more acceptable balance of benefits and harms, and be more cost-effective.AimTo determine the effect of a consultation in general practice using a computerised risk assessment and decision support tool (Colorectal cancer RISk Prediction, CRISP) on risk-appropriate CRC screening.Design and settingRandomised controlled trial in 10 general practices in Melbourne, Australia, from May 2017 to May 2018.MethodParticipants were recruited from a consecutive sample of patients aged 50–74 years attending their GP. Intervention consultations included CRC risk assessment using the CRISP tool and discussion of CRC screening recommendations. Control group consultations focused on lifestyle CRC risk factors. The primary outcome was risk-appropriate CRC screening at 12 months.ResultsA total of 734 participants (65.1% of eligible patients) were randomised (369 intervention, 365 control); the primary outcome was determined for 722 (362 intervention, 360 control). There was a 6.5% absolute increase (95% confidence interval [CI] = −0.28 to 13.2) in risk-appropriate screening in the intervention compared with the control group (71.5% versus 65.0%; odds ratio [OR] 1.36, 95% CI = 0.99 to 1.86,P= 0.057). In those due CRC screening during follow-up, there was a 20.3% (95% CI = 10.3 to 30.4) increase (intervention 59.8% versus control 38.9%; OR 2.31, 95% CI = 1.51 to 3.53,P<0.001) principally by increasing faecal occult blood testing in those at average risk.ConclusionA risk assessm...
Engel, L, Kosowicz, L, Bogatyreva, E, Batchelor, F, Devlin, N, Dow, B, Gilbert, AS, Mulhern, B, Peasgood, T & Viney, R 2023, 'Face Validity of Four Preference-Weighted Quality-of-Life Measures in Residential Aged Care: A Think-Aloud Study', The Patient - Patient-Centered Outcomes Research, vol. 16, no. 6, pp. 655-666.
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OBJECTIVE: There is an increased use of preference-weighted quality-of-life measures in residential aged care to guide resource allocation decisions or for quality-of-care assessments. However, little is known about their face validity (i.e., how understandable, appropriate and relevant the measures are 'on their face' when respondents complete them). The aim of this study was to assess the face validity of four preference-weighted measures (i.e., EQ-5D-5L, EQ-HWB, ASCOT, QOL-ACC) in older people living in residential aged care. METHODS: Qualitative cognitive think-aloud interviews were conducted using both concurrent and retrospective think-aloud techniques. To reduce burden, each resident completed two measures, with the four measures randomised across participants. Audio recordings were transcribed and framework analysis was used for data analysis, based on an existing framework derived from the Tourangeau four-stage response model. RESULTS: In total, 24 interviews were conducted with residents living across three residential aged care facilities in Melbourne, Australia. Response issues were identified across all four measures, often related to comprehension and difficulty selecting a response level due to double-barrelled and ambiguous items that have different meanings in the residential aged care context. We also identified issues related to understanding instructions, non-adherence to the recall period, and noted positive responding that requires attention when interpreting the data. CONCLUSIONS: Our findings provide further evidence on the appropriateness of existing measures, indicating numerous response issues that require further research to guide the selection process for research and practice.
Farris, M, Goodall, S & De Abreu Lourenco, R 2023, 'A systematic review of economic evaluations for RPE65-mediated inherited retinal disease including HTA assessment of broader value', International Journal of Technology Assessment in Health Care, vol. 39, no. 1.
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Abstract Objective To summarize the key methodological challenges identified by health technology assessment (HTA) agencies assessing gene therapy (GT) and consideration of broad elements of value. Method Economic evaluations (EEs) of voretigene neparvovec (VN) in RPE65-mediated inherited retinal disease (IRD) published in English were selected. HTA evaluations from Australia, Canada, Ireland, Scotland, England, and the United States were reviewed. An existing methodological framework was used to identify the challenges and considerations. Results Eight unique EEs were identified of which six were evaluated by HTA agencies. Incremental cost-effectiveness ratios ranged from $68,951 to $643,813 per quality-adjusted life-years (QALY) gained (healthcare perspective) and dominant to $480,130 per QALY gained (societal perspective). The key challenges were the lack of validated surrogate outcome, utility values and indirect costs from IRD patients, and limited evidence of the long-term treatment effect. Two HTA agencies reviewed a range of novel broader elements of value and whether they were associated with VN while other agencies discussed some elements of broader value. Caregiver disutility was included in some, but not all, evaluations. Conclusion The methodological challenges were consistent with innovative interventions for rare diseases and managed using standard methods. Broader value was important to decision-makers but inconsistently a...
Gye, A, Goodall, S & De Abreu Lourenco, R 2023, 'Cost-effectiveness Analysis of Tisagenlecleucel Versus Blinatumomab in Children and Young Adults with Acute Lymphoblastic Leukemia: Partitioned Survival Model to Assess the Impact of an Outcome-Based Payment Arrangement', PharmacoEconomics, vol. 41, no. 2, pp. 175-186.
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Hafiz, N, Hyun, K, Tu, Q, Knight, A, Hespe, C, Chow, C, Briffa, T, Gallagher, R, Reid, C, Hare, D, Zwar, N, Woodward, M, Jan, S, Atkins, E, Laba, T, Halcomb, E, Johnson, T, Manandi, D, Usherwood, T & Redfern, J 2023, 'Process Evaluation Results of QUality Improvement for Effectiveness of Care for People Living With Heart Disease (QUEL):A Cluster Randomised Controlled Data-driven Quality Improvement Trial to Improve Cardiovascular Disease Care in Australian Primary Care Practices', Heart, Lung and Circulation, vol. 32, pp. S340-S341.
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Hettiarachchi, RM, Kularatna, S, Byrnes, J, Mulhern, B, Chen, G & Scuffham, PA 2023, 'Valuing the Dental Caries Utility Index in Australia', Medical Decision Making, vol. 43, no. 7-8, pp. 901-913.
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Introduction The Dental Caries Utility Index (DCUI) is a new oral health–specific health state classification system for adolescents, consisting of 5 domains: pain/discomfort, difficulty eating food/drinking, worried, ability to participate in activities, and appearance. Each domain has 4 response levels. This study aims to generate an Australian-specific utility algorithm for the DCUI. Methods An online survey was conducted using a representative sample of the adult Australian general population. The discrete choice experiment (DCE) was used to elicit the preferences on 5 domains. Then, the latent utilities were anchored onto the full health-dead scale using the visual analogue scale (VAS). DCE data were modeled using conditional logit, and 2 anchoring procedures were considered: anchor based on the worst health state and a mapping approach. The optimal anchoring procedure was selected based on the model parsimony and the mean absolute error (MAE). Results A total of 995 adults from the Australian general population completed the survey. The conditional logit estimates on 5 dimensions and levels were monotonic and statistically significant, except for the second level of the “worried” and “appearance” domains. The mapping approach was selected based on a smaller MAE between the 2 anchoring procedures. The Australian-specific tariff of DCUI ranges from 0.1681 to 1. Conclusion This study developed a utility algorithm for the DCUI. This value set will facilitate utility value calculations from the participants’ responses for DCUI in economic evaluations of dental caries interventions targeted for adolescents. Highlights Preference-based quality-of-life measures (PBM...
Hilmer, SN, Lo, S, Kelly, PJ, Viney, R, Blyth, FM, Le Couteur, DG, McLachlan, AJ, Arora, S, Hossain, L & Gnjidic, D 2023, 'Towards Optimizing Hospitalized Older adults' MEdications (TO HOME): Multi‐centre study of medication use and outcomes in routine care', British Journal of Clinical Pharmacology, vol. 89, no. 8, pp. 2508-2518.
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AimsComprehensively investigate prescribing in usual care of hospitalized older people with respect to polypharmacy; potentially inappropriate medications (PIMs) according to Beers criteria; and cumulative anticholinergic and sedative medication exposure calculated with Drug Burden Index (DBI). Specifically, to quantify exposure to these measures on admission, changes between admission and discharge, associations with adverse outcomes and medication costs.MethodsEstablished new retrospective inpatient cohort of 2000 adults aged ≥75 years, consecutively admitted to 6 hospitals in Sydney, Australia, with detailed information on medications, clinical characteristics and outcomes. Conducted cross‐sectional analyses of index admission data from cohort.ResultsCohort had mean (standard deviation) age 86.0 (5.8) years, 59% female, 21% from residential aged care. On admission, prevalence of polypharmacy was 77%, PIMs 34% and DBI > 0 in 53%. From admission to discharge, mean difference (95% confidence interval) in total number of medications increased 1.05 (0.92, 1.18); while prevalence of exposure to PIMs (−3.8% [−5.4, −2.1]) and mean DBI score (−0.02 [−0.04, −0.01]) decreased. PIMs and DBI score were associated with increased risks (adjusted odds ratio [95% confidence interval]) of falls (PIMs 1.63 [1.28, 2.08]; DBI score 1.21[1.00, 1.46]) and delirium (PIMs 1.76 [1.38, 1.46]; DBI score 1.42 [1.19, 1.71]). Each measure was associated with increased risk of adverse drug reactions (polypharmacy 1.42 [1.19, 1.71]; PIMs 1.87 [1.40, 2.49]; DBI score 1.90 [1.55, 2.15]). Cost (AU$/patient/hospital day) of medications contributing to PIMs and DBI was low ($0.29 and $0.88).ConclusionIn this large cohort of older inpatients, usual hospital ...
Kinchin, I, Edwards, L, Hosie, A, Agar, M, Mitchell, E & Trepel, D 2023, 'Cost‐effectiveness of clinical interventions for delirium: A systematic literature review of economic evaluations', Acta Psychiatrica Scandinavica, vol. 147, no. 5, pp. 430-459.
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AbstractObjectiveLittle is known about the economic value of clinical interventions for delirium. This review aims to synthesise and appraise available economic evidence, including resource use, costs, and cost‐effectiveness of interventions for reducing, preventing, and treating delirium.MethodsSystematic review of published and grey literature on full and partial economic evaluations. Study quality was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS).ResultsFourteen economic evaluations (43% full, 57% partial) across nine multicomponent and nonpharmacological intervention types met inclusion criteria. The intervention costs ranged between US$386 and $553 per person in inpatient settings. Multicomponent delirium prevention intervention and the Hospital Elder Life Program (HELP) reported statistically significant cost savings or cost offsets somewhere else in the health system. Cost savings related to inpatient, outpatient, and out‐of‐pocket costs ranged between $194 and $6022 per person. The average CHEERS score was 74% (±SD 10%).ConclusionEvidence on a joint distribution of costs and outcomes of delirium interventions was limited, varied and of generally low quality. Directed expansion of health economics towards the evaluation of delirium care is necessary to ensure effective implementation that meets patients' needs and is cost‐effective in achieving similar or better outcomes for the same or lower cost.
Kinchin, I, Walshe, V, Normand, C, Coast, J, Elliott, R, Kroll, T, Kinghorn, P, Thompson, A, Viney, R, Currow, D & O’Mahony, JF 2023, 'Expanding health technology assessment towards broader value: Ireland as a case study', International Journal of Technology Assessment in Health Care, vol. 39, no. 1, p. e26.
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Abstract Healthcare innovations often represent important improvements in population welfare, but at what cost, and to whom? Health technology assessment (HTA) is a multidisciplinary process to inform resource allocation. HTA is conventionally anchored on health maximization as the only relevant output of health services. If we accept the proposition that health technologies can generate value outside the healthcare system, resource allocation decisions could be suboptimal from a societal perspective. Incorporating “broader value” in HTA as derived from social values and patient experience could provide a richer evaluative space for informing resource allocation decisions. This article considers how HTA is practiced and what its current context implies for adopting “broader value” to evaluating health technologies. Methodological challenges are highlighted, as is a future research agenda. Ireland serves as an example of a healthcare system that both has an explicit role for HTA and is evolving under a current program of reform to offer universal, single-tier access to public services. There are various ways in which HTA processes could move beyond health, including considering the processes of care delivery and/or expanding the evaluative space to some broader concept of well-being. Methods to facilitate the latter exist, but their adaptation to HTA is still emerging. We recommend a multi-stakeholder working group to develop and advance an international agenda for HTA that captures welfare/benefit beyond health.
Koh, E-S, Gan, HK, Senko, C, Francis, RJ, Ebert, M, Lee, ST, Lau, E, Khasraw, M, Nowak, AK, Bailey, DL, Moffat, BA, Fitt, G, Hicks, RJ, Coffey, R, Verhaak, R, Walsh, KM, Barnes, EH, De Abreu Lourenco, R, Rosenthal, M, Adda, L, Foroudi, F, Lasocki, A, Moore, A, Thomas, PA, Roach, P, Back, M, Leonard, R & Scott, AM 2023, '[18F]-fluoroethyl-L-tyrosine (FET) in glioblastoma (FIG) TROG 18.06 study: protocol for a prospective, multicentre PET/CT trial', BMJ Open, vol. 13, no. 8, pp. e071327-e071327.
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IntroductionGlioblastoma is the most common aggressive primary central nervous system cancer in adults characterised by uniformly poor survival. Despite maximal safe resection and postoperative radiotherapy with concurrent and adjuvant temozolomide-based chemotherapy, tumours inevitably recur. Imaging with O-(2-[18F]-fluoroethyl)-L-tyrosine (FET) positron emission tomography (PET) has the potential to impact adjuvant radiotherapy (RT) planning, distinguish between treatment-induced pseudoprogression versus tumour progression as well as prognostication.Methods and analysisThe FET-PET in Glioblastoma (FIG) study is a prospective, multicentre, non-randomised, phase II study across 10 Australian sites and will enrol up to 210 adults aged ≥18 years with newly diagnosed glioblastoma. FET-PET will be performed at up to three time points: (1) following initial surgery and prior to commencement of chemoradiation (FET-PET1); (2) 4 weeks following concurrent chemoradiation (FET-PET2); and (3) within 14 days of suspected clinical and/or radiological progression on MRI (performed at the time of clinical suspicion of tumour recurrence) (FET-PET3). The co-primary outcomes are: (1) to investigate how FET-PET versus standard MRI impacts RT volume delineation and (2) to determine the accuracy and management impact of FET-PET in distinguishing pseudoprogression from true tumour progression. The secondary outcomes are: (1) to investigate the relationships between FET-PET parameters (including dynamic uptake, tumour to background ratio, metabolic tumour volume) and progression-free survival and overall survival; (2) to assess the change in blood and tissue biomarkers determined by serum assay when comparing FET-PET data acquired prior to chemoradiation with other prognostic markers, looking at the relationships of FET-PET versus MRI-determined site/...
Kularatna, S, Chen, G, Norman, R, Mukuria, C, Rowen, D, Senanayake, S, Hettiarachchi, R, Mulhern, B, Fozzard, K, Parsonage, W & MacPhail, SM 2023, 'Developing an Australian utility value set for MacNew-7D health states', Quality of Life Research, vol. 32, no. 4, pp. 1151-1163.
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Liu, D, Yu, S, Webster, SBG, Moradi, B, Haywood, P, Hall, J, Aranda, S & van Gool, K 2023, 'Geographic variation in out‐of‐pocket costs for radiation oncology services', Medical Journal of Australia, vol. 218, no. 7, pp. 315-319.
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AbstractObjectivesTo examine out‐of‐pocket costs incurred by patients for radiation oncology services and their variation by geographic location.DesignAnalysis of patient‐level Medical Benefits Schedule (MBS) claims data linked with data from the Sax Institute 45 and Up Study.Setting, participantsPeople who received Medicare‐subsidised radiation oncology services in New South Wales, 2006–2017.Main outcome measureMean out‐of‐pocket costs for an episode of radiation oncology (during 90 days from start of radiotherapy planning service), by geographic location (postcode‐based), overall and after excluding episodes with no out‐of‐pocket costs (fully bulk‐billed).ResultsDuring 2006–2017, 12 724 people received 15 506 episodes of radiation oncology care in 25 postcode‐defined geographic areas. The proportion of episodes for which the out‐of‐pocket cost was less than $1 increased from 39% in 2006 to 76% in 2017; the proportion for which out‐of‐pocket costs exceeded $500 declined from 43% in 2006 to 10% in 2014, before increasing to 17% in 2017. For care episodes with non‐zero out‐of‐pocket costs, the mean amount rose from around $1186 to $1611 per episode of care during 2006–2017. The proportion of radiation oncology episodes bulk‐billed exceeded 90% in nine areas; in seven areas, all with exclusively private care provision of radiation oncology, it was 21% or smaller. Within geographic areas, out‐of‐pocket costs for individual care episodes varied widely; in ten areas with lower bulk‐billing rates, the interquartile range for costs ranged from $240 to $1857.ConclusionOut‐of‐pocket cos...
Luckett, T, Pond, D, Mitchell, G, Chenoweth, L, Amgarth-Duff, I, Disalvo, D, Phillips, JL, Beattie, E, Davidson, PM, Luscombe, G, Goodall, S & Agar, M 2023, 'Eating and drinking-related care for persons with advanced dementia in long-term care', Collegian, vol. 30, no. 4, pp. 548-556.
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Manipis, K, Mulhern, B, Haywood, P, Viney, R & Goodall, S 2023, 'Estimating the willingness-to-pay to avoid the consequences of foodborne illnesses: a discrete choice experiment', The European Journal of Health Economics, vol. 24, no. 5, pp. 831-852.
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AbstractLost productivity is one of the largest costs associated with foodborne illness (FBI); however, the methods used to estimate lost productivity are often criticised for overestimating the actual burden of illness. A discrete choice experiment (DCE) was undertaken to elicit preferences to avoid six possible FBIs and estimate whether ability to work, availability of paid sick leave and health-related quality of life affect willingness-to-pay (WTP) to avoid FBI. Respondents (N = 1918) each completed 20 DCE tasks covering two different FBIs [gastrointestinal illness, flu-like illness, irritable bowel syndrome (IBS), Guillain–Barre syndrome (GBS), reactive arthritis (ReA), or haemolytic uraemic syndrome (HUS)]. Attributes included: ability to work, availability of sick leave, treatment costs and illness duration. Choices were modelled using mixed logit regression and WTP was estimated. The WTP to avoid a severe illness was higher than a mild illness. For chronic conditions, the marginal WTP to avoid a chronic illness for one year, ranged from $531 for mild ReA ($1412 for severe ReA) to $1025 for mild HUS ($2195 for severe HUS). There was a substantial increase in the marginal WTP to avoid all the chronic conditions when the ability to work was reduced and paid sick leave was not available, ranging from $6289 for mild IBS to $11,352 for severe ReA. Including factors that reflect productivity and compensation to workers influenced the WTP to avoid a range of FBIs for both acute and chronic conditions. These results have implications for estimating the burden and cost of FBI.
Mazza, D, Assifi, AR, Hussainy, SY, Bateson, D, Johnston, S, Tomnay, J, Kasza, J, Church, J, Grzeskowiak, LE, Nissen, L & Cameron, ST 2023, 'Expanding community pharmacists’ scope of practice in relation to contraceptive counselling and referral: a protocol for a pragmatic, stepped-wedge, cluster randomised trial (ALLIANCE)', BMJ Open, vol. 13, no. 8, pp. e073154-e073154.
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IntroductionImproving access to effective contraception has the potential to reduce unintended pregnancy and abortion rates. Community pharmacists could play an expanded role in contraceptive counselling and referral to contraceptive prescribers particularly when women are already attending community pharmacy to obtain emergency contraceptive pills (ECPs) or to have medical abortion (MA) medicines dispensed. The ALLIANCE trial aims to compare the subsequent uptake of effective contraception (hormonal or intrauterine) in women seeking ECP or MA medicines, who receive the ALLIANCE community pharmacy-based intervention with those who do not receive the intervention.Methods and analysisALLIANCE is a stepped-wedge pragmatic cluster randomised trial in Australian community pharmacies. The ALLIANCE intervention involves community pharmacists delivering structured, patient-centred, effectiveness-based contraceptive counselling (and a referral to a contraceptive prescriber where appropriate) to women seeking either ECPs or to have MA medicines dispensed. Women participants will be recruited by participating pharmacists. A total of 37 pharmacies and 1554 participants will be recruited. Pharmacies commence in the control phase and are randomised to transition to the intervention phase at different time points (steps). The primary outcome is the self-reported use of effective contraception at 4 months; secondary outcomes include use of effective contraception and the rate of pregnancies or induced abortions at 12 months. A process and economic evaluation of the trial will also be undertaken.Ethics and disseminationEthical approval has been obtained from the Monash University Human Research Ethics Committee (#34563). An explanatory statement will be provided and written consent will be obtained from ...
Mazza, D, Shankar, M, Botfield, JR, Moulton, JE, Chakraborty, SP, Black, K, Tomnay, J, Bateson, D, Church, J, Laba, T-L, Kasza, J & Norman, WV 2023, 'Improving rural and regional access to long-acting reversible contraception and medical abortion through nurse-led models of care, task-sharing and telehealth (ORIENT): a protocol for a stepped-wedge pragmatic cluster-randomised controlled trial in Australian general practice', BMJ Open, vol. 13, no. 3, pp. e065137-e065137.
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IntroductionWomen living in rural and regional Australia often experience difficulties in accessing long-acting reversible contraception (LARC) and medical abortion services. Nurse-led models of care can improve access to these services but have not been evaluated in Australian general practice. The primary aim of the ORIENT trial (ImprOving Rural and regIonal accEss to long acting reversible contraceptioN and medical abortion through nurse-led models of care, Tasksharing and telehealth) is to assess the effectiveness of a nurse-led model of care in general practice at increasing uptake of LARC and improving access to medical abortion in rural and regional areas.Methods and analysisORIENT is a stepped-wedge pragmatic cluster-randomised controlled trial. We will enrol 32 general practices (clusters) in rural or regional Australia, that have at least two general practitioners, one practice nurse and one practice manager. The nurse-led model of care (the intervention) will be codesigned with key women’s health stakeholders. Clusters will be randomised to implement the model sequentially, with the comparator being usual care. Clusters will receive implementation support through clinical upskilling, educational outreach and engagement in an online community of practice. The primary outcome is the change in the rate of LARC prescribing comparing control and intervention phases; secondary outcomes include change in the rate of medical abortion prescribing and provision of related telehealth services. A within-trial economic analysis will determine the relative costs and benefits of the model on the prescribing rates of LARC and medical abortion compared with usual care. A realist evaluation will provide contextual information regarding model implementation informing considerations for scale-up. Supporting nurses to work to their full scope of practice has ...
McErlean, G, Bajel, A, Bhattacharyya, A, Brown, N, De Abreu Lourenco, R, Greenwood, M, Kerridge, I, Kim, N, Kliman, D, Maneze, D, O'Brien, T, Szer, J & Twist, I 2023, 'If we do not count it, it does not count: ethnicity in allogeneic haemopoietic stem cell transplant in Australia', Internal Medicine Journal, vol. 53, no. 12, pp. 2155-2158.
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Meldrum, H, Wright, M & Versteeg, R 2023, 'LETTERS', Australian Journal of General Practice, vol. 52, no. 4, pp. 169-170.
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Public perceptions of general practice and the allocation of funds I WRITE in response to the paper, ‘How much of Australia’s health expenditure is allocated to general practice and primary healthcare?’, by Wright et al. This research concluded that 6.8% of the total healthcare spend in Australia went on non-referred services (general practices). My hypothesis was that GP funding is lower than the general public’s perception. To investigate this, I commissioned Roy Morgan to survey a representative sample of 1000 Australian adults with three questions about their perception of general practice care and funding in 2021. The first question asked, ‘how important do you think GPs (general practitioners, sometimes referred to as family doctors) are for the Australian healthcare system?’. On a Likert scale where 10 is very important, 90.6% of respondents rated GPs as ≥8 out of 10. These results suggest that the public hold general practice in high regard.
Mihalopoulos, C, Chen, G, Scott, JG, Bucholc, J, Allen, C, Coghill, D, Jenkins, P, Norman, R, Ratcliffe, J, Richardson, J, Stathis, S & Viney, R 2023, 'Assessing Outcomes for Cost-Utility Analysis in Children and Adolescents With Mental Health Problems: Are Multiattribute Utility Instruments Fit for Purpose?', Value in Health, vol. 26, no. 5, pp. 733-741.
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Milte, R, Crocker, M, Lay, K, Ratcliffe, J, Mulhern, B, Norman, R, Viney, R & Khadka, J 2023, 'Feasibility of self-reported health related quality of life assessment with older people in residential care: insights from the application of eye tracking technology', Quality of Life Research, vol. 32, no. 12, pp. 3557-3569.
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Abstract Purpose Increasingly there are calls to routinely assess the health-related quality of life (HRQoL) of older people receiving aged care services, however the high prevalence of dementia and cognitive impairment remains a challenge to implementation. Eye-tracking technology facilitates detailed assessment of engagement and comprehension of visual stimuli, and may be useful in flagging individuals and populations who cannot reliably self-complete HRQoL instruments. The aim of this study was to apply eye-tracking technology to provide insights into self-reporting of HRQoL among older people in residential care with and without cognitive impairment. Methods Residents (n = 41), recruited based on one of three cognition subgroups (no, mild, or moderate cognitive impairment), completed the EQ-5D-5L on a computer with eye tracking technology embedded. Number and length of fixations (i.e., eye gaze in seconds) for key components of the EQ-5D-5L descriptive system were calculated. Results For all dimensions, participants with no cognitive impairment fixated for longer on the Area of Interest (AOI) for the response option they finally chose, relative to those with mild or moderate cognitive impairment. Participants with cognitive impairment followed similar fixation patterns to those without. There was some evidence that participants with cognitive impairment took longer to complete and spent relatively less time attending to the relevant AOIs, but these differences did not reach statistical significance generally. Conclusions ...
Mu, C & Hall, J 2023, 'Marital status and hospital use in older adults', Australian Economic Papers, vol. 62, no. 2, pp. 185-213.
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AbstractThe proportion of single person households is increasing with population ageing. At older ages living in a single person household is more likely to be due to bereavement or separation than at younger ages. We examine the association between marital status and the likelihood and the length of hospitalisations, with particular emphasis on whether and how this association varies by different types of hospitalisations with a distinct nature of care. Using a large survey linked to multiple years of detailed administrative records enables us to better control for individual heterogeneity and allows us to conduct a finer classification of hospitalisations. A two‐part model is used for estimation. We also investigate the relationship between marital status and the presentations to emergency department. The results show singles have an increased probability of hospitalisation and length of stay, with a substantial heterogeneity revealed in the association between marital status and different types of hospitalisations. The findings are consistent with the lesser availability of informal care for those being single and point to the need to develop appropriate and targeted strategies to reduce hospitalisation in this group.
Mulhern, BJ, Pan, T, Norman, R, Tran-Duy, A, Hanmer, J, Viney, R & Devlin, NJ 2023, 'Understanding the measurement relationship between EQ-5D-5L, PROMIS-29 and PROPr', Quality of Life Research, vol. 32, no. 11, pp. 3147-3160.
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Abstract Purpose Many generic patient-reported instruments are available for the measurement of health outcomes, including EQ-5D-5L, and the Patient-Reported Outcome Measurement Information System (PROMIS). Assessing their measurement characteristics informs users about the consistency between, and limits of, evidence produced. The aim was to assess the measurement relationship between the EQ-5D-5L descriptive system and value sets, the PROMIS-29 and PROPr (PROMIS value set). Methods Data were extracted from a cross-sectional survey administering measures of quality of life online in Australia. Descriptive analysis, agreement and construct validity assessment methods were used to compare instruments at the item, domain and value set level. Results In total, 794 Australians completed the survey. Convergent validity analysis found that similar dimensions across instruments were highly correlated (> 0.50), but the PROMIS-29 assesses additional health concepts not explicitly covered by EQ-5D (sleep and fatigue). Known-group assessment found that EQ-5D-5L and PROPr were able to detect those with and without a condition (ES range 0.78–0.83) but PROPr could more precisely detect differing levels of self-reported health. Both instruments were sensitive to differences in levels of pain. Discussion There is some consistency in what the EQ-5D-5L, PROMIS-29 and PROPr measure. Differences between value set characteristics can be linked to differences what is measured and the valuation approaches used. This has implications for the use of eac...
Mutsekwa, RN, Campbell, KL, Canavan, R, Mulhern, B, Angus, RL & Byrnes, JM 2023, 'Patient Preferences for Attributes that Characterise Alternative Models of Care in Gastroenterology: A Discrete Choice Experiment', The Patient - Patient-Centered Outcomes Research, vol. 16, no. 2, pp. 165-177.
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Naghsh-Nejad, M, Yu, S & Haywood, P 2023, 'Provider responses to the expansion of public subsidies in healthcare: The case of oral chemotherapy treatment in Australia', Social Science & Medicine, vol. 330, pp. 116041-116041.
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We examine provider responses to the expansion of public subsidies in 2015 for innovative oral chemotherapy treatment, in a health system where providers were free to determine their own prices. The new treatment was known to have similar efficacy to its traditional intravenous alternative and was preferred by patients for its at-home administration. However, from a policymaker's perspective, the potential for misalignment between patient and provider preferences was significant given the shift to full reimbursement for the oral chemotherapy medication but no change in fee-for-service payments for associated chemotherapy services. Under this scenario, a shift away from traditional intravenous chemotherapy may entail reduced activity and revenues associated with infusions for providers, and we hypothesise that it may result in unintended policy consequences such as reduced take-up of the new therapy or higher prices. We implement a difference-in-difference model using national administrative data on services provided, and chemotherapy medications prescribed, by providers to 1850 patients in New South Wales, Australia. Our estimates indicate that the subsidies expanded access to oral chemotherapy for newly eligible patients by 15 percentage points. However, prices charged by providers for an episode of care rose by 23 percent, driven mostly by increases in service volumes. The results illustrate the importance of understanding differential provider responses to policy changes in financial incentives.
Norman, R, Mulhern, B, Lancsar, E, Lorgelly, P, Ratcliffe, J, Street, D & Viney, R 2023, 'The Use of a Discrete Choice Experiment Including Both Duration and Dead for the Development of an EQ-5D-5L Value Set for Australia', PharmacoEconomics, vol. 41, no. 4, pp. 427-438.
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BACKGROUND/AIMS: Discrete choice experiments (DCEs) with either duration included an attribute or with dead included as an option can be used as a stand-alone approach to value health states. This paper reports on a DCE with both of these features to develop an EQ-5D-5L value set for Australia. METHODS: A DCE was undertaken using a large Australian panel of internet respondents, from which a sample of more than 4000 Australian adults was chosen, stratified to be population representative on age and gender. The DCE contained 500 choice triplets, with two EQ-5D-5L health states with duration, and dead as the third option. Each respondent answered 12 choice sets from the 500, stating both the best and worst options from the three available. The design was constructed to estimate a utility algorithm with main effects plus some key interaction terms. A variety of approaches to parameterising interactions, and to anchoring the value set on the required 0-1 scale, were tested. A preferred Australian adult utility algorithm for use in cost-utility analysis was then generated. RESULTS: In total, 4477 people completed at least one choice set and were included in the analysis. The results reflected the monotonic structure of the EQ-5D-5L, in that moving from no problems to extreme problems led to worsening utility in each dimension. Inclusion of interaction terms demonstrates that the disutility of the first dimension moving to a poor level (defined as either level 5, or level 4 or 5) had a large impact, but subsequent dimensions moving to a poor level had a relatively smaller disutility. DISCUSSION: This work develops a value set for the EQ-5D-5L in Australia, and also provides a range of methodological insights which can inform future work using a stand-alone DCE to value health in other countries.
Petrozzi, MJ, Wright, M, Hoffman, R, Goodger, B & Wise, S 2023, 'Diverse and vulnerable: experiences of private allied health practices managing through the coronavirus (COVID-19) pandemic. Implications for the financial viability of Australian primary care', Australian Health Review, vol. 47, no. 4, pp. 394-400.
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Background The majority of allied health services are delivered by small, private practices in the primary care setting with limited government funding. During the coronavirus disease 2019 (COVID-19) lockdowns these practices were subject to the same health orders as any other private business with only ‘essential services’ permitted to remain open. Research aim We set out to understand the impact of the COVID-19 pandemic, and associated public health measures, on the financial viability of private allied health practices. Methods Thirteen semi-structured interviews were conducted with primary care allied health practice owners and managers in Sydney. Data were analysed thematically. Findings All of the interviewees reported experiencing the stress of balancing precarious finances caused by reduced and/or fluctuating patient demand. Patients’ reluctance to seek care was compounded by ambiguity around whether allied health services were ‘essential’. Manual therapies were particularly vulnerable to financial stress because their capacity to transition to telehealth and access to government funding were limited. Conversely, psychologists reported demand for their services exceeded what they could provide. Study implications The findings are indicative of primary care allied health’s peripheral status in Australia’s primary care landscape. Greater priority to the funding and integration of primary care allied health is needed in primary care policy.
Simonetti, S, Parker, D, Mack, HA & Wise, S 2023, 'Managers' experiences of providing end‐of‐life care under the Home Care Package Program', Australasian Journal on Ageing, vol. 42, no. 3, pp. 527-534.
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AbstractObjectiveThe study explored the experiences of Australian aged care providers in supporting clients on a home care package to die at home.MethodsSemistructured interviews were conducted with 13 aged care managers responsible for delivering services under the Home Care Package Program. Interviews were analysed thematically.ResultsFour themes emerged that illuminated managers' experiences: struggling to meet a preference to die at home; lack of opportunities to build workforce capacity in end‐of‐life care; challenges in negotiating fragmented funding arrangements between health and aged care providers; and mixed success in collaborating across sectors.ConclusionsAged care providers want to support older Australians who prefer to stay at home at the end of life. However, most clients are admitted to a residential facility when their care needs exceed a home care budget long before a specialist palliative care team will intervene. Budgets for health and aged care providers must be sufficient and flexible to support timely access to end‐of‐life care, to reward collaboration across sectors and to invest in building palliative care skills in the nursing and personal care workforce.
Sousa, MS, Martin, P, Johnson, MJ, Lind, M, Maddocks, M, Bullock, A, Agar, M, Chang, S, Kochovska, S, Kinchin, I, Morgan, D, Fazekas, B, Razmovski-Naumovski, V, Lee, JT, Itchins, M, Bray, V & Currow, DC 2023, 'Phase II, double blind, placebo controlled, multi-site study to evaluate the safety, feasibility and desirability of conducting a phase III study of anamorelin for anorexia in people with small cell lung cancer: A study protocol (LUANA trial)', PLOS ONE, vol. 18, no. 5, pp. e0285850-e0285850.
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Anorexia is experienced by most people with lung cancer during the course of their disease and treatment. Anorexia reduces response to chemotherapy and the ability of patients to cope with, and complete their treatment leading to greater morbidity, poorer prognosis and outcomes. Despite the significant importance of cancer-related anorexia, current therapies are limited, have marginal benefits and unwarranted side effects. In this multi-site, randomised, double blind, placebo controlled, phase II trial, participants will be randomly assigned (1:1) to receive once-daily oral dosing of 100mg of anamorelin HCl or matched placebo for 12 weeks. Participants can then opt into an extension phase to receive blinded intervention for another 12 weeks (weeks 13–24) at the same dose and frequency. Adults (≥18 years) with small cell lung cancer (SCLC); newly diagnosed with planned systemic therapy OR with first recurrence of disease following a documented disease-free interval ≥6 months, AND with anorexia (i.e., ≤ 37 points on the 12-item Functional Assessment of Anorexia Cachexia Treatment (FAACT A/CS) scale) will be invited to participate. Primary outcomes are safety, desirability and feasibility outcomes related to participant recruitment, adherence to interventions, and completion of study tools to inform the design of a robust Phase III effectiveness trial. Secondary outcomes are the effects of study interventions on body weight and composition, functional status, nutritional intake, biochemistry, fatigue, harms, survival and quality of life. Primary and secondary efficacy analysis will be conducted at 12 weeks. Additional exploratory efficacy and safety analyses will also be conducted at 24 weeks to collect data over longer treatment duration. The feasibility of economic evaluations in Phase III trial will be assessed, including the indicative costs and benefits of anamorelin for SCLC to the healthcare system and society, the choice of methods for data...
Tay, E, Makeham, M, Laba, T-L & Baysari, M 2023, 'Prescription drug monitoring programs evaluation: A systematic review of reviews', Drug and Alcohol Dependence, vol. 247, pp. 109887-109887.
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BACKGROUND: Prescription drug monitoring programs (PDMPs) are used to mitigate harms from high-risk medicines including misuse, prescription shopping, overdoses, and death. Previous systematic reviews report inconsistent findings. We undertook a systematic review of reviews to 1) describe and identify the methods and outcome measures used to evaluate PDMPs, 2) summarise existing evidence on outcomes and factors that influence PDMP success or benefit realisation. METHODS: MEDLINE, EMBASE, Scopus, Cochrane Database of Systematic Reviews, and PROSPERO were used to identify systematic reviews on PDMPs. Twelve papers met the inclusion criteria. Data extracted included review aim, study designs, settings, outcome measures, and key findings. Quality was assessed using AMSTAR 2 quality assessment tool. RESULTS: Review papers were categorised as outcome or process evaluation reviews. Process evaluation reviews described implementation processes, barriers and facilitators to PDMP use and/or implementation. Most (57%) papers described barriers which frequently included usability and data integration. Outcome evaluation papers reported impact of PDMPs on outcomes, which were opioid-focused, and findings were highly variable. Most reviews (67%) were rated as low quality, limiting the conclusions that can be drawn. CONCLUSIONS: Inconsistent methods and outcome measures were used to evaluate PDMPs. No economic evaluations of PDMPs were found. Standardising assessment and reporting of results may improve the quality and confidence in an evidence-base to inform future roll-out and evaluation of PDMPs. Targeting barriers such as system-related challenges and negative end-user perceptions could improve sustained uptake of PDMPs, and potentially facilitate benefits realisation, including mitigating harms of high-risk prescription medicines.
Trenaman, L, Kaal, KJ, Laba, T-L, Safari, A, Aguiar, M, Burch, T, Beckett, J, Munro, S, Hudson, M & Harrison, M 2023, 'The financial burden of accessing care for people with scleroderma in Canada: a patient-oriented, cross-sectional survey', CMAJ Open, vol. 11, no. 4, pp. E630-E636.
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Tu, Q, Hyun, K, Hafiz, N, Knight, A, Hespe, C, Chow, C, Briffa, T, Gallagher, R, Reid, C, Hare, D, Zwar, N, Woodward, M, Jan, S, Atkins, E, Laba, T, Halcomb, E, Usherwood, T & Redfern, J 2023, 'Provision of Primary Care Services and Cardioprotective Medication Prescriptions in Patients With Cardiovascular Diseases and Cancer: A Cross-sectional Study', Heart, Lung and Circulation, vol. 32, pp. S344-S345.
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van Gool, K, Hall, J, Haywood, P, Liu, D, Yu, S, Webster, SBG, Moradi, B & Aranda, S 2023, 'Higher fees and out-of-pocket costs in radiotherapy point to a need for funding reform', Australian Health Review, vol. 47, no. 3, pp. 301-306.
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Objective To elucidate the policy implications of recent trends in the funding of radiotherapy services between 2009–10 and 2021–22. Method We use national aggregate claims data to determine time trends in the fees, benefits and out-of-pocket (OOP) costs of radiotherapy and nuclear therapeutic medicine claims funded through the Medicare Benefits Schedule (MBS) program. All dollar figures are expressed in constant 2021 Australian dollars. Results Radiotherapy and nuclear therapeutic medicine MBS claims increased by 78% whereas MBS funding increased by 137% between 2009–10 and 2021–22. The main driver of Medicare funding growth has been the Extended Medicare Safety Net, which has increased by 404%. Over the 13 year observation period, the percentage of bulk-billed claims peaked in 2017–18 at 76.1% but fell to 69.8% in 2021–22. For non-bulk billed services, average OOP costs per claim increased from $20.40 in 2009–10 to $69.78 in 2021–22. Conclusion Despite increased Medicare funding, patients face increasing financial barriers to access radiation oncology services. Policies with regard to funding radiotherapy services should be reviewed to ensure that services are easily accessible and affordable for all those needing treatment and at a reasonable cost to Government.
Vargas, C, Haeusler, GM, Slavin, MA, Babl, FE, Mechinaud, F, Phillips, R, Thursky, K & Lourenco, RDA 2023, 'An analysis of the resource use and costs of febrile neutropenia events in pediatric cancer patients in Australia', Pediatric Blood & Cancer, vol. 70, no. 11, p. e30633.
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AbstractBackgroundFebrile neutropenia (FN) in children with cancer generally requires in‐hospital care, but low‐risk patients may be successfully managed in an outpatient setting, potentially reducing the overall healthcare costs. Updated data on the costs of FN care are lacking.MethodsA bottom‐up microcosting analysis was conducted from the healthcare system perspective using data collected alongside the Australian PICNICC (Predicting Infectious Complications of Neutropenic sepsis In Children with Cancer) study. Inpatient costs were accessed from hospital administrative records and outpatient costs from Medicare data. Costs were stratified by risk status (low/high risk) according to the PICNICC criteria. Estimated mean costs were obtained through bootstrapping and using a linear model to account for multiple events across individuals and other clinical factors that may impact costs.ResultsThe total costs of FN care were significantly higher for FN events classified as high‐risk ($17,827, 95% confidence interval [CI]: $17,193–$18,461) compared to low‐risk ($10,574, 95% CI: $9818–$11,330). In‐hospital costs were significantly higher for high‐risk compared to low‐risk events, despite no differences in the cost structure, mean cost per day, and pattern of resource use. Hospital length of stay (LOS) was the only modifiable factor significantly associated with total costs of care. Excluding antineoplastics, antimicrobials are the most commonly used medications in the inpatient and outpatient setting for the overall period of analysis.ConclusionThe FN costs are driven by in‐hospital admission and LOS. This suggests that the outpatient management of low‐risk patients is likely to reduce the in‐hospital cost ...
Webster, SBG, Neville, SE, Nobbs, J, Ching, J & van Gool, K 2023, 'Incorporating Safety and Quality Measures Into Australia’s Activity-Based Funding of Public Hospital Services', Health Services Insights, vol. 16, p. 11786329231187891.
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In a bid to improve quality of care, numerous countries have incorporated rewards and penalties into the funding and pricing of hospital services. This paper outlines recent advances in Australia to incorporate financial penalties for hospital acquired complications (HACs) and avoidable hospital readmissions (AHRs) adjustments into the funding of public hospital services. It describes the work in the development of suitable measures to identify episodes, the design of the analytical approach used for risk adjustment and the calculation of the funding implications including dampening effects to account for the level of risk. Using the 2019 to 20 round of data collection, this paper reports on the risk adjustment analysis, incremental costs of HACs and AHRs, and the funding dampening effects, the paper further discusses the implementation strategies undertaken by the Independent Health and Aged Care Pricing Authority (IHACPA) to ensure transparency, stakeholder consultation and engagement. The paper argues that both the technical development and its implementation strategies have been central to making safety and quality an integral and accepted part of Australia’s public hospital funding arrangements.
Williams, G & Kinchin, I 2023, 'The application of discrete choice experiments eliciting young peoples’ preferences for healthcare: a systematic literature review', The European Journal of Health Economics, vol. 24, no. 6, pp. 987-998.
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Abstract Objectives Understanding young people’s preferences for healthcare is critical for reducing the negative effect of undesirable choices. This review aims to synthesise the evidence obtained from discrete choice experiments (DCEs) eliciting young people’s preferences for healthcare interventions and service deliveries, specifically, to (1) examine the methodology, including a selection of attributes and levels, experimental design, estimation procedure and validity; (2) evaluate similarities, differences and rigour of designs to the general population DCEs; and, (3) compare the DCEs’ application to the seven health priority areas defined by the World Health Organisation (WHO). Methods A systematic review searching Medline, EconLIT, PsychINFO, Scopus, and Web of Science was performed up until May 2021. Inclusion criteria: a DCE, eliciting young peoples’ preferences (10–24 years of age), on a healthcare-related topic defined by WHO, peer-reviewed, full-text available in English. A bespoke checklist was used to assess the methodological quality of the included studies. Results Eighteen DCE studies were included in the review, exploring interventions and service in sexual and reproductive health (n = 9; 50%), smoking cessation (n = 4; 22%), mental health (n = 1), nutrition (n = 1), unintentional injuries (n = 1), vaccination against severe but rare diseases (n = 1); and diabetes (n = 1). Compared to the general population, DCEs eliciting young people...
Wise, S, Smith, E, Carlos, L, Coleshill, M, Day, RO, Melocco, T & Carland, JE 2023, 'Who is asking? Requests for antimicrobial prescribing advice received by hospital pharmacists', Journal of Pharmacy Practice and Research, vol. 53, no. 1, pp. 39-43.
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AbstractDoctors are perceived as the primary decision makers in antimicrobial therapy, but prescribing decisions are influenced by the multidisciplinary team. Antimicrobial stewardship (AMS) programs formalise interprofessional advice‐giving. No studies capture the advice provided by pharmacists. This study aimed to describe the volume and nature of antimicrobial prescribing advice that healthcare professionals seek from hospital pharmacists. A prospective audit of antimicrobial‐related advice requests received by pharmacists (n = 18) at an Australian public hospital was undertaken in July 2020. Antimicrobial advice was sought from 11 pharmacists on 300 occasions. Most requests (80%) were received by the AMS pharmacist. A mean (range) of 30 (17–40) requests per day was recorded and the AMS pharmacist received 24 (16–31) requests daily. Most requests came from the intensive care unit (22.1%), pharmacy (21.4%), and infectious diseases (17.1%). The AMS pharmacist was mostly contacted by consultants and pharmacists, and other pharmacists were contacted by registrars and junior medical officers. Despite COVID‐19 adaptations, face‐to‐face interaction was most common. This audit demonstrates the value of an AMS pharmacist, and indicates the importance of face‐to‐face interactions and the formalisation of pharmacists' role in prescribing decision‐making. Pharmacists provided antimicrobial advice daily to other healthcare professionals. Further research is required to provide insights into the barriers and enablers to effective advice‐giving interactions.
Wright, M 2023, 'Guest Editorial: Prevention is better than cure for medicolegal matters', Australian Journal of General Practice, vol. 52, no. 12, pp. 821-821.
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Wright, M 2023, 'Medicolegal.', Aust J Gen Pract, vol. 52, no. 12, p. 819.
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Wright, M & Brell, R 2023, 'Balancing care and responsibility: The role of the general practitioner in specialist referrals', Australian Journal of General Practice, vol. 52, no. 12, pp. 843-847.
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Wright, M & Haysom, G 2023, 'Managing patient complaints to improve your practice', Australian Journal of General Practice, vol. 52, no. 12, pp. 848-851.
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Xiong, X, Dalziel, K, Huang, L, Mulhern, B & Carvalho, N 2023, 'How do common conditions impact health-related quality of life for children? Providing guidance for validating pediatric preference-based measures', Health and Quality of Life Outcomes, vol. 21, no. 1, p. 8.
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AbstractBackgroundThere is increasing interest in the validation of pediatric preference-based health-related quality of life measurement instruments. It is critical that children with various degrees of health-related quality of life (HRQoL) impact are included in validation studies. To inform patient sample selection for validation studies from a pragmatic perspective, this study explored HRQoL impairments between known-groups and HRQoL changes over time across 27 common chronic child health conditions and identified conditions with the largest impact on HRQoL.MethodsThe health dimensions of two common preference-based HRQoL measures, the EQ-5D-Y and CHU9D, were constructed using Pediatric Quality of Life Inventory items that overlap conceptually. Data was from the Longitudinal Study of Australian Children, a nationally representative sample with over 10,000 children at baseline. Seven waves of data were included for the analysis, with child age ranging from 2 to18 years. Impacts to specific health dimensions and overall HRQoL between those having a specific condition versus not were compared using linear mixed effects models. HRQoL changes over time were obtained by calculating the HRQoL differences between two consecutive time points, grouped by “Improved” and “Worsened” health status. Comparison among various health conditions and different age groups (2–4 years, 5–12 years and 13–18 years) were made.ResultsConditions with the largest statistically significant total HRQoL impairments of having a specific condition compared with not having the condition were recurrent chest pain, autism, epilepsy, anxiety/depression, irritable bowel, recurrent back pain, recurrent abdominal pain, and attention deficit hyperactivity disorder (ADHD) for the total sample (2–18 y...
Yu, A, Luo, Y, Bahrampour, M, Norman, R, Street, D, Viney, R, Devlin, N & Mulhern, BJ 2023, 'Understanding the valuation of paediatric health-related quality of life: a qualitative study protocol', BMJ Open, vol. 13, no. 8, pp. e073039-e073039.
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IntroductionThere is evidence from previous studies that adults value paediatric health-related quality of life (HRQoL) and adult HRQoL differently. Less is known about how adolescents value paediatric HRQoL and whether their valuation and decision-making processes differ from those of adults. Discrete choice experiments (DCEs) are widely used to develop value sets for measures of HRQoL, but there is still much to understand about whether and how the methods choices in the implementation of DCE valuation tasks, such as format, presentation and perspective, affect the decision-making process of participants. This paper describes the protocol for a qualitative study that aims to explore the decision-making process of adults and adolescents when completing DCE valuation tasks. The study will also explore the impact of methodological choices in the design of DCE studies (including decisions about format and presentation) on participants’ thinking process.Methods and analysisAn interview protocol has been developed using DCE valuation tasks. Interviews will be conducted online via Zoom with both an adolescent and adult sample. In the interview, the participant will be asked to go through some DCE valuation tasks while ‘thinking aloud’. After completion of the survey, participants will then be asked some predetermined questions in relation to various aspects of the DCE tasks. Interviews will be recorded and transcribed and analysed using a thematic analysis approach.Ethics and disseminationEthics approval for this study has been received for the adult sample (UTS ETH20-9632) as well as the youth sample (UTS ETH22-6970) from the University of Technology Sydney Human Research Ethics Committee. Results from this study will inform the methods to be used in development of value sets for use in the ...
Yu, S, Lui, K, Fiebig, DG, Travadi, J, Homer, CSE, Sinclair, L, Scarf, V & Viney, R 2023, 'Preterm Birth and Total Health Care Use and Costs in the First 5 Years of Life: A Population-based Study', The Journal of Pediatrics, vol. 258, pp. 113327-113327.
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OBJECTIVES: To investigate the relationship between preterm birth and hospital/out-of-hospital care and costs over the first 5 years of life. STUDY DESIGN: Birth data from a population-based cohort of 631 532 infants born between 2007 and 2013 were linked probabilistically with data on hospitalizations, primary and secondary care, and the use of medications. We analyzed the distribution of health care use and public health care costs for infants who survived at least 5 years, comparing the outcomes of extremely preterm (<28 weeks of gestation), very preterm (28-32 weeks), moderate to late preterm (32-37 weeks), and term infants (at least 37 weeks). A linear regression model was used to investigate the effect of preterm birth on these outcomes, controlling for important confounders including pregnancy and birth complications, neonatal morbidity, survival, and maternal socioeconomic characteristics. RESULTS: Preterm birth has a statistically significant and economically relevant effect on health care use and costs in the first 5 years of life. Compared with a term infant, preterm infants born at 32-36 weeks, 28-32 weeks, and <28 weeks of gestation had, respectively, an average of 7.0 (SE 0.06), 41.6 (0.18), and 68.7 (0.35) more hospital days; 3.1 (0.04), 11.0 (0.13), and 13.2 (0.25) more outpatient specialist physician visits; and 1.2-fold (<0.01), 6.8-fold (0.01), and 10.9-fold (0.02) higher 5-year public health care costs. Preterm infants also had statistically significantly higher levels of general practitioner visits and use of medications. CONCLUSIONS: Higher levels of accessible care are needed for preterm infants across health care settings and over sustained periods. As our understanding of the impact of preterm birth on long-term clinical outcomes continues to improve, clinicians and policymakers should develop an accurate recognition of these needs to enable appropriate resource allocation toward research priorities and early intervention strategies.
