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Journal articles on the topic 'Family medicine Australia Cost effectiveness'

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Author: Grafiati
Published: 10 December 2022
Last updated: 29 January 2023

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1

Vos, Theo, Michelle M. Haby, Anne Magnus, Cathrine Mihalopoulos, Gavin Andrews, and Rob Carter. "Assessing Cost-Effectiveness in Mental Health: Helping Policy-Makers Prioritize and Plan Health Services." Australian & New Zealand Journal of Psychiatry 39, no. 8 (August 2005): 701–12. http://dx.doi.org/10.1080/j.1440-1614.2005.01654.x.

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Objective: We assessed, from a health sector perspective, options for change that could improve the efficiency of Australia's current mental health services by directing available resources toward ‘best practice’ cost-effective services. Method: We summarize cost-effectiveness results of a range of interventions for depression, schizophrenia, attention deficit hyperactivity disorder and anxiety disorders that have been presented in previous papers in this journal. Recommendations for change are formulated after taking into account ‘second-filter criteria’ of equity, feasibility of implementing change, acceptability to stakeholders and the strength of the evidence. In addition, we estimate the impact on total expenditure if the recommended mental health interventions for depression and schizophrenia are to be implemented in Australia. Results: There are cost-effective treatment options for mental disorders that are currently underutilized (e.g. cognitive–behavioural therapy (CBT) for depression and anxiety, bibliotherapy for depression, family interventions for schizophrenia and clozapine for the worst course of schizophrenia). There are also less cost-effective treatments in current practice (e.g. widespread use of olanzapine and risperidone in the treatment of established schizophrenia and, within those atypicals, a preference for olanzapine over risperidone). Feasibility of funding mechanisms and training of staff are the main second-filter issues for CBT and family interventions. Acceptability to various stakeholders is the main barrier to implementation of more cost-effective drug treatment regimens. More efficient drug intervention options identified for schizophrenia would cost A$68 million less than current practice. These savings would more than cover the estimated A$36M annual cost of delivering family interventions to the 51% of people with schizophrenia whom we estimated to be eligible and this would lead to an estimated 12% improvement in their health status. Implementing recommended strategies for depression would cost A$121M annually for the 24% of people with depression who seek care currently, but do not receive an evidence-based treatment. Conclusions: Despite considerable methodological problems, a range of cost-effective and less cost-effective interventions for major mental disorders can be discerned. The biggest hurdle to implementation of more efficient mental health services is that this change would require reallocation of funds between interventions, between disorders and between service providers with different funding mechanisms.
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Hawthorne, Graeme, Frida Cheok, Robert Goldney, and Laura Fisher. "The Excess Cost of Depression in South Australia: A Population-Based Study." Australian & New Zealand Journal of Psychiatry 37, no. 3 (June 2003): 362–73. http://dx.doi.org/10.1046/j.1440-1614.2003.01189.x.

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Objective: To establish excess costs associated with depression in South Australia, based on the prevalence of depression (from the Primary Care Evaluation of Mental Disorders (PRIME-MD)) and associated excess burden of depression (BoD) costs. Method: Using data from the 1988 South Australian (SA) Health Omnibus Survey, a properly weighted cross-sectional survey of SA adults, we calculated excess costs using two methods. First, we estimated the excess cost based on health service provision and loss of productivity. Second, we estimated it from loss of utility. Results: We found symptoms of major depression in 7% of the SA population, and 11% for other depression. Those with major depression reported worse health status, took more time off work, reported more work performance limitations, made greater use of health services and reported poorer health-related quality-of-life. Using the service provision perspective excess BoD costs were AUD$1921 million per annum. Importantly, this excluded non-health service and other social costs (e.g. family breakdown, legal costs). With the utility approach, using the Assessment of Quality of Life (AQoL) instrument and a very modest life-value (AUD$50 000), the estimate was AUD$2800 million. This reflects a societal perspective of the value of illness, hence there is no particular reason the two different methods should agree as they provide different kinds of information. Both methods suggest estimating the excess BoD from the direct service provision perspective is too restrictive, and that indirect and societal costs ought be taken into account. Conclusions: Despite the high ranking of depression as a major health problem, it is often unrecognized and undertreated. The findings mandate action to explore ways of reducing the BoD borne by individuals, those affected by their illness, the health system and society generally. Given the limited information on the cost-effectiveness of different treatments, it would seem important that resources be allocated to evaluating alternative depression treatments.
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Schofield, Deborah, Michelle M. Cunich, and Lucio Naccarella. "An evaluation of the quality of evidence underpinning diabetes management models: a review of the literature." Australian Health Review 38, no. 5 (2014): 495. http://dx.doi.org/10.1071/ah14018.

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Objective There is a paucity of research on the quality of evidence relating to primary care workforce models. Thus, the aim of the present study was to evaluate the quality of evidence on diabetes primary care workforce models in Australia. Methods The National Health and Medical Research Council of Australia’s (National Health and Medical Reseach Council; 2000, 2001) frameworks for evaluating scientific evidence and economic evaluations were used to assess the quality of studies involving primary care workforce models for diabetes care involving Australian adults. A search of medical databases (MEDLINE, AMED, RURAL, Australian Indigenous HealthInfoNet and The Cochrane Institute), journals for diabetes care (Diabetes Research and Clinical Practice, Diabetes Care, Diabetic Medicine, Population Health Management, Rural and Remote Health, Australian Journal of Primary Health, PLoS Medicine, Medical Journal of Australia, BMC Health Services Research, BMC Public Health, BMC Family Practice) and Commonwealth and state government health websites was undertaken to acquire Australian studies of diabetes workforce models published 2005–13. Various diabetes workforce models were examined, including ‘one-stop shops’, pharmacy care, Aboriginal services and telephone-delivered interventions. The quality of evidence was evaluated against several criteria, including relevance and replication, strength of evidence, effect size, transferability and representativeness, and value for money. Results Of the14 studies found, four were randomised controlled trials and one was a systematic review (i.e. Level II and I (best) evidence). Only three provided a replicable protocol or detailed intervention delivery. Eleven lacked a theoretical framework. Twelve reported significant improvements in clinical (patient) outcomes, commonly HbA1c, cholesterol and blood pressure; only four reported changes in short- and long-term outcomes (e.g. quality of life). Most studies used a small or targeted population. Only two studies assessed both benefits and costs of their intervention compared with usual care and cost effectiveness. Conclusions More rigorous studies of diabetes workforce models are needed to determine whether these interventions improve patient outcomes and, if they do, represent value for money. What is known about the topic? Although health systems with strong primary care orientations have been associated with enhanced access, equity and population health, the primary care workforce is facing several challenges. These include a mal-distribution of resources (supply side) and health outcomes (demand side), inconsistent support for teamwork care models, and a lack of enhanced clinical inter-professional education and/or training opportunities. These challenges are exacerbated by an ageing health workforce and general population, as well as a population that has increased prevalence of chronic conditions and multi-morbidity. Although several policy directions have been advocated to address these challenges, there is a lack of high-quality evidence about which primary care workforce models are best (and which models represent better value for money than current practice) and what the health effects are for patients. What does this paper add? This study demonstrated several strengths and weaknesses of Australian diabetes models of care studies. In particular, only five of the 14 studies assessed were designed in a way that enabled them to achieve a Level II or I rating (and hence the ‘best’ level of evidence), based on the NHMRC’s (2000, 2001) frameworks for assessing scientific evidence. The majority of studies risked the introduction of bias and thus may have incorrect conclusions. Only a few studies described clearly what the intervention and the comparator were and thus could be easily replicated. Only two studies included cost-effectiveness studies of their interventions compared with usual care. What are the implications for practitioners? Although there has been an increase in the number of primary care workforce models implemented in Australia, there is a need for more rigorous research to assess whether these interventions are effective in producing improved health outcomes and represent better value for money than current practice. Researchers and policymakers need to make decisions based on high-quality evidence; it is not obvious what effect the evidence is having on primary care workforce reform.
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Mahmood, Amreen, Anagha Deshmukh, Manikandan Natarajan, Dianne Marsden, Glade Vyslysel, Sebastian Padickaparambil, Shwetha TS, et al. "Development of strategies to support home-based exercise adherence after stroke: a Delphi consensus." BMJ Open 12, no. 1 (January 2022): e055946. http://dx.doi.org/10.1136/bmjopen-2021-055946.

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ObjectiveTo develop a set of strategies to enhance adherence to home-based exercises after stroke, and an overarching framework to classify these strategies.MethodWe conducted a four-round Delphi consensus (two online surveys, followed by a focus group then a consensus round). The Delphi panel consisted of 13 experts from physiotherapy, occupational therapy, clinical psychology, behaviour science and community medicine. The experts were from India, Australia and UK.ResultsIn round 1, a 10-item survey using open-ended questions was emailed to panel members and 75 strategies were generated. Of these, 25 strategies were included in round 2 for further consideration. A total of 64 strategies were finally included in the subsequent rounds. In round 3, the strategies were categorised into nine domains—(1) patient education on stroke and recovery, (2) method of exercise prescription, (3) feedback and supervision, (4) cognitive remediation, (5) involvement of family members, (6) involvement of society, (7) promoting self-efficacy, (8) motivational strategies and (9) reminder strategies. The consensus from 12 experts (93%) led to the development of the framework in round 4.ConclusionWe developed a framework of comprehensive strategies to assist clinicians in supporting exercise adherence among stroke survivors. It provides practical methods that can be deployed in both research and clinical practices. Future studies should explore stakeholders’ experiences and the cost-effectiveness of implementing these strategies.
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Paton, Kate, Lynn Gillam, Hayley Warren, Melissa Mulraney, David Coghill, Daryl Efron, Michael Sawyer, and Harriet Hiscock. "Clinicians’ perceptions of the Australian Paediatric Mental Health Service System: Problems and solutions." Australian & New Zealand Journal of Psychiatry 55, no. 5 (January 18, 2021): 494–505. http://dx.doi.org/10.1177/0004867420984242.

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Objectives: Despite substantial investment by governments, the prevalence of mental health disorders in developed countries remains unchanged over the past 20 years. As 50% of mental health conditions present before 14 years of age, access to high-quality mental health care for children is crucial. Barriers to access identified by parents include high costs and long wait times, difficulty navigating the health system, and a lack of recognition of the existence and/or severity of the child’s mental health disorder. Often neglected, but equally important, are clinician views about the barriers to and enablers of access to high-quality mental health care. We aimed to determine perspectives of Australian clinicians including child and adolescent psychiatrists, paediatricians, psychologists and general practitioners, on barriers and enablers within the current system and components of an optimal system. Methods: A total of 143 clinicians (approximately 35 each of child and adolescent psychiatrists, paediatricians, child psychologists and general practitioners) from Victoria and South Australia participated in semi-structured phone interviews between March 2018 and February 2019. Inductive content analysis was applied to address the broad study aims. Findings: Clinician-identified barriers included multi-dimensional family factors, service fragmentation, long wait times and inadequate training for paediatricians and general practitioners. Rural and regional locations provided additional challenges but a greater sense of collaboration resulting from the proximity of clinicians in rural areas, creating an opportunity to develop support networks. Suggestions for an optimal system included novel ways to improve access to child psychiatry expertise, training for paediatricians and general practitioners, and co-located multidisciplinary services. Conclusion: Within the current mental health system for children, structural, training and workforce barriers prevent optimal access to care. Clinicians identified many practical and systemic ideas to improve the system. Implementation and evaluation of effectiveness and cost effectiveness of these ideas is the next challenge for Australia’s children’s mental health.
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Mumford, Virginia, Mary Ann Kulh, Clifford Hughes, Jeffrey Braithwaite, and Johanna Westbrook. "Controlled pre–post, mixed-methods study to determine the effectiveness of a national delirium clinical care standard to improve the diagnosis and care of patients with delirium in Australian hospitals: a protocol." BMJ Open 8, no. 1 (January 2018): e019423. http://dx.doi.org/10.1136/bmjopen-2017-019423.

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IntroductionDelirium, an acute confusional state, affects up to 29% of acute inpatients aged 65 years and over. The Australian Delirium Clinical Care Standard (the Standard) contains evidence-based, multicomponent interventions, to identify and reduce delirium. This study aims to: (1) conduct a controlled, before-and-after study to assess the clinical effectiveness of the Standard to improve diagnosis and treatment of delirium; (2) conduct a cost-effectiveness study of implementing the Standard and (3) evaluate the implementation process.Methods and analysisThe study will use a controlled, preimplementation and postimplementation mixed-methods study design, including: medical record reviews, activity-based costing analysis and interviews with staff, patients and their family members. The study population will comprise patients 65 years and over, admitted to surgical, medical and intensive care wards in four intervention hospitals and one control hospital. The primary clinical outcome will be the incidence of delirium. Secondary outcomes include: length of stay, severity and duration of delirium, inhospital mortality rates, readmission rates and use of psychotropic drugs. Cost-effectiveness will be evaluated through activity-based costing analysis and outcome data, and the implementation process appraised through the qualitative results.Ethics and disseminationEthics approval has been received for two hospitals. Additional hospitals have been identified and ethics applications will be submitted once the tools in the pilot study have been tested.The results will be submitted for publication in peer-reviewed journals and presented to national and international conferences. Results seminars will provide a quality feedback mechanism for staff and health policy bodies.
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Papadopoulos, Nicole, Emma Sciberras, Harriet Hiscock, Katrina Williams, Jane McGillivray, Cathrine Mihalopoulos, Lidia Engel, et al. "Sleeping sound with autism spectrum disorder (ASD): study protocol for an efficacy randomised controlled trial of a tailored brief behavioural sleep intervention for ASD." BMJ Open 9, no. 11 (November 2019): e029767. http://dx.doi.org/10.1136/bmjopen-2019-029767.

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IntroductionSleep problems are a characteristic feature of children with autism spectrum disorder (ASD) with 40% to 80% of children experiencing sleep difficulties. Sleep problems have been found to have a pervasive impact on a child’s socio-emotional functioning, as well as on parents’ psychological functioning. The Sleeping Sound ASD project aims to evaluate the efficacy of a brief behavioural sleep intervention in reducing ASD children’s sleep problems in a fully powered randomised controlled trial (RCT). Intervention impact on child and family functioning is also assessed.Methods and analysisThe RCT aims to recruit 234 children with a diagnosis of ASD, aged 5–13 years, who experience moderate to severe sleep problems. Participants are recruited from paediatrician clinics in Victoria, Australia, and via social media. Families interested in the study are screened for eligibility via phone, and then asked to complete a baseline survey online, assessing child sleep problems, and child and family functioning. Participants are then randomised to the intervention group or treatment as usual comparator group. Families in the intervention group attend two face-to-face sessions and a follow-up phone call with a trained clinician, where families are provided with individually tailored behavioural sleep strategies to help manage the child’s sleep problems. Teacher reports of sleep, behavioural and social functioning are collected, and cognitive ability assessed to provide measures blind to treatment group. The primary outcome is children’s sleep problems as measured by the Children’s Sleep Habits Questionnaire at 3 months post-randomisation. Secondary outcomes include parent and child quality of life; child social, emotional, behavioural and cognitive functioning; and parenting stress and parent mental health. Cost-effectiveness of the intervention is also evaluated.Ethics and disseminationFindings from this study will be published in peer-reviewed journals and disseminated at national and international conferences, local networks and online.Trial registration numberISRCTN14077107 (ISRCTN registry dated on 3 March 2017).
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Khano, Sonia, Lena Sanci, Susan Woolfenden, Yvonne Zurynski, Kim Dalziel, Siaw-Teng Liaw, Douglas Boyle, et al. "Strengthening Care for Children (SC4C): protocol for a stepped wedge cluster randomised controlled trial of an integrated general practitioner-paediatrician model of primary care." BMJ Open 12, no. 9 (September 2022): e063449. http://dx.doi.org/10.1136/bmjopen-2022-063449.

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IntroductionAustralia’s current healthcare system for children is neither sustainable nor equitable. As children (0–4 years) comprise the largest proportion of all primary care-type emergency department presentations, general practitioners (GPs) report feeling undervalued as an integral member of a child’s care, and lacking in opportunities for support and training in paediatric conditions. This Strengthening Care for Children (SC4C) randomised trial aims to evaluate a novel, integrated GP-paediatrician model of care, that, if effective, will improve GP quality of care, reduce burden to hospital services and ensure children receive the right care, at the right time, closer to home.Methods and analysisSC4C is a stepped wedge cluster randomised controlled trial (RCT) of 22 general practice clinics in Victoria and New South Wales, Australia. General practice clinics will provide control period data before being exposed to the 12-month intervention which will be rolled out sequentially each month (one clinic per state) until all 22 clinics receive the intervention. The intervention comprises weekly GP-paediatrician co-consultation sessions; monthly case discussions; and phone and email paediatrician support, focusing on common paediatric conditions. The primary outcome of the trial is to assess the impact of the intervention as measured by the proportion of children’s (0–<18 years) GP appointments that result in a hospital referral, compared with the control period. Secondary outcomes include GP quality of care; GP experience and confidence in providing paediatric care; family trust in and preference for GP care; and the sustainability of the intervention. An implementation evaluation will assess the model to inform acceptability, adaptability, scalability and sustainability, while a health economic evaluation will measure the cost-effectiveness of the intervention.Ethics and disseminationHuman research ethics committee (HREC) approval was granted by The Royal Children’s Hospital Ethics Committee in August 2020 (Project ID: 65955) and site-specific HRECs. The investigators (including Primary Health Network partners) will communicate trial results to stakeholders and participating GPs and general practice clinics via presentations and publications.Trial registration numberAustralia New Zealand Clinical Trials Registry 12620001299998.
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Quach, Jon L., Ben Deery, Margaret Kern, Janet Clinton, Lisa Gold, Francesca Orsini, and Emma Sciberras. "Can a teacher-led mindfulness intervention for new school entrants improve child outcomes? Protocol for a school cluster randomised controlled trial." BMJ Open 10, no. 5 (May 2020): e036523. http://dx.doi.org/10.1136/bmjopen-2019-036523.

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IntroductionThe first years of school are critical in establishing a foundation for positive long-term academic, social and well-being outcomes. Mindfulness-based interventions may help students transition well into school, but few robust studies have been conducted in this age group. We aim to determine whether compared with controls, children who receive a mindfulness intervention within the first years of primary school have better: (1) immediate attention/short-term memory at 18 months post-randomisation (primary outcome); (2) inhibition, working memory and cognitive flexibility at 18 months post-randomisation; (3) socio-emotional well-being, emotion-regulation and mental health-related behaviours at 6 and 18 months post-randomisation; (4) sustained changes in teacher practice and classroom interactions at 18 months post-randomisation. Furthermore, we aim to determine whether the implementation predicts the efficacy of the intervention, and the cost effectiveness relative to outcomes.Methods and analysisThis cluster randomised controlled trial will be conducted in 22 primary schools in disadvantaged areas of Melbourne, Australia. 826 students in the first year of primary school will be recruited to detect between groups differences of Cohen’s d=0.25 at the 18-month follow-up. Parent, teacher and child-assessment measures of child attention, emotion-regulation, executive functioning, socio-emotional well-being, mental health-related behaviour and learning, parent mental well-being, teacher well-being will be collected 6 and 18 months post-randomisation. Implementation factors will be measured throughout the study. Intention-to-treat analyses, accounting for clustering within schools and classes, will adopt a two-level random effects linear regression model to examine outcomes for the intervention versus control students. Unadjusted and analyses adjusted for baseline scores, baseline age, gender and family socioeconomic status will be conducted.Ethics and disseminationEthics approval has been received by the Human Research Ethics Committee at the University of Melbourne. Findings will be reported in peer-review publications, national and international conference presentations and research snapshots directly provided to participating schools and families.Pre-Results Trial registration numberAustralian New Zealand Clinical Trials Registry (ACTRN12619000326190).
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Byrnes, Joshua M., Linda J. Cobiac, Christopher M. Doran, Theo Vos, and Anthony P. Shakeshaft. "Cost‐effectiveness of volumetric alcohol taxation in Australia." Medical Journal of Australia 192, no. 8 (April 2010): 439–43. http://dx.doi.org/10.5694/j.1326-5377.2010.tb03581.x.

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Byrnes, Joshua M., Linda J. Cobiac, Christopher M. Doran, and Theo Vos. "Cost‐effectiveness of volumetric alcohol taxation in Australia." Medical Journal of Australia 192, no. 11 (June 2010): 655. http://dx.doi.org/10.5694/j.1326-5377.2010.tb03667.x.

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Newall, Anthony T., Philippe Beutels, Kristine Macartney, James Wood, and C. Raina MacIntyre. "The cost-effectiveness of rotavirus vaccination in Australia." Vaccine 25, no. 52 (December 2007): 8851–60. http://dx.doi.org/10.1016/j.vaccine.2007.10.009.

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Mervin, C., and P. Scuffham. "Transcatheter Aortic Valve Replacement: A Cost-Effectiveness Analysis for Australia." Heart, Lung and Circulation 22 (January 2013): S158. http://dx.doi.org/10.1016/j.hlc.2013.05.377.

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Butler, James R. G., Peter McIntyre, C. Raina MacIntyre, Robin Gilmour, Ann L. Howarth, and Beate Sander. "The cost-effectiveness of pneumococcal conjugate vaccination in Australia." Vaccine 22, no. 9-10 (March 2004): 1138–49. http://dx.doi.org/10.1016/j.vaccine.2003.09.036.

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Hirsch, N. A., and D. M. Hailey. "Laparoscopic hernia repair in Australia - some cost and effectiveness considerations." Minimally Invasive Therapy 4, no. 4 (January 1995): 223–26. http://dx.doi.org/10.3109/13645709509152782.

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Norman, Richard, Kees van Gool, Jane Hall, Martin Delatycki, and John Massie. "Cost-effectiveness of carrier screening for cystic fibrosis in Australia." Journal of Cystic Fibrosis 11, no. 4 (July 2012): 281–87. http://dx.doi.org/10.1016/j.jcf.2012.02.007.

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Faunce, Thomas A. "Nanotherapeutics: new challenges for safety and cost‐effectiveness regulation in Australia." Medical Journal of Australia 186, no. 4 (February 2007): 189–91. http://dx.doi.org/10.5694/j.1326-5377.2007.tb00860.x.

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Ye, Xin Tao, Alice Parker, Johann Brink, Robert G. Weintraub, and Igor E. Konstantinov. "Cost-effectiveness of the National Pediatric Heart Transplantation Program in Australia." Journal of Thoracic and Cardiovascular Surgery 157, no. 3 (March 2019): 1158–66. http://dx.doi.org/10.1016/j.jtcvs.2018.11.023.

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Newall, Anthony T., Prudence Creighton, David J. Philp, James G. Wood, and C. Raina MacIntyre. "The potential cost-effectiveness of infant pneumococcal vaccines in Australia." Vaccine 29, no. 45 (October 2011): 8077–85. http://dx.doi.org/10.1016/j.vaccine.2011.08.050.

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Ananthapavan, Jaithri, Phuong K. Nguyen, Steven J. Bowe, Gary Sacks, Ana Maria Mantilla Herrera, Boyd Swinburn, Vicki Brown, et al. "Cost-effectiveness of community-based childhood obesity prevention interventions in Australia." International Journal of Obesity 43, no. 5 (March 29, 2019): 1102–12. http://dx.doi.org/10.1038/s41366-019-0341-0.

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Savira, F., B. Wang, A. Kompa, Z. Ademi, A. Owen, S. Zoungas, A. Tonkin, D. Liew, and E. Zomer. "176 The Cost-Effectiveness of Dapagliflozin for Chronic Heart Failure in Australia." Heart, Lung and Circulation 29 (2020): S114. http://dx.doi.org/10.1016/j.hlc.2020.09.183.

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de Graaff, Barbara, Amanda Neil, Lei Si, Kwang Chien Yee, Kristy Sanderson, Lyle Gurrin, and Andrew J. Palmer. "Cost-Effectiveness of Different Population Screening Strategies for Hereditary Haemochromatosis in Australia." Applied Health Economics and Health Policy 15, no. 4 (December 29, 2016): 521–34. http://dx.doi.org/10.1007/s40258-016-0297-3.

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Magnus, Anne, Vaughan Carr, Cathrine Mihalopoulos, Rob Carter, and Theo Vos. "Assessing Cost-Effectiveness of Drug Interventions for Schizophrenia." Australian & New Zealand Journal of Psychiatry 39, no. 1-2 (January 2005): 44–54. http://dx.doi.org/10.1080/j.1440-1614.2005.01509.x.

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Objective: To assess from a health sector perspective the incremental cost-effectiveness of eight drug treatment scenarios for established schizophrenia. Method: Using a standardized methodology, costs and outcomes are modelled over the lifetime of prevalent cases of schizophrenia in Australia in 2000. A two-stage approach to assessment of health benefit is used. The first stage involves a quantitative analysis based on disability-adjusted life years (DALYs) averted, using best available evidence. The robustness of results is tested using probabilistic uncertainty analysis. The second stage involves application of ‘second filter’ criteria (equity, strength of evidence, feasibility and acceptability) to allow broader concepts of benefit to be considered. Results: Replacing oral typicals with risperidone or olanzapine has an incremental costeffectiveness ratio (ICER) of A$48 000 and A$92 000/DALY respectively. Switching from low-dose typicals to risperidone has an ICER of A$80 000. Giving risperidone to people experiencing side-effects on typicals is more cost-effective at A$20 000. Giving clozapine to people taking typicals, with the worst course of the disorder and either little or clear deterioration, is cost-effective at A$42 000 or A$23 000/DALY respectively. The least costeffective intervention is to replace risperidone with olanzapine at A$160 000/DALY. Conclusions: Based on an A$50 000/DALY threshold, low-dose typical neuroleptics are indicated as the treatment of choice for established schizophrenia, with risperidone being reserved for those experiencing moderate to severe side-effects on typicals. The more expensive olanzapine should only be prescribed when risperidone is not clinically indicated. The high cost of risperidone and olanzapine relative to modest health gains underlie this conclusion. Earlier introduction of clozapine however, would be cost-effective. This work is limited by weaknesses in trials (lack of long-term efficacy data, quality of life and consumer satisfaction evidence) and the translation of effect size into a DALY change. Some stakeholders, including SANE Australia, argue the modest health gains reported in the literature do not adequately reflect perceptions by patients, clinicians and carers, of improved quality of life with these atypicals.
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Freund, Megan, Breanne Hobden, Simon Deeming, Natasha Noble, Jamie Bryant, and Robert W. Sanson-Fisher. "Reducing alcohol-related harm in Australia: a simple data-based tool to assist prioritization of research and health care delivery in primary care." Family Practice 36, no. 4 (October 22, 2018): 473–78. http://dx.doi.org/10.1093/fampra/cmy103.

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Abstract Introduction The detection of harmful alcohol use and the delivery of brief advice in primary care are less than optimal. Given limited health care resources, deciding where best to allocate funding to optimize health outcomes is imperative. A simple data-based tool could be useful when access to specialist health economic advice is unavailable. This study aimed to examine the utility of a simple data-based calculator to facilitate priority setting in general practice for reducing alcohol-related harm. Methods A simple algorithm was developed within Microsoft Excel to allow comparison of hypothetical intervention scenarios that aimed to increase detection and brief advice for harmful alcohol use in general practice. The calculator accommodated varying implementation costs, size of effect and reach for each scenario created. The incremental costs of the intervention scenarios, the incremental number of successes (i.e. abstinence or drinking at safe levels) and the incremental costs-effectiveness ratio (ICER) were calculated for each hypothetical scenario and compared with a usual care scenario. Results In the hypothetical scenarios modelled, increasing both the detection of harmful alcohol consumption and the provision of brief advice produced the greatest number of incremental successes above baseline. Increasing detection alone produced fewer incremental successes but was the most cost-effective approach, as indicated by the lowest ICER. Discussion The data-based calculator provides a simple method of exploring reach and cost-effectiveness outcomes without the need for any specific skills. Although this approach has limitations, the calculator can be used by decision makers to guide intervention planning.
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Zhao, Yuejen, Steven Guthridge, Henrik Falhammar, Howard Flavell, and Dominique A. Cadilhac. "Cost-effectiveness of stroke care in Aboriginal and non-Aboriginal patients: an observational cohort study in the Northern Territory of Australia." BMJ Open 7, no. 10 (October 2017): e015033. http://dx.doi.org/10.1136/bmjopen-2016-015033.

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ObjectiveTo assess cost-effectiveness of stroke care for Aboriginal compared with non-Aboriginal patients in the Northern Territory (NT), Australia.DesignCost-effectiveness analysis using data from a cohort-based follow-up study of stroke incidents.SettingPublic hospitals in the NT from 1992 to 2013.ParticipantsIndividual patient data were extracted and linked from the hospital inpatient and primary care information systems.Outcome measuresIncremental cost-effectiveness ratios were calculated and assessed graphically. Survival time was used to measure effectiveness of stroke care, in comparison with the net costs per life-year gained, from a healthcare perspective, by applying multivariable models to account for time-dependent confounding.Results2158 patients with incident stroke were included (1171 males, 1178 aged <65 years and 966 from remote areas). 992 patients were of Aboriginal origin (46.0%, disproportionately higher than the population proportion of 27%). Of all cases, 42.6% were ischaemic and 29.8% haemorrhagic stroke. Average age of stroke onset was 51 years in Aboriginal, compared with 65 years in non-Aboriginal patients (p<0.001). Aboriginal patients had 71.4% more hospital bed-days, and 7.4% fewer procedures than non-Aboriginal patients. Observed health costs averaged $A50 400 per Aboriginal compared with $A33 700 per non-Aboriginal patient (p<0.001). The differential costs and effects for each population were distributed evenly across the incremental cost-effectiveness plane threshold line, indicating no difference in cost-effectiveness between populations. After further adjustment for confounding and censoring, cost-effectiveness appeared greater for Aboriginal than non-Aboriginal patients, but this was not statistically significant (p=0.25).ConclusionsStroke care for the NT Aboriginal population is at least as cost-effective as the non-Aboriginal population. Stroke care presents worthwhile and equitable survival benefits for Aboriginal patients in remote communities, notwithstanding their higher level burden of disease. These findings are relevant for healthcare planning and policy development regarding equal access to stroke care for Aboriginal patients.
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Tannous, Kathy W., Ajesh George, Moin Uddin Ahmed, Anthony Blinkhorn, Hannah G. Dahlen, John Skinner, Shilpi Ajwani, et al. "Economic evaluation of the Midwifery Initiated Oral Health-Dental Service programme in Australia." BMJ Open 11, no. 8 (August 2021): e047072. http://dx.doi.org/10.1136/bmjopen-2020-047072.

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ObjectivesTo critically evaluate the cost-effectiveness of the Midwifery Initiated Oral Health-Dental Service (MIOH-DS) designed to improve oral health of pregnant Australian women. Previous efficacy and process evaluations of MIOH-DS showed positive outcomes and improvements across various measures.Design and settingThe evaluation used a cost-utility model based on the initial study design of the MIOH-DS trial in Sydney, Australia from the perspective of public healthcare provider for a duration of 3 months to 4 years.ParticipantsData were sourced from pregnant women (n=638), midwives (n=17) and dentists (n=3) involved in the MIOH trial and long-term follow-up.Cost measuresData included in analysis were the cost of the time required by midwives and dentists to deliver the intervention and the cost of dental treatment provided. Costs were measured using data on utilisation and unit price of intervention components and obtained from a micro-costing approach.Outcome measuresUtility was measured as the number of Disability Adjusted Life Years (DALYs) from health-benefit components of the intervention. Three cost-effectiveness analyses were undertaken using different comparators, thresholds and time scenarios.ResultsCompared with current practice, midwives only intervention meets the Australian threshold (A$50 000) of being cost-effective. The midwives and accessible/affordable dentists joint intervention was only ‘cost-effective’ in 6 months or beyond scenarios. When the midwife only intervention is the comparator, the midwife/dentist programme was ‘cost-effective’ in all scenarios except at 3 months scenario.ConclusionsThe midwives’ only intervention providing oral health education, assessment and referral to existing dental services was cost-effective, and represents a low cost intervention. Midwives’ and dentists’ combined interventions were cost-effective when the benefits were considered over longer periods. The findings highlight short and long term economic benefits of the programme and support the need for policymakers to consider adding an oral health component into antenatal care Australia wide.Trial registration numberACTRN12612001271897; Post-results.
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Chen, C., P. Beutels, J. Wood, R. Menzies, C. R. MacIntyre, P. McIntyre, and A. T. Newall. "Retrospective cost-effectiveness of the 23-valent pneumococcal polysaccharide vaccination program in Australia." Vaccine 36, no. 42 (October 2018): 6307–13. http://dx.doi.org/10.1016/j.vaccine.2018.08.084.

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Van Buynder, Paul, and Allan W. Cripps. "Retrospective cost-effectiveness of the 23-valent pneumococcal polysaccharide vaccination program in Australia." Vaccine 37, no. 24 (May 2019): 3141. http://dx.doi.org/10.1016/j.vaccine.2019.03.079.

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Girgis, Afaf, Philip Clarke, Robert C. Burton, and Rob W. Sanson—Fisher. "Screening for Melanoma by Primary Health Care Physicians: A Cost—Effectiveness Analysis." Journal of Medical Screening 3, no. 1 (March 1996): 47–53. http://dx.doi.org/10.1177/096914139600300112.

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Background and design— Australia has the highest rates of skin cancer in the world, and the incidence is estimated to be doubling every 10 years. Despite advances in the early detection and treatment of melanoma about 800 people still die nationally of the disease each year. A possible strategy for further reducing the mortality from melanoma is an organised programme of population screening for unsuspected lesions in asymptomatic people. Arguments against introducing melanoma screening have been based on cost and the lack of reliable data on the efficacy of any screening tests. To date, however, there has been no systematic economic assessment of the cost effectiveness of melanoma screening. The purpose of this research was to determine whether screening may be potentially cost effective and, therefore, warrants further investigation. A computer was used to simulate the effects of a hypothetical melanoma screening programme that was in operation for 20 years, using cohorts of Australians aged 50 at the start of the programme. Based on this simulation, cost—effectiveness estimates of melanoma screening were calculated. Results— Under the standard assumptions used in the model, and setting the sensitivity of the screening test (visual inspection of the skin) at 60%, cost effectiveness ranged from Aust$6853 per life year saved for men if screening was undertaken five yearly to $12137 if screening was two yearly. For women, it ranged from $11 102 for five yearly screening to $20 877 for two yearly screening. Conclusion— The analysis suggests that a melanoma screening programme could be cost effective, particularly if five yearly screening is implemented by family practitioners for men over the age of 50.
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Ray, G. Thomas. "Pneumococcal conjugate vaccine: review of cost–effectiveness studies in Australia, North America and Europe." Expert Review of Pharmacoeconomics & Outcomes Research 8, no. 4 (August 2008): 373–93. http://dx.doi.org/10.1586/14737167.8.4.373.

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Bandara, Piumee, Jane Pirkis, Angela Clapperton, Sangsoo Shin, Lay San Too, Lennart Reifels, Sandersan Onie, et al. "Cost-effectiveness of Installing Barriers at Bridge and Cliff Sites for Suicide Prevention in Australia." JAMA Network Open 5, no. 4 (April 5, 2022): e226019. http://dx.doi.org/10.1001/jamanetworkopen.2022.6019.

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Yan, Bryan P., Angela Brennan, Molla Huq, Nick Andrianopolous, Andrew E. Ajani, David Clark, and Christopher M. Reid. "Cost-effectiveness analysis of drug-eluting stents in Australia from the Melbourne Interventional Group Registry." Heart, Lung and Circulation 18 (2009): S207. http://dx.doi.org/10.1016/j.hlc.2009.05.514.

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Mihalopoulos, Cathrine, Cathrine Mihalopoulos, Anne Magnus, Rob Carter, and Theo Vos. "Assessing Cost-Effectiveness in Mental Health: Family Interventions for Schizophrenia and Related Conditions." Australian & New Zealand Journal of Psychiatry 38, no. 7 (July 2004): 511–19. http://dx.doi.org/10.1080/j.1440-1614.2004.01404.x.

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Ademi, Zanfina, Kumar Pasupathi, and Danny Liew. "Cost-effectiveness of apixaban compared to warfarin in the management of atrial fibrillation in Australia." European Journal of Preventive Cardiology 22, no. 3 (November 26, 2013): 344–53. http://dx.doi.org/10.1177/2047487313514019.

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35

Wonderling, D., C. McDermott, M. Buxton, A. L. Kinmonth, S. Pyke, S. Thompson, and D. Wood. "Costs and cost effectiveness of cardiovascular screening and intervention: the British family heart study." BMJ 312, no. 7041 (May 18, 1996): 1269–73. http://dx.doi.org/10.1136/bmj.312.7041.1269.

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Chalamat, Maturot, Cathrine Mihalopoulos, Rob Carter, and Theo Vos. "Assessing Cost-Effectiveness in Mental Health: Vocational Rehabilitation for Schizophrenia and Related Conditions." Australian & New Zealand Journal of Psychiatry 39, no. 8 (August 2005): 693–700. http://dx.doi.org/10.1080/j.1440-1614.2005.01653.x.

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Objective: Existing evidence suggests that vocational rehabilitation services, in particular individual placement and support (IPS), are effective in assisting people with schizophrenia and related conditions gain open employment. Despite this, such services are not available to all unemployed people with schizophrenia who wish to work. Existing evidence suggests that while IPS confers no clinical advantages over routine care, it does improve the proportion of people returning to employment. The objective of the current study is to investigate the net benefit of introducing IPS services into current mental health services in Australia. Method: The net benefit of IPS is assessed from a health sector perspective using cost–benefit analysis. A two-stage approach is taken to the assessment of benefit. The first stage involves a quantitative analysis of the net benefit, defined as the benefits of IPS (comprising transfer payments averted, income tax accrued and individual income earned) minus the costs. The second stage involves application of ‘second-filter’ criteria (including equity, strength of evidence, feasibility and acceptability to stakeholders) to results. The robustness of results is tested using the multivariate probabilistic sensitivity analysis. Results: The costs of IPS are $A10.3M (95% uncertainty interval $A7.4M–$A13.6M), the benefits are $A4.7M ($A3.1M–$A6.5M), resulting in a negative net benefit of $A5.6M ($A8.4M–$A3.4M). Conclusions: The current analysis suggests that IPS costs are greater than themonetary benefits. However, the evidence-base of the current analysis is weak. Structural conditions surrounding welfare payments in Australia create disincentives to full-time employment for people with disabilities.
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Cobiac, Linda J., King Tam, Lennert Veerman, and Tony Blakely. "Taxes and Subsidies for Improving Diet and Population Health in Australia: A Cost-Effectiveness Modelling Study." PLOS Medicine 14, no. 2 (February 14, 2017): e1002232. http://dx.doi.org/10.1371/journal.pmed.1002232.

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Butler, J. R. G., and P. J. Fletcher. "A cost-effectiveness analysis of enalapril maleate in the management of congestive heart failure in Australia." Australian and New Zealand Journal of Medicine 26, no. 1 (February 1996): 89–95. http://dx.doi.org/10.1111/j.1445-5994.1996.tb02912.x.

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Saing, Sopany, Phil Haywood, Naomi van der Linden, Kathleen Manipis, Elena Meshcheriakova, and Stephen Goodall. "Real-World Cost Effectiveness of Mandatory Folic Acid Fortification of Bread-Making Flour in Australia." Applied Health Economics and Health Policy 17, no. 2 (January 8, 2019): 243–54. http://dx.doi.org/10.1007/s40258-018-00454-3.

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Lee, Peter, Ken Chin, Danny Liew, Dion Stub, Angela L. Brennan, Jeffrey Lefkovits, and Ella Zomer. "Economic evaluation of clinical quality registries: a systematic review." BMJ Open 9, no. 12 (December 2019): e030984. http://dx.doi.org/10.1136/bmjopen-2019-030984.

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ObjectivesThe objective of this systematic review was to examine the existing evidence base for the cost-effectiveness or cost-benefit of clinical quality registries (CQRs).DesignSystematic review and narrative synthesis.Data sourcesNine electronic bibliographic databases, including MEDLINE, EMBASE and CENTRAL, in the period from January 2000 to August 2019.Eligibility criteriaAny peer-reviewed published study or grey literature in English which had reported on an economic evaluation of one or more CQRs.Data extraction and synthesisData were screened, extracted and appraised by two independent reviewers. A narrative synthesis was performed around key attributes of each CQR and on key patient outcomes or changes to healthcare processes or utilisation. A narrative synthesis of the cost-effectiveness associated with CQRs was also conducted. The primary outcome was cost-effectiveness, in terms of the estimated incremental cost-effectiveness ratio (ICER), cost savings or return-on-investment (ROI) attributed to CQR implementation.ResultsThree studies and one government report met the inclusion criteria for the review. A study of the National Surgical Quality Improvement Programme (NSQIP) in the USA found that the cost-effectiveness of this registry improved over time, based on an ICER of US$8312 per postoperative event avoided. A separate study in Canada estimated the ROI to be US$3.43 per US$1.00 invested in the NSQIP. An evaluation of a post-splenectomy CQR in Australia estimated that registry cost-effectiveness improved from US$234 329 to US$18 358 per life year gained when considering the benefits accrued over the lifetime of the population. The government report evaluating five Australian CQRs estimated an overall return of 1.6–5.5 times the cost of investment.ConclusionsAvailable data indicate that CQRs can be cost-effective and can lead to significant returns on investment. It is clear that further studies that evaluate the economic and clinical impacts of CQRs are necessary.PROSPERO registration numberCRD42018116807.
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Truong, Anthony P., Daniel Pérez-Prieto, Joshua Byrnes, Joan C. Monllau, and Christopher J. Vertullo. "Vancomycin Soaking Is Highly Cost-Effective in Primary ACLR Infection Prevention: A Cost-Effectiveness Study." American Journal of Sports Medicine 50, no. 4 (February 18, 2022): 922–31. http://dx.doi.org/10.1177/03635465211073338.

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Background: Although presoaking grafts in vancomycin has been demonstrated to be effective in observational studies for anterior cruciate ligament reconstruction (ACLR) infection prevention, the economic benefit of the technique is uncertain. Purpose: To 1) determine the cost-effectiveness of vancomycin presoaking during primary ACLR to prevent postoperative joint infections and 2) to establish the break-even cost-effectiveness threshold of the technique and determine its cost-effectiveness across various international health care settings. Study Design: Economic and decision analysis; Level of evidence, 2. Methods: A Markov model was used to determine cost-effectiveness and the incremental cost-effectiveness ratio of additional vancomycin presoaking compared with intravenous antibiotic prophylaxis alone. A repeated search of the PubMed, SCOPUS, and Cochrane Central Register of Controlled Trials databases, using the same criteria as a recent meta-analysis, was completed. A repeated meta-analysis of 9 cohort studies (level 3 evidence) was completed to determine the odds ratio of infection with vancomycin presoaking compared with intravenous antibiotics alone. Estimated costs of the vancomycin technique, treatment of infection, and further surgery were sourced from local hospitals and literature. Transitional probabilities for further surgery, including revision reconstruction and primary arthroplasty, were obtained from the literature. Probabilistic sensitivity analyses and a 1-way sensitivity analysis were performed to evaluate the ACLR infection rate break-even threshold for which the vancomycin technique would be no longer cost-effective. Results: The vancomycin soaking technique provides expected cost savings of $660 (USA), A$581 (Australia), and €226 (Spain) per patient. There was an improvement in the quality-adjusted life-years of 0.007 compared with intravenous antibiotic prophylaxis alone (4.297 vs 4.290). If the infection rate is below 0.014% with intravenous antibiotics alone, the vancomycin wrap would no longer be cost-effective. Conclusion: The vancomycin presoaking technique is a highly cost-effective method to prevent postoperative septic arthritis after primary ACLR.
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Schutte, Aletta E., Markus P. Schlaich, Karissa Johnston, Carlo A. Marra, and Ross T. Tsuyuki. "S-15-3: COST-EFFECTIVENESS OF A FULL SCOPE OF PHARMACIST CARE FOR HYPERTENSION IN AUSTRALIA." Journal of Hypertension 41, Suppl 1 (January 2023): e40. http://dx.doi.org/10.1097/01.hjh.0000913100.30857.59.

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Chew, Derek P., Robert Carter, and Andrew Boyden. "Cost-Effectiveness of a General Practice Chronic Disease Management Plan for Coronary Heart Disease in Australia." Heart, Lung and Circulation 16 (January 2007): S189. http://dx.doi.org/10.1016/j.hlc.2007.06.472.

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44

Vivian Moraa Nyaata. "Situating children in divorce mediation in South Africa and Australia: A comparative study." Journal of Policy and Development Studies (JPDS) 1, no. 1 (August 26, 2022): 30–41. http://dx.doi.org/10.51317/jpds.v4i1.226.

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This study focuses on situating children in divorce mediation in South Africa and Australia. This study investigates how South Africa and Australia have domesticated and are implementing relevant international laws and policies that allows hearing the voices of children in divorce mediation. This study found that South Africa and Australia do not have specific legislation that provides hearing in the child's voice in divorce mediation. However, the Australian government funds on-going research to improve the hearing of a child's voice in divorce mediation. Aided by government funding, Australia has developed unique techniques to listen to the child's voice during divorce mediation. The special priority afforded to children’s rights in South Africa and Australia is justified under the Capabilities approach cost-effectiveness principle because it prevents a spiralling need for state intervention later in the lives of its citizens. Some of the techniques used by the Australian government go beyond the requirements of the UNCRC and ACRWC. For example, some FRCs employ technology to screen for child abuse before hearing a child's voice in divorce mediation. Like the Office of the Family Advocate in South Africa, FRCs use a teamwork approach where child consultants and mediators work together to listen to the child's voice during divorce mediation.
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Perez, Marco V., Narmadan A. Kumarasamy, Douglas K. Owens, Paul J. Wang, and Mark A. Hlatky. "Cost-Effectiveness of Genetic Testing in Family Members of Patients With Long-QT Syndrome." Circulation: Cardiovascular Quality and Outcomes 4, no. 1 (January 2011): 76–84. http://dx.doi.org/10.1161/circoutcomes.110.957365.

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46

Donovan, Peter J., Donald S. A. McLeod, Richard Little, and Louisa Gordon. "Cost–utility analysis comparing radioactive iodine, anti-thyroid drugs and total thyroidectomy for primary treatment of Graves’ disease." European Journal of Endocrinology 175, no. 6 (December 2016): 595–603. http://dx.doi.org/10.1530/eje-16-0527.

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Objective Little data is in existence about the most cost-effective primary treatment for Graves’ disease. We performed a cost–utility analysis comparing radioactive iodine (RAI), anti-thyroid drugs (ATD) and total thyroidectomy (TT) as first-line therapy for Graves’ disease in England and Australia. Methods We used a Markov model to compare lifetime costs and benefits (quality-adjusted life-years (QALYs)). The model included efficacy, rates of relapse and major complications associated with each treatment, and alternative second-line therapies. Model parameters were obtained from published literature. One-way sensitivity analyses were conducted. Costs were presented in 2015£ or Australian Dollars (AUD). Results RAI was the least expensive therapy in both England (£5425; QALYs 34.73) and Australia (AUD5601; 30.97 QALYs). In base case results, in both countries, ATD was a cost-effective alternative to RAI (£16 866; 35.17 QALYs; incremental cost-effectiveness ratio (ICER) £26 279 per QALY gained England; AUD8924; 31.37 QALYs; ICER AUD9687 per QALY gained Australia), while RAI dominated TT (£7115; QALYs 33.93 England; AUD15 668; 30.25 QALYs Australia). In sensitivity analysis, base case results were stable to changes in most cost, transition probabilities and health-relative quality-of-life (HRQoL) weights; however, in England, the results were sensitive to changes in the HRQoL weights of hypothyroidism and euthyroidism on ATD. Conclusions In this analysis, RAI is the least expensive choice for first-line treatment strategy for Graves’ disease. In England and Australia, ATD is likely to be a cost-effective alternative, while TT is unlikely to be cost-effective. Further research into HRQoL in Graves’ disease could improve the quality of future studies.
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Thijs, Vincent, Klaus K. Witte, Carmel Guarnieri, Koji Makino, Dominic Tilden, John Gillespie, and Marianne Huynh. "Cost‐effectiveness of insertable cardiac monitors for diagnosis of atrial fibrillation in cryptogenic stroke in Australia." Journal of Arrhythmia 37, no. 4 (June 22, 2021): 1077–85. http://dx.doi.org/10.1002/joa3.12586.

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Dalziel, Kim, Leonie Segal, and Rachelle Katz. "Cost-effectiveness of mandatory folate fortification v. other options for the prevention of neural tube defects: results from Australia and New Zealand." Public Health Nutrition 13, no. 4 (September 17, 2009): 566–78. http://dx.doi.org/10.1017/s1368980009991418.

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AbstractObjectiveTo provide input to Australian and New Zealand government decision making regarding an optimal strategy to reduce the rate of neural tube defects (NTD).DesignStandard comparative health economic evaluation techniques were employed for a set of intervention options for promoting folate/folic acid consumption in women capable of or planning a pregnancy. Evidence of effectiveness was informed by the international literature and costs were derived for Australia and New Zealand.ResultsPopulation-wide campaigns to promote supplement use and mandatory fortification were the most effective at reducing NTD, at an estimated 36 and 31 fewer cases per annum respectively for Australia and New Zealand, representing an 8 % reduction in the current annual NTD rate. Population-wide and targeted approaches to increase supplement use were cost-effective, at less than $AU 12 500 per disability-adjusted life year (DALY) averted ($US 9893, £5074), as was extending voluntary fortification. Mandatory fortification was not cost-effective for New Zealand at $AU 138 500 per DALY ($US 109 609, £56 216), with results uncertain for Australia, given widely varying cost estimates. Promoting a folate-rich diet was least cost-effective, with benefits restricted to impact on NTD.ConclusionsSeveral options for reducing NTD appear to fall well within accepted societal cost-effectiveness norms. All estimates are subject to considerable uncertainty, exacerbated by possible interactions between interventions, including impacts on currently effective strategies. The Australian and New Zealand governments have decided to proceed with mandatory fortification; it is hoped they will support a rigorous evaluation which will contribute to the evidence base.
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Weatherburn, Don. "Law and Order Blues." Australian & New Zealand Journal of Criminology 35, no. 2 (August 2002): 127–44. http://dx.doi.org/10.1375/acri.35.2.127.

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This paper discusses law and order politics and policy in Australia. It challenges the conventional criminological wisdom that Australia does not have a serious crime problem. It argues that, while political responses to crime are all too frequently irrational, this is not because Australian state and territory governments so often rely on punitive law and order policies. Australian law and order policy is irrational because it usually lacks any clear rationale, is rarely subjected to any effectiveness or cost-effectiveness evaluation, frequently ignores the possibility of unintended side-effects and is occasionally founded on a misdiagnosis of the crime problem that prompts it. The paper concludes by discussing various explanations for this state of affairs and what can be done about it.
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Van Den Bogaerde, J., and D. Sorrentino. "Bringing Top-End Endoscopy to Regional Australia: Hurdles and Benefits." Diagnostic and Therapeutic Endoscopy 2012 (September 9, 2012): 1–7. http://dx.doi.org/10.1155/2012/347202.

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This paper focuses on recent experience in setting up an endoscopy unit in a large regional hospital. The mix of endoscopy in three smaller hospitals, draining into the large hospital endoscopy unit, has enabled the authors to comment on practical and achievable steps towards creating best practice endoscopy in the regional setting. The challenges of using what is available from an infrastructural equipment and personnel setting are discussed. In a fast moving field such as endoscopy, new techniques have an important role to play, and some are indeed cost effective and have been shown to improve patient care. Some of the new techniques and technologies are easily applicable to smaller endoscopy units and can be easily integrated into the practice of working endoscopists. Cost effectiveness and patient care should always be the final arbiter of what is essential, as opposed to what is nice to have. Close cooperation between referral and peripheral centers should also guide these decisions.
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