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Current PhD students

Rebecca Addo
The feasibility of health technology assessment in the Ghana health system

With the global movement towards universal health coverage and the continuous increase in the cost of health care the World Health Organisation (WHO) in a resolution made in 2014 entreats all member states to adopt and use health interventions and technology assessment for priority setting in the health system. This is to ensure efficient use of the limited healthcare resources available to meet the numerous demands. 

However, literature shows that low and middle income countries are highly constrained in terms of the technical capacity (labour and data) to conduct Health Technology Assesments (HTAs). This study therefore seeks to assess the feasibility of using HTA in such settings with Ghana as a case study. 

Ghana is a low middle income country which is currently faced with the challenge of sustaining a National health insurance system and the health system as a whole financially. The use of an evidence based priority setting tool such as HTA is needed now more than ever. Also there have been steps made towards using this through the draft health bill 2015 and collaboration with NICE UK international. 

Therefore, in assessing the feasibility of HTA in the Ghana health system , the available technical capacity will be assessed.  Also, transferring data from other settings for use in Ghana in HTA will be explored. To also guide the development of an HTA agency/program in Ghana, the knowledge and perception of decision makers towards the use of HTA will be assessed. 

Supervisors: Prof Jane Hall, Prof Marion Haas, Prof Stephen Goodall

Sheena Arora
Economic evaluation of an intervention in parents with children who have developmental disabilities
Developmental disabilities refer to the group of conditions that arise from physical, learning, language or behavioural impairments. These conditions usually occur in the early stages of life when the majority of physical and cognitive development occurs. Common developmental disabilities include attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorders, cerebral palsy, vision impairment, foetal alcohol spectrum disorders, fragile X syndrome and intellectual disabilities.

This PhD is part of a broader National Health and Medical Research Council (NHMRC) funded research program that will investigate the outcomes of a parenting intervention designed for families with children aged 2-12 years old that have developmental disabilities (Stepping Stones Triple P).

The objective of the PhD is to conduct an economic evaluation of the Stepping Stones Triple P program. Given the long-term impact of developmental disabilities, the economic evaluation will consider the lifetime accrual of benefits and costs. Key issues that will be addressed by the research will include establishing a and validating a tool to estimate resource utilisation in this population, extrapolating short-term outcomes to the longer-term, measuring and valuing workforce participation of parents, and the measurement of costs and opportunity costs associated with informal care.

Supervisors: Prof Stephen Goodall, Prof Rosalie VineyProf Stewart Einfeld1

1. University of Sydney

Paula Cronin
Measuring the social and economic impact of communication disorders in Australia
Speech and language impairment (SLI) is a childhood condition which, if untreated, can have long-term health and welfare consequences. SLI affects up to 20% of Australian 4-5 year olds. Researchers found that  speech only impairment affected up to 24.6%, and language only impairment up to 19% of 4-5yr olds in the United Kingdom. Communication disorders in 4-5 year olds are in the range of 12-13% of Australian children. Primary SLI (where it cannot be accounted for by any other known etiology) is more prevalent than autism (about 0.7%) and about the same as asthma (17-21%) and childhood obesity (about 20%). However, despite its high prevalence, the impact of SLI on children’s development is poorly understood.

Increasingly evidence suggests that there are both short-term and long-term costs and effects of childhood SLI. Children with SLI require more school-based remedial care, achieve lower educational grades, complete fewer years of education and are more likely to be in low paid employment or unemployed.

One of the major problems facing policy makers is how to estimate the burden of SLI and other learning difficulties. According to a Speech Pathology Australia briefing paper, there is an urgent need for data to measure social and economic of communication disorders in Australia. To our knowledge, this will be the first study to address the short-term and long-term economic impact of Australian children with communication disorders, such as those with SLI. This PhD aims to develop models which enable policy makers to estimate the burden of communication disorders in children. A further aim is to create a model that can be used to estimate the benefits and cost-effectiveness of early childhood learning interventions.

Supervisors: Prof Stephen Goodall, Dr Tricia McCabe1, Rosalie Viney, Rebecca Reeve2

1. University of Sydney

Richard De Abreu Lourenço
More than Health:  the role and value of meta-health effects in health care decisions
One of the most visible functions of government is to make decisions about health care; particularly about whether or not to fund new and increasingly expensive treatments and services.  Those decisions are often informed by economic evaluations, cost-utility analyses, that measure value in terms of the cost per quality adjusted life years (QALYs).  However, QALYs might not capture all the benefits that patients and society derive from health; so-called meta-health effects such as reassurance and convenience, that arise out of the experience of health care, are also a source of value that potentially influence decision making.

The focus of this PhD is on how meta-health effects influence decision making in a health care context, and how they can be assessed for use in an economic evaluation.  The research aims to explore how differences in the decision making context (general practitioner use in primary care, ongoing therapy for rheumatoid arthritis, and management of breast cancer recurrence risk) and the presentation of information influence the role and valuation of meta-health effects in decision making.  This research applies existing theories of the impact of framing effects to the relative values derived for meta-health effects compared with health effects, and their influence on choice in a health care context.  Qualitative and quantitative research methods are used to define the parameters of interest for valuation, and subsequently to evaluate them using stated preference methods.

Supervisors: Prof Rosalie Viney, Prof Jane Hall, Prof Marion Haas

Dr Philip Haywood
An outcome based reimbursement scheme for cancer pharmaceuticals
There is a lack of timely economic information at the local level for the treatment of patients with cancer. This lack of information is compounded by the expected increase in the number of cancer pharmaceuticals becoming available for use in treatment. Further increasing the complexity of this problem is the potential for the newer biological pharmaceuticals to have a different adverse event profiles than traditional chemotherapy. A final challenge is that, in practice, cancer treatment is often the consideration of sequences of treatments rather than comparing between individual treatment alternatives. A lack of validated and useful information about opportunity costs may lead to health practitioners making sub-optimal choices about treatment. Developing and validating models for economic information in the Australian context at a local level is an important area of research to overcome this deficit.

The major aims of the research are to:
1. Develop models of cost and consequence for sequences of pharmaceuticals used in the treatment of cancer;
2. Populate the models with information gained from available data collections, existing literature and potentially new data collections; and
3. Validate the use of the models for both traditional and newer pharmaceuticals and the associated sequences.

One of the potential challenges with the proposed research approach will be the issue of switching treatment schedules. The explicit modelling of this decision may be important to producing valuable local level economic evaluations. This has been identified in the literature as a major difficulty in using registry data to develop economic information and also reflects one of the key drivers of cost and consequence.

Supervisors:  Prof Marion HaasProf Rosalie Viney

Brendan Mulhern
Testing and advancing the methods used to develop and value preference based measures for use in economic evaluation
Preference based measures of health (PBMs) are used in the estimation of Quality Adjusted Life Years (QALYs) which is a metric that informs the economic evaluation of new and existing health interventions.  However there are a range of issues with both the descriptive systems and utility value sets that may limit the validity of the measures in healthcare decision making.  Therefore this PhD will investigate and advance methods for the development and valuation of preference based measures for use in healthcare decision making, and investigate the development of a new measurement system.

The aims and objectives are:

1.  To test the performance of a range outcome measures assessing different aspects of quality of life, and develop an innovative approach to the analysis of this data

2.  To investigate the development of measurement system combining outcomes measuring a range of different outcomes related to quality of life

3.  To test the use of existing preference elicitation methods to develop a value set for a combined measurement system

Preference based measures of health (PBMs) are used in the estimation of Quality Adjusted Life Years (QALYs) which is a metric that informs the economic evaluation of new and existing health interventions.  However there are a range of issues with both the descriptive systems and utility value sets that may limit the validity of the measures in healthcare decision making.  Therefore this PhD will investigate and advance methods for the development and valuation of preference based measures for use in healthcare decision making, and investigate the development of a new measurement system.

Supervisors: Prof Rosalie Viney, Prof Debbie Street, Prof John Brazier1

1. University of Sheffield

Bonny Parkinson
Pharmaceutical Policy in Australia: Dealing with Uncertainty
There are increasing demands for the provision of health care to improve survival and quality of life. A dollar spent on one type of health care (e.g. a pharmaceutical, an hour of a clinician’s time, or some medical equipment) is unavailable to spend on another form of health care, or on other public goods such as education or roads, and therefore there is an opportunity cost in terms of forgone benefits. A key plank of pharmaceutical policy in Australia is the use of economic evaluation to ensure that limited health care resources provide the best value for money. Economic evaluation involves evaluating the incremental effectiveness of a treatment versus an alternative use of funds (often current practice) and comparing it to the incremental cost. In the case of pharmaceuticals, randomised controlled trials (RCTs) are the key source of evidence of efficacy. However RCTs often do not collect all the evidence required and there is a need to translate the data, and synthesise with other forms of evidence, to arrive at a form suitable for decision makers. The process of translating the RCT data introduces uncertainty, and sometimes bias, into the economic evaluation results.

The aim of this thesis is to improve the methods used to assess the cost-effectiveness of pharmaceuticals in theory and in practice by understanding:

• How might economic evaluations use different approaches to translate the same RCT data and arrive at different conclusions?
• How the cost-effectiveness of a treatment may differ in clinical practice compared to that assumed in an economic evaluation based on an RCT?
• How can decision makers better handle uncertainty regarding comparative effectiveness and cost-effectiveness, using data obtained through RCTs or observational studies? and
• How can the uptake of a treatment be more accurately predicted?

Bonny was awarded her PhD in 2015.

Supervisors: Prof Stephen Goodall, Prof Rosalie VineyProf Marion Haas.

Ros Pritchard
The cost effectiveness of advanced heart failure management and mechanical circulatory assist therapy
Heart failure is a chronic condition that affects 1.5-2.0% of Australians. It is estimated to cost the economy more than $1 billion annually. For those at the most severe end of the heart failure spectrum, re-hospitalisations are common and costs are compounded by expensive treatment options including transplantation and mechanical circulatory support through the implantation of left ventricular assist devices (LVADs).

The technology is advancing quickly with newer continuous flow devices showing fewer complications and better survival, and the demand for LVAD therapy is likely to rise as the population ages and a significant proportion face the reality of living with advanced heart failure.
No studies have examined cost effectiveness of LVADs in the Australian context, and we know very little about the actual health resource use of patients with advanced heart failure (particularly in the 12 months prior to LVAD implantation).

This study will assess the cost effectiveness of LVAD therapy in an Australian health care setting and explore the development of utility measures that will capture the experience of living with an implantable mechanical support device.

The retrospective component will compare the costs generated by patients with LVADs with the costs for those who receive optimum medical management only. The prospective cohort study will capture the journey of patients from first presentation to a quaternary hospital through four possible treatment pathways, using clinical, frailty and utility outcome measures to generate a comprehensive cost effectiveness evaluation of mechanical heart failure therapy.

(Enrolled Faculty of Health, UTS)

Supervisors: Prof Stephen Goodall, Trish Davidson, Chris Hayward

Mohammad Habibullah Pulok
Equity in the Australian health care system:  Exploring the unknowns and updating the knowns

Equity, efficiency and responsiveness are the three features of a well performing health system. Equity in health care goes beyond equality as it is concerned with fairness and justice in the health system. So, achieving equity is a central policy objective of many care health systems, including Australia. The importance of evaluating the performance of health systems in terms of equity has been in the spotlight for both policymakers' and academics' perspectives in the last two and half decades. The contribution of health economists to develop measurement tools for assessing healthcare equity is substantial and there has been an explosion in the numbers of empirical applications using survey data since early 2000. However, despite this interest, there are substantial gaps in our knowledge and there is a new opportunity of using administrative data to routinely report indicators of health care equity.

Australia’s universal health insurance scheme, Medicare was established to achieve equitable distribution of health care. However, compared to other OECD countries, empirical studies on equity in health care in Australia are limited. Empirical evidence on equity in access to health care from Australia suggests that the system follows a similar pattern to many OECD health systems where the distribution of GP visits is pro-poor and specialist visits are pro-rich. Existing Australian studies have relied on national health surveys and the findings are not routinely updated. Application of administrative data is almost rare and health care equity analysis at the local level is also absent in Australia.

The main objective of this PhD is to contribute methodologically to health care equity analysis using administrative data in the Australian setting. This PhD will also explore methods of health care need assessment from administrative data. Furthermore, this project will explain local level variation in the inequity of health care services. Finally, an update of previous empirical evidence using recent national health surveys will be another outcome of this PhD.

Supervisors: Prof Jane HallA/Prof Kees van GoolProf Rosalie Viney

Sopany Saing
Modelling the cost-effectiveness of strategies to treat end-stage heart failure using discrete event simulation
Economic evaluation is performed to help make better resource allocation decisions within the health care system. Health technology assessment guidelines and methods had first been established in the context of pharmaceutical reimbursement. Its application to medical devices presents some challenges including the lack of quantity and quality of evidence (e.g limited randomised controlled trials and reliance on observational data). Other challenges include the learning curve associated with medical devices, particularly, implantable devices and the incremental improvements of devices over time. In addition to this, operational factors such as restricted supply (either due to high cost or restricted indication) all influence the cost effectiveness of implantable medical devices.

The PhD will explore these complexities using a case-study of treatment options for patients with end-stage heart failure (ESHF). In the past, patients have relied on heart transplants. However, with decreasing donor hearts available, clinicians are looking towards other treatment strategies including mechanical circulatory support in the form of ventricular assist devices (VADs). VADs represent an opportunity for patients with ESHF to be given a VAD whilst waiting for a donor heart to become available. Overseas, VADs are becoming long-term option for patients not being considered for heart transplants, that is, until death.

This PhD aims to conduct an economic evaluation of the treatment strategies of ESHF in Australia. The PhD will explore the application of advanced modelling methods to address the resource capacity constraints associated with life-saving treatments in ESHF. This project will also review methods to incorporate observational data into measures of effectiveness. The project will use individual patient data on costs and outcomes from St. Vincents Hospital.

Supervisors: Prof Stephen Goodall, Dr Naomi van der Linden, Prof Christopher Hayward1

1. St Vincent's Hospital 

Heni Wayhuni
Maternal and infant health in Indonesia
The aim is to examine factors that determine infant health at birth. The research uses the conceptual framework of the infant health production function. Inputs into the infant health production function include mother’s health, education, income, other individual factors, use of prenatal care, access to health care providers, and mother’s participation in community groups. The research aims to extend beyond previous research that uses an infant health production function by considering the impact of mother’s participation in community activities. Heni has given presentations on her research at national and international conferences including AHES and iHEA.

Heni holds a World Bank Scholarship and her PhD was awarded in 2014.

Supervisors: Prof Jane Hall, Prof Rosalie VineyDr Rebecca Reeve

Dr Michael Wright
21st Century Continuity of Care - Understanding Person and Place Based Continuity in Australian General Practice

Continuity of care is considered an essential characteristic of primary health care and one of the building blocks of a high performing primary health system.  Traditionally continuity of care has considered the therapeutic relationship that develops between a doctor and patient over multiple consultations, as typically occurs in general practice. More recently, the concept of continuity of care has expanded to include the coordination of information and management required for safe care in an increasingly complex health system.

Relational continuity of care with a single doctor (such as a GP) has been associated with increased patient satisfaction and decreased health care costs.  The evidence for the non-relational aspects of continuity of care (more important in coordinating care) in decreasing health care costs is inconclusive.

This research seeks to understand both relational and non-relational continuity of care in Australian general practice, and to understand if the benefits of relational continuity of care with a provider (in terms of decreased health care usage and health care costs) are applicable at a practice level.

This research also seeks to understand why patients seek out continuity of care, the value of seeing a known provider, and whether this value is applicable to a known practice. This research uses predominantly econometric techniques.

This research has policy implications for future structure and funding of general practice services.

Supervisors: Prof Jane Hall, A/Prof Kees van Gool, Prof Marion Haas