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Dr Richard Norman

Biography

Richard is a Health Economist with ongoing interest in the economic evaluation of healthcare, the measurement and valuation of quality of life, discrete choice experiments and econometric analysis of large panel datasets. He holds an BA(Hons) in Philosophy and Economics and an MSc in Health Economics, both from the University of York in the UK, and a PhD from the University of Technology, Sydney. He is a current recipient of an NHMRC Early Career Research Fellowship to explore patterns and preferences around quality of life. Additionally, he is a Chief Investigator on projects funded by the NHMRC and the ARC.

A STATA do file to generate Australia EQ-5D weights based on Viney et al. (2011) can be found here.

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Visiting Fellow, Centre for Health Economics Research and Evaluation
MSc (York), PhD Health Economics
 

Chapters

Norman, R. 2013, 'Were just 67% of GP visits bulk-billed when Tony Abbott was health minister?' in Conversation, T. & Sykes, H. (eds), The story of the 2013 election: Insight and analysis from Australia's leading minds, Future Leaders, Melbourne, pp. 276-280.

Conferences

Viney, R.C., Street, D., Norman, R. & Mulhern, B. 2016, 'Discrete Choice Experiments: An Introduction (Invited Workshop)', EuroQoL Mid Year Plenary Meeting, Nordwijk, Netherlands.
Norman, R., Viney, R.C., Street, D., Cronin, P.A. & Ratcliffe, J. 2013, 'Using choice experiments to explore preferences for health profiles with different survival durations: experience from Australia', iHEA 9th World Congress on Health Economics, Sydney.
Gu, Y., Norman, R. & Viney, R.C. 2013, 'Estimating health state utility values from discrete choice experiments: a QALY space model approach', Fourth Australasian Workshop on Econometrics and Health Economics, Launceston, Tasmania.
Gu, Y., Norman, R. & Viney, R.C. 2013, 'Estimating QALY values from discrete choice experiments using mixed logit models', 3rd International Choice Modelling Conference, Sydney.
Cronin, P.A., Goodall, S., Lockett, T., O'Keefe, R., Norman, R. & Church, J. 2013, 'Cost-effectiveness of a mailed advance notification letter to increase colorectal cancer screening', ISPOR 18th Annual International Meeting, New Orleans, USA.
Norman, R., Viney, R.C., Brazier, J.E., King, M.T., Cronin, P.A., Ratcliffe, J. & Street, D. 2012, 'Australian algorithms for the EQ-5D-3L and EQ-5D-5L', International Society for Quality of Life Research Congress, Budapest, Hungary.
Norman, R., Brazier, J.E., Viney, R.C., Burgess, L.B., Cronin, P.A., King, M.T., Ratcliffe, J. & Street, D. 2012, 'Revaluing the SF-6D using ordinal methods for eliciting preferences', International Society for Quality of Life Research Congress, Budapest, Hungary.
Norman, R., Viney, R.C., Brazier, J.E., Cronin, P.A., King, M.T., Ratcliffe, J. & Street, D. 2012, 'Valuing EQ-5D health states: The Australian experience', EuroQoL Group Plenary Meeting, Rotterdam.
Norman, R., Viney, R.C., Brazier, J.E., Cronin, P.A., King, M.T., Ratcliffe, J. & Street, D. 2012, 'Using discrete choice experiments to value health states for economic evaluation: The SF-6D in Australia', ISPOR Asia-Pacific Congress, Taiwan.
Norman, R., Viney, R.C., Brazier, J.E., Burgess, L.B., Cronin, P.A., King, M.T., Ratcliffe, J. & Street, D. 2012, 'A DCE-derived algorithm for the SF-6D', 34th Australian Conference of Health Economists (AHES), Darwin.
Church, J., Goodall, S., Norman, R., Reeve, R.D. & Haas, M.R. 2012, 'Using panel data to inform economic evaluation', ISPOR 5th Asia-Pacific Conference, Taipei, Taiwan.
Gu, Y., Norman, R. & Viney, R.C. 2012, 'Estimating QALY values from discrete choice experiments using mixed logit models', 34th Australian Conference of Health Economists (AHES), Darwin.
Church, J., Goodall, S., Norman, R., Reeve, R.D. & Haas, M.R. 2012, 'PRM19: Using panel data to inform economic evaluation [conference abstract]', Value in Health, Elsevier, Taiwan, pp. 1-1.
Norman, R. 2012, 'Equity weighting in the economic evaluation of healthcare', PhD conference in Economics and Business, Perth.
Norman, R. & Goodall, S. 2012, 'Panel discussion - Integrating research and policy to safeguard fair distribution of health care resources: Incorporating an ethical and social value focus', Health Technology Assessment Conference, Sydney.
Norman, R. 2011, 'Tragedy of the uncommon? A comparison of preference elicitation techniques for Australian EQ-5D weights', Australian Conference of Health Economists, Melbourne.
Viney, R.C., Norman, R., King, M.T., Cronin, P.A., Street, D., Ratcliffe, J. & Brazier, J.E. 2011, 'Using a discrete choice experiment to value EQ-5D health states', iHEA 8th World Congress, Toronto, Canada.
Church, J., Norman, R. & Goodall, S. 2011, 'Relationship between body mass index and quality of life for application in economic evaluation', iHEA 8th World Congress, Toronto, Canada.
Church, J. & Norman, R. 2010, 'Modelling the costs and benefits of interventions to prevent and reduce obesity', Emerging Health Policy Research Conference, Sydney University.
Parkinson, B.T. & Norman, R. 2010, 'Measuring Loss of Consumer Choice in mandatory health programmes using discrete choice experiments', 32nd Conference of Australian Health Economists, Sydney.
Norman, R., Gallego, G., Goodall, S. & Hall, J.P. 2009, 'Equity weights for economic evaluation: Using Discrete Choice Experiments in an Australian population', iHEA 7th World Congress, Beijing, China.
Cronin, P.A., Norman, R., Viney, R.C., King, M.T., Street, D., Burgess, L.B., Brazier, J.E. & Ratcliffe, J. 2009, 'Can Time Trade Off be implemented online? A case study from Australia using the EQ-5D (Poster)', iHEA 7th World Congress, Beijing, China.
Viney, R.C., Norman, R., Street, D., King, M.T., Burgess, L.B., Brazier, J.E. & Ratcliffe, J. 2009, 'Application of discrete choice experiments to value multi-attribute health states: experimental design issues', iHEA 7th World Congress, Beijing, China.
Gallego, G., Casey, R., Norman, R. & Goodall, S. 2009, 'Introduction and uptake of new medical technologies in the Australian health care system: Hesitant, uneven or ill-informed?', 6th Health Services and Policy Research Conference 2009, Brisbane.
Cronin, P.A., Goodall, S., Norman, R. & Church, J. 2009, 'The impact of improving screening participation rate and diagnostic test sensitivity on colorectal cancer screening', 6th Health Services and Policy Research Conference 2009, Brisbane.
Gallego, G., Casey, R., Norman, R. & Goodall, S. 2009, 'Does the procedure matter? Differences in the funding of drugs and medical services in Australia', ISPOR 12th Annual European Congress, Paris.
Cronin, P.A., Norman, R., King, M.T., Clarke, D., Viney, R.C. & Street, D. 2009, 'Does mode of administration matter? Comparison of online and face to face administration of a time trade-off task', Brisbane.
Chenoweth, L., Haas, M.R., Jeon, Y., Stein-Parbury, M.J., Anstey, K., Brodaty, H., King, M.T., Luscombe, G. & Norman, R. 2008, 'Can we improve well-being and quality of care for people with dementia by providing person-centred care?', 13th National Health Outcomes Conference, 13th National Health Outcomes Conference, University of Wollongong, Canberra, Australia, pp. 1-11.
To test the effectiveness and cost-effectiveness of two models of nursing care, person-centred care (PCC) and Dementia Care Mapping (DCM), relative to Usual Care (UC), in improving well-being and quality of care and reducing agitation and other behaviourial disturbances, for people with Demetia in residential care facilities.
Gallego, G., Goodall, S. & Norman, R. 2008, 'The implementation of economic evaluation for blood and blood products in Australia: the challenges ahead', Australian Conference of Health Economists, Adelaide.
Haas, M.R., Norman, R., Walkley, J. & Brennan, L. 2008, 'Evaluating the cost-effectiveness of Cognitive Behavioural Therapy for Overweight/Obese Adolescents', Health Outcomes Conference, Canberra.
Viney, R.C., Norman, R., King, M.T., Cronin, P.A., Street, D., Brazier, J.E. & Ratcliffe, J. 2008, 'Application of discrete choice experiments to value multi-attribute health states for use in economic evaluation', Australian Conference of Health Economists, Adelaide.
Viney, R.C., Norman, R., King, M.T., Cronin, P.A., Street, D., Ratcliffe, J. & Brazier, J.E. 2008, 'Application of discrete choice experiments to value multi-attribute health states for use in economic evaluation', 13th National Health Outcomes Conference, Canberra.
Norman, R., Goodall, S., Gallego, G. & Hall, J.P. 2008, 'The trade-off between equality of outcome and efficiency in healthcare: A discrete choice experiment', Australian Conference of Health Economists, Adelaide.
King, M.T., Viney, R.C., Norman, R., Cronin, P.A., Street, D., Brazier, J.E. & Ratcliffe, J. 2008, 'Valuation of EQ-5D health states using discrete choice experiments: effect of excluding implausible states', International Society for Quality of Life Research (ISOQOL) Conference, Montevideo, Uruguay.
Goodall, S., Norman, R. & Gallego, G. 2008, 'The Cost-effectiveness of Mandatory Iodine Fortification in Australia', Public Health Nutrition in Australia: Principles to Practice, reality to Rhetoric, Adelaide.
Goodall, S., Norman, R. & Gallego, G. 2008, 'The Cost-effectiveness of Iodine Fortification in Australia', Australian Academy of Science symposium: Iodine Deficiency in Australia: A Call for Action, Canberra.
King, M.T., Chenoweth, L., Brodaty, H., Jeon, Y., Stein-Parbury, M.J., Haas, M.R., Luscombe, G. & Norman, R. 2007, 'Can we improve well-being for people with dementia by providing person-centred nursing care?', 14th Annual Conference of the International Society for Quality of Life Research, International Society for Quality of Life Research, Toronto, Canada.
To test the effectiveness and cost-effectiveness of the two models of nursing care, person-centred care (PCC) and Dementia Care Mapping (DCM), relative to usual care (UC), in improving well-being and quality of care and reducing agitation and other behavioural disturbances, for people with dementia in residential care facilities.
Norman, R., Cronin, P.A., Viney, R.C., King, M.T., Street, D., Brazier, J.E. & Ratcliffe, J. 2007, 'Issues in the valuation of health using multi-attribute utility measures; the EQ-5D', Australian Conference of Health Economists, Brisbane.

Journal articles

Hole, A.R., Norman, R. & Viney, R. 2016, 'Response patterns in health state valuation using endogenous attribute attendance and latent class analysis', Health economics, vol. 25, no. 2, pp. 212-224.
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Not accounting for simplifying decision-making heuristics when modelling data from discrete choice experiments has been shown potentially to lead to biased inferences. This study considers two ways of exploring the presence of attribute non-attendance (that is, respondents considering only a subset of the attributes that define the choice options) in a health state valuation discrete choice experiment. The methods used include the latent class (LC) and endogenous attribute attendance (EAA) models, which both required adjustment to reflect the structure of the quality-adjusted life year (QALY) framework for valuing health outcomes. We find that explicit consideration of attendance patterns substantially improves model fit. The impact of allowing for non-attendance on the estimated QALY weights is dependent on the assumed source of non-attendance. If non-attendance is interpreted as a form of preference heterogeneity, then the inferences from the LC and EAA models are similar to those from standard models, while if respondents ignore attributes to simplify the choice task, the QALY weights differ from those using the standard approach. Because the cause of non-attendance is unknown in the absence of additional data, a policymaker may use the range of weights implied by the two approaches to conduct a sensitivity analysis. Copyright © 2014 John Wiley & Sons, Ltd.
Norman, R., Viney, R.C., Aaronson, N.K., Brazier, J.E., Cella, D., Costa, D.S., Fayers, P.M., Kemmler, G., Peacock, S., Pickard, A.S., Rowen, D., Street, D.J., Velikova, G., Young, T.A. & King, M.T. 2016, 'Using a discrete choice experiment to value the QLU-C10D: feasibility and sensitivity to presentation format', Quality of Life Research, vol. 25, no. 3, pp. 637-649.
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Purpose To assess the feasibility of using a discrete choice experiment (DCE) to value health states within the QLU-C10D, a utility instrument derived from the QLQ-C30, and to assess clarity, difficulty, and respondent preference between two presentation formats. Methods We ran a DCE valuation task in an online panel (N = 430). Respondents answered 16 choice pairs; in half of these, differences between dimensions were highlighted, and in the remainder, common dimensions were described in text and differing attributes were tabulated. To simplify the cognitive task, only four of the QLU-C10D's ten dimensions differed per choice set. We assessed difficulty and clarity of the valuation task with Likert-type scales, and respondents were asked which format they preferred. We analysed the DCE data by format with a conditional logit model and used Chi-squared tests to compare other responses by format. Semi-structured telephone interviews (N = 8) explored respondents' cognitive approaches to the valuation task. Results Four hundred and forty-nine individuals were recruited, 430 completed at least one choice set, and 422/449 (94 %) completed all 16 choice sets. Interviews revealed that respondents found ten domains difficult but manageable, many adopting simplifying heuristics. Results for clarity and difficulty were identical between formats, but the 'highlight format was preferred by 68 % of respondents. Conditional logit parameter estimates were monotonic within domains, suggesting respondents were able to complete the DCE sensibly, yielding valid results. Conclusion A DCE valuation task in which only four of the QLU-C10D's ten dimensions differed in any choice set is feasible for deriving utility weights for the QLU-C10D.
King, M.T., Costa, D.S., Aaronson, N.K., Brazier, J.E., Cella, D., Fayers, P.M., Grimison, P., Janda, M., Kemmler, G., Norman, R., Pickard, A.S., Rowan, D., Velikova, G., Young, T.A. & Viney, R.C. 2016, 'QLU-C10D: a health state classification system for a multi-attribute utility measure based on the EORTC QLQ-C30', Quality of Life Research, vol. 25, no. 3, pp. 625-636.
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Norman, R., Mulhern, B.J. & Viney, R. 2016, 'The impact of different DCE-based approaches when anchoring utility scores', PharmacoEconomics, vol. 34, no. 8, pp. 805-814.
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Norman, R., Kemmler, G., Viney, R., Pickard, A.S., Gamper, E., Holzner, B., Nerich, V. & King, M. 2016, 'Order of Presentation of Dimensions Does Not Systematically Bias Utility Weights from a Discrete Choice Experiment', Value in Health, vol. 19, no. 8, pp. 1033-1038.
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© 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR).Background: Discrete choice experiments (DCEs) are increasingly used to value aspects of health. An issue with their adoption is that results may be sensitive to the order in which dimensions of health are presented in the valuation task. Findings in the literature regarding order effects are discordant at present. Objectives: To quantify the magnitude of order effect of quality-of-life (QOL) dimensions within the context of a DCE designed to produce country-specific value sets for the EORTC Quality of Life Utility Measure-Core 10 dimensions (QLU-C10D), a new utility instrument derived from the widely used cancer-specific QOL questionnaire, the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30. Methods: The DCE comprised 960 choice sets, divided into 60 versions of 16 choice sets, with each respondent assigned to a version. Within each version, the order of QLU-C10D QOL dimensions was randomized, followed by life duration in the last position. The DCE was completed online by 2053 individuals in France and Germany. We analyzed the data with a series of conditional logit models, adjusted for repeated choices within respondent. We used . F tests to assess order effects, correcting for multiple hypothesis testing. Results: Each . F test failed to reject the null hypothesis of no position effect: 1) all QOL order positions considered jointly; 2) last QOL position only; 3) first QOL position only. Furthermore, the order coefficients were small relative to those of the QLU-C10D QOL dimension levels. Conclusions: The order of presentation of QOL dimensions within a DCE designed to provide utility weights for the QLU-C10D had little effect on level coefficients of those QOL dimensions.
Norman, R., Mulhern, B., Viney, R., Bansback, N. & Pearce, A. 2016, 'The Impact of Duration on EQ5D5L Value Sets Derived from a Discrete Choice Experiment', Value in Health, vol. 19, no. 7, pp. A828-A828.
Burgess, L., Knox, S.A., Street, D.J. & Norman, R. 2015, 'Comparing Designs Constructed With and Without Priors for Choice Experiments: A Case Study', Journal of Statistical Theory and Practice, vol. 9, no. 2, pp. 330-360.
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This article describes the second stage of an empirical comparison of the performance of designs for a discrete choice experiment. Six designs were chosen to represent the range of construction techniques that are currently popular for choice experiments, with some of the designs incorporating into the design generation process prior knowledge of the parameters gained from the previous stage of this experiment. Each design had 320 respondents, each of whom completed 16 choice sets. The results indicate that efficient designs constructed using several different strategies all identify various types of heterogeneity with similar levels of precision. Specifying the right model to best describe the underlying preferences of respondents in each sample may then become the limiting factor in the estimation of more complex generalized multinomial models, rather than the design per se. Copyright © Grace Scientific Publishing, LLC.
Ward, R.L., Laaksonen, M.A., van Gool, K., Pearson, S.-.A., Daniels, B., Bastick, P., Norman, R., Hou, C., Haywood, P. & Haas, M. 2015, 'Cost of cancer care for patients undergoing chemotherapy: The Elements of Cancer Care study.', Asia Pac J Clin Oncol, vol. 11, no. 2, pp. 178-186.
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AIM: To determine the monthly treatment costs for each element of cancer care in patients receiving chemotherapy and to apportion the burden of cost by financing agent (Commonwealth, State government, private health insurer, patient). METHODS: A cohort of 478 patients (54% breast, 33% colorectal and 13% non-small-cell lung cancer) were recruited from 12 centers representing metropolitan and regional settings in public and private sectors. Primary data were linked to secondary data held in New South Wales state (Admitted Patients and Emergency Department Data) and Commonwealth (Medicare and Pharmaceutical Benefits) databases. The monthly treatment costs of each element of care and the funding agent were calculated from secondary health data. RESULTS: Across all tumor types, the mean monthly treatment cost was $4162 (10%-90% quantiles $1018-$8098; range $2853 [adjuvant colorectal] to $5622 [metastatic lung]), with 54% of this cost borne by Commonwealth government, 26% by private health insurers, 14% by State government and 6% by patients. The mean monthly costs of treating metastatic disease were $1415 greater than those for adjuvant therapy. The mean monthly costs were contributed to by inpatient care ($1657, 40%), chemotherapy prescriptions ($1502, 36%), outpatient care ($452, 11%) and administration of chemotherapy ($364, 9%). CONCLUSION: All four funders have a shared incentive to reduce absolute monthly treatment costs since their proportional contribution is relatively constant for most tumor types and stages. There are opportunities to reduce cancer care costs by minimizing the risk of inpatient hospital admissions that arise from chemotherapy administration and by recognizing incentives for cost-shifting.
Bundy, A.C., Wyver, S., Beetham, K.S., Ragen, J., Naughton, G., Tranter, P., Norman, R., Villeneuve, M., Spencer, G., Honey, A., Simpson, J., Baur, L. & Sterman, J. 2015, 'The Sydney playground project- levelling the playing field: a cluster trial of a primary school-based intervention aiming to promote manageable risk-taking in children with disability', BMC Public Health, vol. 15, no. 1.
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Norman, R., Viney, R.C., Brazier, J.E., Burgess, L.B., Cronin, P.A., King, M.T., Ratcliffe, J. & Street, D. 2014, 'Valuing SF-6D health states using a Discrete Choice Experiment', Medical Decision Making, vol. 34, no. 6, pp. 773-786.
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Background. SF-6D utility weights are conventionally produced using a standard gamble (SG). SG-derived weights consistently demonstrate a floor effect not observed with other elicitation techniques. Recent advances in discrete choice methods have allowed estimation of utility weights. The objective was to produce Australian utility weights for the SF-6D and to explore the application of discrete choice experiment (DCE) methods in this context. We hypothesized that weights derived using this method would reflect the largely monotonic construction of the SF-6D. Methods. We designed an online DCE and administered it to an Australia-representative online panel (n = 1017). A range of specifications investigating nonlinear preferences with respect to additional life expectancy were estimated using a random-effects probit model. The preferred model was then used to estimate a preference index such that full health and death were valued at 1 and 0, respectively, to provide an algorithm for Australian cost-utility analyses. Results. Physical functioning, pain, mental health, and vitality were the largest drivers of utility weights. Combining levels to remove illogical orderings did not lead to a poorer model fit. Relative to international SG-derived weights, the range of utility weights was larger with 5% of health states valued below zero. Conclusions. DCEs can be used to investigate preferences for health profiles and to estimate utility weights for multi-attribute utility instruments. Australian cost-utility analyses can now use domestic SF-6D weights. The comparability of DCE results to those using other elicitation methods for estimating utility weights for quality-adjusted life-year calculations should be further investigated.
Viney, R.C., Norman, R., Brazier, J.E., Cronin, P.A., King, M.T., Ratcliffe, J. & Street, D. 2014, 'An Australian discrete choice experiment to value EQ-5D health states', Health Economics, vol. 23, no. 6, pp. 729-742.
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Conventionally, generic quality-of-life health states, defined within multi-attribute utility instruments, have been valued using a Standard Gamble or a Time Trade-Off. Both are grounded in expected utility theory but impose strong assumptions about the form of the utility function. Preference elicitation tasks for both are complicated, limiting the number of health states that each respondent can value and, therefore, that can be valued overall. The usual approach has been to value a set of the possible health states and impute values for the remainder. Discrete Choice Experiments (DCEs) offer an attractive alternative, allowing investigation of more flexible specifications of the utility function and greater coverage of the response surface. We designed a DCE to obtain values for EQ-5D health states and implemented it in an Australia-representative online panel (n?=?1,031). A range of specifications investigating non-linear preferences with respect to time and interactions between EQ-5D levels were estimated using a random-effects probit model. The results provide empirical support for a flexible utility function, including at least some two-factor interactions. We then constructed a preference index such that full health and death were valued at 1 and 0, respectively, to provide a DCE-based algorithm for Australian cost-utility analyses.
Norman, R. & Hall, J.P. 2014, 'Can hospital-based doctors change their working hours? Evidence from Australia', Internal Medicine Journal, vol. 44, no. 7, pp. 658-664.
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Background and Aims To explore factors predicting hospital-based doctors desire to work less, and then their success in making that change. Methods Consecutive waves of an Australian longitudinal survey of doctors (Medicine in Australia Balancing Employment and Life). There were 6285 and 6337 hospital-based completers in the two waves, consisting of specialists, hospital-based non-specialists and specialist registrars. Results Forty-eight per cent stated a preference to reduce hours. Predictive characteristics were being female and working more than 40?h/week (both P < 0.01). An inverted U-shape relationship was observed for age, with younger and older doctors less likely to state the preference. Factors associated with not wanting to reduce working hours were being in excellent health and being satisfied with work (both P < 0.01). Of those who wanted to reduce working hours, only 32% successfully managed to do so in the subsequent year (defined by a reduction of at least 5?h/week). Predictors of successfully reducing hours were being older, female and working more than 40?h/week (all P < 0.01). Conclusion Several factors predict the desire of hospital-based doctors to reduce hours and then their subsequent success in doing so. Designing policies that seek to reduce attrition may alleviate some of the ongoing pressures in the Australian hospital system.
Gu, Y., Norman, R. & Viney, R.C. 2014, 'Estimating health state utility values from discrete choice experiments: a QALY space model approach', Health Economics, vol. 23, no. 9, pp. 1098-1114.
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Using discrete choice experiments (DCEs) to estimate health state utility values has become an important alternative to the conventional methods of Time Trade-Off and Standard Gamble. Studies using DCEs have typically used the conditional logit to estimate the underlying utility function. The conditional logit is known for several limitations. In this paper, we propose two types of models based on the mixed logit: one using preference space and the other using quality-adjusted life year (QALY) space, a concept adapted from the willingness-to-pay literature. These methods are applied to a dataset collected using the EQ-5D. The results showcase the advantages of using QALY space and demonstrate that the preferred QALY spacemodel provides lower estimates of the utility values than the conditional logit, with the divergence increasing with worsening health states.
Norman, R. & Hall, J.P. 2014, 'The desire and capability of Australian general practitioners to change their working hours', Medical Journal of Australia, vol. 200, no. 7, pp. 399-402.
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Objective: To explore factors associated with general practitioners desire to work less and their success in making that change. Design, participants and setting: Waves 3 and 4 (conducted in 2010 and 2011) of a national longitudinal survey of Australian doctors in clinical practice (Medicine in Australia: Balancing Employment and Life). Of the broader group of medical practitioners in the survey, there were 3664 and 3436 GP completers in Waves 3 and 4, respectively. Main outcome measures: The association between the desire to reduce hours and doctor, job and geographic characteristics; the association between predictors of the capability to reduce hours and these same doctor, job and geographic characteristics. Results: Over 40% of GPs stated a preference to reduce their working hours. Characteristics that predicted this preference were being middle-aged, being female, working = 40 hours per week (all P < 0.01), and being on call (P = 0.03). Factors associated with not wanting to reduce working hours were being in excellent health, being satisfied or very satisfied with work (both P < 0.01), and not being a partner in a practice (P < 0.01 for a number of alternative options [ie, associates, contractors and locums]). Of those who wanted to reduce working hours, 26.8% successfully managed to do so in the subsequent year (where reduction was defined as reducing hours by at least 5 per week). Predictors of successfully reducing hours were being younger, female and working = 40 hours per week (all P < 0.01). Conclusion: A number of factors appear to determine both the desire of GPs to reduce hours and their subsequent success in doing so. Declining working hours have contributed to the perceived shortage in GPs. Therefore, designing policies that address not just the absolute number of medical graduates but also their subsequent level of work may alleviate some of the pressures on the Australian primary health care system.
Whitehurst, D., Norman, R., Brazier, J.E. & Viney, R.C. 2014, 'Comparison of contemporaneous EQ-5D and SF-6D responses using published scoring algorithms derived from similar valuation exercises', Value in Health, vol. 17, pp. 570-577.
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Objectives Poor agreement between preference-based health-related quality-of-life instruments has been widely reported across patient and community-based samples. This study compares index scores generated from contemporaneous EQ-5D (3-level version) and SF-6D (SF-36 version) responses using scoring algorithms derived from independently-conducted Australian population-representative discrete choice experiments (DCEs), providing the first comparative analysis of health state valuations using the same method of valuation across the full value sets. Methods EQ-5D and SF-6D responses from seven patient data sets were transformed into health state valuations using published DCE-derived scoring algorithms. The empirical comparative evaluation consisted of graphical illustration of the location and spread of index scores, reporting of basic descriptive statistics, exploration of between-measure differences in mean index scores, and analysis of agreement. Results Compared with previously published findings regarding the comparability of "conventional" EQ-5D and SF-6D index scores, health state valuations from the DCE-derived scoring procedures showed that agreement between scores remained "fair" (intraclass correlation coefficient values across the seven data sets ranged from 0.375 to 0.615). Mean SF-6D scores were significantly lower than the respective mean EQ-5D score across all patient groups (mean difference for the whole sample = 0.253). Conclusions The magnitude of disagreement previously reported between EQ-5D and SF-6D index scores is not ameliorated through the application of DCE-derived value sets; sizeable discrepancies remain. These findings suggest that differences between EQ-5D and SF-6D index scores persist because of their respective descriptive systems. Further research is required to explore the implications of variations in the descriptive systems of preference-based instruments.
Wong, S.F., Norman, R., Dunning, T.L., Ashley, D.M. & Lorgelly, P.K. 2014, 'A protocol for a discrete choice experiment: understanding preferences of patients with cancer towards their cancer care across metropolitan and rural regions in Australia', BMJ Open, vol. 4, no. 10, pp. e006661-e006661.
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Introduction: Medical decision-making in oncology is a complicated process and to date there are few studies examining how patients with cancer make choices with respect to different features of their care. It is also unknown whether patient choices vary by geographical location and how location could account for observed rural and metropolitan cancer differences. This paper describes an ongoing study that aims to (1) examine patient and healthcare-related factors that influence choices of patients with cancer; (2) measure and quantify preferences of patients with cancer towards cancer care using a discrete choice experiment (DCE) and (3) explore preference heterogeneity between metropolitan and rural locations. Methods and analysis: A DCE is being conducted to understand how patients with cancer choose between two clinical scenarios accounting for different patient and healthcare-related factors (and levels). Preliminary qualitative research was undertaken to guide the development of an appropriate DCE design including characteristics that are important and relevant to patients with cancer. A fractional factorial design using the D-efficiency criteria was used to estimate interactions among attributes. Multinomial logistic regression will be used for the primary DCE analysis and to control for sociodemographic and clinical characteristics. Ethics and dissemination: The Barwon Health Human Research Ethics Committee approved the study. Findings from the study will be presented in national/international conferences and peer-reviewed journals. Our results will form the basis of a feasibility study to inform the development of a larger scale study into preferences of patients with cancer and their association with cancer outcomes.
Norman, R., Hall, J.P., Street, D. & Viney, R.C. 2013, 'Efficiency and equity: A stated preference approach', Health Economics, vol. 22, no. 5, pp. 568-581.
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Outcome measurement in the economic evaluation of health care considers outcomes independent of to whom they accrue. This article reports on a discrete choice experiment designed to elicit population preferences regarding the allocation of health gain between hypothetical groups of potential patients. A random-effects probit model is estimated, and a technique for converting these results into equity weights for use in economic evaluation is adopted. On average, the modelling predicts a relatively high social value on health gains accruing to nonsmokers, carers, those with a low income and those with an expected age of death less than 45?years. Respondents tend to favour individuals with similar characteristics to themselves. These results challenge the conventional practice of assuming constant equity weighting. For decision makers, whether a formal equity weighting system represents an improvement on more informal approaches to weighing up equity and efficiency concerns remains uncertain
Norman, R., Church, J., Van den Berg, B. & Goodall, S. 2013, 'Australian health-related quality of life population norms derived from the SF-6D', Australian & New Zealand Journal of Public Health, vol. 37, no. 1, pp. 17-23.
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Objective: To investigate population health-related quality of life norms in an Australian general sample by age, gender, BMI, education and socioeconomic status. Method: The SF-36 was included in the 2009/10 wave of the Household, Income and Labour Dynamics in Australia (HILDA) survey (n=17,630 individuals across 7,234 households), and converted into SF-6D utility scores. Trends across the various population subgroups were investigated employing population weights to ensure a balanced panel, and were all sub-stratified by gender. Results: SF-6D scores decline with age beyond 40 years, with decreasing education and by higher levels of socioeconomic disadvantage. Scores were also lower at very low and very high BMI levels. Males reported higher SF-6D scores than females across most analyses. Conclusions: This study reports Australian population utility data measured using the SF-6D, based on a national representative sample. These results can be used in a range of policy settings such as cost-utility analysis or exploration of health-related inequality. In general, the patterns are similar to those reported using other multi-attribute utility instruments and in different countries.
Parkinson, B.T., Goodall, S. & Norman, R. 2013, 'Measuring the loss of consumer choice in mandatory health programs using discrete choice experiments', Applied Health Economics and Health Policy, vol. 11, no. 2, pp. 139-150.
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BACKGROUND: Economic evaluation of mandatory health programmes generally do not consider the utility impact of a loss of consumer choice upon implementation, despite evidence suggesting that consumers do value having the ability to choose. OBJECTIVES: The primary aim of this study was to explore whether the utility impact of a loss of consumer choice from implementing mandatory health programmes can be measured using discrete choice experiments (DCEs). RESULTS: Responses were provided by 535 participants (a response rate of 83 %). For the influenza vaccination and folate fortification programmes, the results suggested that some level of compensation may be required for introducing the programme on a mandatory basis. Introducing a mandatory influenza vaccination programme required the highest compensation (Australian dollars [A$] 112.75, 95 % CI -60.89 to 286.39) compared with folate fortification (A$18.05, 95 % CI -3.71 to 39.80). No compensation was required for introducing the trans-fats programme (-A$0.22, 95 % CI -6.24 to 5.80) [year 2010 values]. In addition to the type of mandatory health programme, the compensation required was also found to be dependent on a number of other factors. In particular, the study found an association between the compensation required and stronger libertarian preferences. CONCLUSIONS: DCEs can be used to measure the utility impact of a loss of consumer choice. Excluding the utility impact of a loss of consumer choice from an economic evaluation taking a societal perspective may result in a sub-optimal, or incorrect, funding decision.
Van Gool, K., Norman, R., Hall, J.P., Massie, J. & Delatycki, M. 2013, 'Understanding the costs of care for cystic fibrosis: an analysis by age and health state', Value in Health, vol. 16, no. 2, pp. 345-355.
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Objectives: Cystic fibrosis (CF) is an inherited disease that requires more intensive treatments as the disease progresses. Recent medical advancements have improved survival but have also increased costs. Our lack of understanding on the relationship between disease severity and lifetime health care costs is a major impediment to the timely economic assessment of new treatments. Methods: Using data from three waves of the Australian Cystic Fibrosis Australia Data Registry, we estimate the annual costs of CF care by age and health state. We define health states on the basis of annual lung-function scores and patient's organ transplant status. We exploit the longitudinal nature of the data to model disease progression, and we use this to estimate lifetime health care costs. Results: The mean annual health care cost for treating CF is US $15,571. Costs for patients with mild, moderate, and severe disease are US $10,151, US $25,647, and US $33,691, respectively. Lifetime health care costs are approximately US $306,332 (3.5% discount rate). The majority of costs are accounted for by hospital inpatients (58%), followed by pharmaceuticals (29%), medical services (10%), complications (2%), and diagnostic tests (1%). Conclusions: Our study is the first of its kind using the Australian Cystic Fibrosis Data Registry, and demonstrates the utility of longitudinal registry data for the purpose of economic analysis. Our results can be used as an input to future economic evaluations by providing analysts with a better understanding of the long-term cost impact when new treatments are developed.
Cronin, P.A., Goodall, S., Lockett, T., O'Keefe, C., Norman, R. & Church, J. 2013, 'Cost-effectiveness of an advance notification letter to increase colorectal cancer screening', International Journal of Technology Assessment in Health Care, vol. 29, no. 3, pp. 261-268.
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Objectives: The aim of this study is to evaluate the cost-effectiveness of a patient-direct mailed advance notification letter on participants of a National Bowel Cancer Screening Program (NBCSP) in Australia, which was launched in August 2006 and offers free fecal occult blood testing to all Australians turning 50, 55, or 65 years of age in any given year. Methods: This study followed a hypothetical cohort of 50-year-old, 55-year-old, and 65-year-old patients undergoing fecal occult blood test (FOBT) screening through a decision analytic Markov model. The intervention compared two strategies: (i) advance letter, NBCSP, and FOBT compared with (ii) NBCSP and FOBT. The main outcome measures were life-years gained (LYG), quality-adjusted life-years (QALYs) gained and incremental cost-effectiveness ratio. Results: An advance notification screening letter would yield an additional 54 per 100,000 colorectal cancer deaths avoided compared with no letter. The estimated cost-effectiveness was $3,976 per LYG and $6,976 per QALY gained. Conclusions: An advance notification letter in the NBCSP may have a significant impact on LYG and cancer deaths avoided. It is cost-effective and offers a feasible strategy that could be rolled out across other screening program at an acceptable cost.
Norman, R., Cronin, P.A. & Viney, R.C. 2013, 'A pilot discrete choice experiment to explore preferences for EQ-5D-5L health states', Applied Health Economics and Health Policy, vol. 11, no. 3, pp. 287-298.
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The EQ-5D-5L has recently been developed to improve the sensitivity of the widely used three-level version. Valuation studies are required before the use of this new instrument can be adopted. The use of discrete choice experiments (DCEs) in this area is a promising area of research. PURPOSE: To test the plausibility and acceptability of estimating an Australian algorithm for the newly developed five-level version of the EQ-5D using a DCE. METHODS: A choice experiment was designed, consisting of 200 choice sets blocked such that each respondent answered 10 choice sets. Each choice set presented two health state-duration combinations, and an immediate death option. The experiment was implemented in an online Australian-representative sample. A random-effects probit model was estimated. To explore the feasibility of the approach, an indicative algorithm was developed. The algorithm is transformed to a 0 to 1 scale suitable for use to estimate quality-adjusted life-year weights for use in economic evaluation. RESULTS: A total of 973 respondents undertook the choice experiment. Respondents were slightly younger and better educated than the general Australian population. Of the 973 respondents, 932 (95.8 %) completed all ten choice sets, and a further 12 completed some of the choice sets. In choice sets in which one health state-duration combination dominated another, the dominant option was selected on 89.5 % of occasions. The mean and median completion times were 17.9 and 9.4 min, respectively, exhibiting a highly skewed distribution. The estimation results are broadly consistent with the monotonic nature of the EQ-5D-5L. Utility is increasing in life expectancy (i.e., respondents tend to prefer health profiles with longer life expectancy), and mainly decreases in higher levels in each dimension of the instrument. A high proportion of respondents found the task clear and relatively easy to complete.
Couzner, L., Crotty, M., Norman, R. & Ratcliffe, J. 2013, 'A comparison of the EQ-5D-3L and the ICECAP-O in an older post-acute patient population relative to the general population', Applied Health Economics and Health Policy, vol. 11, no. 4, pp. 415-425.
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The measurement and valuation of quality of life forms a major component of economic evaluation in health care and is a major issue in health services research. However, differing approaches exist in the measurement and valuation of quality of life from a health economics perspective. While some instruments such as the EQ-5D-3L focus on health-related quality of life alone, others assess quality of life in broader terms, for example, the newly developed ICECAP-O. OBJECTIVE: The aim of this study was to utilize two generic preference-based instruments, the EQ-5D-3L and the ICECAP-O, to measure and value the quality of life of older adult patients receiving post-acute care. An additional objective was to compare the values obtained by each instrument with those generated from two community-based general population samples.
Church, J., Goodall, S., Norman, R. & Haas, M.R. 2012, 'The cost-effectiveness of falls prevention interventions for older community-dwelling Australians', Australian and New Zealand Journal of Public Health, vol. 36, no. 3, pp. 241-248.
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Objective: To evaluate the cost-effectiveness of strategies designed to prevent falls among older people. Methods: A decision analytic Markov model of interventions designed to prevent falls was developed. Incremental cost-effectiveness ratios (ICERs) using quality adjusted life year (QALYs) as the measure, were calculated for those interventions aimed at the general population (home exercise, group exercise, tai chi, multiple and multi-factorial interventions); high-risk populations (group exercise, home hazard assessment/modification and multi-factorial interventions); and specific populations (cardiac pacing, expedited cataract surgery and psychotropic medication withdrawal). Uncertainty was explored using univariate and probabilistic sensitivity analysis. Conclusion: In the general population, compared with no intervention the ICERs were tai chi ($44,205), group-based exercise ($70,834), multiple interventions ($72,306), home exercise ($93,432), multifactorial interventions with only referral ($125,868) and multifactorial interventions with an active component ($165,841). The interventions were ranked by cost in order to exclude dominated interventions (more costly, less effective) and extendedly dominated interventions (where an intervention is more costly and less effective than a combination of two other interventions). Tai chi remained the only cost-effective intervention for the general population. Implications: Interventions designed to prevent falls in older adults living in the community can be cost-effective. However, there is uncertainty around some of the model parameters which require further investigation.
Blinman, P., King, M.T., Norman, R., Viney, R.C. & Stockler, M.R. 2012, 'Preferences for cancer treatments: an overview of methods and applications in oncology', Annals Of Oncology, vol. 23, no. 5, pp. 1104-1110.
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This review provides cancer clinicians and researchers with an overview of methods for assessing preferences, with examples and recommendations for their application in oncology. Decisions about cancer treatments involve trade-offs between their relative benefits and harms. An individuals preference for a cancer treatment reflects their evaluation of the relative benefits and harms in comparison with a given alternative or alternatives. Methods of preference assessment include the ranking or rating scale, standard gamble (SG), time trade-off (TTO), visual analogue scale, discrete choice experiment (DCE), and multi-attribute utility instrument (MAUI). The choice of method depends on the purpose of preference assessment; the ranking or rating scale, SG, TTO, and DCEs are best suited to clinical decisions, whereas MAUIs are best suited to health policy decisions. Knowledge of patients preferences for cancer treatments can better inform clinical decisions about patient management by enabling the tailoring of decisions to individual patients values, attitudes, and priorities and health policy decisions through economic evaluations of cancer treatments and their suitability for coverage by health payers.
Norman, R., Van Gool, K., Hall, J.P., Delatycki, M. & Massie, J. 2012, 'Cost-effectiveness of carrier screening for cystic fibrosis in Australia', Journal of Cystic Fibrosis, vol. 11, no. 4, pp. 281-287.
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Carrier screening for cystic fibrosis is not widely available in Australia, partly due to concerns regarding its cost-effectiveness. The benefit of information from pregnancy to pregnancy has not been widely considered in existing cost-effectiveness analyses. Methods: A decision tree was constructed estimating costs and outcomes from screening, including both initial and subsequent pregnancies. Effectiveness was expressed in terms of CF births averted. Costs were collected using a health service perspective. All costs and outcomes were discounted at 5% per annum. Results: Screening reduced the annual incidence of CF births from 34 to 14/100,000 births (an aggregate number of CF births of 100.9 and 41.9 respectively). In initial pregnancies, costs in the screening arm (A$16.6. million/100,000 births) exceed those in the non-screening arm (A$13.4. million/100,000 births). The incremental cost per CF birth in initial pregnancies is therefore approximately A$150,000. However, this was reversed for subsequent pregnancies, in that the pre-collected information reduces the incidence of CF in subsequent pregnancies at low additional costs. When aggregated, the results suggest screening is likely to be cost-saving. Conclusions: The introduction of national carrier screening for cystic fibrosis should be considered, as it is likely to reduce CF incidence at an acceptable (potentially negative) cost.
Devine, A., Spencer, A., Eldridge, S., Norman, R. & Feder, G. 2012, 'Cost-effectiveness of Identification and Referral to Improve Safety (IRIS), a domestic violence training and support programme for primary care: a modelling study based on a randomised controlled trial', BMJ Open, vol. 2, no. 3, pp. 1-8.
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Objective The Identification and Referral to Improve Safety (IRIS) cluster randomised controlled trial tested the effectiveness of a training and support intervention to improve the response of primary care to women experiencing domestic violence (DV). The aim of this study is to estimate the cost-effectiveness of this intervention. Design Markov model-based cost-effectiveness analysis. Setting General practices in two urban areas in the UK. Participants Simulated female individuals from the general UK population who were registered at general practices, aged 16 years and older. Intervention General practices received staff training, prompts to ask women about DV embedded in the electronic medical record, a care pathway including referral to a specialist DV agency and continuing contact from that agency. The trial compared the rate of referrals of women with specialist DV agencies from 24 general practices that received the IRIS programme with 24 general practices not receiving the programme. The trial did not measure outcomes for women beyond the intermediate outcome of referral to specialist agencies. The Markov model extrapolated the trial results to estimate the long-term healthcare and societal costs and benefits using data from other trials and epidemiological studies.
Stein-Parbury, J., Chenoweth, L., Jeon, Y., Brodaty, H., Haas, M.R. & Norman, R. 2012, 'Implementing person-centered care in residential dementia care', Clinical Gerontology, vol. 35, no. 5, pp. 404-424.
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This article provides a detailed overview of the PCC intervention arm of the study and describes the training and procedures used to facilitate implementation of PCC. Training emphasized the impact of the social world on the person with dementia and promoted the skills of interpersonal engagement, especially in relation to feeling expression. Facilitated on-site learning involved care planning that included obtaining a life story of the person with dementia and observing social interactions.
Viney, R.C., Norman, R., King, M.T., Cronin, P.A., Street, D., Knox, S.A. & Ratcliffe, J. 2011, 'Time trade-off derived EQ-5D weights for Australia', Value in Health, vol. 14, no. 6, pp. 928-936.
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Background: Cost-utility analyses (CUAs) are increasingly common in Australia. The EuroQol five-dimensional (EQ-5D) questionnaire is one of the most widely used generic preference-based instruments for measuring health-related quality of life for the estimation of quality-adjusted life years within a CUA. There is evidence that valuations of health states vary across countries, but Australian weights have not previously been developed. Methods: Conventionally, weights are derived by applying the time trade-off elicitation method to a subset of the EQ-5D health states. Using a larger set of directly valued health states than in previous studies, time trade-off valuations were collected from a representative sample of the Australian general population (n = 417). A range of models were estimated and compared as a basis for generating an Australian algorithm. Results: The Australia-specific EQ-5D values generated were similar to those previously produced for a range of other countries, but the number of directly valued states allowed inclusion of more interaction effects, which increased the divergence between Australia's algorithm and other algorithms in the literature. Conclusion: This new algorithm will enable the Australian community values to be reflected in future economic evaluations.
Gallego, G., Casey, R., Goodall, S. & Norman, R. 2011, 'Introduction and uptake of new medical technologies in the Australian health care system: a qualitative study', Health Policy, vol. 102, no. 2-3, pp. 152-158.
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Objective: The aim of this study was to explore the views and perceptions of stakeholders about the current national health technology assessment process conducted by the Medical Services Advisory Committee (MSAC) and its role in the uptake and diffusion of new medical technologies in Australia. Methods: Data collection occurred over a nine month period (August 2008April 2009). Twenty in-depth, semi-structured interviews were conducted with individuals from four stakeholders groups: (i) MSAC members and evaluators, (ii) academic and health technology assessment experts, (iii) medical industry representatives and (iv) medical specialists. Interviews were digitally recorded, transcribed verbatim and coded using a constant comparative method.
Church, J., Goodall, S., Norman, R. & Haas, M.R. 2011, 'An economic evaluation of community and residential aged care falls prevention strategies in NSW', NSW Public Health Bulletin, vol. 22, no. 3-4, pp. 60-68.
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Aim: To evaluate the cost-effectiveness of strategies designed to prevent falls amongst people aged 65 years and over living in the community and in residential aged-care facilities. Methods: A systematic review and meta-analysis of the literature was conducted. The pooled fall rate ratio was used in a decision analytic model that combined a Markov model and decision tree to estimate the costs and outcomes of potential interventions and/or strategies. The resulting cost per quality-adjusted life year was estimated. Results: The most cost-effective falls prevention strategy in community-dwelling older people was Tai Chi. Expedited cataract surgery and psychotropic medication withdrawal were also found to be cost-effective; however, the effectiveness of these interventions is less certain due to small numbers of trials and participants. The most costeffective falls prevention strategies in residential aged-care facilities were medication review and vitamin D supplementation.
Gold, L., Norman, R., Devine, A., Feder, G., Taft, A. & Hegarty, K. 2011, 'Cost-effectiveness of health care interventions to address intimate partner violence: What do we know and what else should we look for?', Violence Against Women: an international and interdisciplinary journal, vol. 17, no. 3, pp. 389-403.
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Intimate partner violence (IPV) creates a substantial burden of disease and significant costs to families, communities, and governments. Building the evidence for effective interventions to reduce violence and its sequelae requires increased use of economic evaluation to inform policy through the analysis of costs and potential savings of interventions. The authors review existing economic evaluations and present case studies of current research from the United Kingdom and Australia to illustrate the strengths and limitations of two approaches to generating economic evidence: economic evaluation alongside randomized controlled trials and economic modeling. Economic evaluation should always be considered in the design of IPV intervention research.
Norman, R., King, M.T., Clarke, D., Viney, R.C., Cronin, P.A. & Street, D. 2010, 'Does mode of administration matter? Comparison of online and face-to-face administration of a time trade-off task', Quality of Life Research, vol. 19, no. 4, pp. 499-508.
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Purpose Developments in electronic data collection methods have allowed researchers to generate larger datasets at lower costs, but relatively little is known about the comparative performance of the new methods. This paper considers the comparability of two modes of administration (face-to-face and remote electronic) for the time trade-off. Method Data were collected from a convenience sample of adults (n = 135) randomised to either a face-to-face time trade-off or a remote electronic tool. Patterns of responses were considered. For each sample, standard regression analysis was undertaken to generate a valuation set, which were then contrasted
Norman, R., Spencer, A., Eldridge, S. & Feder, G. 2010, 'Cost-effectiveness of a programme to detect and provide better care for female victims of intimate partner violence', Journal of Health Services Research and Policy, vol. 15, no. 3, pp. 143-149.
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Objective: Primary care clinicians often fail to detect women who are victims of intimate partner violence (IPV). Our aim was to investigate the cost-effectiveness of a programme in primary care to detect and support such women. Methods: We developed a Markov model to estimate the cost-effectiveness of education and support for primary care clinicians to increase their identification of survivors of IPV and to refer them to a specialist advocacy agency or a psychologist with specialist skills. The programme was implemented in three general practices in the United Kingdom (with an additional practice acting as a control) and provided cost data and rates of identification and referral. Other cost data and the effectiveness of IPV advocacy came from published sources. Results: The model gave an incremental cost-effectiveness ratio (ICER) of approximately &pound;2,450 per quality adjusted life year (QALY). Although the ratio increased in some of the sensitivity analyses, most were under a conventional willingness to pay threshold (&pound;30,000/QALY). Conclusions: While there is considerable uncertainty in the underlying parameters, a training programme for primary care teams to increase identification and referral of women experiencing IPV is likely to be costeffective.
Norman, R., Haas, M.R. & Wilcken, B. 2009, 'International perspectives on the cost-effectiveness of tandem mass spectrometry for rare metabolic conditions', Health Policy, vol. 89, no. 3, pp. 252-260.
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To examine and evaluate the economic evidence regarding the use of tandem mass spectrometry (MS/MS) for the detection of rare metabolic conditions in neonates, and then to consider the transferability of these national-level results to other decision-making contexts. Methods A systematic literature review was undertaken, identifying papers published between January 1997 and March 2008. Thirteen unique cost-effectiveness evaluations were identified and appraised for comparability and transferability of results across settings.
Chenoweth, L., King, M.T., Jeon, Y., Brodaty, H., Stein-Parbury, J., Norman, R., Haas, M.R. & Luscombe, G. 2009, 'Caring for Aged Dementia Care Resident Study (CADRES) of person-centred care, dementia-care mapping, and usual care in dementia: A cluster-randomised trial', Lancet Neurology, vol. 8, no. 4, pp. 317-325.
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Background Evidence for improved outcomes for people with dementia through provision of person-centred care and dementia-care mapping is largely observational. We aimed to do a large, randomised comparison of person-centred care, dementia-care mapping, and usual care. Methods In a cluster randomised controlled trial, urban residential sites were randomly assigned to person-centred care, dementia-care mapping, or usual care. Carers received training and support in either intervention or continued usual care. Treatment allocation was masked to assessors. The primary outcome was agitation measured with the Cohen-Mansfield agitation inventory (CMAI). Secondary outcomes included psychiatric symptoms including hallucinations, neuropsychological status, quality of life, falls, and cost of treatment. Outcome measures were assessed before and directly after 4 months of intervention, and at 4 months of follow-up. Hierarchical linear models were used to test treatment and time effects. Analysis was by intention to treat. This trial is registered with the Australia and New Zealand Clinical Trials Registry, number ACTRN12608000084381. Findings 15 care sites with 289 residents were randomly assigned. Pairwise contrasts revealed that at follow-up, and relative to usual care, CMAI score was lower in sites providing mapping (mean difference 109, 95% CI 07211; p=004) and person-centred care (136, 33239; p=001). Compared with usual care, fewer falls were recorded in sites that used mapping (024, 008040; p=002) but there were more falls with person-centred care (015, 002028; p=003). There were no other significant effects. Interpretation Person-centred care and dementia-care mapping both seem to reduce agitation in people with dementia in residential care.
Norman, R., Haas, M.R., Chaplin, M., Joy, P. & Wilcken, B. 2009, 'Economic evaluation of Tandem Mass Spectrometry Newborn Screening in Australia', Pediatrics, vol. 123, no. 2, pp. 451-457.
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OBJECTIVE. The goal was to investigate the cost-effectiveness of tandem mass spectrometry screening for the detection of inborn metabolic errors in an Australian setting. METHODS. Cost-effectiveness analysis from the health service perspective was undertaken on the basis of registry data for affected individuals. The intervention group was contrasted with both a contemporaneous group in nonscreening states and a historical cohort. The registry covers all individuals identified in Australia between 1994 and 2002. Main outcome measures were the total net cost of screening, the cost of treatment, life-years saved, and deaths averted. RESULTS. The total net cost of testing was estimated to be A$218 000 per 100 000 infants. Medical costs incurred by the intervention group exceeded those for the control group by A$131 000 per 100 000 infants. The number of life-years saved per 100 000 infants screened was 32.378 life-years per 100 000 infants through an expected mortality rate reduction of 0.738 deaths per 100 000 infants. The cost per death averted was estimated to be A$472 913 and the cost per life-year saved was estimated to be A$10 779, which compare favorably with existing cost-effectiveness standards. This conclusion is particularly robust because conservative assumptions were made throughout, because of data limitations. Sensitivity analyses suggested that this result was relatively robust to adjustment of model parameters.
Feder, G., Ramsay, J., Dunne, D., Rose, M., Arsene, C., Norman, R., Kuntze, S., Spencer, A., Bacchus, L., Hague, G., Warburton, A. & Taket, A. 2009, 'How far does screening women for domestic (partner) violence in different health-care settings meet criterian for a screening programme? Systematic reviews of nine UK National Screening Committee criteria', Health Technology Assessment, vol. 13, no. 16, pp. 1-136.
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OBJECTIVES: The two objectives were: (1) to identify, appraise and synthesise research that is relevant to selected UK National Screening Committee (NSC) criteria for a screening programme in relation to partner violence; and (2) to judge whether current evidence fulfils selected NSC criteria for the implementation of screening for partner violence in health-care settings. DATA SOURCES: Fourteen electronic databases from their respective start dates to 31 December 2006. REVIEW METHODS: The review examined seven questions linked to key NSC criteria: QI: What is the prevalence of partner violence against women and what are its health consequences? QII: Are screening tools valid and reliable? QIII: Is screening for partner violence acceptable to women? QIV: Are interventions effective once partner violence is disclosed in a health-care setting? QV: Can mortality or morbidity be reduced following screening? QVI: Is a partner violence screening programme acceptable to health professionals and the public? QVII: Is screening for partner violence cost-effective? Data were selected using different inclusion/exclusion criteria for the seven review questions. The quality of the primary studies was assessed using published appraisal tools. We grouped the findings of the surveys, diagnostic accuracy and intervention studies, and qualitatively analysed differences between outcomes in relation to study quality, setting, populations and, where applicable, the nature of the intervention. We systematically considered each of the selected NSC criteria against the review evidence.
Norman, R., Cronin, P.A., Viney, R.C., King, M.T., Street, D. & Ratcliffe, J. 2009, 'International comparisons in valuing EQ-5D health states: A review and analysis', Value in Health, vol. 12, no. 8, pp. 1194-1200.
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Objective: To identify the key methodological issues in the construction of population-level EuroQol 5-dimensions (EQ-5D)/time trade-off (TTO) preference elicitation studies. Method: This study involved three components. The first was to identify existing population-level EQ-5D TTO studies. The second was to illustrate and discuss the key areas of divergence between studies, including the international comparison of tariffs. The third was to portray the relative merits of each of the approaches and to compare the results of studies across countries. Results: While most articles report use of the protocol developed in the original UK study, we identified three key areas of divergence in the construction and analysis of surveys. These are the number of health states valued to determine the algorithm for estimating all health states, the approach to valuing states worse than immediate death, and the choice of algorithm. The evidence on international comparisons suggests differences between countries although it is difficult to disentangle differences in cultural attitudes with random error and differences as a result of methodological divergence. Conclusions: Differences in methods may obscure true differences in values between countries. Nevertheless, population-specific valuation sets for countries engaging in economic evaluation would better reflect cultural differences and are therefore more likely to accurately represent societal attitudes.
Norman, R., Spencer, A. & Feder, G. 2007, 'Cost-Effectiveness Analysis: What you always wanted to know but were afraid to ask', Family Violence Prevention & Health Practice, vol. 1, no. 5, pp. 1-8.
Across industrialised countries, health care spending, as a proportion of gross domestic product (GDP) has increased over the past thirty years. In the United States, this percentage increased from 7.6% in 1972 to 14.0% in 1992, to around 16.0% in 2004 (McPake, Normand, and Kumaranayake, 2002; Smith, Cowan, Heffler, and Caitlin, 2006). This is not confined to health care systems with predominantly private funding. Publicly funded systems, as in the United Kingdom, and social insurance-based systems, as in France, have also witnessed large absolute and proportional increases in expenditures. As society's investment in health care increases, appropriate and transparent decision-making by policy makers becomes increasingly important. Cost-effectiveness analysis (CEA), part of the discipline of health economics, plays a crucial role in helping decisionmakers allocate scarce funds efficiently, i.e., to health interventions that yield the most improvement in outcome for the least amount of expenditure. The volume of cost-effectiveness studies has increased dramatically in the past 10 years. The importance of these studies has been acknowledged formally by policy makers across the world, such as the Center for Disease Control and Prevention (CDC) in the United States, the National Institute for Health and Clinical Excellence (NICE) in England and Wales, and the Pharmaceutical Benefits Advisory Committee (PBAC) in Australia. At best, they will assure that health care dollars are allocated to interventions that provide the most improvement in outcome per dollar expended. Conversely, there are risks secondary to badly designed analyses or misunderstanding of well designed ones.
Norman, R., Evans, G., Easton, D.F. & Young, K.C. 2007, 'The cost-utility of Magnetic Resonance Imaging for breast cancer in BRCA1 mutation carriers aged 30-49', European Journal of Health Economics, vol. 8, no. 2, pp. 137-144.
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Recent evidence has investigated the costeffectiveness of magnetic resonance imaging (MRI) in younger women with a BRCA1 mutation. However, this evidence has not been contrasted with existing cost-effectiveness standards to determine whether screening is appropriate, given limited societal resources. We constructed a Markov model investigating surveillance tools (mammography, MRI, both in parallel) under a National Health Service (NHS) perspective. The key benefit of MRI is that increased sensitivity leads to early detection, and improved prognosis. For a 30- to 39-year-old cohort, the cost per quality-adjusted life year (QALY) of mammography relative to no screening was &pound;5,200. The addition of MRI to this costs &pound;13,486 per QALY. For a 40- to 49- year-old cohort, the corresponding values were &pound;2,913 and &pound;7,781. Probabilistic sensitivity analysis supported the cost-effectiveness of the parallel approach of mammography and MRI. It is necessary to extend this analysis beyond BRCA1 carriers within this age group, and also to other age groups.

Other

Norman, R., Cronin, P.A. & Viney, R.C. 2012, 'Deriving utility weights for the EQ-5D-5L using a discrete choice experiment. CHERE Working Paper 2012/1', CHERE Working Papers.
Parkinson, B.T., Goodall, S. & Norman, R. 2012, 'Measuring the loss of consumer choice in mandatory health programs using Discrete Choice Experiments. CHERE Working Paper 2012/04'.
Van Gool, K., Norman, R., Delatycki, M., Hall, J.P. & Massie, J. 2011, 'Understanding the costs of care for cystic fibrosis: an analysis by age and severity. CHERE Working Paper 2011/1', CHERE Working Papers.
Haas, M.R., Norman, R., Walkley, J. & Brennan, L. 2009, 'Issues in evaluating the costs and cost-effectiveness of Cognitive Behavioural Therapy for Overweight/Obese Adolescents CHERE Working Paper 2009/1'.
Norman, R. & Gallego, G. 2008, 'Equity weights for economic evaluation: An Australian Discrete Choice Experiment, CHERE Working Paper 2008/5'.
Haas, M.R., Hall, J.P., Viney, R.C., Gallego, G., Goodall, S., Norman, R. & Van Gool, K. 2008, 'A model for best practice HTA, CHERE Working Paper 2008/1'.
Norman, R. & Viney, R.C. 2008, 'The effect of discounting on quality of life valuation using the Time Trade-Off, CHERE Working Paper 2008/3'.
Norman, R., Haas, M.R., Chenoweth, L., Jeon, Y., King, M.T., Brodaty, H., Stein-Parbury, J. & Luscombe, G. 2008, 'Dementia Care Mapping and Patient-Centred Care in Australian Residential Homes: An Economic Evaluation of the CARE Study, CHERE Working Paper 2008/4'.
Bird, A., Norman, R. & Goodall, S. 2007, 'Economic Evaluation of Positron Emission Tomography (PET) in Non Small Cell Lung Cancer (NSCLC), CHERE Working Paper 2007/6', CHERE Working Paper.
Norman, R., Cronin, P.A., Viney, R.C., King, M.T., Street, D., Brazier, J.E. & Ratcliffe, J. 2007, 'Valuing EQ-5D health states: A review and analysis, CHERE Working Paper 2007/9', CHERE Working Paper.

Reports

Church, J., Goodall, S., Norman, R. & Haas, M.R. NSW Ministry of Health 2011, An economic evaluation of community and residential aged care falls prevention strategies in NSW, Sydney.
View/Download from: UTS OPUS
Cronin, P.A., Goodall, S., Norman, R., Church, J. & Gallego, G. CHERE University of Technology, Sydney 2010, The impact of improving screening participation rate on bowel screening for colorectal cancer: Final report part A, Sydney.
Cronin, P.A., Goodall, S., Norman, R. & Church, J. CHERE University of Technology, Sydney 2010, The impact of a new bowel cancer screening test on detection of colorectal cancer: Part B Replacing FOBT with new test, Sydney.
Cronin, P.A., Goodall, S., Norman, R. & Church, J. CHERE University of Technology, Sydney 2010, The impact of a new bowel cancer screening test on detection of colorectal cancer: Part B2 FOBT + New screening test in a triage model.
Norman, R., Goodall, S. & Cameron, A. MSAC 2010, Second Generation Contrast Agents for Use in Patients with Suboptimal Echocardiograms: MSAC Application 1129, pp. 1-137.
Goodall, S., Norman, R. & Haas, M.R. NSW Bureau of Crime Statistics and Research 2008, The costs of NSW Drug Court, Crime and Justice Bulletin, pp. 1-35, Sydney, Australia.
In 2001, the Bureau of Crime Statistics and Research (BOCSAR) and the Centre for Health Economics Research and Evaluation (CHERE) undertook an analysis of the cost-effectiveness of the NSW Drug Court. In the intervening years, a number of changes have been made to the system, and the role the Drug Court undertakes has changed as the population it serves has changed. The aim of this report is to estimate the cost of these changes to the NSW Drug Court.
Haas, M.R., Hall, J.P., Gallego, G., Goodall, S., Norman, R., Van Gool, K. & Viney, R.C. CHERE, University of Technology, Sydney 2008, Development of an evaluation framework and methodology for national blood supply change proposals: Final report, pp. 1-105, Sydney.
Haas, M.R., Hall, J.P., Gallego, G., Goodall, S., Norman, R., Van Gool, K. & Viney, R.C. CHERE, University of Technology, Sydney 2008, Framework and methodology for national blood supply change proposals: Part 2, pp. 1-33, Sydney.
Norman, R., Goodall, S. & Cameron, A. MSAC 2008, Deep brain stimulation for essential tremor and dystonia: Application 1109, pp. 1-190, Canberra.
Goodall, S., Norman, R. & Gallego, G. CHERE 2007, Cost-effectiveness analysis of alternate strategies to address iodine deficiency in Australia, CHERE Project Report for the Department of Health and Ageing, Australian Government, pp. 1-99, Sydney.
De Mott, K., Bick, D., Norman, R. & Ritchie, G. Royal College of General Practitioners (UK) 2006, Clinical guidelines and evidence review for post natal care: Routine post natal care of recently delivered women and their babies, London.
Cullum, A., Shaw, B., Stokes, T., Kelly, M. & Norman, R. Royal College of General Practitioners (UK) 2006, Clinical guidelines and evidence review for obesity: The prevention, identification, assessment and management of overweight and obesity in adults and children, London.
Norman, R., Ritchie, G., Evans, D. & Turnbull, N. Royal College of General Practitioners (UK) 2006, Clinical guidelines and evidence review for familial breast cancer: The classification and care of women at risk of familial breast cancer in primary, secondary and tertiary care (partial update): Routine surveillance Using Magnetic Resonance imaging, London.