Marion is Professor of Health Economics at CHERE. Formerly a physiotherapist, she has a Masters of Public Health (University of Sydney), a Graduate Diploma of Applied Epidemiology (NSW Health) and a PhD (University of Sydney). A leading health services researcher for many years, Marion has extensive policy and research based experience of health services funding and financing in Australia. Her research interests are in the application of economic analysis to policy and practice; planning and evaluating health services; incorporating health economics into health services research, including clinical trials; the application of discrete choice methods to consumer preferences in health; and understanding the impact of health policy on access to, utilisation and costs of health care services. She is currently a chief investigator on a number of major NHMRC grants, including a CRE in Women’s Sexual and Reproductive Health (SPHERE). Between 2010 and 2017, Marion was one of the leaders of the Cancer Research Economics Research Team (CREST) at CHERE. She is an honorary life member of the Health Services Research Association of Australia and New Zealand.
Can supervise: YES
Undertaking health economics research into and applying the results of economic evaluation to health services; investigating the preferences and behaviour of providers and consumers/patients in relation to health care; and evaluation of health policy in terms of access to, utilisation and costs of health services.
Lynch, M, De Abreu Lourenco, R, Flattery, M & Haas, M 2019, 'Reviewing the Cost-Effectiveness of Long Acting Reversible Contraceptive Methods in an Australian Context', Australian and New Zealand Journal of Obstetrics and Gynaecology, vol. 59, no. 1, pp. 21-35.View/Download from: Publisher's site
De Abreu Lourenco, R, Haas, M, Hall, J, Parish, K, Domini, S & Viney, R 2019, 'My mind is made up: cancer concern and women's preferences for contralateral prophylactic mastectomy', European Journal of Cancer Care.View/Download from: UTS OPUS or Publisher's site
Reeve, R, Srasuebkul, P, Langton, J, Haas, MR, Viney, R & Pearson, S-A 2018, 'Health care use and costs at the end of life: A comparison of elderly Australian decedents with and without a cancer history', BMC Palliative Care, vol. 17, no. 1, pp. 1-10.View/Download from: UTS OPUS or Publisher's site
There is limited population-level research on end-of-life care in Australia that considers health care use and costs across hospital and community sectors. The aim of this study was to quantify health care use and costs in the last 6 months of life in a cohort of elderly Australian decedents and to examine the factors associated with end-of-life resource use and costs.
A retrospective cohort study using routinely collected health data from Australian Government Department of Veterans' Affairs clients. The study included two cohorts of elderly Australians who died between 2005 and 2009; one cohort with a recorded cancer diagnosis and a comparison cohort with no evidence of a cancer history. We examined hospitalisations, emergency department (ED) visits, prescription drugs, clinician visits, pathology, and procedures and associated costs in the last 6 months of life. We used negative binominal regression to explore factors associated with health service use and costs.
The cancer cohort had significantly higher rates of health service use and 27% higher total health care costs than the comparison cohort; in both cohorts, costs were driven primarily by hospitalisations. Older age was associated with lower costs and those who died in residential aged care incurred half the costs of those who died in hospital.
The results suggest differences in end-of-life care pathways dependent on patient factors, with younger, community-dwelling patients and those with a history of cancer incurring significantly greater costs. There is a need to examine whether the investment in end-of-life care meets patient and societal needs.
Wright, MC, Hall, J, Van Gool, K & Haas, M 2018, 'How common is multiple general practice attendance in Australia?', Australian Journal of General Practice, vol. 47, no. 5, pp. 289-296.View/Download from: UTS OPUS
Background and objectives
Australians can seek general practice care from multiple general practitioners (GPs) in multiple locations. This provides high levels of patient choice but may reduce continuity of care. The aim of this study was to estimate the prevalence of attendance at multiple general practices in Australia, and identify patient characteristics associated with multiple practice attendances.
A cross-sectional survey of 2477 Australian adults was conducted online in July 2013. Respondents reported whether they had attended more than one general practice in the past year, and whether they had a usual general practice and GP. Demographic information, health service use and practice characteristics were also obtained from the survey.
Over one-quarter of the sample reported attending more than one practice in the previous year. Multiple practice attendance is less common with increasing age, and less likely for survey respondents from regional Australia, compared with respondents from metropolitan areas. Multiple practice attenders are just as likely as single practice attenders to have a usual GP. Discussion
A significant proportion of general practice care is delivered away from usual practices. This may have implications for health policy, in terms of continuity and quality of primary care.
Phan, YHL, De Abreu Lourenco, R, Haas, M & Van Der Linden, N 2018, 'Key considerations in reimbursement decision-making for multiple sclerosis drugs in Australia', Multiple Sclerosis and Related Disorders, vol. 25, pp. 144-149.View/Download from: UTS OPUS or Publisher's site
De Abreu Lourenco, R, Haas, M, Hall, J & Viney, R 2017, 'Valuing meta-health effects for use in economic evaluations to inform reimbursement decisions: a review of the evidence', PharmacoEconomics, vol. 35, no. 3, pp. 347-362.View/Download from: UTS OPUS or Publisher's site
This review explores the evidence from the literature regarding how meta-health effects (effects other than health resulting from the consumption of health care) are valued for use in economic evaluations.
A systematic review of the published literature (the EMBASE, MEDLINE, PsycINFO, CINAHL, EconLit and SocINDEX databases were searched for publications in March 2016, plus manual searching) investigated the associations between study methods and the resulting values for meta-health effects estimated for use in economic evaluations. The review considered which meta-health effects were being valued and how this differed by evaluation approach, intervention investigated, source of funds and year of publication. Detailed reasons for differences observed between values for comparable meta-health effects were explored, accounting for the method of valuation.
The search of the literature revealed 71 studies of interest; 35% involved drug interventions, with convenience, information and process of care the three meta-health effects most often investigated. Key associations with the meta-health effects were the evaluation method, the intervention, and the source of funds. Relative values for meta-health effects ranged from 0.9% to 68% of the overall value reported in a study. For a given meta-health effect, the magnitude of the effect evaluated and how the meta-health effect was described and framed relative to overall health explained the differences in relative values.
Evidence from the literature shows variability in how meta-health effects are being measured for use in economic evaluations. Understanding the sources of that variability is important if decision makers are to have confidence in how meta-health effects are valued.
De Abreu Lourenco, R, Kenny, P, Haas, MR & Hall, J 2017, 'Factors affecting general practitioner charges and Medicare bulk-billing: results of a survey of Australians - erratum.', Med J Aust, vol. 206, no. 7, pp. 326-326.View/Download from: UTS OPUS
Pearce, AM, Haas, M, Viney, R, Pearson, S-A, Haywood, P, Brown, C & Ward, R 2017, 'Incidence and severity of self-reported chemotherapy side effects in routine care: A prospective cohort study', PLoS ONE, vol. 12, no. 10.View/Download from: UTS OPUS or Publisher's site
Van Breeschoten, J, De Abreu Lourenco, R, Signorelli, C, Haas, M, Cohn, RJ, Wakefield, CE & Fardell, JE 2017, 'Patterns and drivers of health care use in long-term childhood cancer survivors: a systematic review', Critical Reviews in Oncology/Hematology, vol. 220, pp. 60-76.View/Download from: UTS OPUS or Publisher's site
Eakin, E, Hayes, S, Reeves, M, Goode, A, Vardy, J, Boyle, F, Haas, M, Hiller, J, Mishra, G, Jefford, M, Koczwara, B, Saunders, C, Chapman, K, Boltong, A, Lane, K, Baldwin, P, Robertson, A, Millar, L, McKiernan, S, Demark-Wahnefried, W, Courneya, K & Robson, E 2017, 'Translating Research into Community Practice: The Healthy Living after Cancer Partnership Project', Obesity, vol. 25, p. S31.View/Download from: UTS OPUS or Publisher's site
Fiebig, D, Viney, RC, Knox, S, Haas, M, Street, D, Hole, AR, Weisberg, E & Bateson, D 2017, 'Consideration sets and their role in modelling doctor recommendations about contraceptives', Health Economics, vol. 26, no. 1, pp. 54-73.View/Download from: UTS OPUS or Publisher's site
Decisions about prescribed contraception are typically the result of a consultation between a woman and her doctor. In order to better understand contraceptive choice within this environment, stated preference methods are utilized to ask doctors about what contraceptive options they would discuss with different types of women. The role of doctors is to confine their discussion to a subset of products that best match their patient. This subset of options forms the consideration set from which the ultimate recommendation is made. Given the existence of consideration sets we address the issue of how to model appropriately the ultimate recommendations. The estimated models enable us to characterize doctor recommendations and how they vary with patient attributes and to highlight where recommendations are clear and when they are uncertain. The results also indicate systematic variation in recommendations across different types of doctors, and in particular we observe that some doctors are reluctant to embrace new products and instead recommend those that are more familiar. Such effects are one possible explanation for the relatively low uptake of more cost effective longer acting reversible contraceptives and indicate that further education and training of doctors may be warranted. Copyright © 2015 John Wiley & Sons, Ltd.
Rechel, B, Džakula, A, Duran, A, Fattore, G, Edwards, N, Grignon, M, Haas, M, Habicht, T, Marchildon, GP, Moreno, A, Ricciardi, W, Vaughan, L & Smith, TA 2016, 'Hospitals in rural or remote areas: An exploratory review of policies in 8 high-income countries.', Health Policy, vol. 120, no. 7, pp. 758-769.View/Download from: Publisher's site
Our study reviewed policies in 8 high-income countries (Australia, Canada, United States, Italy, Spain, United Kingdom, Croatia and Estonia) in Europe, Australasia and North America with regard to hospitals in rural or remote areas. We explored whether any specific policies on hospitals in rural or remote areas are in place, and, if not, how countries made sure that the population in remote or rural areas has access to acute inpatient services. We found that only one of the eight countries (Italy) had drawn up a national policy on hospitals in rural or remote areas. In the United States, although there is no singular comprehensive national plan or vision, federal levers have been used to promote access in rural or remote areas and provide context for state and local policy decisions. In Australia and Canada, intermittent policies have been developed at the sub-national level of states and provinces respectively. In those countries where access to hospital services in rural or remote areas is a concern, common challenges can be identified, including the financial sustainability of services, the importance of medical education and telemedicine and the provision of quick transport to more specialized services.
Mazza, D, Black, K, Taft, A, Lucke, J, McGeech, K, Haas, MR, McKay, H & Peipert, J 2016, 'Increasing the uptake of long-acting reversible contraception in general practice: the Australian Contraceptive ChOice pRoject (ACCORd) cluster randomised controlled trial protocol', BMJ Open, vol. 6, no. 10, pp. e012491-e012491.View/Download from: Publisher's site
Kenny, P, De Abreu Lourenco, R, Wong, CY, Haas, M & Goodall, S 2016, 'Community preferences in general practice: important factors for choosing a general practitioner.', Health expectations : an international journal of public participation in health care and health policy, vol. 19, no. 1, pp. 26-38.
Understanding the important factors for choosing a general practitioner (GP) can inform the provision of consumer information and contribute to the design of primary care services.To identify the factors considered important when choosing a GP and to explore subgroup differences.An online survey asked about the respondent's experience of GP care and included 36 questions on characteristics important to the choice of GP.An Australian population sample (n = 2481) of adults aged 16 or more.Principal components analysis identified dimensions for the creation of summated scales, and regression analysis was used to identify patient characteristics associated with each scale.The 36 questions were combined into five scales (score range 1-5) labelled: care quality, types of services, availability, cost and practice characteristics. Care quality was the most important factor (mean = 4.4, SD = 0.6) which included questions about technical care, interpersonal care and continuity. Cost (including financial and time cost) was also important (mean = 4.1, SD = 0.6). The least important factor was types of services (mean = 3.3, SD = 0.9), which covered the range of different services provided by or co-located with the practice. Frequent GP users and females had higher scores across all 5 scales, while the importance of care quality increased with age.When choosing a GP, information about the quality of care would be most useful to consumers. Respondents varied in the importance given to some factors including types of services, suggesting the need for a range of alternative primary care services.
Cheng, Q, Church, J, Haas, M, Goodall, S, Sangster, J & Furber, S 2016, 'Cost-effectiveness of a population-based lifestyle intervention to promote healthy weight and physical inactivity in non-attenders of cardiac rehabilitation', Heart Lung and Circulation, vol. 25, pp. 265-274.View/Download from: Publisher's site
Langton, J, Reeve, R, Srasuebkul, P, Haas, M, Viney, R, Currow, D & Pearson, S-A 2016, 'Health service use and costs in the last six months of life in elderly decedents with a history of cancer: A comprehensive analysis from a health payer perspective', British Journal of Cancer, vol. 114, no. 11, pp. 1293-1302.View/Download from: Publisher's site
Sangster, J, Church, J, Haas, M, Furber, S & Bauman, A 2016, 'Corrigendum to "A Comparison of the Cost-effectiveness of two Pedometer-based Telephone Coaching Programs for People with Cardiac Disease". [Heart, Lung and Circulation (2015) 24, 471-479]. DOI: 10.1016/j.hlc.2015.01.008', Heart Lung and Circulation, vol. 25, no. 4, pp. 410-411.View/Download from: Publisher's site
Rechel, B, McKee, M, Haas, MR, Marchildon, GP, Bousquet, F, Blümel, M, Geissler, A, van Ginneken, E, Ashton, T, Sperre Saunes, I, Anell, A, Quentin, W, Saltman, R, Culler, SD, Barnes, AJ, Palm, W & Nolte, E 2016, 'Public reporting on quality, waiting times and patient experience in 11 high-income countries', Health Policy, vol. 120, no. 4, pp. 377-383.View/Download from: UTS OPUS or Publisher's site
Siva, S, Kron, T, Bressel, M, Haas, MR, Mai, T, Vinod, S, Sasso, G, Wong, W, Le, H, Eade, T, Hardcastle, N, Chesson, B, Pham, D, Høyer, M, Montgomery, R & Ball, D 2016, 'A Randomised Phase II Trial of Stereotactic Ablative Fractionated Radiotherapy versus Radiosurgery for Oligometastatic Neoplasia to the Lung (TROG 13.01 SAFRON II)', BMC Cancer, vol. 16.View/Download from: UTS OPUS or Publisher's site
Bloem, L, De Abreu Lourenco, R, Chin, M, Ly, B & Haas, M 2016, 'Factors impacting treatment choice in the first-line treatment of colorectal cancer', Oncology and Therapy, vol. 4, no. 1, pp. 103-116.View/Download from: UTS OPUS or Publisher's site
Parkinson, B, Viney, RC, Haas, M, Goodall, S, Srasuebkul, P & Pearson, SA 2016, 'Real world evidence: a comparison of the Australian Herceptin Program and clinical trials of trastuzumab for HER2+ metastatic breast cancer', PharmacoEconomics, vol. 34, no. 10, pp. 1039-1050.View/Download from: UTS OPUS or Publisher's site
Sangster, J, Furber, S, Allman-Farinelli, M, Phongsavan, P, Redfern, J, Haas, M, Church, J, Mark, A & Bauman, A 2015, 'Effectiveness of a Pedometer-based Telephone Coaching Program on Weight and Physical Activity for People Referred to a Cardiac Rehabilitation Program: A Randomized Controlled Trial', Journal of Cardiopulmonary Rehabilitation and Prevention, vol. 35, no. 2, pp. 124-129.View/Download from: Publisher's site
PURPOSE: To determine the effectiveness of a pedometer-based telephone lifestyle coaching intervention on weight and physical activity.
METHODS: A randomized controlled trial was conducted with 313 patients referred to cardiac rehabilitation in rural and urban Australia. Participants were allocated to a healthy weight (HW) (4 telephone coaching sessions on weight and physical activity) or a physical activity (PA) intervention (2 telephone coaching sessions on physical activity). Weight and physical activity were assessed by self-report at baseline, short-term (6-8 weeks), and medium-term (6-8 months).
RESULTS: More than 90% of participants completed the trial. Over the medium-term, participants in the HW group decreased their weight compared with participants in the PA group (P = .005). Participants in the HW group with a body mass index of ≥25 kg/m2 had a mean weight loss of 1.6 kg compared with participants in the PA-only group who lost a mean of 0.4 kg (P = .015). Short-term, both groups increased their physical activity time, and the PA group maintained this increase at the medium-term.
CONCLUSIONS: Participants in the HW group achieved modest improvements in weight, and those in the PA group demonstrated increased physical activity. Low-contact, telephone-based interventions are a feasible means of delivering lifestyle interventions for underserved rural communities, for those not attending cardiac rehabilitation, or as an adjunct to cardiac rehabilitation.
Pearce, A, Haas, M, Viney, R, Haywood, P, Pearson, S-A, van Gool, K, Srasuebkul, P & Ward, R 2015, 'Can administrative data be used to measure chemotherapy side effects?', EXPERT REVIEW OF PHARMACOECONOMICS & OUTCOMES RESEARCH, vol. 15, no. 2, pp. 215-222.View/Download from: Publisher's site
Haas, M & De Abreu Lourenco, R 2015, 'Pharmacological Management of Chronic Lower Back Pain: A Review of Cost Effectiveness', PharmacoEconomics, vol. 33, no. 6, pp. 561-569.View/Download from: Publisher's site
Lower back pain is one of the most prevalent musculoskeletal conditions in the developed world and accounts for significant health services use. The American College of Physicians and the American Pain Society have published a joint clinical guideline that recommends providing patients with information on prognosis and self-management, the use of medications with proven benefits and, for those who do not improve, consideration be given to the use of spinal manipulation (for acute lower back pain only), interdisciplinary rehabilitation, exercise, acupuncture, massage, yoga, cognitive behavioural therapy or relaxation. The purpose of this review was to evaluate published economic evaluations of pharmacological management for chronic lower back pain. A total of seven studies were eligible for inclusion in there view. The quality of the economic evaluations undertaken in the included studies was not high. This was primarily because of the nature of the underlying clinical evidence, most of which did not come from rigorous randomised controlled trials (RCTs), and the manner in which it was incorporated into the economic evaluations. All studies provided reasonable information about what aspects of healthcare and other resource use were identified, measured and valued. However, the reporting of total costs was not uniform across studies. Measures of pain and disability were the most commonly collected outcomes measures. Two studies collected information on quality of life directly from participants while two studies modelled this information based on the literature. Future economic evaluations of interventions for chronic lower back pain, including pharmacological interventions, should be based on the results of well-conducted RCTs where the measurement of costs and outcomes such as quality of life and quality-adjusted life-years is included in the trial protocol, and which have a follow-up period sufficient to capture meaningful changes in both costs and outcomes. In ...
Lourenco, RDA, Kenny, P, Haas, MR & Hall, JP 2015, 'Factors affecting general practitioner charges and Medicare bulk-billing: results of a survey of Australians', MEDICAL JOURNAL OF AUSTRALIA, vol. 202, no. 2, pp. 87-+.View/Download from: Publisher's site
Comino, EJ, Islam, MDF, Tran, DT, Jorm, L, Flack, J, Jalaludin, B, Haas, M & Harris, MF 2015, 'Association of processes of primary care and hospitalisation for people with diabetes: A record linkage study', Diabetes Research and Clinical Practice, vol. 108, no. 2, pp. 296-305.View/Download from: Publisher's site
Aims: To explore the association of primary care and hospitalisation for people with diabetes. Methods: The study comprised 20,433 diabetic participants in the Sax Institute's 45 and Up Study. Data on processes of care at recruitment (15 months) were extracted from the Department of Human Services Medicare database. Processes included continuity of primary care (47.1%), and claims for completion of an annual cycle of care (25.0%), GP management plan/team care arrangement (GPMP/TCA, 41.3%), review of GPMP/TCA (24.0%), and monitoring including HbA1c (62.7%). Hospitalisation (12 months) following recruitment was extracted from administrative data held by NSW Ministry of Health. Adjusted incidence rate ratios (aIRR) with 95% confidence interval were calculated. Results: A hospital admission was reported for 33.0% of participants. Continuity of care (aIRR: 0.92 (95%CI: 0.89-0.96)), or claims for an annual cycle of care (aIRR: 0.77 (0.74-0.80)) or HbA1c testing (aIRR: 0.92 (0.89-0.96) were associated with a reduced likelihood of hospitalisation. While claims for preparation of GPMP/TCA were not associated with hospitalisation, a claim for review of GPMP/TCA was associated with a reduced likelihood of hospitalisation (aIRR: 0.92 (95%CI: 0.89 0.96)). Conclusions: This study has implications for hospital avoidance programmes suggesting that strengthening primary care may be more important than care coordination for this group of patients.
Sangster, J, Church, J, Haas, M, Furber, S & Bauman, A 2015, 'A Comparison of the Cost-effectiveness of Two Pedometer-based Telephone Coaching Programs for People with Cardiac Disease', Heart Lung and Circulation, vol. 24, no. 5, pp. 471-479.View/Download from: Publisher's site
Introduction: Following a cardiac event it is recommended that cardiac patients participate in cardiac rehabilitation (CR) programs. However, little is known about the relative cost-effectiveness of lifestyle-related interventions for cardiac patients. This study aimed to compare the cost-effectiveness of a telephone-delivered Healthy Weight intervention to a telephone-delivered Physical Activity intervention for patients referred to CR in urban and rural Australia. Methods: A cost-utility analysis was conducted alongside a randomised controlled trial of the two interventions. Outcomes were measured as Quality Adjusted Life Years (QALYs) gained. Results: The estimated cost of delivering the interventions was $201.48 per Healthy Weight participant and $138.00 per Physical Activity participant. The average total cost (cost of health care utilisation plus patient costs) was $1,260 per Healthy Weight participant and $2,112 per Physical Activity participant, a difference of $852 in favour of the Healthy Weight intervention. Healthy Weight participants gained an average of 0.007 additional QALYs than did Physical Activity participants. Thus, overall the Healthy Weight intervention dominated the Physical Activity intervention (Healthy Weight intervention was less costly and more effective than the Physical Activity intervention). Subgroup analyses showed the Healthy Weight intervention also dominated the Physical Activity intervention for rural participants and for participants who did not attend CR. Conclusions: The low-contact pedometer-based telephone coaching Healthy Weight intervention is overall both less costly and more effective compared to the Physical Activity intervention, including for rural cardiac patients and patients that do not attend CR.
Langton, JM, Srasuebkul, P, Reeve, R, Parkinson, B, Gu, Y, Buckley, NA, Haas, M, Viney, R, Pearson, SA & The End-of-Life in Cancer Care (EoL-CC) Investigators 2015, 'Resource use, costs and quality of end-of-life care: observations in a cohort of elderly Australian cancer decedents.', Implementation Science, vol. 10, no. 25, pp. 1-14.View/Download from: UTS OPUS or Publisher's site
BACKGROUND: The last year of life is one of the most resource-intensive periods for people with cancer. Very little population-based research has been conducted on end-of-life cancer care in the Australian health care setting. The objective of this program is to undertake a series of observational studies examining resource use, costs and quality of end-of-life care in a cohort of elderly cancer decedents using linked, routinely collected data. METHODS/DESIGN: This study forms part of an ongoing cancer health services research program. The cohorts for the end-of-life research program comprise Australian Government Department of Veterans' Affairs decedents with full health care entitlements, residing in NSW for the last 18 months of life and dying between 2005 and 2009. We used cancer and death registry data to identify our decedent cohorts and their causes of death. The study population includes 9,862 decedents with a cancer history and 15,483 decedents without a cancer history. The median age at death is 86 and 87 years in the cancer and non-cancer cohorts, respectively. We will examine resource use and associated costs in the last 6 months of life using linked claims data to report on health service use, hospitalizations, emergency department visits and medicines use. We will use best practice methods to examine the nature and extent of resource use, costs and quality of care based on previously published indicators. We will also examine factors associated with these outcomes. DISCUSSION: This will be the first Australian research program and among the first internationally to combine routinely collected data from primary care and hospital-based care to examine comprehensively end-of-life care in the elderly. The research program has high translational value, as there is limited evidence about the nature and quality of care in the Australian end-of-life setting.
Comino, EJ, Harris, MF, Islam, MDF, Tran, DT, Jalaludin, B, Jorm, L, Flack, J & Haas, M 2015, 'Impact of diabetes on hospital admission and length of stay among a general population aged 45 year or more: a record linkage study.', BMC Health Services Research, vol. 15, no. 12, pp. 1-13.View/Download from: UTS OPUS or Publisher's site
The increased prevalence of diabetes and its significant impact on use of health care services, particularly hospitals, is a concern for health planners. This paper explores the risk factors for all-cause hospitalisation and the excess risk due to diabetes in a large sample of older Australians.The study population was 263,482 participants in the 45 and Up Study. The data assessed were linked records of hospital admissions in the 12 months following completion of a baseline questionnaire. All cause and ambulatory care sensitive admission rates and length of stay were examined. The associations between demographic characteristics, socioeconomic status, lifestyle factors, and health and wellbeing and risk of hospitalisation were explored using zero inflated Poisson (ZIP) regression models adjusting for age and gender. The ratios of adjusted relative rates and 95% confidence intervals were calculated to determine the excess risk due to diabetes.Prevalence of diabetes was 9.0% (n = 23,779). Age adjusted admission rates for all-cause hospitalisation were 631.3 and 454.8 per 1,000 participant years and the mean length of stay was 8.2 and 7.1 days respectively for participants with and without diabetes. In people with and without diabetes, the risk of hospitalisation was associated with age, gender, household income, smoking, BMI, physical activity, and health and wellbeing. However, the increased risk of hospitalisation was attenuated for participants with diabetes who were older, obese, or had hypertension or hyperlipidaemia and enhanced for those participants with diabetes who were male, on low income, current smokers or who had anxiety or depression.This study is one of the few studies published to explore the impact of diabetes on hospitalisation in a large non-clinical population, the 45 and Up Study. The attenuation of risk associated with some factors is likely to be due to correlation between diabetes and factors such as age and obesity. The increased risk in a...
Ward, RL, Laaksonen, MA, 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-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, vol. 11, no. 2, pp. 178-+.View/Download from: Publisher's site
Church, J, Goodall, S & Haas, M 2015, 'Cost-effectiveness of injury and falls prevention strategies for older adults living in residential aged care facilities', PharmacoEconomics, vol. 33, no. 12, pp. 1301-1310.View/Download from: Publisher's site
Moseley, AM, Beckenkamp, PR, Haas, MR, Herbert, RD, Lin, C-WC & EXACT Team 2015, 'Rehabilitation after immobilization for ankle fracture: the EXACT randomized clinical trial', JAMA, vol. 314, no. 13, pp. 1376-1385.View/Download from: UTS OPUS or Publisher's site
Importance The benefits of rehabilitation after immobilization for ankle fracture are unclear.
Objectives To determine the effectiveness of a supervised exercise program and advice (rehabilitation) compared with advice alone and to determine if effects are moderated by fracture severity or age and sex.
Design, Setting, and Participants The EXACT trial was a pragmatic, randomized clinical trial conducted from December 2010 to June 2014. Patients with isolated ankle fracture presenting to fracture clinics in 7 Australian hospitals were randomized on the day of removal of immobilization. Of 571 eligible patients, 357 chose not to participate and 214 were allocated to rehabilitation (n = 106) or advice alone (n = 108), with 194 (91%) followed up at 1 month, 173 (81%) at 3 months, and 170 (79%) at 6 months. There were no withdrawals attributed to adverse effects. Recruitment terminated early on December 31, 2013 (planned enrollment, 342; actual, 214), because funding was exhausted.
Interventions Supervised exercise program and advice about self-management (rehabilitation) (individually tailored, prescribed, monitored, and progressed) or advice alone, both delivered by a physical therapist.
Main Outcomes and Measures Primary outcomes were activity limitation assessed using the Lower Extremity Functional Scale (score range, 0-80; higher scores indicate better activity), and quality of life assessed using the Assessment of Quality of Life (score range, 0-1; higher scores indicate better quality of life), measured at baseline and at 1, 3 (primary time point), and 6 months.
Results Mean activity limitation and quality of life at baseline were 30.1 (SD, 12.5) and 0.51 (SD, 0.24), respectively, for advice and 30.2 (SD, 13.2) and 0.54 (SD, 0.24) for rehabilitation, increasing to 64.3 (SD, 13.5) and 0.85 (SD, 0.17) for advice vs 64.3 (SD, 15.1) and 0.85 (SD, 0.20) for rehabilitation at 3 months. Rehabilitation was not more effective than advice for activity limitati...
Dunbabin, J, Perry, L, Steinbeck, K, Haas, MR, James, S & Lowe, J 2015, 'Can Telehealth engage young people with Type 1 Diabetes? Experiences from the YOuR-Diabetes Project', Australian Diabetes Educator, vol. 18, no. 3, pp. 32-34.
Eakin, EG, Hayes, SC, Haas, MR, Reeves, MM, Vardy, JL, Boyle, F, Hiller, JE, Mishra, GD, Goode, AD, Jefford, M, Koczwara, B, Saunders, CM, Demark‐Wahnefried, W, Courneya, KS, Schmitz, KH, Girgis, A, White, K, Chapman, K, Boltong, AG, Lane, K, McKiernan, S, Millar, L, O'Brien, L, Sharplin, G, Baldwin, P & Robson, EL 2015, 'Healthy Living after Cancer: A dissemination and implementation study evaluating a telephone-delivered healthy lifestyle program for cancer survivors', BMC Cancer, vol. 15.View/Download from: UTS OPUS or Publisher's site
Hou, C, Siva, S, Haas, M & Viney, R 2014, 'COST-EFFECTIVENESS OF POST-THERAPY PET AND TELEPHONE INTERVIEW IN THE CLINICAL FOLLOW-UP OF PATIENTS TREATED WITH LOCALLY ADVANCED CERVICAL CANCER.', Value in Health, vol. 17, no. 7, pp. A736-A737.View/Download from: UTS OPUS
Our previous research indicated that post-therapy PET scanning may obviate the need for hospital-based follow-up in patients with locally advanced cervical cancer who achieved a complete metabolic response (CMR). In these patients, asymptomatic recurrences were rarely discovered through examination in the clinic. The aim of this research is to evaluate the cost-effectiveness of applying different follow-up strategies in Australia.
A decision analytical model was constructed to evaluate cost per quality-adjusted life-year (QALY) and life-years gained (LYG) by comparing two follow-up strategies: 1) Routine hospital-based follow-up and 2) Alternative follow-up involving post-therapy PET and nurse-led telephone interview. A model was built using data from a prospective institutional registry study of 105 consecutive women underwent definitive chemoradiation therapy. Based on published institutional data, it was estimated that patients who had a complete metabolic response identified by PET, would have 5-year overall-survival of 93% and 1.5% recurrence rate, while those without CMR would have a 5-year overall-survival of only 36%.The impact of uncertainty was evaluated using probabilistic sensitivity analysis.
Costs for Alternative follow-up was estimated to be $25,657 compared with $19,982 for Routine follow-up. Alternative follow-up is not cost-saving; this is because the cost of PET screening and additional treatment performed on those without CMR is more than offset by the cost of intensive hospital-based visits avoided. Preliminary modeling suggest that the Alternative follow-up is likely to be cost-effective compared with Routine follow-up with an ICER of $4,094/QALYs gained, given the survival benefit associated with better targeted salvage therapy and that this result is robust to a range of survival gain estimates and other parameters.
Performing PET scan to evaluate patient's risk of recurrence is an appealing prosp...
Eakin, E, Hayes, S, Haas, M, Reeves, M, Goode, A, Vardy, J, Boyle, F, Hiller, J, Mishra, G, Jefford, M, Kocwara, B, Demark-Wahnefried, W, Courneya, K, O'Brien, L, Boltong, A, Sharplin, G, McKiernan, S & Robson, E 2014, 'Translating research into practice: The healthy living after cancer partnership project', Journal of Science and Medicine in Sport, vol. 18, pp. e13-e13.View/Download from: Publisher's site
Langton, JM, Blanch, B, Drew, AK, Haas, M, Ingham, JM & Pearson, S-A 2014, 'Retrospective studies of end-of-life resource utilization and costs in cancer care using health administrative data: A systematic review', PALLIATIVE MEDICINE, vol. 28, no. 10, pp. 1167-1196.View/Download from: UTS OPUS or Publisher's site
Girgis, A, Kelly, B, Boyes, A, Haas, M, Viney, R, Descallar, J, Candler, H, Bellamy, D & Proietto, A 2014, 'The PACT study protocol: a time series study investigating the impact, acceptability and cost of an integrated model for psychosocial screening, care and treatment of patients with urological and head and neck cancers.', BMJ Open, vol. 4, no. 1, pp. 1-11.View/Download from: UTS OPUS or Publisher's site
INTRODUCTION: While there is good evidence of the effectiveness of a variety of interventions and services to prevent and/or relieve distress experienced by people affected by cancer, much of this psychosocial morbidity is undetected and untreated, with consequent exacerbated suffering, decreased satisfaction with care, impaired adherence to treatment regimens and poorer morbidity and mortality outcomes. The objective of this study is to develop, implement and assess the impact, acceptability and cost of an integrated, patient-centred Psychosocial Assessment, Care and Treatment (PACT) model of care for patients with urological and head and neck cancers. METHODS AND ANALYSIS: A time series research design will be used to test the PACT model of care, newly introduced in an Australian tertiary hospital. The primary outcome is system-level impact, assessed through audit of patients' medical records and Medicare claims for follow-up care. The secondary outcomes are impact of the model on patients' experience and healthcare professionals' (HCPs) knowledge and confidence, assessed via patient and HCP surveys at baseline and at follow-up. Acceptability of the intervention will be assessed through HCP interviews at follow-up, and cost will be assessed from Medicare and Pharmaceutical Benefits Scheme claims information and information logged pertaining to intervention activities (eg, time spent by the newly appointed psycho-oncology staff in direct patient contact, providing training sessions, engaging in case review) and their associated costs (eg, salaries, training materials and videoconferencing). ETHICS AND DISSEMINATION: Ethics approval was obtained from the Human Research Ethics Committees of Hunter New England Local Health District and the University of NSW. RESULTS: The results will be widely disseminated to the funding body and through peer-reviewed publications, HCP and consumer publications, oncology conferences and meetings. TRIAL REGISTRATION: The study is re...
Pearce, AM, Van Gool, K, Haywood, P & Haas, MR 2014, 'Delays in access to affordable medicines: putting policy into perspective - Authors' response', Australian Health Review, vol. 38, no. 1, pp. 16-17.
Reeve, RD, Church, J, Haas, MR, Bradford, W & Viney, RC 2014, 'Factors that drive the gap in diabetes rates between Aboriginal and non-Aboriginal people in non-remote NSW?', Australian and New Zealand Journal of Public Health, vol. 38, no. 5, pp. 459-465.View/Download from: Publisher's site
Objective: To identify factors underpinning the gap in diabetes rates between Aboriginal and non-Aboriginal people in non-remote NSW. This will indicate appropriate target areas for policy and for monitoring progress towards reducing the gap. Methods: Data from the 200405 National Health Survey and National Aboriginal and Torres Strait Islander Health Survey were used to estimate differences in self-reported diabetes rates and risk/prevention factors between Aboriginal and non-Aboriginal people in non-remote NSW. Logistic regression models were used to investigate the contribution of each factor to predicting the probability of diabetes. Results: Risk factors for diabetes are more prevalent and diabetes rates 2.5 to 4 times higher in Aboriginal compared to non-Aboriginal adults in non-remote NSW. The odds of (known) diabetes for both groups are significantly higher for older people, those with low levels of education and those who are overweight or obese. In the Aboriginal sample, the odds of diabetes are significantly higher for people reporting forced removal of their relatives. Conclusions: Differences in BMI and education appear to be driving the diabetes gap, together with onset at younger ages in the Aboriginal population. Psychological distress, indicated by removal of relatives, may contribute to increased risk of diabetes in the Aboriginal population. Implications: The results imply that improved nutrition and exercise, capacity to access and act upon health care information and early intervention are required to reduce the diabetes gap. Current strategies appear to be appropriately aligned with the evidence; however, further research is required to determine whether implementation methods are effective.
Chenoweth, L, Forbes, I, King, MT, Fleming, R, Stein-Parbury, J, Yun-Hee, J, Haas, MR, Kenny, PM, Luscombe, G & Brodaty, H 2014, 'PerCEN: a cluster randomized controlled trial of person-centered residential care and environment for people with dementia', International Psychogeriatrics, vol. 26, no. 7, pp. 1147-1160.View/Download from: UTS OPUS or Publisher's site
Background: There is good evidence of the positive effects of person-centered care (PCC) on agitation in dementia. We hypothesized that a person-centered environment (PCE) would achieve similar outcomes by focusing on positive environmental stimuli, and that there would be enhanced outcomes by combining PCC and PCE. Methods: 38 Australian residential aged care homes with scope for improvement in both PCC and PCE were stratified, then randomized to one of four intervention groups: (1) PCC; (2) PCE; (3) PCC +PCE; (4) no intervention. People with dementia, over 60 years of age and consented were eligible. Co-outcomes assessed pre and four months post-intervention and at 8 months follow-up were resident agitation, emotional responses in care, quality of life and depression, and care interaction quality. Results: From 38 homes randomized, 601 people with dementia were recruited. At follow-up the mean change for quality of life and agitation was significantly different for PCE (p = 0.02, p = 0.05, respectively) and PCC (p = 0.0003, p = 0.002 respectively), compared with the non-intervention group (p = 0.48, p = 0.93 respectively). Quality of life improved non-significantly for PCC+PCE (p = 0.08), but not for agitation (p = 0.37). Improvements in care interaction quality (p = 0.006) and in emotional responses to care (p = 0.01) in PCC+PCE were not observed in the other groups. Depression scores did not change in any of the groups. Intervention compliance for PCC was 59%, for PCE 54% and for PCC+PCE 66%. Conclusion: The hypothesis that PCC+PCE would improve quality of life and agitation even further was not supported, even though there were improvements in the quality of care interactions and resident emotional responses to care for some of this group. The Australian New Zealand Clinical Trials Registry Number is ACTRN 12608000095369.
Blanch, B, Drew, A, Haas, M, Ingham, JM & Pearson, S 2013, 'Resource utilization, costs, and quality of end-of-life cancer care: A systematic review of retrospective cohort studies based on routinely collected data (1990-2011).', Journal of Clinical Oncology, vol. 31, no. 31_suppl, pp. 111-111.View/Download from: UTS OPUS or Publisher's site
111 Background: The last year of life is one of the most resource intensive periods in cancer care. The aim of this systematic review is to synthesize retrospective observational studies examining resource utilization and costs at the end-of-life period in adult cancer patients. The purpose is to examine study methodology and outcomes, with a particular focus on studies using quality indicators. METHODS: We searched Medline, Embase, CINAHL, and York Centre for Research and Dissemination (1990-2011). Two reviewers screened titles and abstracts of 14,424 articles and 835 full-text, potentially relevant articles. Inclusion criteria were: English-language; at least one resource utilization or cost outcome in adult cancer decedents with solid tumors; outcomes derived from health administrative data; and an exclusive end-of-life or palliative focus. RESULTS: We reviewed 78 studies examining end-of-life care in over 3.7 million cancer decedents; 55 were from the North America; and 33 published since 2008. We observed exponential increases in service use and costs as death approached. Hospital services were the main cost driver. Palliative services were relatively underutilized, and associated with lower expenditures than hospital-based care. The 15 studies using quality of care indicators demonstrated significant proportions of up to 33% of patients receive chemotherapy or life sustaining treatments in the last month of life; up to 66% do not receive hospice/palliative services. CONCLUSIONS: Observational studies using routinely collected health administrative data have the potential to drive evidence-based palliative care practice and policy. Further refinement of quality of care markers will enhance benchmarking activities across health care jurisdictions, providers, and patient populations.
Johar, M, Fiebig, DG, Haas, MR & Viney, RC 2013, 'Using repeated choice experiments to evaluate the impact of policy changes on cervical screening', Applied Economics, vol. 45, no. 14, pp. 1845-1855.View/Download from: UTS OPUS or Publisher's site
Australia was one of the first countries to introduce a publicly funded Human Papilloma Virus (HPV) vaccine program, and its introduction coincided with a media campaign to promote regular cervical screening. One issue with HPV vaccination is how it impacts on demand for screening. This study examines changes in women's screening preferences following these two interventions, using a novel approach to policy evaluation based on repeated discrete choice experiments. The study extends our previous analysis of attitudes to screening by taking advantage of the timing of the choice experiments to examine the impact of the two policy changes on determinants of screening. We find that, unexpectedly, willingness to screen is generally lower post-interventions. The reason for this trend appears to be related to HPV vaccination. We also find that interventions have minor impacts on how women value screening attributes. Our approach allows us to examine the impact of provider behaviour. A simulation demonstrates that under certain conditions, participation rates can be increased by 40% to 50% if health providers actively encourage women to undertake a cervical screening test.
O'Hara, B, Bauman, AE, Eakin, E, King, L, Haas, MR, Allman-Farinelli, MA, Owen, N, Cardona-Morrell, M, Farrell, L, Milat, AJ & Phongsavan, P 2013, 'Evaluation Framework for Translational Research: Case Study of Australia's Get Healthy Information and Coaching Service®', Health Promotion Practice, vol. 14, no. 3, pp. 380-389.View/Download from: UTS OPUS or Publisher's site
The Get Healthy Information and Coaching Service® (GHS), a free government-funded telephone-delivered information and coaching service was launched in February 2009 by the Australian New South Wales state government. It represents the translation of research evidence applied in the real world (T4 or Phase 4 translation), aimed at addressing the modifiable risk factors associated with the overweight and obesity. In controlled settings, it has been established that telephone-based lifestyle counseling programs are efficacious in reducing anthropometric and behavioral risk factors. This article presents the GHS case study as a population-wide intervention and describes the quasi-experimental evaluation framework used to evaluate both the process (statewide implementation) and impact (effectiveness) of the GHS in a real-world environment. It details the data collection, measures, and statistical analysis required in assessing the process of implementationreach and recruitment, marketing and promotion, service satisfaction, intervention fidelity, and GHS setting up and operations costsand in assessing the impact of GHSincreasing physical activity, improving dietary practices, and reducing body weight and waist circumference. The comprehensive evaluation framework designed for the GHS provides a method for building effectiveness evidence of a rare translation of efficacy trial evidence into population-wide practice
Pearce, AM, Haas, MR & Viney, RC 2013, 'Are the true impacts of adverse events considered in economic models of antineoplastic drugs? A systematic review', Applied Health Economics and Health Policy, vol. 11, no. 6, pp. 619-637.View/Download from: UTS OPUS or Publisher's site
Background Antineoplastic drugs for cancer are often associated with adverse events, which influence patients' physical health, quality of life and survival. However, the modelling of adverse events in cost-effectiveness analyses of antineoplastic drugs has not been examined. Aims This article reviews published economic evaluations that include a calculated cost for adverse events of antineoplastic drugs. The aim is to identify how existing models manage four issues specific to antineoplastic drug adverse events: the selection of adverse events for inclusion in models, the influence of dose modifications on drug quantity and survival outcomes, the influence of adverse events on quality of life and the consideration of multiple simultaneous or recurring adverse events. Methods A systematic literature search was conducted using MESH headings and key words in multiple electronic databases, covering the years 19992009. Inclusion criteria for eligibility were papers covering a population of adults with solid tumour cancers, the inclusion of at least one adverse event and the resource use and/or costs of adverse event treatment. Results From 4,985 citations, 26 eligible articles were identified. Studies were generally of moderate quality and addressed a range of cancers and treatment types. While the four issues specific to antineoplastic drug adverse events were addressed by some studies, no study addressed all of the issues in the same model. Conclusion This review indicates that current modelling assumptions may restrict our understanding of the true impact of adverse events on cost effectiveness of antineoplastic drugs. This understanding could be improved through consideration of the selection of adverse events, dose modifications, multiple events and quality of life in cost-effectiveness studies.
Weisberg, E, Bateson, D, Knox, SA, Haas, MR, Viney, RC, Fiebig, DG & Street, D 2013, 'Do women and providers value the same features of contraceptive products? Results of a best-worst stated preference experiment', The European Journal of Contraception & Reproductive Health Care, vol. 18, no. 3, pp. 181-190.View/Download from: UTS OPUS or Publisher's site
Objectives To determine how women and physicians rate individual characteristics of contraceptives. Methods Discrete choice experiments are used in health economics to elicit preferences for healthcare products. A choice experiment uses hypothetical scenarios to determine which individual factors infl uence choice. Women and general practitioners (GPs) were shown individual characteristics of contraceptives, not always matching existing methods, and chose the best and worst features. Results Two hundred women, mean age 36, 71% using contraception, were presented with descriptions of 16 possible methods and asked to indicate their preference for individual characteristics. One hundred and sixty-two GPs, mostly women, also completed 16 descriptions. Longer duration of action was most favoured by both, followed by lighter periods with less pain or amenorrhoea. The least attractive features for women were heavier and more painful periods, high cost, irregular periods, low effi cacy (10% failure) and weight gain of 3 kg. GPs ranked a 10% pregnancy rate as least attractive followed by heavy painful periods and a 5% failure rate. Conclusion Women and GPs differed in their ranking of contraceptive characteristics. Long duration of use, high effi cacy, minimal or no bleeding without pain, were preferred by both. Very undesirable were heavy periods especially with pain, and low effi cacy.
Knox, SA, Viney, RC, Gu, Y, Hole, A, Fiebig, DG, Street, D, Haas, MR, Weisberg, E & Bateson, D 2013, 'The effect of adverse information and positive promotion on women's preferences for prescribed contraceptive products', Social Science & Medicine, vol. 83, pp. 70-80.View/Download from: UTS OPUS or Publisher's site
Recent rapid growth in the range of contraceptive products has given women more choice, but also adds complexity to the resultant decision of which product to choose. This paper uses a discrete choice experiment (DCE) to investigate the effect of adverse information and positive promotion on women's stated preferences for prescribed contraceptive products. In November 2007, 527 Australian women aged 18-49 years were recruited from an online panel. Each was randomly allocated to one of three information conditions. The control group only received basic information on contraceptive products. One treatment group also received adverse information on the risks of the combined oral pill. The other group received basic information and promotional material on the vaginal ring, newly introduced into Australia and on the transdermal patch, which is unavailable in Australia. Respondents completed 32 choice sets with 3 product options where each option was described by a product label: either combined pill, minipill, injection, implant, hormonal IUD, hormonal vaginal ring, hormonal transdermal patch or copper IUD; and by the attributes: effect on acne, effect on weight, frequency of administration, contraceptive effectiveness, doctor's recommendation, effect on periods and cost. Women's choices were analysed using a generalized multinomial logit model (G-MNL) and model estimates were used to predict product shares for each information condition. The predictions indicated that adverse information did not affect women's preferences for products relative to only receiving basic information. The promotional material increased women's preferences for the transdermal patch. Women in all groups had a low preference for the vaginal ring which was not improved by promotion. The findings highlight the need for researchers to pay attention to setting the context when conducting DCEs as this can significantly affect results.
Comino, E, Tran, D, Haas, MR, Flack, J, Jalaludin, B, Jorm, L & Harris, MF 2013, 'Validating self-report of diabetes use by participants in the 45 and Up Study: a record linkage study', BMC Health Services Research, vol. 13, no. 481, pp. 1-17.View/Download from: UTS OPUS or Publisher's site
Background Prevalence studies usually depend on self-report of disease status in survey data or administrative data collections and may over- or under-estimate disease prevalence. The establishment of a linked data collection provided an opportunity to explore the accuracy and completeness of capture of information about diabetes in survey and administrative data collections. Methods Baseline questionnaire data at recruitment to the 45 and Up Study was obtained for 266,848 adults aged 45 years and over sampled from New South Wales, Australia in 2006-2009, and linked to administrative data about hospitalisation from the Admitted Patient Data Collection (APDC) for 2000-2009, claims for medical services (MBS) and pharmaceuticals (PBS) from Medicare Australia data for 2004-2009. Diabetes status was determined from response to a question `Has a doctor EVER told you that you have diabetes? (n=23,981) and augmented by examination of free text fields about diagnosis (n=119) or use of insulin (n=58). These data were used to identify the sub-group with type 1 diabetes. We explored the agreement between self-report of diabetes, identification of diabetes diagnostic codes in APDC data, claims for glycosylated haemoglobin (HbA1c) in MBS data, and claims for dispensed medication (oral hyperglycaemic agents and insulin) in PBS data. Results Most participants with diabetes were identified in APDC data if admitted to hospital (79.3%), in MBS data with at least one claim for HbA1c testing (84.7%; 73.4% if 2 tests claimed) or in PBS data through claim for diabetes medication (71.4%). Using these alternate data collections as an imperfect `gold standard? we calculated sensitivities of 83.7% for APDC, 63.9% (80.5% for two tests) for MBS, and 96.6% for PBS data and specificities of 97.7%, 98.4% and 97.1% respectively. The lower sensitivity for HbA1c may reflect the use of this test to screen for diabetes suggesting that it is less useful in identifying people with diabetes without a...
Church, J, Goodall, S, Norman, R & Haas, MR 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.View/Download from: UTS OPUS or Publisher's site
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.
Jeon, Y, Luscombe, G, Chenoweth, L, Stein-Parbury, J, Brodaty, H, King, MT & Haas, MR 2012, 'Staff outcomes from the Caring for Aged Dementia Care REsident Study (CADRES): A cluster randomised trial', International Journal of Nursing Studies, vol. 49, no. 5, pp. 508-518.View/Download from: UTS OPUS or Publisher's site
BACKGROUND: Dementia care mapping and person centred care are well-accepted as processes for improving care and well-being for persons with dementia living in the residential setting. However, the impact of dementia care mapping and person centred care on staff has not been well researched. OBJECTIVES: The impact of person centred care and dementia care mapping compared to each other and to usual dementia care on staff outcomes was examined in terms of staff burnout, general well-being, attitudes and reactions towards resident behavioural disturbances, perceived managerial support, and quality of care interactions. DESIGN: A cluster-randomised, controlled trial. SETTINGS: The study was conducted between 2005 and 2007 in 15 residential aged care sites in the Sydney metropolitan area, Australia, with comparable management structures, staffing mix and ratios, and standards of care. PARTICIPANTS: 194 consenting managers, nurses, therapists and nurse assistants working in the participating sites.
Haas, MR, Hall, JP, Viney, RC & Gallego, G 2012, 'Breaking up is hard to do: why disinvestment in medical technology is harder than investment', Australian Health Review, vol. 36, no. 2, pp. 148-152.View/Download from: UTS OPUS or Publisher's site
disinvestment, health technology assessment
Knox, SA, Viney, RC, Street, DJ, Haas, MR, Fiebig, DG, Weisberg, E & Bateson, D 2012, 'What's good and bad about contraceptive products?: A best-worst attribute experiment comparing the values of women consumers and GPs', PharmacoEconomics, vol. 30, no. 12, pp. 1187-1202.View/Download from: UTS OPUS or Publisher's site
Background: In the past decade, the range of contraceptives available has increased dramatically. There are limited data on the factors that determine women's choices on contraceptive alternatives or what factors providers consider most important when recommending contraceptive products to women. Objectives: Our objectives were to compare women's (consumers') preferences and GPs' (providers') views in relation to existing and new contraceptive methods, and particularly to examine what factors increase the acceptability of different contraceptive products. Methods: A best-worst attribute stated-choice experiment was completed online. Participants (Australian women of reproductive age and Australian GPs) completed questions on 16 contraceptive profiles. 200 women of reproductive age were recruited through a commercial panel. GPs from all states of Australia were randomly sampled and approached by phone; 162 GPs agreed to participate. Participants chose the best and worst attribute levels of hypothetical but realistic prescribed contraceptive products. Best and worst choices were modelled using multinomial logit and product features were ranked from best to worst according to the size of model coefficients. Results: The most attractive feature of the contraceptive products for both GPs and women consumers were an administration frequency of longer than 1 year and light or no bleeding. Women indicated that the hormonal vaginal ring was the least attractive mode of administration. Conclusions: Women and GPs agree that longer-acting methods with less bleeding are important features in preferred methods of contraception; however, women are also attracted to products involving less invasive modes of administration. While the vaginal ring may fill the niche in Australia for a relatively non-invasive, moderately long-acting and effective contraceptive, the results of this study indicate that GPs will need to promote the benefits of the vaginal ring to overcome negative per...
Haywood, P, de Raad, J, Van Gool, K, Haas, MR, Gallego, G, Pearson, S, Faedo, M & Ward, RL 2012, 'Title:Chemotherapy administration: modelling the costs of alternative protocols..', Pharmacoeconomics, vol. 30, no. 12, pp. 1173-1186.View/Download from: UTS OPUS or Publisher's site
O'Hara, B, Phongsavan, P, Venugopal, K, Eakin, E, Eggins, D, Caterson, H, King, L, Allman-Farinelli, M, Haas, MR & Bauman, AE 2012, 'Effectiveness of Australia's Get Healthy Information and Coaching Service: translational research with population wide impact', Preventive Medicine, vol. 55, no. 4, pp. 292-298.View/Download from: UTS OPUS or Publisher's site
OBJECTIVE: With increasing rates of non-communicable disease, there is a need for implementing population-wide, evidence-based interventions for improving behavioural risk factors. Telephone-based interventions provide one option. This study reports on the evaluation of the Australia's Get Healthy Information and Coaching Service®, to improve lifestyle behaviours, amongst a population-wide sample who completed the 6-month coaching programme. METHODS: Using a pre-post design, New South Wales participants who completed telephone-based coaching between February 2009 and December 2011 were included. Outcomes comprised self-reported weight, waist circumference, height, physical activity and dietary behaviours. Matched pair analyses and multivariate modelling were performed to assess behavioural changes. RESULTS: Participants (n=1440) reported statistically significant improvements in weight (-3.9kg (5.1)); waist circumference (-5.0cm (6.0)); and Body Mass Index (-1.4 BMI units (1.8)); number of walking and moderate-vigorous physical activity sessions of =30min per week; number of vigorous physical activity sessions of =20min per week and servings of vegetables; fruit; take-away meals and sweetened drinks (all p<0.001). Improvements in weight, waist, moderate physical activity, fruit and vegetable and take-away meals consumption remained significant after adjusting for socio-demographic characteristics
Comino, E, Davies, G, Krastev, Y, Haas, MR, Christl, B, Furler, J, Raymont, A & Harris, M 2012, 'A systematic review of interventions to enhance access to best practice primary health care for chronic disease management, prevention and episodic care', BMC Health Services Research, vol. 12:415, pp. 1-9.View/Download from: UTS OPUS or Publisher's site
Background Although primary health care (PHC) is a key component of all health care systems, services are not always readily available, accessible or affordable. This systematic review examines effective strategies to enhance access to best practice processes of PHC in three domains: chronic disease management, prevention and episodic care. Methods An extensive search of bibliographic data bases to identify peer and non-peer reviewed literature was undertaken. Identified papers were screened to identify and classify intervention studies that measured the impact of strategies (singly or in combination) on change in use or the reach of services in defined population groups (evaluated interventions). Results The search identified 3,148 citations of which 121 were intervention studies and 75 were evaluated interventions. Evaluated interventions were found in all three domains: prevention (n?=?45), episodic care (n?=?19), and chronic disease management (n?=?11). They were undertaken in a number of countries including Australia (n?=?25), USA (n?=?25), and UK (n?=?15). Study quality was ranked as high (31% of studies), medium (61%) and low (8%). The 75 evaluated interventions tested a range of strategies either singly (n?=?46 studies) or as a combination of two (n?=?20) or more strategies (n?=?9). Strategies targeted both health providers and patients and were categorised to five groups: practice re-organisation (n?=?43 studies), patient support (n?=?29), provision of new services (n?=?19), workforce development (n?=?11), and financial incentives (n?=?9). Strategies varied by domain, reflecting the complexity of care needs and processes. Of the 75 evaluated interventions, 55 reported positive findings with interventions using a combination of strategies more likely to report positive results.
Pearce, AM, Van Gool, K, Haywood, P & Haas, MR 2012, 'Delays in access to affordable medicines: putting policy into perspective', Australian Health Review, vol. 36, no. 4, pp. 412-418.View/Download from: UTS OPUS or Publisher's site
To save costs, the Australian Government recently deferred approval of seven new medicines recommended by the Pharmaceutical Benefits Advisory Committee (PBAC) for up to 7 months.Objectives: The aim of this research is to examine the timelines of PBAC applications following approval by the Therapeutic Goods Administration (TGA), allowing the recent Cabinet delays to be considered in the context of the overall medicines approval process. Methods. All new chemical entities and products for new indications approved in 2004 by the Australian Drug Evaluation Committee (ADEC) were identified. Outcomes of PBAC meetings from 2004 to 2010 were then searched to identify if and when these products were reviewed by PBAC. Results: ADEC recommended 63 eligible products for registration in 2004. Of the 113 submissions made to PBAC for these products, 66 were successful. Only 43% of the products were submitted to PBAC within 2 years, with an average 17-month delay from TGA approval of a product to consideration by the PBAC. Conclusions: Cabinet decisions to defer listing of new medicines delays access to new treatments. This occurred in addition to other longer delays, earlier in the approval process for medicines, resulting in a significant impact on the overall timeliness of listing.
Stein-Parbury, J, Chenoweth, L, Jeon, Y, Brodaty, H, Haas, MR & Norman, R 2012, 'Implementing person-centered care in residential dementia care', Clinical Gerontology, vol. 35, no. 5, pp. 404-424.View/Download from: UTS OPUS or Publisher's site
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.
Fiebig, DG, Knox, SA, Viney, RC, Haas, MR & Street, D 2011, 'Preferences for new and existing contraceptive products', Health Economics, vol. 20, no. S1, pp. 35-52.View/Download from: UTS OPUS or Publisher's site
New contraceptive methods provide greater choice in terms of effectiveness, management of side-effects, convenience and frequency of administration and flexibility, but make the decisions about contraception more complex. There are limited data on the factors that determine womenâs choices among these alternatives, to inform providers about the factors which are most important to women, or to predict uptake of new products. This paper reports on a choice experiment designed to elicit womenâs preferences in relation to prescribed contraception and to forecast the impact of the introduction of two new products into the Australian market. A generalised multinomial logit model is estimated and used in the simulation exercise. The model forecasts that the hormonal patch would be well received among women, achieving a greater market share than current non-pill products, but the vaginal ring would have limited appeal.
Lin, C, Haas, MR, Maher, G, Machado, L & van Tulder, M 2011, 'Cost-effectiveness of guideline-endorsed treatments for low back pain: A systematic review', European Spine Journal, vol. 20, no. 7, pp. 1024-1038.View/Download from: UTS OPUS or Publisher's site
Healthcare costs for low back pain (LBP) are increasing rapidly. Hence, it is important to provide treatments that are effective and cost-effective. The purpose of this systematic review was to investigate the cost-effectiveness of guideline-endorsed treatments for LBP. We searched nine clinical and economic electronic databases and the reference list of relevant systematic reviews and included studies for eligible studies. Economic evaluations conducted alongside randomised controlled trials investigating treatments for LBP endorsed by the guideline of the American College of Physicians and the American Pain Society were included. Two independent reviewers screened search results and extracted data. Data extracted included the type and perspective of the economic evaluation, the treatment comparators, and the relative costeffectiveness of the treatment comparators. Twenty-six studies were included. Most studies found that interdisciplinary rehabilitation, exercise, acupuncture, spinal manipulation or cognitive-behavioural therapy were costeffective in people with sub-acute or chronic LBP. Massage alone was unlikely to be cost-effective. There were inconsistent results on the cost-effectiveness of advice, insufficient evidence on spinal manipulation for people with acute LBP, and no evidence on the cost-effectiveness of medications, yoga or relaxation. This review found evidence supporting the cost-effectiveness of the guidelineendorsed treatments of interdisciplinary rehabilitation, exercise, acupuncture, spinal manipulation and cognitivebehavioural therapy for sub-acute or chronic LBP. There is little or inconsistent evidence for other treatments endorsed in the guideline.
Lin, CW, Haas, M, Maher, CG, MacHado, LA, Van Tulder, MW & Joos, S 2011, 'Cost-effectiveness of guideline-endorsed treatments for low back pain: A systematic review', Deutsche Zeitschrift fur Akupunktur, vol. 54, no. 2, pp. 26-27.View/Download from: Publisher's site
Church, J, Goodall, S, Norman, R & Haas, MR 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.View/Download from: UTS OPUS or Publisher's site
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.
Lin, C, Haas, MR, Maher, G, Machado, L & van Tulder, M 2011, 'Cost-effectiveness of general practice care for low back pain: A systematic review', European Spine Journal, vol. 20, no. 7, pp. 1012-1023.View/Download from: UTS OPUS or Publisher's site
Care from a general practitioner (GP) is one of the most frequently utilised healthcare services for people with low back pain and only a small proportion of those with low back pain who seek care from a GP are referred to other services. The aim of this systematic review was to evaluate the evidence on cost-effectiveness of GP care in non-specific low back pain. We searched clinical and economic electronic databases, and the reference list of relevant systematic reviews and included studies to June 2010. Economic evaluations conducted alongside randomised controlled trials with at least one GP care arm were eligible for inclusion. Two reviewers independently screened search results and extracted data. Eleven studies were included; the majority of which conducted a costeffectiveness or cost-utility analysis. Most studies investigated the cost-effectiveness of usual GP care. Adding advice, education and exercise, or exercise and behavioural counselling, to usual GP care was more cost-effective than usual GP care alone. Clinical rehabilitation and/or occupational intervention, and acupuncture were more costeffective than usual GP care. One study investigated the cost-effectiveness of guideline-based GP care, and found that adding exercise and/or spinal manipulation was more cost-effective than guideline-based GP care alone. In conclusion, GP care alone did not appear to be the most cost-effective treatment option for low back pain. GPs can improve the cost-effectiveness of their treatment by referring their patients for additional services, such as advice and exercise, or by providing the services themselves.
Chenoweth, L, King, MT, Luscombe, G, Forbes, I, Yun-Hee, J, Stein-Parbury, J, Brodaty, H, Fleming, R & Haas, MR 2011, 'Study Protocol of a Randomised Controlled Group Trial of Client and Care Outcomes in the Residential Dementia Care Setting', Worldviews on Evidence-Based Nursing, vol. 8, no. 3, pp. 153-165.View/Download from: UTS OPUS or Publisher's site
Literature suggests that quality of life (QOL), quality of care (QOC) and Behavioural and Psychological Symptoms of Dementia (BPSD) can be improved by relatively simple and inexpensive person-centred approaches to nursing care practices (PCC) and modifications to physical environment (PCE). Most research on this topic is observational and few randomised controlled trials have included an economic evaluation of PCC and PCE together. The PerCEN study aims to confirm the value of evidencebased nursing by evaluating the efficacy and cost effectiveness of implementing PCCand PCE in residential dementia care services. This article describes the PerCEN study protocol (ANZCTR 12608000095369).
Beckenkamp, P, Lin, C, Herbert, R, Haas, MR, Khera, K, Moseley, A & EXACT Team 2011, 'EXACT: EXercise or Advice after ankle fraCTure: Design of a randomised controlled trial', BMC Musculoskeletal Disorders, vol. 12, no. 148, pp. 1-7.View/Download from: UTS OPUS or Publisher's site
Background: Ankle fractures are common. Management of ankle fractures generally involves a period of immobilisation followed by rehabilitation to reduce pain, stiffness, weakness and swelling. The effects of a rehabilitation program are still unclear. However, it has been shown that important components of rehabilitation programs may not confer additional benefits over exercise alone. The primary aim of this trial is to determine the effectiveness and cost-effectiveness of an exercise-based rehabilitation program after ankle fracture, compared to advice alone.
Owen, KM, Pettman, TL, Haas, MR, Viney, RC & Misan, GM 2010, 'Individual preferences for diet and exercise programmes: changes over a lifestyle intervention and their link with outcomes', Public Health Nutrition, vol. 13, no. 2, pp. 245-252.View/Download from: UTS OPUS or Publisher's site
Objective To investigate the influence of a trial lifestyle intervention on participantsï½ preferences for a range of exercise and diet programmes and whether these differ between successful and unsuccessful participants. Design Hypothetical scenarios that describe attributes of diet and exercise programmes were developed using an experimental design. Participants completed an online questionnaire at baseline, 16 weeks and 12 months where they chose their most preferred of three programmes in each of sixteen scenarios. Discrete choice modelling was used to identify which attributes participants emphasised at each time point. Subjects Fifty-five individuals who exhibited symptoms of metabolic syndrome and who participated in a 16-week trial lifestyle intervention. Results There was a clear shift in programme preferences from structure to flexibility over the intervention. At baseline, emphasis was on individually designed and supervised exercise, structured diets and high levels of support, with Gainers focusing almost exclusively on support and supervision. Losers tended to consider a wider range of programme attributes. After 16 weeks preferences shifted towards self-directed rather than organised/supervised exercise and support was less important (this depended on the type of participant and whether they were in the follow-up group). Cost became significant for Gainers following the end of the primary intervention. Conclusions The stated preference method could be a useful tool in identifying potential for success and specific needs. Gainersï½ relinquishment of responsibility for lifestyle change to programme staff may be a factor in their failure and in their greater cost sensitivity, since they focus on external rather than internal resources.
Colagiuri, S, Vita, P, Cardona-Morrell, M, Fiatarone-Singh, M, Farrell, L, Milat, AJ, Haas, MR & Bauman, AE 2010, 'The Sydney Diabetes Prevention Program: A community-based translational study', BMC Public Health, vol. 10, pp. 1-7.View/Download from: UTS OPUS or Publisher's site
Background: Type 2 diabetes is a major public health problem in Australia with prevalence increasing in parallel with increasing obesity. Prevention is an essential component of strategies to reduce the diabetes burden. There is strong and consistent evidence from randomised controlled trials that type 2 diabetes can be prevented or delayed through lifestyle modification which improves diet, increases physical activity and achieves weight loss in at risk people. The current challenge is to translate this evidence into routine community settings, determine feasible and effective ways of delivering the intervention and providing on-going support to sustain successful behavioural changes.
Ting, HJ, Haas, MR, Valenzuela, S & Martin, DK 2010, 'Terminating polyelectrolyte in multilayer films influences growth and morphology of adhering cells', Iet Nanobiotechnology, vol. 4, no. 3, pp. 77-90.View/Download from: UTS OPUS or Publisher's site
Polyelectrolyte films of anionic poly(sodium 4-styrenesulphonate) (PSS) and cationic poly (allylamine hydrochloride) (PAH) were constructed using layer-by-layer assembly. The authors examined the cytocompatibility of these films for future use in nanobiotechnology applications. Cell lines HEK-293 and 3T3-L1 were cultured on these films and the initial attachment, adhesion, proliferation and cytotoxicity of the cells were measured using a propidium iodide assay. The morphology and spread of the cells were measured by phase-contrast microscopy. The actin cytoskeleton was observed using fluorescent microscopy. Neither the PAH-terminated nor the PSS-terminated polyelectrolyte films were cytotoxic. The PAH-terminated polyelectrolyte films improved the initial attachment and subsequent adhesion of the cells, in addition to enhancing the production of extracellular matrix and the modelling of the actin filaments. The PSS-terminated film enhanced the proliferation of the cells compared to the PAH-terminated film. That was despite the cell cycle, the spreading or the cytotoxicity of both cell types being similar for either the PSS-terminated surfaces or the PAH-terminated surfaces. Cell behaviour can be modulated by the final surface charge of the polyelectrolyte film and the results are useful in guiding the choice of substrates and/or coatings for potential biomedical applications (e.g. implants) as well as cell biology research.
de Raad, J, Van Gool, K, Haas, MR, Haywood, P, Faedo, M, Gallego, G, Pearson, S & Ward, R 2010, 'Nursing takes time: Workload associated with administering cancer protocols', Clinical Journal of Oncology Nursing, vol. 14, no. 6, pp. 735-741.View/Download from: UTS OPUS or Publisher's site
New medicines and therapeutic combinations are tested and marketed every year. Healthcare decision makers have to make explicit choices about adopting new treatments and deal with the resource consequences of their choices. The aim of this article is to examine the nursing workload of administering alternative chemotherapy protocols as a driver of costs. Data collection (focus groups with chemotherapy nurses and a survey of nurse unit managers) was conducted to ascertain the time required to undertake chemotherapy-related tasks and the sources of variability in six chemotherapy centers in New South Wales, Australia. Four task types (patient education, patient assessment, administration, and patient communication) were identified as being associated with administering chemotherapy. On average, patient education required 48 minutes during the first visit and 18.5 minutes thereafter, patient assessment took 20.3 minutes, administration averaged 23 minutes, and patient communication required 24.2 minutes. Each center treated an average of 14 patients per day. Each patient received 3.3 hours of staff time (1.7 hours of direct contact time and 1.6 hours of noncontact time). The result of this research will allow healthcare decision makers and evaluators to predict the amount of nursing time required to administer chemotherapy based on the characteristics of a wide range of chemotherapy protocols.
Sangster, J, Furber, S, Allman-Farinelli, MA, Haas, MR, Phongsavan, P, Mark, A & Bauman, AE 2010, 'A population-based lifestyle intervention to promote healthy weight and physical activity in people with cardiac disease: The PANACHE (Physical Activity, Nutrition And Cardiac HEalth) study protocol', BMC Cardiovascular Disorders, vol. 10, no. 17, pp. 1-8.View/Download from: UTS OPUS or Publisher's site
Methods/Design: This study is a randomised controlled trial. People referred for CR at two urban and two rural Australian hospitals will be invited to participate. The intervention (healthy weight) group will participate in four telephone delivered behavioural coaching and goal setting sessions over eight weeks. The coaching sessions will be on weight, nutrition and physical activity and will be supported by written materials, a pedometer and two follow-up booster telephone calls. The control (physical activity) group will participate in a six week intervention previously shown to increase physical activity, consisting of two telephone delivered behavioural coaching and goal setting sessions on physical activity, supported by written materials, a pedometer and two booster phone calls. Data will be collected at baseline, eight weeks and eight months for the intervention group (baseline, six weeks and six months for the control group). The primary outcome is weight change. Secondary outcomes include physical activity, sedentary time and nutrition habits. Costs will be compared with outcomes
Van Gool, K, Savage, EJ, Viney, RC, Haas, MR & Anderson, R 2009, 'Who's getting caught? An analysis of the Australian Medicare Safety Net', The Australian Economic Review, vol. 42, no. 2, pp. 143-154.View/Download from: UTS OPUS or Publisher's site
The Medicare Safety Net (MSN) was introduced in March 2004 to provide financial relief for those who incur high out-of-pocket costs from medical services. The policy has the potential to improve equity. This study examines: (i) how the health and income profiles of small areas influence MSN expenditure; and (ii) the distribution of expenditure by medical service type. The results indicate that MSN expenditure is positively related to income and that patients who use private obstetricians and assisted reproductive services are the greatest beneficiaries. The MSN has possibly created greater inequities in Australia's health-care financing arrangements.
Joy, P, Black, C, Rocca, A, Haas, MR & Wilcken, B 2009, 'Neuropsychological functioning in children with Medium Chain Acyl coenzyme a Dehydrogenase Deficiency (MCADD): The impact of early diagnosis and screening on outcome', Child Neuropsychology, vol. 15, no. 1, pp. 8-20.View/Download from: UTS OPUS or Publisher's site
Children with medium chain acyl coenzyme A dehydrogenase deficiency (MCADD) have been reported to be at high risk for neurocognitive deficits. However this has not been systematically studied and little is known about the exact nature of neuropsychological sequelae or of the impact of early diagnosis and screening on outcome. We examined cognitive and adaptive outcome in children with MCADD (N = 38, age range: 2 years, 2 months - 10 years, 3 months) diagnosed either through a newborn screening program (tandem mass spectrometry/MSMS) or upon clinical presentation. There was no evidence of overall intellectual impairment in either groups but there was some suggestion of poorer verbal and specific executive functioning (i.e., planning) abilities in the unscreened cohorts. Adaptive functioning was relatively intact with the exception of reduced Daily Living Skills in both our screened and unscreened groups. Early diagnosis and greater number of hospitalizations were related to higher verbal, communication, and socialization skills. Overall, our results highlight the importance of early diagnosis and management for children with MCADD.
Norman, R, Haas, MR & 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.View/Download from: UTS OPUS or Publisher's site
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.
Mitchell, P, Pirkis, J, Hall, JP & Haas, MR 2009, 'Partnerships for knowledge exchange in health services research, policy and practice', Journal of Health Services Research & Policy, vol. 14, no. 2, pp. 104-111.View/Download from: UTS OPUS or Publisher's site
Within the health services research community there is a growing strength of feeling that ongoing partnerships between researchers and decision-makers are critically important to effective transfer and exchange of knowledge generated from health services research. A body of literature is emerging around this idea that favours a particular model of partnership based on decision-maker involvement in research. This model is also gaining favour among health research funding bodies internationally. We argue that it is premature for the health services community to privilege any particular model of partnership between researchers and decision-makers. Rather a diversity of models should be conceptualized, explored in theory and practice, and evaluated. We identify seven dimensions that could be used to describe and differentiate models of partnerships for knowledge exchange and illustrate how these dimensions could be applied to analysing partnerships, using three case studies from recent and ongoing health services research partnerships in Australia.
Chenoweth, L, King, MT, Jeon, Y, Brodaty, H, Stein-Parbury, J, Norman, R, Haas, MR & 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.View/Download from: UTS OPUS or Publisher's site
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 10·9, 95% CI 0·721·1; p=0·04) and person-centred care (13·6, 3·323·9; p=0·01). Compared with usual care, fewer falls were recorded in sites that used mapping (0·24, 0·080·40; p=0·02) but there were more falls with person-centred care (0·15, 0·020·28; p=0·03). 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, MR, 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.View/Download from: UTS OPUS or Publisher's site
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.
Haas, MR, Ashton, T, Blum, K, Christiansen, T, Conis, E, Crivelli, L, Lim, M, Lisac, M, MacAdam, M & Schlette, S 2009, 'Drugs, sex, money and power: An HPV vaccine case study', Health Policy, vol. 92, no. 2-3, pp. 288-295.View/Download from: UTS OPUS or Publisher's site
In this paper we compare the experiences of seven industrialized countries in considering approval and introduction of the world's first cervical cancer-preventing vaccine. Based on case studies, articles from public agencies, professional journals and newspapers we analyse the public debate about the vaccine, examine positions of stakeholder groups and their influence on the course and outcome of this policy process. The analysis shows that the countries considered here approved the vaccine and established related immunization programs exceptionally quickly even though there still exist many uncertainties as to the vaccine's long-term effectiveness, cost-effectiveness and safety. Some countries even bypassed established decision-making processes. The voice of special interest groups has been prominent in all countries, drawing on societal values and fears of the public. Even though positions differed among countries, all seven decided to publicly fund the vaccine, illustrating a widespread convergence of interests. It is important that decision-makers adhere to transparent and robust guidelines in making funding decisions in the future to avoid capture by vested interests and potentially negative effects on access and equity.
Wilcken, B, Haas, MR, Joy, P, Wiley, V, Bowling, F, Carpenter, K, Christodoulou, J, Cowley, D, Ellaway, C, Fletcher, J, Kirk, E, Lewis, B, McGill, J, Peters, H, Pitt, J, Ranieri, E, Yaplito-Lee, J & Boneh, A 2009, 'Expanded newborn screening: Outcome in screened and unscreened patients at age 6 years', Pediatrics, vol. 124, no. 2, pp. 241-248.View/Download from: UTS OPUS or Publisher's site
OBJECTIVE: Tandem mass spectrometry is widely applied to routine newborn screening but there are no long-term studies of outcome. We studied the clinical outcome at six years of age in Australia. METHODS: In a cohort study, we analyzed the outcome at 6 years for patients detected by screening or by clinical diagnosis among >2 million infants born from 1994 to 1998 (1 017 800, all unscreened) and 1998 to 2002 (461 500 screened, 533 400 unscreened) recording intellectual and physical condition, school placement, other medical problems, growth, treatment, diet, and hospital admissions. Results were analyzed separately for medium-chain acyl-CoA dehydrogenase deficiency (MCADD) and other disorders, and grouped patients as those who presented clinically or died in the first 5 days of life; patients presented later or diagnosed by screening, and those with substantially benign disorders. RESULTS: Inborn errors, excluding phenylketonuria, were diagnosed in 116 of 1 551 200 unscreened infants (7.5/100 000 births) and 70 of 461 500 screened infants (15.2/100 000 births). Excluding MCADD, 21 unscreened patients with metabolic disorders diagnosed after 5 days of life died or had a significant intellectual or physical handicap (1.35/100 000 population) compared with 2 of the screened cohort (0.43/100 000; odds ratio: 3.1 [95% CI: 0.7313.32]). Considering the likely morbidity or mortality among the expected number of never-diagnosed unscreened patients, there would be a significant difference. Growth distribution was normal in all cohorts.
Lin, C & Haas, MR 2009, 'The Assessment of Quality of Life (AQoL)', Australian Journal of Physiotherapy, vol. 55, pp. 212-212.
Fiebig, DG, Haas, MR, Hossain, I, Street, D & Viney, RC 2009, 'Decisions about Pap tests: What influences women and providers?', Social Science & Medicine, vol. 68, no. 10, pp. 1766-1774.View/Download from: UTS OPUS or Publisher's site
Despite the success internationally of cervical screening programs debate continues about optimal program design. This includes increasing participation rates among under-screened women, reducing unnecessary early re-screening, improving accuracy of and confidence in screening tests, and determining the cost-effectiveness of program parameters, such as type of screening test, screening interval and target group. For all these issues, information about consumer and provider preferences and insight into the potential impact of any change to program design on consumer and provider behaviour are essential inputs into evidence-based health policy decision making. This paper reports the results of discrete choice experiments to investigate women's choices and providers' recommendations in relation to cervical screening in Australia. Separate experiments were conducted with women and general practitioners, with attributes selected to allow for investigation of how women and general practitioners differ in their preferences for attributes of screening programs. Our results indicate a considerable commonality in preferences but the alignment was not complete. Women put relatively more weight on cost, chance of a false positive and if the recommended screening interval were changed to one year.
Lin, C & Haas, M 2009, 'Commentary', Australian Journal of Physiotherapy, vol. 55, no. 3, p. 212.
Haas, MR 2008, 'No difference in cost-effectiveness of intensive group training for chronic back pain compared with usual physiotherapy care [Commentary]', Australian Journal of Physiotherapy, vol. 54, pp. 144-144.
Lin, C, Haas, MR, Moseley, A, Herbert, R & Refshauge, K 2008, 'Cost and utilisation of healthcare resources during rehabilitation after ankle fracture are not linked to health insurance, income, gender, or pain: An observational study', Australian Journal of Physiotherapy, vol. 54, no. 3, pp. 201-208.View/Download from: UTS OPUS
Lin, C, Moseley, A, Haas, MR, Refshauge, K & Herbert, R 2008, 'Manual therapy in addition to physiotherapy does not improve clinical or economic outcomes after ankle fracture', Journal of Rehabilitation Medicine, vol. 40, no. 6, pp. 433-439.View/Download from: UTS OPUS or Publisher's site
physiotherapy, ankle fracture, economic issues
Anderson, R, Haas, MR & Shanahan, M 2008, 'The cost-effectiveness of cervical screening in Australia: What is the impact of screening at different intervals or over a different age-range?', Australian and New Zealand Journal of Public Health, vol. 32, no. 1, pp. 43-52.View/Download from: UTS OPUS or Publisher's site
To estimate the cost-effectiveness of altering the currently recommended interval and age range for cervical screening of Australian women. METHODS: The cost and effectiveness estimates of alternative screening strategies were generated using an established decision model. This model incorporated a Markov model (of the natural history of cervical cancer and pre-cancerous lesions) and decision trees which: 'mapped' the various pathways to cervical cancer screening; the follow-up of abnormal Pap test results; and the management of confirmed lesions. The model simulated a hypothetical large cohort of Australian women from age 15 to age 85 and calculated the accumulated costs and life-years under each screening strategy. RESULTS: Our model estimated that moving from the current two-yearly screening strategy to annual screening (over the same age range) would cost $379,300 per additional life-year saved. Moving from the current strategy to three-yearly screening would yield $117,100 of savings per life-year lost (costs and effects both discounted at 5% per year), with a relatively modest (<5%) reduction in the total number of life-years saved by the program. CONCLUSIONS: Although moving to annual screening would save some additional lives, it is not a cost-effective strategy. Consideration should be given to increasing the recommended interval for cervical screening. However, the net value of any such shift to less effective (e.g. less frequent) and less costly screening strategies will require better evidence about the cost-effectiveness of strategies that encourage non-screeners or irregular screeners to have a Pap test more regularly.
Haas, MR, Chaplin, M, Joy, P, Wiley, V, Black, C & Wilcken, B 2007, 'Healthcare use and costs of medium-chain acyl-coa dehydrogenase deficiency in Australia: Screening versus no screening', Journal of Pediatrics, vol. 151, no. 2, pp. 121-126.View/Download from: UTS OPUS or Publisher's site
Objective To describe and analyze the use and costs of hospital services for children diagnosed with medium-chain acyl-CoA dehydrogenase (MCAD) deficiency either with newborn screening or clinical diagnosis in Australia between 1994 and 2002. MCAD deficiency is a potentially lethal disorder of fatty-acid oxidation. Study design We conducted a retrospective audit of medical records supplemented by a parental survey. Results A total of 59 children with MCAD deficiency were identified, 24 by using newborn screening. In the first 4 years of life, screening children cost an average of $A1676 (US$1297) per year for inpatient, emergency department, and outpatient visits, compared with $A1796 (US$1390) for children in whom a clinical diagnosis was made. Forty-two percent of the children who underwent screening were admitted to the hospital, compared with 71% of children who did not undergo screening. Children who did not undergo screening used significantly more inpatient services and cost significantly more in emergency services. There were also some significant differences in use on a year-by-year basis. Conclusions Children who do not undergo screening may be more likely to be admitted to the hospital and to incur higher emergency department costs than children who underwent screening, and children seem more likely to attend hospital outpatient clinics. Screening does not result in higher costs from a hospital perspective.
Birch, S, Haas, MR, Savage, EJ & Van Gool, K 2007, 'Targeting services to reduce social inequalities in utilisation: An analysis of breast cancer screening in New South Wales', Australia and New Zealand Health Policy, vol. 4:12, pp. 1-9.View/Download from: UTS OPUS
Many jurisdictions have used public funding of health care to reduce or remove price at the point of delivery of services. Whilst this reduces an important barrier to accessing care, it does nothing to discriminate between groups considered to have greater or fewer needs. In this paper, we consider whether active targeted recruitment, in addition to offering a 'free' service, is associated with a reduction in social inequalities in self-reported utilization of the breast screening services in NSW, Australia.
Van Gool, K, Gallego, G, Haas, MR, Viney, RC, Hall, JP & Ward, R 2007, 'Economic evidence at the local level: Options for making it more useful', Pharmacoeconomics, vol. 25, no. 12, pp. 1055-1062.View/Download from: UTS OPUS or Publisher's site
Like other countries, Australia has had some success in incorporating economic evidence into national healthcare decisions. However, it has been recognised that this coverage does not extend to the local hospital or health region level. An extensive body of research has identified barriers to the use of economic evidence at the local level, leading some commentators to suggest that economic evaluation should only be targeted at national decision-making bodies. Yet, local decision makers in Australia and elsewhere make important choices about the uptake and diffusion of healthcare technologies. We propose a number of interrelated options to address the barriers that currently prohibit the use of economic evaluation by local decision makers in many jurisdictions. These include wider dissemination of user friendly models, inclusion of assessments of the cost impact of interventions on various budgets, and the establishment of an authoritative body that ensures the production of high quality economic models. It is argued that these options can have a significant impact on the way economic evaluations are conducted, reported, disseminated and used.
Wilcken, B, Haas, MR, Joy, P, Wiley, V, Chaplin, M, Black, C, Fletcher, J, McGill, J & Boneh, A 2007, 'Outcome of neonatal screening for medium-chain acyl-CoA dehydrogenase deficiency in Australia: a cohort study', Lancet, vol. 369, no. 9555, pp. 37-42.View/Download from: UTS OPUS or Publisher's site
Background Medium-chain acyl-CoA dehydrogenase (MCAD) deficiency is the disorder thought most to justify neonatal screening by tandem-mass spectrometry because, without screening, there seems to be substantial morbidity and mortality. Our aim was to asse
Owen, K, Haas, MR & Viney, R 2007, 'Expectations of outcomes and individuals' framing of the benefits and effort required in diet and exercise', International Journal of Obesity, vol. 31, no. Suppl 1, pp. S147-S147.
Belkar, R, Fiebig, DG, Haas, MR & Viney, RC 2006, 'Why worry about awareness in choice problems? Econometric analysis of screening for cervical cancer', Health Economics, vol. 15, no. 1, pp. 33-47.View/Download from: UTS OPUS or Publisher's site
The decision to undertake a screening test is conditional upon awareness of screening. From an econometric perspective there is a potential selection problem, if no distinction is made between aware and unaware non-screeners. This paper explores this pro
Moore, K, Cruickshank, M & Haas, MR 2006, 'The influence of managers on job satisfaction in occupational therapy', British Journal of Occupational Therapy, vol. 69, no. 7, pp. 312-318.View/Download from: UTS OPUS
Lin, C, Moseley, A, Refshauge, K, Haas, MR & Herbert, R 2006, 'Effectiveness of joint mobilisation after cast immobilisation for ankle fracture a protocol for a randomised controlled trial', Bmc Musculoskeletal Disorders, vol. 7, no. 46, pp. 1-10.View/Download from: UTS OPUS
Background: Passive joint mobilisation is a technique frequently used by physiotherapists to reduce pain, improve joint movement and facilitate a return to activities after injury, but its use after ankle fracture is currently based on limited evidence.
Moore, K, Cruickshank, M & Haas, MR 2006, 'Job satisfaction in occupational therapy: a qualitative investigation in urban Australia', Australian Occupational Therapy Journal, vol. 53, no. 1, pp. 18-26.View/Download from: UTS OPUS
Background: Job satisfaction has been shown to affect levels of staff retention and work productivity, but few studies have been conducted with occupational therapists in an Australian setting. Methods: Using a hermeneutical phenomenological approach, the findings from a study examining the factors that contribute to job satisfaction in occupational therapists working in Australia, are reported. Results: Job satisfaction in occupational therapy was derived from the sense of achievement felt when providing effective clinical care. Job dissatisfaction stemmed from the poor profile and status of the profession. Conclusions: Based on the study findings, there is an imperative that the profession of occupational therapy continue to use research findings to support clinicians in providing effective health care, and improve the community understanding of occupational therapy.
Anderson, R, Haywood, P, Usherwood, T, Haas, MR & Hall, JP 2005, 'Alternatives to for-profit corporatisation: The view from general practice', Australian Journal of Primary Health, vol. 11, no. 2, pp. 78-86.View/Download from: UTS OPUS
Pirkis, J, Goldfeld, S, Peacock, S, Dodson, S, Haas, MR, Cumming, J, Hall, JP & Boulton, A 2005, 'Assessing the capacity of the health services research community in Australia and New Zealand', Australia and New Zealand Health Policy, vol. 2, no. 4, pp. 1-10.View/Download from: UTS OPUS
Shanahan, M, Lancsar, E, Haas, MR, Lind, B, Weatherburn, D & Chen, S 2004, 'Cost-effectiveness analysis of the New South Wales adult drug court program', Evaluation Review, vol. 28, no. 1, pp. 3-27.View/Download from: UTS OPUS or Publisher's site
Haas, MR 2003, 'Economic evaluation: a useful research method', Australian Journal of Physiotherapy, vol. 49, no. --, pp. 85-86.
Kenny, PM, Hall, JP, Viney, RC & Haas, MR 2003, 'Do participants understand a stated preference health survey? a qualitative approach to assessing validity', International Journal of Technology Assessment in Health Care, vol. 19, no. 4, pp. 664-681.View/Download from: UTS OPUS
Van Gool, K, Haas, MR & Viney, RC 2002, 'From flying doctor to virtual doctor: an economic perspective on Australia's telemedicine experience', Journal of Telemedicine and Telecare, vol. 8, pp. 249-254.View/Download from: UTS OPUS or Publisher's site
Pollicino, C, Viney, RC & Haas, MR 2002, 'Measuring health system resource use for economic evaluation: a comparison of data source', Australian Health Review, vol. 25, no. 3, pp. 171-178.View/Download from: UTS OPUS
Bridges, JFP, Mazevska, D & Haas, M 2001, 'Developing better casemix education for rural New South Wales', The Australian journal of rural health, vol. 9, no. 4, pp. 193-199.View/Download from: Publisher's site
Casemix is now an important mechanism for the planning, evaluation and funding of health services in Australia. In New South Wales (NSW) it was believed that while staff from most hospitals in metropolitan Sydney had become both literate and vocal about casemix, staff from rural areas were less familiar and much less likely to participate in casemix initiatives. In conjunction with the NSW Casemix Clinical Committee (NCCC), NSW Health considered a special program of casemix education for rural NSW. Before an education program was attempted, NSW Health inquired into the specific needs for casemix education in rural NSW. Qualitative and quantitative methods of analysis were used. Results of the quantitative analysis indicate that the understanding of casemix classifications is highest among managers. Of concern were the relatively low proportion of Allied Health staff who had more than a vague understanding of the Sub- and Non-Acute Patient (SNAP) classification; the lack of any knowledge of the Mental Health Costing And Service Classification (MH-CASC) by nursing staff; and the lack of any knowledge of the emergency department classification: Urgency, Disposition and Age-related Groups (UDAG), either by clinical or nursing staff. The results of the qualitative analysis show that casemix education for rural areas needs to differ from metropolitan education programs. The analysis also highlights the perception of casemix in rural areas and the special circumstances in rural hospitals that place limits on the ability to use casemix more fully.
Haas, MR, Chapman, S, Viney, RC, Hall, JP & Ferguson, A 2001, 'The news on health care costs: a study of reporting in the Australian print media for 1996', Journal of Health Services Research and Policy, vol. 6, pp. 78-84.
Haas, MR, Viney, RC, Kristensen, E, Pain, C & Foulds, K 2001, 'Using programme budgeting and marginal analysis to assist population-based strategic planning for coronary heart disease', Health Policy, vol. 55, pp. 173-186.View/Download from: Publisher's site
Haas, MR 2001, 'Using NSW Health survey data for economic analyses', NSW Public Health Bulletin, vol. 12, pp. 227-228.
Bridges, J, Mezevska, D & Haas, MR 2001, 'Evaluation of physiotherapy using cost utility analysis', Australian Journal of Rural Health, vol. 9, pp. 193-199.
Haas, M 1999, 'Commentary on McKenzie therapy and manipulation have similar effects and costs and provide only marginally better outcomes than an educational booklet', Australian Journal of Physiotherapy, vol. 45, no. 1, p. 46.
Haas, MR 1999, 'Mckenzie Therapy And Manipulation Have Similar Effects And Costs And Provide Only Marginally Better Outcomes Than An Educational Booklet - Commentary', Australian Journal Of Physiotherapy, vol. 45, no. 1, pp. 48-48.
Objective To examine relative costs and effectiveness of chiropractic manipulation, McKenzie therapy and an educational booklet as treatments for low back pain. Design Randomised controlled trial. Setting: Two primary care clinics in the United States of
Haas, M 1999, 'A critique of patient satisfaction.', Health information management : journal of the Health Information Management Association of Australia, vol. 29, no. 1, pp. 9-13.View/Download from: Publisher's site
Measures of patient satisfaction have been developed primarily so that patients could furnish health care providers and services with feedback on the quality of health care provided to them. However, the theoretical underpinnings of the concept of patient satisfaction are under-developed and the framework within which patient satisfaction has evolved is considered by some to be in need of review and overhaul. In this article, the concept and measurement of patient satisfaction is critically reviewed. Potentially better ways of asking patients (and their families and carers) to describe and/or assess their care are suggested.
Haas, M 1999, 'The relationship between expectations and satisfaction: A qualitative study of patients' experiences of surgery for gynaecological cancer', Health Expectations, vol. 2, no. 1, pp. 51-60.View/Download from: Publisher's site
It is important that a patient perspective is introduced to the identification and measurement of the outcomes of health care. The aim of this study was to use qualitative methods to examine the presence or absence of expectations prior to the experience of health care and the relationship between expectations, satisfaction and dissatisfaction in a group of women undergoing surgery in a large teaching hospital. Nineteen women with a diagnosis of gynaecological cancer were interviewed on two occasions, before and after surgery. A thematic analysis was undertaken. The results suggest that there is not a clear relationship between expectations and satisfaction. Women had different levels of expectations about different types of care and different aspects of care. Unfulfilled expectations did not lead to less satisfaction. The women were able to express satisfaction either with the care overall or with specific aspects of care, as well as being able to distinguish aspects of care with which they were dissatisfied.
Hall, JP, Viney, RC & Haas, MR 1998, 'Taking A Count The Evaluation Of Genetic Testing', Australian And New Zealand Journal Of Public Health, vol. 22, no. 7, pp. 754-758.View/Download from: Publisher's site
While some forms of genetic testing have been available for decades, the progress of the Human Genome Project will expand the possibilities for testing. Evaluation of genetic testing is warranted because health care services have an opportunity cost and
Viney, R & Haas, M 1998, 'Funding arrangements for telehealth: encouraging efficiency rather than proliferation.', Australian health review : a publication of the Australian Hospital Association, vol. 21, no. 3, pp. 34-48.
The use of telehealth as a basis for delivering health services is growing across Australia, and there is clear potential for these technologies to address some of the enduring issues of access and costs of service delivery. However, appropriate incentives must be created to encourage clinicians and managers to evaluate the true opportunity costs and benefits of delivering services in this way against the relevant alternative. This paper examines how different funding arrangements might encourage or discourage efficient use of telehealth.
Haas, M & Hall, J 1998, 'The economic evaluation of health care.', Health information management : journal of the Health Information Management Association of Australia, vol. 28, no. 4, pp. 169-172.View/Download from: Publisher's site
Economic evaluation is the comparative analysis of alternative courses of action in terms of both costs and consequences. Economic evaluation can also be called economic appraisal or the cost-benefit approach. The basis of economic evaluation lies in comparing costs and benefits of an intervention, program or service. The most important reasons for undertaking an economic evaluation are that resources (e.g., money, time, staff, equipment) are scarce compared with the demands made on them, and that such resource constraints require choices to be made. In this paper, four types of economic evaluations (cost-minimisation, cost-effectiveness, cost-utility and cost-benefit analyses) are described.
Salkeld, G, Young, G, Irwig, L, Haas, MR & Glasziou, PP 1996, 'Cost-effectiveness Analysis Of Screening By Faecal Occult Blood Testing For Colorectal Cancer In Australia', Australian And New Zealand Journal Of Public Health, vol. 20, no. 2, pp. 138-143.View/Download from: Publisher's site
The incremental costs and effects of annual faecal occult blood test screening in Australia were modelled for a hypothetical cohort of 1000 persons offered screening or not offered screening. Incremental costs and effects were estimated as the difference
Viney, R, Haas, MR & Seymour, J 1996, 'Seeing through the smoke: Using economic evaluation to allocate health promotion resources to prevent smoking', Health Promotion Journal of Australia, vol. 6, no. 1, pp. 7-15.
Towler, B, Irwig, L, Glasziou, PP, Haas, MR, Plunkett, A & Salkeld, G 1995, 'The Potential Benefits And Harms Of Screening For Colorectal-cancer', Australian Journal Of Public Health, vol. 19, no. 1, pp. 24-28.
Australian guidelines for colorectal cancer screening for average-risk populations vary from recommendations for annual screening by faecal occult blood testing for those over 40 years to recommendations that screening may be appropriate if requested by
Haas, MR, Rushworth, R & Rob, M 1995, 'Health Services And The Elderly An Evaluation Of Utilisation Data', Australian Journal On Ageing, vol. 14, no. 4, pp. 176-180.View/Download from: Publisher's site
Medical and diagnostic services for people aged 65 and over comprise a substantial proportion of all services provided by the Health insurance Commission under the Medicare Benefits Schedule. To examine the utilisation of these services by people in this
Westbrook, J, Haas, MR, Rushworth, RL & Rob, M 1994, 'Evaluating Health Care: What can Hospital Separation Data tell us about complications of Hospital Care', Journal of Quality in Clinical Care, vol. 14, pp. 157-166.
Limits on health care resources mean that resource allocation decisions should be guided by considerations of cost in relation to benefits. A method of economic evaluation, (cost-utility analysis) was used to evaluate the costs and benefits of a physiotherapy outpatient department. The quality of life of 56 patients was measured before and after physiotherapy intervention and the costs of the treatment compared with the benefits gained. Within the limitations of the study, physiotherapy was found to be good value for money compared with other health care interventions, with treatment for chronic conditions such as back pain, neck pain and osteoarthritis representing better value for money than treatment for acute conditions such as strains and sprains and fractures. © 1993, Australian Physiotherapy Association. All rights reserved.
The Oregon Plan is an ambitious attempt to address the widespread problem in the United States of a growing number of individuals who are without private health insurance and are not eligible for federal assistance programs. Its aim is to provide univers
Haas, MR & Viney, RC 2012, 'Health insurance' in Sheridan, H (ed), The law handbook: your practical guide to the law in NSW 12th edition, Thomson Reuters (Professional) Australia Ltd, Prymont, NSW, pp. 908-914.
Haas, MR, Tschaut, N & Viney, RC 2009, 'Health insurance' in Fallon, M (ed), The law handbook: Your practical guide to the law in New South Wales 11th edition, Redfern Legal Centre, Redfern, pp. 843-849.
De Abreu Lourenco, R, Hegi-Johnson, F, Ball, D, Wright, G & Haas, M 2019, 'Factors influencing participation in curative intent treatment for lung cancer: A discrete choice experiment', TROG ASM, Melbourne.
Wright, MC, Hall, J, Haas, M, Van Gool, K & Yu, S 2018, 'The relationship between continuity of care and cervical cancer screening', 40th Annual Australian Health Economics Society Conference, Hobart.
Addo, R, Hall, J, Goodall, S & Haas, M 2017, 'The knowledge and perception of Ghanaian decision makers and researchers towards the use of health technology assessment for health decision making [Conference Presentation]', iHEA Boston World Congress, Boston, USA.
De Abreu Lourenco, R, Haas, M, Hall, J, Parish, K, Stuart, D & Viney, R 2016, 'Placing a value on avoiding cancer recurrence: women's preferences for contralateral prophylactic mastectomy', 38th Annual Australian Health Economics Society Conference, Perth.
Lourenco, RDA, Haas, M, Hall, J, Parish, K, Stuart, D & Viney, R 2016, 'Women's preferences for avoiding cancer recurrence: a focus on contralateral prophylactic mastectomy', Asia-pacific Journal of Clinical Oncology, pp. 137-137.
Haas, MR 2016, 'Health Economics 101 (Invited during plenary session)', TROG Annual Scientific Meeting.
Haas, MR 2015, 'Ethics for Big Data', Australia symposium on Big Data, Sydney.
Haas, MR 2015, 'At what cost? Collecting data for costing clinical (research) interventions', Centre for Palliative Care Research Forum, Melbourne.
Parkinson, B, Viney, RC, Goodall, S & Haas, M 2015, 'Real-world observational data in cost-effectiveness analyses: Herceptin as a case study', iHEA 11th World Congress on Health Economics, Milan, Italy.
Haas, MR 2015, 'Health economics analysis using secondary data', TROG Annual Scientific Meeting.
Pearce, AM, Haas, M, Viney, R, Pearson, S, Haywood, P & Ward, R 2014, 'Rates of chemotherapy adverse event in clinical practice: results from a prospective cohort study', World Cancer Congress, Melbourne.View/Download from: UTS OPUS
Reeve, RD, Srasuebkul, P, Haas, MR, Pearson, S & Viney, RC 2014, 'Utilisation and cost of health services in the last six months of life: A comparison of cohorts with and without cancer', CAER 11th Annual Summer Workshop, Sydney.
Church, J, Reeve, RD, Goodall, S & Haas, MR 2013, 'Deconstructing the positive feedback loop between depression and obesity: can stressful life events be used as an instrument?', iHEA 9th World Congress on Health Economics, Sydney.
Haas, MR, Goodall, S & De Abreu Lourenco, R 2013, 'Awareness and uptake among Australians of innovations in the delivery of primary care', 8th Health Services and Policy Research Conference, Wellington, New Zealand.
Reeve, RD, Srasuebkul, P, Pearson, S, Haas, MR & Viney, RC 2013, 'Resource use and costs of cancer care at the end of life', 8th Health Services and Policy Research Conference, Wellington, New Zealand.
Langton, J, Blanch, B, Anabelle, D, Haas, MR, Jane, I & Pearson, S 2013, 'Systematic review of studies examining resource use, costs, and quality of end-of-life cancer care: Lessons for local health services research', 8th Health Services and Policy Research Conference, Wellington, New Zealand.
Reeve, RD, Church, J, Haas, MR, Bradford, W & Viney, RC 2013, 'What factors drive the gap in diabetes rates between Aboriginal and non-Aboriginal people in non-remote New South Wales?', World Diabetes Congress 2013, Melbourne.
Goodall, S, Kenny, PM, De Abreu Lourenco, R & Haas, MR 2013, 'Understanding patients' preferences for primary care services: Have Discrete Choice Experiments helped?', 8th Health Services and Policy Research Conference, Wellington, New Zealand.
Knox, SA, Viney, RC, Gu, Y, Hole, A, Fiebig, DG, Street, D & Haas, MR 2011, 'The effect of information and promotion on preferences for contraceptive products', iHEA 8th World Congress, Toronto, Canada.
Fiebig, DG, Viney, RC, Knox, SA, Haas, MR, Weisberg, E, Street, D & Bateson, D 2011, 'Talking about contraception: how do doctors decide what to discuss and recommend?', iHEA 8th World Congress, Toronto, Canada.
Knox, SA, Viney, RC, Street, D, Haas, MR, Fiebig, DG, Weisberg, E & Bateson, D 2010, 'Whatâs good and bad about contraception? Application of a Best-Worst Attribute experiment', CAER Health Economics Workshop, Sydney.
Haas, MR, Ashton, T, Christiansen, T, Crivelli, L, Conis, E, Lim, M, McAdam, C, Lisac, M, Blum, K & Schlette, S 2009, 'Drugs, Sex, Money and Power: an HPV case study', Academy Health Annual Research Meeting, Chicago, USA.
Haas, MR, Viney, RC, Gallego, G & Hall, JP 2009, 'Implementing guidelines for reimbursement in Australia: How the PBAC & MSAC use comparative cost-effectiveness', International Network Health Policy and Reform Meeting, Krakow, Poland.
Haas, MR, Ashton, T, Blum, K, Christiansen, T & Conis, E 2009, 'Drugs, sex, money and power: an HPV vaccine case study', 6th Health Services and Policy Conference 2009, Brisbane.
Owen, KM, Pettman, TL, Haas, MR, Viney, RC & Misan, GM 2009, 'Individual preferences for diet and exercise programs: changes over a lifestyle intervention and their link with outcomes', Australian Conference of Health Economists, Hobart.
Knox, SA, Viney, RC, Street, D, Haas, MR, Weisberg, E & Bateson, D 2009, 'Do women and GPs agree in their preferences around contraceptive methods?', 6th Health Services and Policy Conference 2009, Brisbane.
Faedo, M, Pearson, S, Bastick, P, Van Gool, K, Haywood, P, Haas, MR & Ward, R 2009, 'Elements of Care Study: Tracking resource utilisation and costs in a cohort of NSW cancer patients', 6th Health Services and Policy Conference 2009, Brisbane.
Haas, MR, Ward, R, Van Gool, K, Hall, JP, Stewart, B, Pearson, S, Links, M & Board, N 2009, 'Economic Modelling applied to Cancer Protocols: EM-CAP', 6th Health Services and Policy Research Conference 2009, Brisbane.
Pearson, S, Faedo, M, Van Gool, K, Haas, MR & Ward, R 2009, 'Using routinely collected health data to inform economic models of cancer care', 6th Health Services and Policy Research Conference 2009, Brisbane.
Johar, M, Fiebig, DG, Haas, MR & Viney, RC 2009, 'Evaluating changes in women's attitudes towards cervical screening following a screening promotion campaign and a free vaccination', 6th Health Services and Policy Research Conference 2009, Brisbane.
Gallego, G, Van Gool, K, Haas, MR & Tannous, K 2009, 'Once upon a time in a land far far away: the evidence on early childhood intervention programs and its relevance to the here and now', Australian Conference of Health Economists, Hobart.
Chenoweth, L, Haas, MR, Jeon, Y, Stein-Parbury, MJ, Anstey, K, Brodaty, H, King, MT, 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.
Haas, MR, Norman, R, Walkley, J & Brennan, L 2008, 'Evaluating the cost-effectiveness of Cognitive Behavioural Therapy for Overweight/Obese Adolescents', Health Outcomes Conference, Canberra.
Haas, MR 2008, 'Gardasil in Australia', Meeting of the International Network Health Policy and Reform, Ljubljana, Slovenia.
Haas, MR 2008, 'Weigh too much', UTS Speaks, University of Technology, Sydney.
Haas, MR 2008, 'Health Services Research and the Health Services Research Association of Australia and New Zealand', Emerging Researchers Conference, University of Sydney.
Haas, MR 2008, 'Planning for prevention in obesity: what do we know?', Health Policy and Research Exchange, Sydney.
Knox, SA, Fiebig, DG, Viney, RC, Haas, MR, Weisberg, E, Street, D, Bateson, D & Cheung, SS 2008, 'Choosing how not to get pregnant: evidence from a discrete choice experiment', 30th Australian Conference Of Health Economists, Adelaide.
Haywood, P, Van Gool, K, Haas, MR & Ward, R 2008, 'A pragmatic approach to economic evaluation in an age of evidence based clinical guideline production', Australian Conference of Health Economists, Adelaide.
Fiebig, DG, Haas, MR & Viney, RC 2007, 'Preferences for new and alternative cervical cancer screening technologies: Results from a discrete choice experiment with nested choices', Australian Conference of Health Economists, Brisbane.
Van Gool, K, Vu, M, Savage, EJ, Haas, MR & Birch, S 2007, 'Equitable use of breast screening services in NSW: The role of income, age and locality', 29th Australian Conference for Health Economists, Brisbane.
King, MT, Chenoweth, L, Brodaty, H, Jeon, Y, Stein-Parbury, MJ, Haas, MR, 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.
Van Gool, K, Gallego, G, Haas, MR & Fisher, K 2007, 'Economic Evaluation of Early childhood intervention programs: How hard is it to make rational investments for the future?', 29th Australian Conference for Health Economists, Brisbane.
Van Gool, K, Gallego, G, Haas, MR, Hall, JP, Viney, RC, Ward, R, Links, M, Stewart, B, Board, N & Pearson, S 2006, 'Incorporating economic evidence into cancer care: searching for the missing link', Australian Conference of Health Economists, Perth.
Haas, M 2004, 'Health services research in Australia: An investigation of its current status', Journal of Health Services Research and Policy.
Objectives: The objectives of this audit were to document the current status of health services research (HSR) in Australia in terms of inputs and outputs. Inputs were defined as the number of organised centres or groups undertaking HSR, the extent to which HSR was being developed and the funding available for HSR. Outputs were measured as the number of peer-reviewed papers. Methods: Centres or groups were identified via the membership of the HSRAANZ and a web-based search. Information from annual reports and/or other published sources was used to determine the extent of capacity building and available funding. The tables of contents of 21 journals published over a 10-year period were searched for articles reporting Australian HSR. Results: Eighteen groups were identified that undertook HSR as their predominant activity, while twelve were involved in HSR as a collaborative activity. No HSR-specific training (in terms of under- or postgraduate degrees) was identified, although more than 400 postgraduate students were being supervised in the university departments where HSR groups were situated. Between 1998 and 2001, more than AU$13 million was awarded for HSR, most of it by the National Health and Medical Research Council (NHMRC). Over the past 10 years, 482 articles about Australian health services have been published in the peer-reviewed journals audited. Conclusions: Although HSR is widespread in Australia, no specific training appears to be available to build capacity. Overall, HSR is not well-funded especially by organisations outside the NHMRC or Australian Research Council. Thus, it is not surprising that the output of Australian HSR, in terms of peer-reviewed articles, is slight. © The Royal Society of Medicine Press Ltd 2004.
Haas, MR, Van Gool, K, Birch, S & Savage, EJ 2001, 'Breast screening utilisation in NSW: the importance of region and socio-economic status', 3rd International Health Economics Association Conference, York, UK.
Viney, RC, Pollicino, C, Haas, MR, King, MT & Kenny, PM 2001, 'Assessing the value of a PET scan for patients with non-small cell lung cancer', International Health Economics Association (iHEA) 3rd World Conference, York, UK.
Haas, MR 2001, 'The research highway: Developing research questions and liaising with other interested parties', Allied Health Research Education Session, Central Sydney Area Health Service.
Haas, MR & Van Gool, K 2001, 'Estimating the benefits of preventing cardiovascular disease: when is an ounce of prevention worth a pound of cure?', 23rd Australian Health Economics Society Conference, Canberra.
Haas, MR, Savage, EJ, Van Gool, K & Birch, S 2001, 'Breast screening utilisation in NSW: the impact of income, region and ethnicity', Health Services Research Association of Australia and New Zealand Conference, Wellington, NZ.
Hall, JP & Haas, MR 2001, 'Research and public policy: If health economics is the answer, what is the question?', Where to with Health Economics, Royal Childrenâ¿¿s Hospital and Murdoch Childrenâ¿¿s Research Institute, Melbourne.
Haas, MR 2001, 'Patientsâ preferences for outcomes other than health outcomes', 2nd New Zealand Australia Health Services & Policy Research Conference, Wellington, NZ.
Kenny, PM, Hall, JP, Viney, RC, Haas, MR & King, MT 2001, 'Validity of choice modelling for measuring consumer preferences in health', 2nd New Zealand Australia Health Services & Policy Research Conference, Wellington, NZ.
Sangster, J, Furber, S, Allman-Farinelli, M, Phongsavan, P, Redfern, J, Haas, MR, Church, J, Mark, A & Bauman, A NSW Ministry of Health 2017, A population-based lifestyle intervention to promote healthy weight and physical activity in people with cardiac disease: The PANACHE trial, Sydney.View/Download from: UTS OPUS
Haywood, P, Goodall, S, Chinchen, E, Haas, M, Manipis, K, Meshcheriakova, O, Saing, S & van der Linden, N COAG Health Council 2017, The effectiveness and cost-effectiveness of mandatory folic acid and iodine fortification. A report for the Australian Health Ministers' Advisory Council, Adelaide.View/Download from: UTS OPUS
Van Gool, K, Woods, M, Hall, J, Haas, M & Yu, S CHERE 2015, Sustainability, efficiency and equity in health care: The role of funding arrangements in Australia. A report by the Centre for Health Economics Research and Evaluation for the Australian Healthcare and Hospitals Association (AHHA), Sydney.
Van Gool, K, Woods, M, Hall, J, Haas, M, Yu, S & Wright, M CHERE 2015, Primary Health Networks as a disruptive force for positive change: A report by the Centre for Health Economics Research and Evaluation for the Australian Healthcare and Hospitals Association (AHHA), Sydney.
Church, J, Goodall, S, Norman, R & Haas, MR 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
Hilferty, F, Mullan, K, Van Gool, K, Chan, S, Eastman, C, Reeve, RD, Heese, K, Haas, MR, Newton, B, Griffiths, M & Katz, I Social Policy Research Centre 2010, The evaluation of Brighter Futures, NSW Community Services' early intervention program: Final report, pp. 1-305, Australia.View/Download from: UTS OPUS
This report presents the findings of the evaluation of the NSW Community Services` early intervention program, Brighter Futures. Brighter Futures is an innovative program, which has changed the practice of child abuse prevention services in NSW. The program has broken new ground nationally and internationally by developing an evidence-based service model; requiring caseworkers to use validated instruments for assessment and reporting; and being delivered through a cross-sectoral partnership between Community Services and non-government organisations. It is also innovative in specifically targeting families who are at most risk of entering the child protection system.
Savage, EJ, Van Gool, K, Haas, MR, Viney, RC & Vu, M Department of Health & Ageing 2009, Extended Medicare safety net review report 2009 : a report by CHERE prepared for the Australian Government Department of Health & Ageing, pp. 1-80, Canberra.
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, MR, Hall, JP, Gallego, G, Goodall, S, Norman, R, Van Gool, K & Viney, RC 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, MR, Hall, JP, Gallego, G, Goodall, S, Norman, R, Van Gool, K & Viney, RC CHERE, University of Technology, Sydney 2008, Framework and methodology for national blood supply change proposals: Part 2, pp. 1-33, Sydney.
Haas, MR & Ivancic, L CHERE 2003, Evaluation of directional vacuum-assisted breast biopsy: Report for the National Breast Cancer Centre final report, CHERE Project Report No 21, Sydney.
Lind, B, Weatherburn, D, Chen, D, Shanahan, M, Lancsar, E, Haas, MR & De Abreu Lourenco, R NSW Bureau of Crime Statistics and Research 2002, New South Wales drug court evaluation: Cost-effectiveness, CHERE Project Report No 17, Sydney.
Anderson, R & Haas, MR CHERE 2001, Cost-effectiveness of shared care compared with usual hospital-based care for people with Hepatitis C: CHERE Project Report 17, Sydney.
Haas, MR, Chapman, S, Viney, RC, Hall, JP & Ferguson, AC CHERE 1999, The news on health economics: a study of resource allocation in health in the Australian print media for 1996, CHERE Discussion Paper No 40, Sydney.
Bridges, JF, Haas, MR & Mazevska, D CHERE 1999, A qualitative insight into rural casemix education, CHERE Project Report No 10, Sydney.
Haas, MR, Shanahan, M, Viney, RC & Cameron, I Commonwealth Department of Health and Ageing 1999, Consultancy to progress hospital in the home care provision: Final report, CHERE Project Report No 13, Canberra.
Haas, MR CHERE 1998, An empirical exploration of patient expectations of health care, CHERE Discussion Paper No 35, Sydney.
Mooney, G, Haas, MR, Viney, RC & Cooper, L CHERE 1997, Linking health outcomes to priority setting, planning and resource allocation - Report to the NSW Department of Health, CHERE Project Report No 1, Sydney.
Glasziou, PP & Haas, MR CHERE 1994, An economic evaluation of the use of tamoxifen in the treatment of early breast cancer, CHERE Discussion Paper No 25, Sydney.
Haas, MR CHERE 1992, A cost utility analysis of physiotherapy, CHERE Discussion Paper No 6, Sydney.
Shiell, A, Haas, MR, King, MT, Jan, S & Seymour, J CHERE 1992, Optimal size and throughput of tertiary services: A Case Study in Renal Transplant and Cardiac Surgery in NSW, CHERE Discussion Paper No 5, Sydney.
Fiebig, D, Viney, RC, Haas, M, Knox, S, Street, D, Weisberg, E & Bateson, D 2015, 'Complexity and doctor choices when discussing contraceptives', Health, Econometrics and Data Group, University of York. WP15/14.View/Download from: UTS OPUS
This brief methods paper explains how to use the NSW Government Health Costs of Care Standards to estimate the cost of presentations to emergency departments (ED) in NSW. We begin with a discussion of the allocation of presentations according to visit type, triage category and mode of separation to urgency disposition group (UDG) class for the purpose of allocating cost weights and how to apply these weights to estimate the cost per presentation. The discussion is then extended to incorporate a suggested approach for estimating ED costs when mode of separation is known but visit type and triage category are unknown; we do this by using the distribution of current NSW ED presentations by visit type, triage category and mode of separation to calculate the average cost for each mode of separation.
While there is increasing evidence that group-based lifestyle-focussed interventions may provide more realistic, effective and cost-effective alternatives to intensive, individualised dietary counselling and exercise training, relatively little is known about individualsâ preferences for and perceptions of these programs. This paper reports the results of qualitative interviews conducted with participants of a lifestyle intervention trial (Shape up for LifeÂ© (SufL) aimed to improve body composition and metabolic health through long-term non-restrictive behaviour modification. Purposive sampling was used to identify 22 participants who participated in detailed interviews regarding their expectations of the intervention, perceptions of benefits and their experience post-intervention and capacity to maintain the lifestyle changes. The results indicate that in general participants are focussed on weight loss as a goal, even when the intervention offered and provided other benefits such as improved fitness and body shape and composition. The individuals who benefited most from the intervention typically had lower baseline knowledge about dietary and exercise guidelines. While the relatively non-restrictive nature of SufL provided flexibility for participants, many participants perceived that a more structured program may have assisted in achieving weight loss goals.
Van Gool, K, Haas, MR, Gallego, G, Tannous, K & Katz, I 2009, 'Framework for the cost benefit analysis of the NSW Department of Community Services Brighter Futures Program. CHERE Working Paper 2009/4', CHERE Working Paper 2009/4.
Haas, MR, 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'.
Johar, M, Fiebig, DG, Haas, MR & Viney, RC 2009, 'Evaluating changes in women's attitudes towards cervical screening following a screening promotion campaign and a free vaccination program. CHERE Working Paper 2009/3', CHERE Working Paper.
This study examines behavioural changes brought about by two interventions introduced to lower the incidence of cervical cancer in Australia. The first intervention is a media campaign promoting regular screening behaviour to women. The second intervention is a vaccination program providing a free HPV vaccine, Gardasil, to young women launched in the same period. The results using data from discrete choice experiments find that in general, given individual characteristics, the interventions have minor impact on how women value screening attributes. The interventions however alter womenâs inherent taste for screening. Unexpectedly, willingness to screen is generally lower post-interventions. The reason for this trend appears to be related to HPV events. For instance, the reduction in screening participation is particularly marked among young women who are eligible for the vaccination program. There is also a larger aversion towards testing among women who gained information on HPV facts and HPV-related measures. Thus, in the face of HPV innovations, screening promotions need to account for these factors. A simulation exercise is then performed to assess the plausibility of several strategies to increase the screening rate. The results nominate supply-side policies, in particular those targeted to health providers, as the most effective strategy.
Haas, MR 2009, 'Social network theory and analysis: a preliminary exploration. CHERE Working Paper 2009/5'.
Haas, MR, Hall, JP & Gallego, G 2009, 'Evidence for funding, organising and delivering health care services targeting secondary prevention and management of chronic conditions. CHERE Working Paper 2009/6'.
BreastScreen Australia provides free mammography services to women in the target age group of 50 to 69 years. The program uses a variety of measures to recruit women to the service and, subsequently, encourage them to screen at two year intervals. One of the stated aims of the program is to provide equitable access to all women in the target age group. This paper analyses the extent to which systematic variation can be observed amongst women in terms of their screening behaviour, focusing on those who have never screened or are irregular screeners. Data on self reported utilisation of breast screening services was obtained from the 2002/04 NSW Health Surveys. A multinomial logit (MNL) model was used to examine the role of socioeconomic status, cultural background, education and region of residence on breast screening behaviour. The results show that lower income is associated with a woman never screening or screening irregularly. Region of residence is an important predictor of screening behaviour, although the degree of remoteness was not influential in determining participation. A higher number of hours worked was associated with women being more likely to screen irregularly. These results provide evidence of persistent and systematic variation in screening uptake and regular participation. The results also point towards targeted recruitment and retainment strategies that may provide the greatest potential benefits.
Norman, R, Haas, MR, Chenoweth, L, Jeon, Y, King, MT, 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'.
Vu, M, Van Gool, K, Savage, EJ, Haas, MR & Birch, S 2007, 'The use of breast screening services in NSW: Are we moving towards greater equity? [Draft - not for quotation or citation], CHERE Working Paper 2007/7', CHERE Working Paper.
Despite the success internationally of cervical screening programs debate continues about optimal program design. This includes increasing participation rates among under-screened women, reducing unnecessary early re-screening, improving accuracy of and confidence in screening tests, and determining the cost-effectiveness of program parameters, such as type of screening test, screening interval and target group. For all these issues, information about consumer and provider preferences and insight into the potential impact of any change to program design on consumer and provider behaviour are essential inputs into evidence-based health policy decision making. This paper reports the results of discrete choice experiments to investigate womenâs choices and providersâ recommendations in relation to cervical screening in Australia. Separate experiments were conducted with women and general practitioners, with attributes selected to allow for investigation of interaction between womenâs and providersâ preferences and to determine how women and general practitioners differ in their preferences for common attributes. The results provide insight into the agency relationship in this context. Our results indicate a considerable commonality in preferences but the alignment was not complete. Women put relatively more weight on cost, chance of a false positive and if the recommended screening interval were changed to one year.
Van Gool, K, Gallego, G, Haas, MR, Viney, RC, Hall, JP & Ward, R 2007, 'Incorporating economic evidence into cancer care: searching for the missing link, CHERE Working Paper 2007/3', CHERE Working Paper.
Ting, HJ, Martin, DK & Haas, MR 2007, 'A Markov model of Diabetic Retinopathy Progression for the Economic Evaluation of a novel DR prognostic device, CHERE Working Paper 2007/14', CHERE Working Paper.
The initial diagnosis of Diabetic Retinopathy (DR) is often in the advance stages of the condition, as patients are only promoted for an examination when sight has been affected. An innovative prognostic technique has recently been made available which can non-invasively detect the damaging effects of high blood glucose before the development of clinical symptoms. This innovation offers the opportunity to patients to make the necessary behavioural and medicinal modification to prevent further progress of the disease. This paper reports the development of a Markov model which emulates the natural progression of Diabetic Retinopathy based on data from clinical trials. The purpose of such a model is to estimate the chronic cost and health outcomes of DR, and it may be modified to reflect the potential changes in current practice or condition changes, hence allowing for an economic evaluation of the DR prognostic test. The implications and limitations of the model were also discussed in the paper.
Haas, MR, Shanahan, M & Anderson, R 2007, 'Assessing the costs of organised health programs: The case of the National Cervical Screening Program, CHERE Working Paper 2007/2', CHERE Working Paper.
Van Gool, K, Savage, EJ, Viney, RC, Haas, MR & Anderson, R 2006, 'Catastrophic insurance: Impact of the Australian Medicare Safety Net on fees, service use and out-of-pocket costs, CHERE Working Paper 2006/9', CHERE Working Paper 2006/9.
Haas, MR & Sainsbury, P 2006, 'Decision making by patients: An application of naturalistic decision making theory to cervical screening and chronic renal failure, CHERE Working Paper 2006/5', CHERE Working Paper 2006/5.
Haas, MR 2006, 'Economic analysis of Tai Chi as a means of preventing falls and falls related injuries among older adults, CHERE Working Paper 2006/4', CHERE Working Paper 2006/4.
Haas, MR & Fowler, S 2006, 'A synthesis of qualitative research on cervical cancer screening behaviour: Women's perceptions of the barriers and motivators to screen and the implications for policy and practice, CHERE Working Paper 2006/7', CHERE Working Paper 2006/7.
The aims of this paper are: to review and describe different approaches to HTA used in Australia and in other countries and to identify the features of best practice in HTA, particularly those likely to be most relevant to HTA at a local (ie state/regional) level.
There are a number of well-developed models of HTA at the national and local levels. Most information about the operation of these models, particularly about the type and number of evaluations conducted, the recommendations/decisions made and the reasons for these is available for national processes, but there is much less readily available documentation about local level HTA. Most HTA processes that operate nationally and internationally can be categorised in one of three ways: guidance (provides structured information about appropriate technologies), mandatory (provides mandatory information about technologies to be implemented) and funding and implementation (provides structured evidence-based advice about which technologies should be implemented, the level of funding required to implement them and the source of these funds).
The main factors which distinguish a high quality HTA process are that i) it is efficient in terms of setting priorities, the scope of the technologies to be assessed, avoidance of duplication and overall cost of the process, ii) the overall impact on utilisation and health budget is calculated as part of the HTA and iii) procedural justice occurs and is seen to occur; iv) it includes a comprehensive assessment of the impact on issues such as workforce, credentialing of providers and the ethical dimension of the technology; v) it influences decision making by being communicated appropriately and using trusted methods; vi) it influences adoption and diffusion of technology by ensuring that there is no diffusion prior to HTA, the results are incorporated into guidelines or recommendations, funding is linked to the decision, and remuneration arrangements and other characteristics o...
Glasziou, P & Haas, M, 'An economic evaluation of the use of tamoxifen in the treatment of early breast cancer'.
This analysis compared the costs and benefits of tamoxifen for women with early breast cancer. The main question addressed was: what are the costs and benefits of the use of tamoxifen as an adjuvant treatment in terms of survival and disease free survival for women? Survival and disease free survival estimates were based on statistical overviews of existing clinical trial data (EBCTCG 1990, 1992), and used a method (quality adjusted survival analysis) developed to analyse controlled trials where overall survival and quality of life are important. The difference in benefits between those treated with tamoxifen and the control group was measured as a difference in QALYs gained. On average, women treated with tamoxifen gained 0.405 more QALYs than the control group. Calculation of the net cost over 10 years took into account the cost of tamoxifen and the cost of recurrence for both groups. The net cost over 10 years was $553. The incremental cost per QALY gained was $1365.
Vu, M, Gool, KV, Savage, E, Haas, M & Birch, S, 'Breast screening in NSW, Australia: predictors of non-attendance and irregular attendance'.
BreastScreen Australia provides free mammography services to women in the target age group of 50 to 69 years. The program uses a variety of measures to recruit women to the service and, subsequently, encourage them to screen at two year intervals. One of the stated aims of the program is to provide equitable access to all women in the target age group. This paper analyses the extent to which systematic variation can be observed amongst women in terms of their screening behaviour, focusing on those who have never screened or are irregular screeners. Data on self reported utilisation of breast screening services was obtained from the 2002/04 NSW Health Surveys. A multinomial logit (MNL) model was used to examine the role of socioeconomic status, cultural background, education and region of residence on breast screening behaviour. The results show that lower income is associated with a woman never screening or screening irregularly. Region of residence is an important predictor of screening behaviour, although the degree of remoteness was not influential in determining participation. A higher number of hours worked was associated with women being more likely to screen irregularly. These results provide evidence of persistent and systematic variation in screening uptake and regular participation. The results also point towards targeted recruitment and retainment strategies that may provide the greatest potential benefits.
Overweight and obesity continue to contribute to increased risk of chronic diseases, including higher lifetime health expenditures and impacting on individuals? quality of life. Whilst international studies have compared individuals? perceptions of their body mass with more objective measures such as Body Mass Index (BMI) few Australian studies have examined this relationship in any detail. This study uses unit record data from the 2003 NSW Health Survey to identify factors associated with the accuracy of adults perceived body mass. Descriptive methods and logistical models are used to quantify the effects of a number of demographic, socio?economic, behavioural and health?related variables on the accuracy of self?assessed
The results support earlier findings that there are large gender differences in perception of body mass. Women are most likely to report they are overweight. In
contrast there is a pattern of underestimation of weight amongst men, particularly at the higher BMI deciles. Clearly these results have different policy implications. This information may be useful for public health programs to take into account the issue of whether individuals accurately perceive themselves at risk of developing weight?related health conditions.
Haas, M, Shanahan, M & Anderson, R, 'Assessing the costs of organised health programs: The case of the National Cervical Screening Program'.
Economic evaluations of health care programs are relatively common. However, the costs reported often use budgetary information alone, rather than undertake the potentially more complex task of using a variety of routinely collected data for which adjustments and assumptions will need to be made. Relative to the effort required for an individual-level costing exercise, investigating the costs of a health care program targeted at a population or group is likely to be a more complex and difficult undertaking. This paper describes the process of undertaking a program-level cost analysis, using principles developed to ensure the quality of such evaluations. Documenting the costs of the National Cervical Screening Program is used to illustrate the approach and the difficulties encountered, assumptions made and solutions employed are discussed. Despite the limitations to estimating the costs of health programs identified in this paper, evaluators can take full advantage of the data available by using a systematic description of the program as a basis for costing, testing the assumptions and adjustments needed using the expertise available within a specifically appointed advisory or working group and using sensitivity analysis to provide a greater level of confidence in the results.
van Gool, K, Haas, M, Sainsbury, P & Gilbert, R, 'When is an ounce of prevention worth a pound of cure: The case of cardiovascular disease?'.
Objective: To provide decision makers with a tool to inform resource allocation decisions at the local level, using cardiovascular disease prevention as an example. Method: Evidence from the international literature was extrapolated to estimate the health and financial impacts in Central Sydney Area Health Service (CSAHS) of three different prevention programs; smoking cessation; blood pressure reduction and cholesterol lowering. The cost-effectiveness analysis framework was reconfigured to 1) estimate the risk of CVD in the community using local risk factor data, 2) estimate the number of CVD events prevented through investment in preventive programs and 3) estimate the local financial flow-on effects of prevention on acute care services. The model developed here estimates an upper bound of what local decision makers could spend on preventive programs whilst remaining consistent with their willingness to pay for one additional life-year gained. Results: The model predicted that over a five-year period the cumulative impact of the three programs has the potential to save 1245 life-years in people aged 40-79 years living in CSAHS. If decision-makers are willing to invest in cost-saving preventive programs only, the model estimates that they can spend up $12 per person in the target group per year. However, if they are willing to spend $70,000 per life-year gained, this amount rises to $201. Conclusions: Modelling the impact of preventive activities on the acute care health system enables us to estimate the amount that can be spent on preventive programs. The model is flexible in terms of its ability to examine these impacts in a variety of settings and therefore has the potential to be a useful resource planning tool.