Richard is employed as an Associate Professor with the Centre for Health Economics Research and Evaluation. He is currently working as the Senior Evaluator for the PBAC Team and as the Project Officer/Coordinator for the Cancer Research Economics Support Team (CREST). Richard is a very experienced health economist who has spent the last 12 years working in the field of market access and reimbursement for pharmaceuticals and medical devices in Australia. Most recently, this included seven years with Covance, a clinical research organisation, as a Director of Health Economics. This work has involved liaison with multiple stakeholders throughout the treatment development pathway including clinical trialists, clinicians, patients and patient support networks, statisticians and the reimbursement authorities. He has a keen interest in applied economic evaluations, the economics of specialty health areas, patient preference and quality of life, and priority setting. Richard’s primary interest and focus in specialty health has been in the fields of oncology/haematology, across a broad range of indications and clinical settings. Prior to joining Covance, he spent five years as a member of the health economics team at Novartis Pharmaceuticals, and prior to that four years CHERE. He commenced his career as an Economist with the Reserve Bank of Australia. He holds an MEc (Hons) from Sydney University, and a BEc (Hons) from Murdoch University and PhD from UTS.
Can supervise: YES
Farrar, M, Carey, K, Paguinto, SG, Kasparian, NA & De Abreu Lourenco, R 2020, '"The whole game is changing and you’ve got hope”: Australian perspectives on treatment decision-making in Spinal Muscular Atrophy', The Patient: Patient Centered Outcomes Research.View/Download from: Publisher's site
Findlay, M, Brown, C, De Abreu Lourenco, R, White, K & Bauer, JD 2020, 'Sarcopenia and myosteatosis in patients undergoing curative radiotherapy for head and neck cancer: Impact on survival, treatment completion, hospital admission and cost', Journal of Human Nutrition and Dietetics.
Findlay, M, Rankin, NM, Shaw, T, White, K, Boyer, M, Milross, C, De Abreu Lourenco, R, Brown, C, Collett, G, Beale, P & Bauer, JD 2020, 'Best Evidence to Best Practice: Implementing an Innovative Model of Nutrition Care for Patients with Head and Neck Cancer Improves Outcomes', Nutrients, vol. 12, no. 5, pp. 1465-1465.View/Download from: Publisher's site
Malnutrition is prevalent in patients with head and neck cancer (HNC), impacting outcomes. Despite publication of nutrition care evidence-based guidelines (EBGs), evidence–practice gaps exist. This study aimed to implement and evaluate the integration of a patient-centred, best-practice dietetic model of care into an HNC multidisciplinary team (MDT) to minimise the detrimental sequelae of malnutrition. A mixed-methods, pre–post study design was used to deliver key interventions underpinned by evidence-based implementation strategies to address identified barriers and facilitators to change at individual, team and system levels. A data audit of medical records established baseline adherence to EBGs and clinical parameters prior to implementation in a prospective cohort. Key interventions included a weekly Supportive Care-Led Pre-Treatment Clinic and a Nutrition Care Dashboard highlighting nutrition outcome data integrated into MDT meetings. Focus groups provided team-level evaluation of the new model of care. Economic analysis determined system-level impact. The baseline clinical audit (n = 98) revealed barriers including reactive nutrition care, lack of familiarity with EBGs or awareness of intensive nutrition care needs as well as infrastructure and dietetic resource limitations. Post-implementation data (n = 34) demonstrated improved process and clinical outcomes: pre-treatment dietitian assessment; use of a validated nutrition assessment tool before, during and after treatment. Patients receiving the new model of care were significantly more likely to complete prescribed radiotherapy and systemic therapy. Differences in mean percentage weight change were clinically relevant. At the system level, the new model of care avoided 3.92 unplanned admissions and related costs of $AUD121K per annum. Focus groups confirmed clear support at the multidisciplinary team level for continuing the new model of care. Implementing an evidence-based nutrition model of car...
Haeusler, G, Thursky, K, Slavin, MA, Babl, FE, De Abreu Lourenco, R, Mechinaud, F & Phillips, B 2020, 'Re-evaluating and recalibrating predictors of bacterial infection in children with cancer and febrile neutropenia', EClinicalMedicine.
Haeusler, GM, De Abreu Lourenco, R, Clark, H, Thursky, KA, Slavin, MA, Babl, FE, Mechinaud, F, Alvaro, F, Clark, J, Padhye, B, Phillips, M, Super, L, Tapp, H, Walwyn, T, Ziegler, D, Phillips, R & Worth, LJ 2020, 'Diagnostic Yield of Initial and Consecutive Blood Cultures in Children With Cancer and Febrile Neutropenia', Journal of the Pediatric Infectious Diseases Society.View/Download from: Publisher's site
BACKGROUND:The timing and necessity of repeated blood cultures (BCs) in children with cancer and febrile neutropenia (FN) are unknown. We evaluated the diagnostic yield of BCs collected pre- and post-empiric FN antibiotics. METHODS:Data collected prospectively from the Australian Predicting Infectious ComplicatioNs in Children with Cancer (PICNICC) study were used. Diagnostic yield was calculated as the number of FN episodes with a true bloodstream infection (BSI) detected divided by the number of FN episodes that had a BC taken. RESULTS:A BSI was identified in 13% of 858 FN episodes. The diagnostic yield of pre-antibiotic BCs was higher than of post-antibiotic cultures (12.3% vs 4.4%, P < .001). Two-thirds of the post-antibiotic BSIs were associated with a new episode of fever or clinical instability, and only 2 new BSIs were identified after 48 hours of empiric antibiotics and persistent fever. A contaminated BC was identified more frequently in post-antibiotic cultures. CONCLUSIONS:In the absence of new fever or clinical instability, BCs beyond 48 hours of persistent fever have limited yield. Opportunity exists to optimize BC collection in this population and reduce the burden of unnecessary tests on patients, healthcare workers, and hospitals.
Haeusler, GM, Thursky, KA, Slavin, MA, Babl, FE, De Abreu Lourenco, R, Allaway, Z, Mechinaud, F & Phillips, R 2020, 'Risk stratification in children with cancer and febrile neutropenia: A national, prospective, multicentre validation of nine clinical decision rules', EClinicalMedicine, vol. 18.View/Download from: Publisher's site
© 2019 Background: Reduced intensity treatment of low-risk febrile neutropenia (FN) in children with cancer is safe and improves quality of life. Identifying children with low-risk FN using a validated risk stratification strategy is recommended. This study prospectively validated nine FN clinical decision rules (CDRs) designed to predict infection or adverse outcome. Methods: Data were collected on consecutive FN episodes in this multicentre, prospective validation study. The reproducibility and discriminatory ability of each CDR in the validation cohort was compared to the derivation dataset and details of missed outcomes were reported. Findings: There were 858 FN episodes in 462 patients from eight hospitals included. Bacteraemia occurred in 111 (12·9%) and a non-bacteraemia microbiological documented infection in 185 (21·6%). Eight CDRs exhibited reproducibility and sensitivity ranged from 64% to 96%. Rules that had >85% sensitivity in predicting outcomes classified few patients (<20%) as low risk. For three CDRs predicting a composite outcome of any bacterial or viral infection, the sensitivity and discriminatory ability improved for prediction of bacterial infection alone. Across all CDRs designed to be implemented at FN presentation, the sensitivity improved at day 2 assessment. Interpretation: While reproducibility was observed in eight out of the nine CDRs, no rule perfectly differentiated between children with FN at high or low risk of infection. This is in keeping with other validation studies and highlights the need for additional safeguards against missed infections or adverse outcomes before implementation can be considered.
McCarthy, M, De Abreu Lourenco, R, McMillan, LJ & Meshcheriakova, O 2020, 'Finding out what matters in decision-making related to genomics and personalized medicine in pediatric oncology: Developing attributes to include in a discrete choice experiment', The Patient: Patient Centered Outcomes Research.View/Download from: Publisher's site
Ong, J, De Abreu Lourenco, R, Street, D, Smith, K, Jamil, M, Terris-Prestholt, F, Fairley, C, McNulty, A, Hynes, A, Johnson, K, Chow, E, Bavinton, BR, Grulich, A, Stoove, M, Holt, M, Kaldor, J & Guy, R 2020, 'The preferred qualities of HIV testing and self-testing among men who have sex with men: a discrete choice experiment', Value in Health.
Shanahan, M, Seddon, J, Ritter, A & De Abreu Lourenco, R 2020, 'Valuing families’ preferences for drug treatment: a discrete choice experiment', Addiction, vol. 115, no. 4, pp. 690-699.View/Download from: Publisher's site
Van Gelder, T, Mulhern, B, Schoormans, D, Husson, O & De Abreu Lourenco, R 2020, 'Assessing health-related quality of life in cancer survivors: Factors impacting on EORTC QLU-C10D derived utility values', Quality of Life Research, vol. 29, no. 6, pp. 1483-1494.View/Download from: Publisher's site
Barakat-Johnson, M, Lai, M, Ward, T, White, K & De Abreu Lourenco, R 2019, 'Costs and consequences of an intervention-based program to reduce hospital-acquired pressure injuries in one health district in Australia', Australian Health Review, vol. 43, no. 5, pp. 516-525.View/Download from: Publisher's site
De Abreu Lourenco, R & Williams, S 2019, 'Health Technology Assessment and Health Care Utilisation in the Management of Early Prostate Cancer', European urology focus, vol. 5, no. 2, pp. 134-136.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, vol. 28, no. 4, pp. e13058-e13058.View/Download from: Publisher's site
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
MacManus, M, De Abreu Lourenco, R & Hegi-Johnson, F 2019, 'Helping patients with lung cancer choose between surgery or stereotactic body radiotherapy: the importance of the patient experience', Journal of Thoracic Disease, vol. 11, no. 11.View/Download from: Publisher's site
Mulhern, B, Norman, R, De Abreu Lourenco, R, Street, D, Malley, J & Viney, R 2019, 'Investigating the relative value of health and social care related quality of life using a discrete choice experiment', Social Science and Medicine, vol. 233, pp. 28-37.View/Download from: Publisher's site
Sweeney, CJ, De Abreu Lourenco, R, Hamid, AA & Buyse, M 2019, 'What Does Metastasis Free Survival Actually Mean?', Journal of Clinical Oncology, vol. 37, no. 19, pp. 1679-1680.
Ager, B, Jansen, J, Porter, D, Phillips, KA, Glassey, R, Rankin, N, Musiello, T, Boyle, F, Zdenkowski, N, Skandarajah, A, Saunders, C, Sundaresan, P, De Abreu Lourenco, R & Butow, P 2018, 'Development and pilot testing of a Decision Aid (DA) for women with early-stage breast cancer considering contralateral prophylactic mastectomy', Breast, vol. 40, pp. 156-164.View/Download from: Publisher's site
© 2018 Elsevier Ltd Objective: Describe the development, acceptability and feasibility of a Decision Aid (DA) for women with early-stage breast cancer (BC) at average contralateral breast cancer (CBC) risk considering contralateral prophylactic mastectomy (CPM). Methods: The DA was developed using the International Patient Decision Aid Standards (IPDAS) and the Ottawa Decision Support Framework. It provides evidence-based information about CPM in a booklet format combining text, graphs and images of surgical options. Twenty-three women with a history of early-stage breast cancer were interviewed in person or over the phone using a ‘think aloud approach’. Framework analysis was used to code and analyse data. Results: Twenty-three women participated in the study. Mean age of participants was 58.6 years and time since diagnosis ranged from 14 months to 21 years. Five women had CPM and eighteen had not. Women strongly endorsed the DA. Many felt validated by a section on appearance and found information on average risk of recurrence and metastases helpful, however, noted the importance of discussing personal risk with their surgeon. Many requested more information on surgery details (time taken, recovery) and costs of the different options. Conclusion: The DA was acceptable to women, including the format, content and proposed implementation strategies. Practical and financial issues are important to women in considering treatment options. Practice implications: Women appreciate information about CPM at diagnosis and emphasised the importance of discussing potential downsides of the procedure in addition to benefits. The DA was considered acceptable to facilitate such discussions.
De Abreu Lourenco, R & Williams, S 2018, 'Building an understanding of the value of docetaxel plus hormone therapy in prostate cancer: an ever-growing evidence base', European Urology Oncology, vol. 1, no. 6, pp. 459-460.View/Download from: Publisher's site
Haeusler, GM, Thursky, KM, Slavin, M, Mechinaud, F, Babl, FE, Bryant, P, De Abreu Lourenco, R & Phillips, R 2018, 'External validation of six pediatric fever and neutropenia clinical decision rules', Pediatric Infectious Disease Journal, vol. 37, no. 4, pp. 329-335.View/Download from: Publisher's site
Background: Fever and neutropenia (FN) clinical decision rules (CDRs) are recommended to help distinguish children with cancer at high and low risk of severe infection. The aim of this study was to validate existing pediatric FN CDRs designed to stratify children with cancer at high or low risk of serious infection or medical complication.
Methods: Pediatric CDRs suitable for validation were identified from a literature search. Relevant data were extracted from an existing data set of 650 retrospective FN episodes in children with cancer. The sensitivity and specificity of each of the CDR were compared with the derivation studies to assess reproducibility.
Results: Six CDRs were identified for validation: 2 were designed to predict bacteremia and 4 to predict adverse events. Five CDRs exhibited reproducibility in our cohort. A rule predicting bacteremia had the highest sensitivity (100%; 95% confidence interval (CI): 93%–100%) although poor specificity (17%), with only 15% identified as low risk. For adverse events, the highest sensitivity achieved was 84% (95% CI: 75%–90%), with specificity of 29% and 27% identified as low risk. A rule intended for application after a 24-hour period of inpatient observation yielded a sensitivity of 80% (95% CI: 73–86) and specificity of 46%, with 44% identified as low risk.
Conclusions: Five CDRs were reproducible, although not all can be recommended for implementation because of either inadequate sensitivity or failure to identify a clinically meaningful number of low-risk patients. The 24-hour rule arguably exhibits the best balance between sensitivity and specificity in our population.
The risk of infection in the setting of chemotherapy-induced neutropenia, heralded by fever, remains an unavoidable complication of the treatment of childhood cancer. Treatment strategies for fever and neutropenia (FN) that are tailored to an individual’s likelihood of severe infection, by incorporating risk stratification, are well descri...
Hofman, MS, Murphy, DG, Williams, SG, Nzenza, T, Herschtal, A, De Abreu Lourenco, R, Bailey, DL, Budd, R, Hicks, RJ, Francis, RJ & Lawrentschuk, N 2018, 'A prospective randomised multi-centre study of the impact of Ga-68 PSMA-PET/CT imaging for staging high risk prostate cancer prior to curative-intent surgery or radiotherapy (proPSMA study): clinical trial protocol', BJU International, vol. 122, no. 5, pp. 783-793.View/Download from: Publisher's site
Kasparian, N, De Abreu Lourenco, R, Winlaw, DS, Sholler, DF, Viney, R & Kirk, EPE 2018, 'Tell me once, tell me soon: Parents’ preferences for clinical genetics services for congenital heart disease', Genetics in Medicine, vol. 20, no. 11, pp. 1387-1395.View/Download from: Publisher's site
Mu, C, De Abreu Lourenco, R, van Gool, K & Hall, J 2018, 'Is low priced primary care bad for quality? Evidence from Australian general practice', Applied Economics, vol. 50, no. 5, pp. 475-491.View/Download from: Publisher's site
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: Publisher's site
Shankar, S, Chesson, B, Bressel, M, Pryor, D, Higgs, B, Reynolds, H, Hardcastle, N, Montgomery, R, Vanneste, B, Khoo, V, Ruben, J, Lau, E, Hofman, M, De Abreu Lourenco, R, Sridharan, S, Brook, N, Martin, J, Lawrentschuk, N, Kron, T & Foroudi, F 2018, 'TROG 15.03 Phase II Clinical Trial of Focal Ablative STereotactic Radiosurgery for Cancers of the Kidney - FASTRACK II', BMC Cancer, vol. 18:1030.
van Sambeek, B, Flattery, M, Mitchell, R & De Abreu Lourenco, R 2018, 'Comparing the cost of preparing matched unrelated donor and TCR α+ β+ /CD19+ depleted donor material for pediatric hematopoietic stem cell transplants in Australia', Pediatric Transplantation, vol. 22, no. 7, pp. E13279-E13279.View/Download from: Publisher's site
Walker, JG, Macrae, F, Winship, I, Oberoi, J, Saya, S, Milton, S, Bickerstaffe, A, Dowty, JG, De Abreu Lourenço, R, Clark, M, Galloway, L, Fishman, G, Walter, FM, Flander, L, Chondros, P, Ait Ouakrim, D, Pirotta, M, Trevena, L, Jenkins, MA & Emery, JD 2018, 'The use of a risk assessment and decision support tool (CRISP) compared with usual care in general practice to increase risk-stratified colorectal cancer screening: study protocol for a randomised controlled trial.', Trials, vol. 19, pp. 397-397.View/Download from: Publisher's site
Australia and New Zealand have the highest incidence rates of colorectal cancer worldwide. In Australia there is significant unwarranted variation in colorectal cancer screening due to low uptake of the immunochemical faecal occult blood test, poor identification of individuals at increased risk of colorectal cancer, and over-referral of individuals at average risk for colonoscopy. Our pre-trial research has developed a novel Colorectal cancer RISk Prediction (CRISP) tool, which could be used to implement precision screening in primary care. This paper describes the protocol for a phase II multi-site individually randomised controlled trial of the CRISP tool in primary care.This trial aims to test whether a standardised consultation using the CRISP tool in general practice (the CRISP intervention) increases risk-appropriate colorectal cancer screening compared to control participants who receive standardised information on cancer prevention. Patients between 50 and 74 years old, attending an appointment with their general practitioner for any reason, will be invited into the trial. A total of 732 participants will be randomised to intervention or control arms using a computer-generated allocation sequence stratified by general practice. The primary outcome (risk-appropriate screening at 12 months) will be measured using baseline data for colorectal cancer risk and objective health service data to measure screening behaviour. Secondary outcomes will include participant cancer risk perception, anxiety, cancer worry, screening intentions and health service utilisation measured at 1, 6 and 12 months post randomisation.This trial tests a systematic approach to implementing risk-stratified colorectal cancer screening in primary care, based on an individual's absolute risk, using a state-of-the-art risk assessment tool. Trial results will be reported in 2020.Australian and New Zealand Clinical Trial Registry, ACTRN12616001573448p . Registered on 14 November 2016.
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: 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.
Haeusler, G, Thursky, K, Mechinaud, F, Babl, F, De Abreu Lourenco, R, Slavin, M & Phillips, B 2017, 'Predicting Infectious ComplicatioNs In Children with Cancer: an external validation study', British Journal of Cancer, vol. 117, no. 2, pp. 171-178.View/Download from: Publisher's site
Jefford, M, Emery, J, Grunfeld, E, Martin, A, Rodger, P, Murray, A, De Abreu Lourenco, R, Heriot, A, Phipps-Nelson, J, Guccione, L, King, D, Lisy, K, Tebbutt, N, Burgess, A, Faragher, I, Woods, R & Schofield, P 2017, 'SCORE: Shared care of colorectal cancer survivors: study protocol for a randomised controlled trial', Trials, vol. 18, no. 506.
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: Publisher's site
Wakefield, C, Fardell, J, Doolan, E, Drew, D, De Abreu Lourenco, R, Young, A & Cohn, R 2017, 'Grandparents of children with cancer: quality of life, medication and hospitalizations', Pediatric Blood and Cancer, vol. 64, no. 1, pp. 163-171.View/Download from: 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: 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.
Austin, K, Chambers, GM, De Abreu Lourenco, R, Madan, A, Susic, D & Henry, A 2015, 'Cost-effectiveness of term induction of labour using inpatient prostaglandin gel versus outpatient Foley catheter', Australian and New Zealand Journal of Obstetrics and Gynaecology, vol. 55, no. 5, pp. 440-445.View/Download from: Publisher's site
Advances in cancer detection and treatment pose a challenge to traditional cancer services focused on the acute delivery of specialist care. In The Lancet Oncology Commission,1 Greg Rubin and colleagues set out an exhaustive charter for the role of primary care services, and the primary care physician (PCP). The authors suggest 18 action points for a greater role for the PCP from detection to palliation.
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
Shah, K, te Marvelde, L, Collins, M, De Abreu Lourenco, R, D'Costa, I, Coleman, A, Fua, T, Liu, C, Rischin, D, Lau, E & Corry, J 2015, 'Safety and cost analysis of an 18FDG-PET-CT response based follow-up strategy for head and neck cancers treated with primary radiation or chemoradiation', Oral Oncology, vol. 51, no. 5, pp. 529-535.View/Download from: Publisher's site
Background: Prognostic information can rationalise clinical follow-up after radical cancer treatment. This retrospective cohort study of radical head and neck (chemo)radiotherapy patients examines the clinical safety and cost implications of stratifying follow-up intensity by post-treatment 18FDG-PET-CT response. Methods: In 2008 clinical review after radical head and neck radiotherapy was reduced from 3- to 6-monthly for patients with complete 18FDG-PET-CT response at 3months. 184 patients treated after this change ("PET Stratified", 2009-11) were compared to 178 patients treated before ("Standard", 2005-7). Clinical safety was assessed by the time to detection of recurrence, overall survival and potential for radical treatment of recurrence. A hospital cost analysis was performed using individual patient data. Results: 127 of 178 Standard and 148 of 184 PET Stratified patients achieved complete response on post-treatment imaging. Baseline clinical characteristics were comparable. Median follow-up from response assessment was 4.8. years in the Standard cohort and 2.1. years for PET Stratified. PET Stratified patients had a mean 4.4 outpatient visits in 2. years, compared to 7.0 among Standard patients. Over 90% of patients remained free of recurrence at 2. years in both cohorts. Time to detection of recurrence was similar between two cohorts (HR1.05, 95%CI 0.45-2.52), as was overall survival (HR0.91, 95%CI 0.36-2.29). The proportion of radically treatable recurrences was also similar (42% Standard vs. 47% PET Stratified). The hospital cost savings per patient from reduced review were AUD$2606 over 2. years, AUD$5012 over five. Conclusion: 18FDG-PET-CT to stratify follow-up intensity after radical radiotherapy for head and neck cancer reduces costs with no apparent clinical detriment.
Kalff, A, Kennedy, N, Smiley, A, Miles Prince, H, Roberts, AW, Bradstock, K, de Abreu Lourenco, R, Frampton, C & Spencer, A 2014, 'Thalidomide and prednisolone versus prednisolone alone as consolidation therapy after autologous stem-cell transplantation in patients with newly diagnosed multiple myeloma: Final analysis of the ALLG MM6 multicentre, open-label, randomised phase 3 study', The Lancet Haematology, vol. 1, no. 3, pp. e112-e119.View/Download from: Publisher's site
Background: We previously showed that consolidation therapy with thalidomide and prednisolone improved progression-free and overall survival in patients with multiple myeloma who had undergone autologous stem-cell transplantation. We aimed to assess whether these survival advantages were durable at 5 years. Methods: The ALLG MM6 trial was a multicentre, open-label, randomised phase 3 trial done between Jan 13, 2002, and March 15, 2005, at 29 sites in Australia and New Zealand. Patients with newly diagnosed multiple myeloma were randomly assigned (1:1), via computer-generated randomisation charts, to receive indefi nite prednisolone maintenance alone (control group) or in combination with 12 months of thalidomide consolidation (thalidomide group) after autologous stem-cell transplantation. Randomisation was stratifi ed by treating centre and pre-transplantation concentrations of ß2 microglobulin. Patients and treating physicians were not masked to treatment allocation. Primary endpoints were progression-free survival and overall survival. Analysis was by intention to treat. Secondary endpoints were overall response to salvage therapy, incidence of second primary malignancy incidence, and cost-eff ectiveness. This trial is registered with the Australian and New Zealand Clinical Trials Registry, number ACTRN12607000382471. Findings: We randomly assigned 269 patients to the thalidomide (n=114) or control group (n=129). After a median followup of 5·4 years (IQR 3·1-7·2), estimated 5-year progression-free survival was 27% (95% CI 23-32) in the thalidomide group and 15% (11-18) in the control group (hazard ratio [HR] 0·16, 95% CI 0·044-0·58; p=0·0054) and 5-year overall survival was 66% (95% CI 61-70) and 47% (42-51), respectively (HR 0·12, 95% CI 0·028-0·56; p=0·0072). There was no diff erence in overall response to salvage therapy, survival post-progression, or incidence of secondary malignancies between the two groups. Incremental cost-eff ectiveness ratio was AUS$26...
Liew, D, De Abreu Lourenco, R, Adena, M, Chim, L & Aylward, P 2013, 'Cost-effectiveness of 12-month treatment with Ticagrelor compared to Clopidogrel in the management of acute coronary syndromes', Clinical Therapeutics, vol. 35, no. 8, pp. 1110-1117.View/Download from: Publisher's site
Background: The PLATO (Platelet Inhibition and Patient Outcomes) randomized trial (NCT00391872) in patients with acute coronary syndromes (ACS) reported that ticagrelor (in addition to aspirin) reduced the rate of the composite end point of myocardial infarction (MI), stroke, or cardiovascular death compared with clopidogrel (in addition to aspirin) by 16% over 12 months (P o 0.001). No significant difference in the incidence of major bleeding was noted, but ticagrelor was associated with a higher rate of major bleeding not related to coronary artery bypass grafting. Objective: By extrapolating the key findings of PLATO, we sought to assess the cost-effectiveness of ticagrelor compared with clopidogrel in the management of ACS in a contemporary Australian setting. Methods: A Markov model with 4 health states (free from further ACS events, MI, stroke, and death) was developed to simulate the long-term costs and outcomes associated with ACS. Event risks were based on data derived directly from PLATO, and costs and utilities were drawn from published sources. A 10- year time horizon was simulated, and future costs and benefits were discounted at a 5% annual rate. However, treatment with ticagrelor and clopidogrel was only assumed for the first 12 months, with no benefits applied beyond drug cessation. Sensitivity analyses were undertaken based on variations to key data inputs. All costs for resource use applied in the analysis were based on published Australian prices (in 2010/2011 dollars [A$]). Results: Over 10 years, the estimated qualityadjusted life-years lived per-patient were 5.74 and 5.68 for ticagrelor and clopidogrel, respectively. Net costs were A$19,132 for ticagrelor and A$18,428 for clopidogrel. These equated to an incremental costeffectiveness ratio of A$9031 per quality-adjusted lifeyear gained for ticagrelor compared with clopidogrel. Sensitivity analyses indicated the result to be robust. Conclusions: When assessed from the perspective of the Austr...
Ghaly, S, Lourenco, RDA & Abbott, JA 2008, 'Audit of endometrial biopsy at outpatient hysteroscopy', AUSTRALIAN & NEW ZEALAND JOURNAL OF OBSTETRICS & GYNAECOLOGY, vol. 48, no. 2, pp. 202-206.View/Download from: Publisher's site
De Abreu Lourenco, R, Houltram, J & Pearce, G 2007, 'Assessment of the cost-effectiveness in Australia of cetuximab in the treatment of patients with locally advanced squamous cell cancers of the head and neck', VALUE IN HEALTH, vol. 10, no. 6, pp. A326-A326.
Osborne, R, De Abreu Lourenco, R, Dalton, A, Houltram, JA, Dowton, D, Joshua, D & Lindeman, R 2007, 'Quality of life related to oral versus subcutaneous iron chelation: a time trade off study', Value in Health, vol. 10, no. 6, pp. 451-456.View/Download from: Publisher's site
Schrover, R, Adena, M, De Abreu Lourenco, R, Prince, H, Seymour, J & Wonder, M 2006, 'Development of a predictive population survival model according to the cytogenetic response rate for patients with chronic myeloid leukemia in the chronic phase', Leukemia & Lymphoma, vol. 47, no. 6, pp. 1069-1081.View/Download from: Publisher's site
Chern, B, Joseph, D, Joshua, D, Pittman, K, Richardson, G, Shou, M, Lowe, S, Copeman, M & De Abreu Lourenco, R 2004, 'Bisphosphonate infusions: patient preference, safety and clinic use', Supportive Care in Cancer, vol. 12, no. 6, pp. 463-466.View/Download from: Publisher's site
Kessabi, S, de Abreu Lourenco, R & Wonder, M 2003, 'Rescuing patients from the rule of efficiency: a need to debate the 'rule of rescue'.', PharmacoEconomics, vol. 21, no. 9, p. 681.View/Download from: Publisher's site
De Abreu Lourenco, R & Wonder, M 2002, 'More than just currency conversion may be needed', British Medical Journal, vol. 17.
Hall, JP, Lourenco, R & Viney, RC 1999, 'Carrots And Sticks - The Fall And Fall Of Private Health Insurance In Australia', Health Economics, vol. 8, no. 8, pp. 653-660.View/Download from: 3.0.CO;2-I">Publisher's site
De Abreu Lourenco, R 2020, 'Valuing the symptoms patients experience in cancer care', Cancer Symptom Trials (CST) Annual Research Forum 2020, Sydney.
Rankin, N, McGregor, D, De Abreu Lourenco, R, Cust, A, Donnelly, C, Van Dort, B, Broome, K & Stone, E 2020, 'The potential for implementation of LDCT lung cancer screening in the Australian setting: outcomes of an Evidence Check review', Australian Lung Cancer Conference, Melbourne.
Craig, BM, De Abreu Lourenco, R & Huynh, E 2019, 'Good practices in health preference research', 11th Meeting of the International Academy of Health Preference Research, Auckland, New Zealand.
De Abreu Lourenco, R 2019, 'Grappling with the health, economics and health economics of immunotherapies', Immunotherapy Symptoms Clinical Trials: a new paradigm, Melbourne.
De Abreu Lourenco, R 2019, 'Health Economics, Drug Funding and Consumers', ANZGOG ASM, Sydney.
De Abreu Lourenco, R 2019, 'More than a fraction of value. Incorporating health economics into radiotherapy research', TROG ASM, Melbourne.
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.
Hegi-Johnson, F, Haas, M, Ball, D, Wright, G & Lourenco, RDA 2019, 'What Influences Patient Decision-Making About Lung-Cancer Treatment? A Discrete Choice Experiment', JOURNAL OF THORACIC ONCOLOGY, IASLC 2019 World Conference on Lung Cancer Conquering Thoracic Cancers Worldwide, ELSEVIER SCIENCE INC, Barcelona, Spain, pp. S878-S878.View/Download from: Publisher's site
Despite major advances in radiotherapy, surgery remains the treatment of choice for patients with stage I non-small cell
lung cancer. We sought to investigate what influenced preferences
for surgery or SABR among cancer patients.
McCarthy, MC, De Abreu Lourenco, R, Gillam, L, McMillan, L, Sullivan, M & Downie, P 2019, 'Personalised medicine in paediatric cancer care: What matters in decision-making?', 51st Congress of the International Society of Paediatric Oncology, Lyon, France.
De Abreu Lourenco, R 2018, 'A role for health economics in the changing face of radiotherapy', TROG ASM, Hobart.
De Abreu Lourenco, R 2018, 'Drug funding and consumers, Improving Participation and Advocacy for Clinical Trials', Breast Cancer Trials Group, Melbourne.
De Abreu Lourenco, R 2018, 'Health care, costs and quality of life: Trials informing reimbursement decision-making', Breast Cancer Trials 40th Annual Scientific Meeting, Sydney.
De Abreu Lourenco, R 2018, 'Health Economics, Drug funding and consumers', Cancer Trials Consumer Network (CTCN), COSA, Sydney.
De Abreu Lourenco, R 2018, 'Is it too early to think about health economics?', PoCoG Fear of Cancer Recurrence Concept Development Workshop, Sydney.
De Abreu Lourenco, R 2018, 'Should you be thinking about costs and outcomes?', ANZUP Renal Cell Carcinoma Concept Development Workshop, Sydney.
De Abreu Lourenco, R 2018, 'The reimbursement process in Australia', ISPOR-AP and COSA Workshop, COSA Meeting, Perth.
De Abreu Lourenco, R 2018, 'Thinking about “value” in translational studies', TCRN Research Symposium, Lowy Institute, Sydney.
De Abreu Lourenco, R 2018, 'Who’s Involved in Reimbursement – Consumers, Producers, HTA Agencies and Government', ISPOR-AP and COSA Workshop, COSA Meeting, Perth.
Ong, JJ, De Abreu Lourenco, R, Street, D, Jamil, MS, Smith, K, Terris-Prestholt, F & Guy, R 2018, 'What Australian gay and bisexual men want from HIV self-test kits: a discrete choice experiment (DCE)', Australian Society of HIV Medicine, Sydney.
Trevena, L, Mulhern, B, Viney, R & De Abreu Lourenco, R 2018, 'That’s what I want to avoid: Do clinical recommendations on risk reduction mirror what the community wants to avoid?', PC4 Scientific Symposium, Sydney.
De Abreu Lourenco, R 2017, 'Assessing the cost-effectiveness of immunotherapy: Do modern drugs need modern methods?', Clinical Oncology Society of Australia (COSA) Annual Scientific Meeting, Perth.
De Abreu Lourenco, R 2017, 'Does one size fit all? Determining value of prostate cancer and urology care', ANZUP Annual Scientific Meeting, Melbourne.
De Abreu Lourenco, R 2017, 'Estimating non (meta) health effects', ISPOR-AC Workshop, Sydney.
De Abreu Lourenco, R 2017, 'One in, all in: Involving patients in research', The Time is Now, University of Technology Sydney.
Mulhern, B, Norman, R, De Abreu Lourenco, R & Viney, R 2017, 'Investigating the relative value of health and social care related quality of life using discrete choice', International Society for Pharmacoeconomics and Outcomes Research 22nd Annual International Meeting, Boston, USA.
Viney, RC, Mulhern, B, Norman, R & De Abreu Lourenco, R 2017, 'Investigating the relative value of health and social care related quality of life using discrete choice experiments [Conference Presentation]', iHEA Boston World Congress, Boston, USA.
White, K, De Abreu Lourenco, R, Kenny, P, Lehane, L & D'Abrew, N 2017, 'Dollars and Sense: Exploring the Financial Impact of Cancer for Australian Patients and their Families', MAS-C/ISOO Annual Meeting on Supportive Care in Cancer, Washington, USA.
De Abreu Lourenco, R 2016, 'Incorporating Patient Values (Session Chair)', Room with a Patient View – Engaging patients in health care decision making, Sydney.
De Abreu Lourenco, R 2016, 'Using health economics in radiotherapy research (Invited during plenary session)', TROG Annual Scientific Meeting.
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.
Mulhern, BJ, De Abreu Lourenco, R & Viney, R 2016, 'Investigating the relative value of health and social care related quality of life using discrete choice', 38th Annual Australian Health Economics Society Conference, Perth.
Tillemans, R, De Abreu Lourenco, R, Fardell, JE, Wakefield, CE, Signorelli, C, McLoone, J & Cohn, RJ 2016, 'What influences quality of life in paediatric cancer survivors?', ISOQOL 23rd Annual Conference, Copenhagen, Denmark.
De Abreu Lourenco, R 2015, 'Drug reimbursement – a little bit of this…and a whole lot of that…', Hepatitis C Consumer Advocacy Workshop.
De Abreu Lourenco, R 2015, 'Drug Reimbursement in Australia: Through the looking Glass', HCA Consumer Workshop, Webinar hosted by ZEST.
De Abreu Lourenco, R 2015, 'Valuing meta-health effects: how we ask matters', 2nd International Academy of Health Preference Research meeting, Brisbane.
De Abreu Lourenco, R & Parish, K 2015, 'One of the team: research with, not just about, consumers', Sydney Catalyst, 2015 PostGraduate and Early Career Research Symposium.
De Abreu Lourenco, R, Parish, K & Butow, P 2015, 'Effective Consumer Engagement (Panel Session)', Sydney Catalyst, 2015 PostGraduate and Early Career Research Symposium.
Bonney, M, Rose, J, De Abreu Lourenco, R, Taylor, C & Frenzel, C 2013, 'A preference study investigating choices for different forms of an inhaled antibiotic in patients with cystic fibrosis or their carergivers', 10th Australasian Cystic Fibrosis Conference, Auckland, New Zealand.
De Abreu Lourenco, R 2013, 'Paying primary care providers [invited speaker]', National Primary Health Care Conference 2013.
De Abreu Lourenco, R, Kenny, PM & Hall, JP 2013, 'Factors linked to patient GP payments: results of a survey of Australian patients', 8th Health Services and Policy Research Conference, Wellington, New Zealand.
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.
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.
De Abreu Lourenco, R, Haywood, P, Parkinson, B, van Gool, K & Viney, R CHERE 2015, The economic implications of a genomically guided approach to cancer: A report by the Centre for Health Economics Research and Evaluation for the Cancer Council, Sydney.
This report examines how genomically based approaches may also alter the way that new technologies are funded and adopted in the health care system. In particular, how they challenge the routine pathways by which technologies are diffused into routine practice. The report also focuses on how genomically guided technologies challenge current coverage decisions. It examines the economic evidence-base for assessing the cost and benefits of such technologies. In doing so, the report highlights the current limitations in this field of research as identified through a systematic review of recommendations made by Australian policy-makers, as well as through a review of the literature. This analysis is then used to develop a framework for economic evaluations with special reference to genomically based technologies. Finally, the report also identifies a number of key policy challenges for the efficient diffusion of genomically guided cancer care into the Australian health care system.
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.