Australian Dollars Research Articles

Ear, nose, and throat surgical access for remote living Indigenous children: What is the least costly model?

This costing evaluation compares three service delivery models for ear, nose, and throat (ENT) surgery for remote living Indigenous children to improve their hearing outcomes, with the aim to identify the least costly model. The main outcome measure presented was the incremental cost difference between the base case (Model 1) and two alternative models (Model 2, 3). The costs in 2017 Australian dollars are assessed from two viewpoints: (1) health system perspective, and (2) patients and their families including travel out-of-pocket expenses, presented separately according to the funding source. Findings indicate that the least costly model offered low-risk ENT surgery from a state funded hospital in a remote setting, with high use of videoconference technology: TeleHealth (Model 3) could save $3626 to $5067 per patient, compared with patients travelling to a regional centre public hospital (Model 1). A federally funded scheme which allowed groups of patients to access a direct flight charter transfer to the private hospital in regional centre (Model 2) reduced the cost by $2178 to $2711 per patient when compared with standard care (Model 1). From a societal perspective, Model 1 required out-of-pocket patient expenses, with greater time away from home, and hence appears the least preferred option. The sensitivity analyses also demonstrate that Model 3 would be the more economical model for providing ENT surgery for remote living children. By proving an accurate assessment of the true costs of delivering these important ear and hearing health services, strategic health service planners may be better informed and sufficient budgets can be allocated to provide improved service delivery. The benefits of Model 3, over Models 1 or 2, would also incorporate improvements to patient safety as a result of reducing patient travel, which should in-turn, reduce failure-to-attend rates.

The cost-effectiveness of a 20% price discount on fruit, vegetables, diet drinks and water, trialled in remote Australia to improve Indigenous health.

This paper estimates the cost-effectiveness of a 20% price discount on healthy food and beverages with and without consumer nutrition education, as trialled in remote Northern Australia. Changes in actual store sales, from the pre-discount baseline period, were analysed for population impact on consumption of fruit and vegetables, water and artificially sweetened soft drinks, in addition with total dietary weight (grams), energy (Mega Joules), and sodium (milligrams). Disability Adjusted Life Years (DALYs), arising from changes in dietary risk factor prevalence in the population, were estimated as the primary health outcome in a multi health-state Markov model. The costs of the strategies were sourced from paid invoices and time estimates of staff providing store-based discount promotion and consumer education. The incremental cost-effectiveness ratio adopted a partial societal perspective, (including health and retail sector costs), as cost per DALY averted and was presented in 2011 Australian dollars. The price discount, helped address a gap in food price equity for residents of remote communities. However, the discount strategy, with or without consumer education led to a net loss of population health –36 95%CI (-47,-25) or -21(-28, -15) DALYs respectively, at increased cost to the retail and health sectors, of AUD860000 95%CI (710000, 1million) or AUD500000 (410000, 590000). The strategies trialled were thereby categorised as dominated by current practice while acknowledging considerable uncertainty surrounding the health outcome estimates. The 20% discount on limited targeted products appeared to need to be considered in conjunction with other marketing strategies to support healthy food choices, if remote Australian Indigenous population health is to be improved.

Calculating the economic burden of fatal drowning in Australia

BackgroundAquatic activities provide physical and social benefits, while the risk of drowning generates countervailing social costs. Drawing on estimates of fatal drowning gathered by Royal Life Saving Society – Australia, this paper outlines a method for estimating the economic burden attributable to fatal drowning. MethodsThis study estimated the burden of fatal drowning by combining Value of a Statistical Life Year (VSLY), hospitalization, productivity and emergency services costs. All unintentional fatal drowning cases in Australia between 1-July-2002 and 30-June-2017 were included. Foregone life years from each drowning were estimated based on Australian life expectancies for the year of death. The societal value of these Years of Life Lost was calculated using the VSLY for Australia, adjusted to reflect income elasticity. Corrections to discounting of VSLY were applied. Estimates of productivity losses not captured in VSLY were produced using net national capital growth. Time spent in hospital was found using coronial data and existing estimates of search, ambulance and coronial costs were adapted and incorporated. ResultsThe study covers 4285 cases of unintentional fatal drowning over 15 years. Based on this sample and estimates for the VSLY ($203,000), the economic burden of fatal drowning for Australia over this 14 year period was $18.63 billion in 2017 Australian dollars, averaging $1.24 billion annually. ConclusionsFatal drowning represents a significant source of health burden in Australia, underlining the need for further preventative measures. Practical applicationsWe provide an easily-understood estimate of the scale of Australia's fatal drowning problem, permitting comparison with other social problems. They can also be used in determining net benefits of proposed drowning prevention policies and to identify situations where burden of fatal drowning is disproportionate. Suggestions for improving the calculation of societal burden of illness can be incorporated in cost-benefit analyses in related fields of study.

Cost-Effectiveness of Renal Denervation Therapy for Treatment-Resistant Hypertension: A Best Case Scenario.

Renal denervation (RDN) is effective at reducing blood pressure (BP) among patients with treatment-resistant hypertension (TRH). However, recent findings regarding the effectiveness of RDN for BP reduction compared with standard treatment of care (SoC) has initiated a rigorous debate about its role in TRH management. In this study, we sought to determine the thresholds for cardiovascular risk and costs of RDN which would make RDN cost-effective. A Markov model was constructed to simulate cardiovascular events over a lifetime among TRH subjects aged 60 years at baseline, and without prior cardiovascular disease. The effect on lowering BP was based on results observed in clinical trials of RDN undertaken to date, and the expected subsequent change to cardiovascular risk was drawn from a published meta-regression. Cost and utility data were drawn from published sources. Incremental cost-effectiveness ratios (ICER) in terms of Australian dollars (AUD) per life year and per quality-adjusted life year (QALY) gained were estimated to assess RDN cost-effectiveness relative to SoC from the Australian health care perspective, assuming a willingness-to-pay threshold of AUD 50,000. Over a lifetime horizon, the model predicted that at the current estimated costs of RDN (AUD 9531/€6573, 1€ = 1.45 AUD), it would be cost-effective only if it was targeted to patients whose 10-year predicted cardiovascular risk was at least 13.2% initially. The ICERs (discounted) were AUD 49,519 per life year gained and AUD 47,130 per QALY gained. At current costs and based on currently observed effects on BP reduction, RDN would be cost-effective among patients with TRH.

Where are falls prevention resources allocated by hospitals and what do they cost? A cross sectional survey using semi-structured interviews of key informants at six Australian health services

BackgroundFalls are a major problem for patients and hospitals, resulting in death, disability and increased costs of healthcare. ObjectivesThis study aimed to estimate the resource allocation across a partnership of large health services, in an attempt to understand the amount and variability of resource allocation to various falls prevention activities. DesignA cross sectional survey using semi-structured interviews. SettingSix tertiary health services in Australia. ParticipantsA collaboration of six health services, spanning twenty-eight hospitals, was formed to investigate falls prevention resource allocation. We interviewed 186 health service staff who were involved in falls prevention activities, such as projects, audits and risk management, clinical and operational managers responsible for falls prevention resource allocation and clinical staff on targeted acute, subacute and mental health wards. MethodsThis study used a mixed methods, cross sectional, observational design. To collect data, we used key informant interviews with a purposive and snowball sampled group of people working in the included health services. During interviews, study participants were asked where and how falls prevention resources and equipment were utilised and to estimate the time allocated to performing falls prevention activities. The opportunity cost of each activity was estimated. All costs were reported in Australian dollars. ResultsWe estimate the annual opportunity cost of health service attempts to prevent in-hospital falls across the six health services to be AU$46,478,014. If we extrapolate this to a national level, health services would be consuming AU$590 million per year in resources trying to prevent falls in hospital. The areas of greatest resource consumption were physiotherapy (18%), continuous patient observers (14%), falls assessments (12%) and screens (8%), and falls prevention alarms (11%). Falls prevention alarms and falls risk assessment screening tools were also used only for falls prevention, and are potentially ineffective falls prevention strategies. ConclusionsHealth services are investing considerable amounts of resource in attempting to prevent falls. However much of this resource is consumed in activities with weak or little evidence of effectiveness. Health services may be better served by considering tighter targeting, reduction or disinvestment in this area. This may release time and resources which could be used to provide interventions with a stronger evidence base, such as patient education using a structured patient education program or in other areas of practice where evidence of benefit exist.

Diagnostic yield of targeted massively parallel sequencing in children with epileptic encephalopathy

PurposeTo report our institutional experience of targeted massively parallel sequencing (MPS) testing in children with epilepsy. MethodWe retrospectively analysed the yield of targeted epileptic encephalopathy (EE) panel of 71 known EE genes in patients with epilepsy of unknown cause, who underwent clinical triage by a group of neurologists prior to the testing. We compared cost of the EE panel approach compared to traditional evaluation in patients with identified pathogenic variants. ResultsThe yield of pathogenic variants was 28.5% (n = 30/105), highest in early onset EE <3 months including Ohtahara syndrome (52%, n = 10/19) and lowest in generalized epilepsy (0/17). Patients identified with pathogenic variants had earlier onset of seizures (median 3.6 m vs 1.1y, p < 0.001, OR 0.6/year, P < 0.02) compared to those without pathogenic variants. Pathogenic/likely pathogenic variants were found in ALDH7A1 (2), CACNA1A (1), CDKL5 (3), FOXG1 (2), GABRB3 (1), GRIN2A (1), KCNQ2 (4), KCNQ3 (1), PRRT2 (1), SCN1A (6), SCN2A (2), SCN8A (2), SYNGAP1 (1), UBE3A (2) and WWOX (1) genes. This study expands the inheritance pattern caused by KCNQ3 mutations to include an autosomal recessive severe phenotype with neonatal seizures and severe developmental delay. The average cost of etiological evaluation was less with early use of EE panel compared to the traditional investigation approach ($5990 Australian dollars (AUD) vs $13069 AUD ; p = 0.02) among the patients with identified pathogenic variants. ConclusionTargeted MPS testing is a comprehensive and economical investigation that enables early genetic diagnosis in children with EE. Careful clinical triage and selection of patients with young onset EE may maximize the yield of EE panel testing.

The long-term economic impacts of arthritis through lost productive life years: results from an Australian microsimulation model

BackgroundWhile the direct (medical) costs of arthritis are regularly reported in cost of illness studies, the 'true' cost to indivdiuals and goverment requires the calculation of the indirect costs as well including lost productivity due to ill-health.MethodsRespondents aged 45-64 in the ABS Survey of Disability, Ageing and Carers 2003, 2009 formed the base population. We projected the indirect costs of arthritis using Health&WealthMOD2030 – Australia’s first microsimulation model on the long-term impacts of ill-health in older workers – which incorporated outputs from established microsimulation models (STINMOD and APPSIM), population and labour force projections from Treasury, and chronic conditions trends for Australia. All costs of arthritis were expressed in real 2013 Australian dollars, adjusted for inflation over time.ResultsWe estimated there are 54,000 people aged 45-64 with lost PLYs due to arthritis in 2015, increasing to 61,000 in 2030 (13% increase). In 2015, people with lost PLYs are estimated to receive AU$706.12 less in total income and AU$311.67 more in welfare payments per week than full-time workers without arthritis, and pay no income tax on average. National costs include an estimated loss of AU$1.5 billion in annual income in 2015, increasing to AU$2.4 billion in 2030 (59% increase). Lost annual taxation revenue was projected to increase from AU$0.4 billion in 2015 to $0.5 billion in 2030 (56% increase). We projected a loss in GDP of AU$6.2 billion in 2015, increasing to AU$8.2 billion in 2030.ConclusionsSignificant costs of arthritis through lost PLYs are incurred by individuals and government. The effectiveness of arthritis interventions should be judged not only on healthcare use but quality of life and economic wellbeing.

Uptake of and Expenditure on Direct-Acting Antiviral Agents for Hepatitis C Treatment in Australia.

Direct-acting antiviralagents (DAAs) have revolutionised treatment for thehepatitis C virus (HCV). Currently, treatment costs between 20,000 and 80,000 Australian dollars ($A) per patient. The Australian Federal Government provided $A1 billion over 5years to subsidise these drugs. The aim of this paper was to evaluate the uptake and financial impact of DAA prescribing in Australia. We undertook a retrospective analysis of Medicare prescription and expenditure data for March 2016 to August 2017. Prescription numbers and expenditure datawere extracted from the Medicare Statistical Reports website. Numbers of prescriptions were converted to per capita rates. HCV prevalence measures were used to provide context to prescription rates. All costs were reported in $A, year 2017 values. Nationally, 211,184 DAA prescriptions were reimbursed. Whilst $A3.6 billion was expended through the Pharmaceutical Benefits Scheme, confidential pricing agreements precluded calculation of the precise cost. In 18months,estimatedexpenditure greatly exceeded the $A1 billion in funding for 5years. Nationally, the rate of prescriptions was 872/100,000 individuals. Prescription rates were highest in the Australian Capital Territory (1087/100,000) and lowest in Western Australia (625/100,000) despite HCV prevalence being comparable to the national rate in both regions. Uptake of DAAs has been enthusiastic in the first 18months of this funding agreement. However, the lack of transparency due to the confidential special pricing agreements means actual government expenditure is unknown. Post-marketing review by the Pharmaceutical Benefits Advisory Committee may enable renegotiation of DAA prices with the sponsors.

Measuring the financial and productivity burden of paediatric hospitalisation on the wider family network

AimTo estimate the non‐medical out‐of‐pocket costs for families with a child in hospital.MethodsThis study was a survey of 225 parents of paediatric inpatients on nine wards of an Australian public paediatric teaching hospital on two separate days. Our primary outcomes were the costs associated with: (i) time taken off work to care for the child in hospital; (ii) time off work or contributed by family and friends to care for other dependents; and (iii) travel, meals, accommodation and incidental expenses during the child's stay. Demographic data included postcode (to assess distance, socio‐economic status and remoteness), child's age, ward and whether this was their child's first admission.ResultsMean patient age was 6.5 years (standard deviation 5.2). On an average per patient day basis, parents took 1.12 days off work and spent 0.61 (standard deviation 0.53) nights away from home, with 83.8% of nights away at the child's bedside. Parents spent Australian dollars (AUD)89 per day on travel and AUD36 on meals and accommodation. Total costs (including productivity costs) were AUD589 per patient day. Higher costs per patient day were correlated with living in a more remote area (0.48) and a greater travel distance to the hospital (0.41). A higher number of days off work was correlated (0.69) with number of school days missed.ConclusionThese results demonstrate the considerable time and financial resources expended by families caring for a child in hospital and are important inputs in evaluating health‐care interventions that affect risk of hospitalisation and length of stay in paediatric care.

The Costs of Confronting Osteoporosis: Cost Study of an Australian Fracture Liaison Service.

ABSTRACTFracture liaison services (FLS) are an accepted approach to lowering rates of osteoporotic refractures. However, resource allocations to FLS are open to challenge, as most relevant cost analyses are based on anticipated, rather than observed, benefits. To support informed decision making, we have estimated the cost of operating an FLS, from the perspective of the Australian health system, with real life costs. On the basis of hospital records, we compared total costs of two cohorts of patients presenting with minimal trauma fractures (MTFs) at two hospital emergency departments (EDs) across a 6‐month period (July to December 2010). The treatment cohort (FLS Cohort, n = 515) attended an ED at a hospital offering FLS post‐fracture care; the Usual Care Cohort (n = 416) attended an ED at a hospital without an FLS. Hospital records were reviewed for further attendance of both groups at their respective hospitals’ EDs with refractures for the subsequent 3 years. Costs were constructed from “bottom up” with a “microcosting” approach. Total costs for both cohorts included any FLS and the costs of refractures. Cohort costs were estimated for every 1000 patients over the 3 observed years. Compared with the Usual Care Cohort, the FLS Cohort had 62 fewer fractures per 1000 patients and $617,275 lower costs over 3 years. In a sensitivity analysis, where 20% of the Usual Care Cohort received FLS preventative treatment, FLS Cohort costs were lower by $880,154. As both hospitals consistently process around 2000 patients per year, the estimated annual saving is $1.2 million to $1.8 million (Australian dollars). From the perspective of the Australian public health system, investment in FLS can be a financially effective way of reducing the cost of osteoporotic fracture management. © 2018 The Authors JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.

Heatwave and elderly mortality: An evaluation of death burden and health costs considering short-term mortality displacement

BackgroundA heatwave can be a devastating natural disaster to human health, and elderly people are particularly vulnerable. With the continuing rise in earth's surface temperature alongside the world's aging population, research on the mortality burden of heatwave for the older population remains relatively sparse. The potential magnitude of benefits of averting such deaths may be considerable. ObjectivesThis paper examined the short-term mortality displacement (or “harvesting”) of heatwave, characterized the heatwave-mortality relationship, and estimated death burden and health costs attributable to heatwave among the elderly in Australia. MethodsWe collected daily data on the temperature and deaths of people aged ≥75 years in the five largest cities of Australia (Sydney, Melbourne, Brisbane, Perth and Adelaide), totaling 368,767 deaths in different periods between 1988 and 2011. A total of 15-tiered heatwave definitions, based on intensity (95th to 99th percentiles of temperature distribution) and duration (two or more consecutive days), were used to quantify heatwave effects, using time-series regression and random-effects meta-analysis. We calculated attributable deaths for each city and by different types of heatwave. Potential economic benefits in monetary terms were also estimated, considering that heat-related deaths are avoidable. ResultsAmong the Australian elderly population, we found significant associations between heatwave and deaths, with raised mortality immediately in the first few days followed by lower-than-expected mortality. In general, heatwave was associated with an average death increase of 28% (95% confidence interval: 15% to 42%), and greater increases were mostly observed for more intense heatwaves across multiple megacities. During the study period, there were dozens to hundreds of deaths attributable to heatwave for each city, equating to an economic loss of several million Australian dollars every year. Although the estimated attributable deaths varied by heatwave intensity and duration, the pattern was not consistent across cities. ConclusionsHeatwave caused harvesting effects on mortality in the elderly population of Australia, and contributed to a substantial amount of death burden and indirect financial costs. To lessen the health impacts of heatwave in the affected regions, effective heatwave early warning systems and interventions targeted at the elderly population could be beneficial, both now and in the future.

Using Discrete-Choice Experiment Methods to Estimate the Value of Informal Care: The Case of Children with Intellectual Disability.

This research produces a preference-based monetary valuation of informal care provided to children with intellectual disability (ID) that can be directly applied in economic evaluations. A discrete-choice experiment (DCE) was designed to elicit an individual's willingness to accept compensation for different care tasks. Respondents were presented choice sets that included a care package comprising different amounts and types of care and asked to choose between the care package provided free of charge or providing that care themselves and receiving cash compensation. The care package included personal care, social support, household errands and housework, with the value of compensation, number of care hours provided and types of care varied across the choice sets. Choices were analysed using a generalised multinomial logit model and latent class model. A representative sample of 198 caregivers completed the survey (response rate 52%). Participants were recruited in Australia. Overall, caregivers would accept a minimum of Australian dollars ($A)20.61 to provide 1h of care. The preferences for assistance varied significantly with different types of care tasks. Individuals placed the highest value on receiving assistance with social support ($A35.96) and the least value on receiving assistance with household errands ($A-0.92) CONCLUSIONS: This study produces a value of informal care provided to children with ID that can be directly applied in economic evaluations. The study shows that informal care tasks are not valued equally. Caregivers placed the most value on receiving assistance with social support, which may reflect the time spent by caregivers on these tasks.

Healthcare costs and outcomes for patients undergoing tracheostomy in an Australian tertiary level referral hospital.

Patients undergoing tracheostomy represent a unique cohort, as often they have prolonged hospital stay, require multi-disciplinary, resource-intensive care, and may have poor outcomes. Currently, there is a lack of data around overall healthcare cost for these patients and their outcomes in terms of morbidity and mortality. The objective of the study was to estimate healthcare costs and outcomes associated in tracheostomy patients at a tertiary level hospital in South Australia. Retrospective review of prospectively collected data in patients who underwent tracheostomy between July 2009 and May 2015. Overall healthcare-associated costs, length of mechanical ventilation, length of intensive care unit stay, and mortality rates were assessed. A total of 454 patients with tracheostomies were examined. Majority of the tracheostomies (n = 386 (85%)) were performed in intensive care unit patients, predominantly using bedside percutaneous approach (85%). The median length of hospital stay was 44 (29-63) days and the in-hospital mortality rate was 20%. Overall total cost of managing a patient with tracheostomy was median $192,184 (inter-quartile range $122560-$295553); mean 225,200 (range $5942-$1046675) Australian dollars. There were no statistically significant differences in any of the measured outcomes, including costs, between patients who underwent percutaneous versus surgical tracheostomy and patients who underwent early versus late tracheostomy in their intensive care unit stay. Factors that predicted (adjusted R 2 = 0.53) the cost per patient were intensive care unit length of stay and hospital length of stay. Hospitalised patients undergoing tracheostomy experience high morbidity and mortality and typically experience highly resource-intensive and costly healthcare.

Cost-effectiveness of a Ceramide-Infused Skin Barrier Versus a Standard Barrier: Findings From a Long-Term Cost-effectiveness Analysis.

PURPOSE:To assess the cost-effectiveness of a ceramide-infused skin barrier (CIB) versus other skin barriers (standard of care) among patients who have undergone ostomy creation.DESIGN:Cost-effectiveness analysis, based on a decision-analytic model that was estimated using data from the ADVOCATE (A Study Determining Variances in Ostomy Skin Conditions And The Economic Impact) trial, which investigated stoma-related healthcare costs over 12 weeks among patients who recently underwent fecal ostomy, and from other sources.SUBJECTS AND SETTING:Analysis was based on a hypothetical cohort of 1000 patients who recently underwent fecal ostomy; over a 1-year period, 500 patients were assumed to use CIB and 500 were assumed to use standard of care.METHODS:We adapted a previous economic model to estimate expected 1-year costs and outcomes among persons with a new ostomy assumed to use CIB versus standard of care. Outcomes of interest included peristomal skin complications (PSCs) (up to 2 during the 1-year period of interest) and quality-adjusted life days (QALDs); QALDs vary from 1, indicating a day of perfect health to 0, indicating a day with the lowest possible health (deceased). Subjects were assigned QALDs on a daily basis, with the value of the QALD on any given day based on whether the patient was experiencing a PSC. Costs included those related to skin barriers, ostomy accessories, and care of PSCs. The incremental cost-effectiveness of CIB versus standard of care was estimated as the incremental cost per PSC averted and QALD gained, respectively; net monetary benefit of CIB was also estimated. All analyses were run using the perspective of an Australian payer.RESULTS:On a per-patient basis, use of CIB was expected over a 1-year period to result in 0.16 fewer PSCs, an additional 0.35 QALDs, and a savings of A$180 (Australian dollars, US $137) in healthcare costs all versus standard of care. Management with CIB provided a net monetary benefit (calculated as the product of maximum willingness to pay for 1 QALD times additional QALDs with CIB less the incremental cost of CIB) of A$228 (US $174). Probabilistic sensitivity analysis was also completed; it revealed that 97% of model runs resulted in fewer expected PSCs with CIB; 92% of these runs resulted in lower expected costs with CIB.CONCLUSIONS:Findings suggest that the CIB is a cost-effective skin barrier for persons living with an ostomy.

Public health social media communications and consumer neuroscience

Consumer neuroscience is an emerging discipline. Potential exists for neurological quantitative research techniques to be used for the development and analysis of public health messages due to limited numbers of successful campaigns. In some instances, highly successful public health marketing campaigns have been designed to address something greater than financial gain and have achieved exceptional reach. This results in increased public awareness using social amplification platforms. Examples of these include action-oriented social media campaigns that ask individuals to “act”, “share”, “pledge” or “challenge” on behalf of a health or social cause. Neurological and physiological techniques include functional magnetic resonance imaging, magnetoencephalography, electroencephalography, eye tracking, galvanic skin response, heart rate, facial recognition and implicit association testing. Due to nonconscious decision-making processes these techniques have the potential to identify driving forces behind individuals’ decision to become involved in health and social cause marketing campaigns that are unable to be identified with qualitative research methods. In 2014/2015 the Australian Government spent $23.3 million Australian dollars (AUD) on health and social service marketing campaigns, with $19.4 million AUD on health communications, and $3.9 million AUD on social services. These figures are considered conservative as expenditure on marketing campaigns below $250 thousand AUD is excluded. Thus, using consumer neuroscience to inform the design of future public health and social cause communications, which may help to save a life, while reducing expenditure on unsuccessful campaigns, requires greater understanding of the effectiveness of a positive action orientation vs. a fear and shock approach.

A National Budget Impact Analysis of a Specialised Surveillance Programme for Individuals at Very High Risk of Melanoma in Australia.

Specialised surveillance using total body photography and digital dermoscopy to monitor people at very high risk of developing a second or subsequent melanoma has been reported as cost effective. We aimed to estimate the 5-year healthcare budget impact of providing specialised surveillance for people at very high risk of subsequent melanoma from the perspective of the Australian healthcare system. A budget impact model was constructed to assess the costs of monitoring and potential savings compared with current routine care based on identification of patients at the time of a melanoma diagnosis. We used data from a published cost-effectiveness analysis of specialised surveillance, and Cancer Registry data, to estimate the patient population and healthcare costs for 2017-2021. When all eligible patients, estimated at 18% of patients with melanoma diagnosed annually in Australia, received specialised surveillance rather than routine care, the cumulative 5-year cost was estimated at $93.5million Australian dollars ($AU) ($US 64million) for specialised surveillance compared with $AU 120.7 million ($US 82.7million) for routine care, delivering savings of $AU 27.2million ($US 18.6million). With a staggered introduction of 60% of eligible patients accessing surveillance in year 1, increasing to 90% in years 4 and 5, the cumulative cost over 5years was estimated at $AU 98.1 million ($US 67.2 million), amounting to savings of $AU 22.6million ($US 15.5million) compared with routine care. Specialised melanoma surveillance is likely to provide substantial cost savings for the Australian healthcare system.

PD70 Cost-Effectiveness Of Deep Brain Stimulation For Epilepsy In Australia

Introduction:Deep brain stimulation (DBS), which uses an implantable device to modulate brain activity, is an adjunctive treatment for partial-onset seizures in patients with medically refractory epilepsy. Our objective was to perform an exploratory cost-utility analysis of DBS in conjunction with medical therapy, compared with medical therapy alone, using the latest clinical data and costs for the Australian healthcare system.Methods:A deterministic five-state Markov model was used to project treatment response and outcomes over the patients’ lifetimes, based on 5-year data from the recent Stimulation of the Anterior Nucleus of the Thalamus for Epilepsy (SANTE) DBS trial and drug outcome data identified through a literature search. Costs were based on 2017 data for the Australian healthcare system, and response-specific utilities were derived from published literature. We estimated the lifetime discounted incremental cost-effectiveness ratio (ICER) in Australian dollars per quality-adjusted life-year (QALY) for patients 36 years of age, fifty-five percent of whom were men. Costs and effects were discounted at five percent per annum. The robustness of projections was evaluated through scenario and sensitivity analyses.Results:Under assumed continued treatment benefit, DBS was projected to add 3.48 QALYs over the patients’ lifetimes, at an increased cost of AUD 142,304 (USD 105,960), resulting in an ICER of AUD 40,951 (USD 30,492) per QALY gained. Reducing the analysis horizon to 20 years increased the ICER to AUD 49,803 (USD 37,083). Increasing the DBS generator life from 3 to 6 years decreased the ICER to AUD 23,956 (USD 17,838) per QALY. Longer follow-up periods and younger age at treatment were associated with greater cost effectiveness. Results were sensitive to assumptions about health state-specific utility estimates and long-term treatment effects.Conclusions:Our exploratory findings suggest that DBS is a cost-effective treatment strategy in the Australian healthcare system for patients with medically refractory epilepsy. DBS therapy might meaningfully improve patient outcome at a health economic profile that compares favorably to other well accepted therapies. Consideration of indirect costs would further add to this value proposition.

Disease burden and productivity cost of chronic rhinosinusitis patients referred to a tertiary centre in Australia

Background: This study aims to examine the productivity cost of chronic rhinosinusitis (CRS) in Australia. Secondary objective is to describe the use of Sino-Nasal Outcome Test-22 (SNOT-22) and its associated domains. Methods: In a retrospective approach, data were collected on productivity loss and SNOT-22 among 309 patients referred for management of CRS at a tertiary rhinology clinic. Productivity cost was defined via the human capital approach and monetised from the average weekly income recorded by the Australian Bureau of Statistics, May 2016. Results: CRS-related productivity cost was determined to be 37.3 work days or Australian Dollars (AUD) $10,893.84 per patient per annum. Higher productivity cost significantly correlated to higher SNOT-22 scores (P value: 0.014) and younger working age (P value: 0.005). The mean SNOT-22 score was 42.0 with no specifically worse domains. Conclusions: The estimated productivity cost of CRS provides insights and incentives for its cost-effective management.

Carbon Value Analysis of Batang Gadis National Park, Mandailing Natal Regency, North Sumatera Province, Indonesia

Global warming is an important issue in the world which it gives a negative effect on human life. One indicator of global warming is increasing greenhouse gas i.e. carbondioxide from human activities. Deforestation and forest degradation are the second largest contributor of carbon into the atmosphere, after the use of fossil fuels by industry and transportation. As lungs of the world, forest is enable to produce renewable energy sources i.e. biomass. Forest carbon stock in above ground biomass (AGB) is the greatest effect source on deforestation and forest degradation. Therefore, it is necessary to perform a study the potential of carbon in forest. The purpose of this research is to determine carbon stock value in Batang Gadis National Park, Mandailing Natal Regency, North Sumatera Province, Indonesia. The carbon potential stored in this forest vegetation is calculated using AGB allometric equation by using data in diameter at breast height (dbh = 1.3 m), height, and density of the wood for trees. Data obtained from secondary data is Asset Assessment Report which State Controlled Forest Natural Resources Batang Gadis National Park, 2016. Study locations were Pagar Gunung and Sopo Tinjak Villages. Carbon stock values were calculated and analyzed with assumption that a half of biomass part is carbon stock which using Australian carbon price about AUD $ 11.82 Australia (Australian dollars) and EU € 5 (US $ 6). The results showed that the total biomass in Pagar Gunung and Sopo Tinjak Villages amounted to 259.83 tonnes and 160.89 tonnes. From the results of the total biomass, the total carbon stocks (C) and CO2 stocks in both villages are 210.36 tonnes (129.92 tonnes in Pagar Gunung Village and 80.45 tonnes in Sopo Tinjak Village) and 772.03 tonnes (476.79 tonnes in Pagar Gunung Village and 295.24 tonnes in Sopo Tinjak Village). By using the carbon price prevailing in the market place Australia Emission Trading System (ETS) and the EU ETS (AUD $ 11.82/t CO2e and € 5 (US $ 6)/t CO2e), the value of carbon stock that can be produced from Batang Gadis National Park (Pagar Gunung and Sopo Tinjak Villages) is about Rp. 92,499,921.72 (in AUD $) or Rp. 61,654,433.67 (in US $).

Economic modelling of telehealth substitution of face-to-face specialist outpatient consultations for Queensland correctional facilities.

Objective The provision of healthcare services to inmates in correctional facilities is costly and resource-intensive. This study aimed to estimate the costs of transporting prisoners from 11 Queensland correctional facilities to the Princess Alexandra Hospital Secure Unit (PAHSU) in Brisbane for non-urgent specialist outpatient consultations and identify the cost consequences that would result from the substitution of face-to-face visits with telehealth consultations. Methods A 12-month retrospective review of patient activity at the PAHSU was conducted to obtain the number of transfers per correctional facility. The total cost of transfers was calculated with estimates for transport vehicle costs and correctional staff escort wages, per diem and accommodation costs. A cost model was developed to estimate the potential cost savings from substituting face-to-face consultations with telehealth consultations. A sensitivity analysis on the cost variables was conducted. Costs are reported from a government funding perspective and presented in 2016 Australian dollars (A$). Results There were 3539 inmate appointments from July 2015 to June 2016 at the PAHSU, primarily for imaging, general practice, and orthopaedics. Telehealth may result in cost savings from negligible to A$969731, depending on the proportion, and travel distance, of face-to-face consultations substituted by telehealth. Wages of correctional staff were found to be the most sensitive variable. Conclusions Under the modelled conditions, telehealth may reduce the cost of providing specialist outpatient consultations to prisoners in Queensland correctional facilities. Telehealth may improve the timeliness of services to a traditionally underserved population. What is known about the topic? Specialist medical services are located in only a few metropolitan centres across Australia, which requires some populations to travel long distances to attend appointments. Some face-to-face specialist outpatient consultations can be substituted by telehealth. What does this paper add? Prisoners from correctional facilities represent one specific population that requires complex travel arrangements for specialist medical appointments. Transportation of prisoners for specialist health appointments represents a substantial cost to the government. This paper quantifies the annual cost in Queensland for transporting prisoners, taking into account fuel and vehicle costs, staff wages, per diem rates, and accommodation. In addition, it quantifies the costs of substituting face-to-face consultations with telehealth consultations. What are the implications for practitioners? This research encourages practitioners to consider using telehealth services for prisoners, as well providing an argument for tertiary centres to include telehealth as a model of care for this population. Telehealth can result in major cost savings and state and federal governments should consider implementation especially in Australia where correctional facilities and specialist services are separated by great geographic distances.