Australian Perspective Research Articles

Cost-effectiveness of abobotulinumtoxinA plus best supportive care compared with best supportive care alone for early treatment of adult lower limb spasticity following an acute event.

Spasticity is an incurable chronic condition, and patients with spasticity frequently experience symptoms such as muscle stiffness, restricted mobility, fatigue, spasms, and pain. The study objective was to assess the cost-effectiveness of abobotulinumtoxinA plus best supportive care compared with best supportive care alone for the early treatment of adult lower limb spasticity following an acute event (e.g. stroke or traumatic brain injury), from an Australian payer perspective. Using clinical data from published pivotal trials, an economic model based on a Markov model was developed to capture changes in treatment costs, healthcare resource use costs, functional outcomes, and health-related quality of life over a lifetime horizon. Scenario analyses and a probabilistic sensitivity analysis were conducted to explore the uncertainty in the model parameters and assumptions used in the base case. AbobotulinumtoxinA plus best supportive care was cost-effective versus best supportive care, yielding an incremental cost-effectiveness ratio of $35,721 per quality-adjusted life year gained. Sensitivity analyses confirm the robustness of the base case, with most results remaining below the commonly acceptable cost-effectiveness willingness-to-pay threshold of $75,000 per quality-adjusted life year for cost-effectiveness in Australia. Inputs and assumptions that produced the top four highest incremental cost-effectiveness ratios include the application of different health resource utilisation source, short time horizon, unweighted regression analyses to determine regression probabilities, and no stopping rule. AbobotulinumtoxinA plus best supportive care has a 74% probability of being cost-effective compared with best supportive care alone at the willingness to pay threshold. AbobotulinumtoxinA plus best supportive care treatment is cost-effective in Australia for the management of adult lower limb spasticity in patients treated within 2 years of an acute event.

Analysis of Fiscal Policy and Monetary Policy during Covid-19 Crisis---an Australian perspective

The outbreak of new coronavirus pneumonia in 2020 has emerged as a significant global epidemic, representing a profound disaster. All nations encounter a shift towards crisis management frameworks, exhibiting variable levels of success in limiting the spread of the virus and mitigating economic repercussions. This is by far the most far-reaching public health event of the 21st century on a global scale, with immeasurable research significance from immunological, economic, and sociological perspectives. For the continent of Australia, which is alone in the ocean, the Australian community could not carry the blow once the epidemic exploded across the country. So, as early as the 20th of March, Australia quickly declared a "border closure", banning all non-Australian citizens and non-permanent residents from entering the country. Moreover, with regard to the movement of persons, production activities and control of cases and close contacts in the region, each oblast has adopted restrictive measures of varying degrees, depending on the severity and development of the outbreak. The special geographical conditions and the policy of a completely closed borderline allow us to value the effectiveness of the Australian government's and banks' response to the stimulus provided by the COVID-19 policy directly by removing most of the external conditions from the equation.

Should there be an app for that? Australian perspectives on the utility of a mobile app to support people in the criminal justice system

Mobile technology presents opportunities within the justice system to support and promote behaviour change and the past decade has seen increased development and use of mobile applications for this purpose. This article aims to contribute to this burgeoning area by presenting the findings of research which scoped the utility of a mobile application (app) intended to support Indigenous people on bail or parole in the Australian Capital Territory. The project sought the views of 12 people with lived experience of the criminal justice system, as well as 23 professional stakeholders who engage with the justice system, to determine the utility of such an app.

Coastal mortality burden on school holidays 2004–2021: an Australian perspective

IntroductionSchool holidays are a known period of increased risk of paediatric drowning. However, the risk of coastal death for all age groups is unknown.MethodsThis case–control study aimed to identify high-risk...

“We became our own media!” : Australian perspectives on the beneficial potentialities of new media for environmental activism

This article discusses activist perceptions of the beneficial potentialities of new media for environmental campaigning as investigated in Australia, due to its high level of environmental activism and Internet usage. Drawing upon literature on communication theory, environmental politics, digital activism, and social movement theory, this study explores new media use for activism in two large Australia-wide environmental campaigns: contestation of old-growth forest logging and unconventional gas mining (fracking) development. From March to May 2017, 34 environmental activists involved in these campaigns were interviewed for this study. They shared their opinions on what it meant for them to use new media, the difficulties they encountered, but also the beneficial potentialities they identified in using these media for their activism. The study findings show that new media built significantly on more ‘traditional’ forms of activism, including stalls and non-violent street demonstrations, but also enabled extended activist outreach, enhanced engagement with supporters, and boosted campaign mobilisation. As such, despite an array of quite challenging limitations they also referred to, and to which they responded strategically, Australian environmental activists found new media highly beneficial to their activism.

Australian perspectives on global air and space power: past, present, future

Australian perspectives on global air and space power: past, present, future

The cost-effectiveness of germline BRCA testing-guided olaparib treatment in metastatic castration resistant prostate cancer.

Olaparib targets the DNA repair pathways and has revolutionized the management of metastatic castration resistant prostate cancer (mCRPC). Treatment with the drug should be guided by genetic testing; however, published economic evaluations did not consider olaparib and genetic testing as codependent technologies. This study aims to assess the cost-effectiveness of BRCA germline testing to inform olaparib treatment in mCRPC. We conducted a cost-utility analysis of germline BRCA testing-guided olaparib treatment compared to standard care without testing from an Australian health payer perspective. The analysis applied a decision tree to indicate the germline testing or no testing strategy. A Markov multi-state transition approach was used for patients within each strategy. The model had a time horizon of 5years. Costs and outcomes were discounted at an annual rate of 5 percent. Decision uncertainty was characterized using probabilistic and scenario analyses. Compared to standard care, BRCA testing-guided olaparib treatment was associated with an incremental cost of AU$7,841 and a gain of 0.06 quality-adjusted life-years (QALYs). The incremental cost-effectiveness ratio (ICER) was AU$143,613 per QALY. The probability of BRCA testing-guided treatment being cost effective at a willingness-to-pay threshold of AU$100,000 per QALY was around 2 percent; however, the likelihood for cost-effectiveness increased to 66 percent if the price of olaparib was reduced by 30 percent. This is the first study to evaluate germline genetic testing and olaparib treatment as codependent technologies in mCRPC. Genetic testing-guided olaparib treatment may be cost-effective with significant discounts on olaparib pricing.

Visitation, communication, and participation: an ethical and respectful strategy for engaging Australian South Sea Islander communities when sharing their lived experiences.

This study examines the experiences of three Australian South Sea Islanders from the same community who are part of a larger research team scheduled to engage in an archaeological research project in Mackay, Queensland, in 2021. The aim of the project was to highlight Australian South Sea Islander knowledge, voices, and lived experiences. However, owing to COVID-19 and persistent lockdowns in Queensland and New South Wales, the project faced significant delays. The timeline was adjusted, with plans to reintroduce the project to the community after an 18-month hiatus, aiming to rekindle interest and encourage participation. This study focuses on designing a community engagement strategy that builds on established protocols for researchers working with Australian South Sea Islander communities. The strategy includes three key steps: visitation, communication, and participation. By integrating the Tok Stori methodology-an Indigenous research approach from the Solomon Islands and Vanuatu-the strategy supports the decolonisation of the collaborative research process, enabling the sharing of Australian South Sea Islander lived experiences in a culturally safe manner. The authors provide contextualised reflections, offering insights from an Australian South Sea Islander perspective.

Ageing Well in Place: An Australian and New Zealand Perspective

Ageing Well in Place: An Australian and New Zealand Perspective

Church as Community: Australian Perspectives of Expressing Faith and Experiencing Hope

Church as Community: Australian Perspectives of Expressing Faith and Experiencing Hope

Australian Spine Surgeon's Perspectives on Endoscopic Spine Surgery: An In-depth Analysis.

Endoscopic spine surgery (ESS) is a minimally invasive approach with reduced tissue trauma, shorter hospital stays, and faster recovery times. It employs advanced endoscopic instruments and imaging technologies to address a wide range of spinal pathologies with minimal disruption to surrounding tissues. As ESS continues to evolve, this article aims to gather insights into the opinions and perspectives of the key stakeholders involved, and highlight strategies to improve implementation. A cross-sectional survey was distributed to collect data on Australian spine surgeons' perspectives of ESS. The survey questionnaire was distributed electronically to a diverse group of spine surgeons who are members of the Spine Society of Australia. Of responders, 46.8% were already integrating ESS into practice, or had the sufficient training to commence ESS. A further 29.8% were contemplating introduction of ESS techniques, while just under one quarter of respondents (23.4%) were not interested in implementing minimally invasive techniques. Primary motivators for implementation included skill development and improved patient outcomes. Primary barriers included lack of training opportunities, length of time to develop competency and lack of current supporting evidence. The study contributes to the existing body of knowledge on ESS by providing a comprehensive analysis of surgeon opinions and experiences. The results highlight the growing interest in endoscopic techniques, while recognizing the challenges that need to be addressed to make this more widely utilised and available. The findings can guide future research, training programs, clinical practice and ultimately improve health and financial outcomes to patients and the wider health system.

An Australian Perspective on Occitan and Breton Ethnoregionalism in the Post-war Period to 1981

In France, the student occupations and strikes of May ’68 are well known, but the period was also of immense significance to the country’s ethnoregionalist movements, who sought to increase power and self-determination. From a period of rebuilding following the Second World War, the Breton and Occitan movements, which campaigned against the perceived oppression of their regions by the central French state, were able to find new audiences and grow significantly in the 1960s and 1970s. Through an analysis of primary and secondary sources, this article charts the history of the movements throughout the era, demonstrating how the growth of the movements was linked to the broader societal politicisation of the era. As the period of radicalism waned, so did the Breton and Occitan movements, which saw many of their key demands implemented following the election of François Mitterrand as President, depriving the movements of their key reasons for existence. Nevertheless, the movements left a significant legacy in this period, through both the acceptance of regionalist political demands by the national left, and the ideological refoundation of Breton and Occitan ethnoregionalism. The author reflects on how these movements have some parallels in Australian history.

Gene-based COVID-19 vaccines: Australian perspectives in a corporate and global context

Pandemic management requires societal coordination, global orchestration, respect for human rights and defence of ethical principles. Yet some approaches to the COVID-19 pandemic, driven by socioeconomic, corporate, and political interests, have undermined key pillars of ethical medical science. We explore significant mistakes that may have occurred in recent pandemic control, in order to better navigate the future. Within corporate and geopolitical infrastructure, we review the COVID-19 pandemic and novel mRNA and viral-vector DNA COVID-19 vaccines, deployed by wealthy western countries. The pandemic, together with rollouts of unconventional, gene-based vaccine technology, has provided experimental opportunity to engineer social control of entire populations. The haste and scale of development, production, and distribution of these new pharmaceuticals is unprecedented in history. Key phase III clinical trials for these products are yet to be fully completed, despite administration to billions of people. Mass vaccination of workforces has been mandated, and vaccine mandates correlate with excess mortality. Many independent data sets concur - we have experienced a pandemic of viral illness, followed by a pandemic of vaccine injury. For Australia, matters have operated the other way around. Vaccination followed later by the main viral wave. Australian excess mortality data correlates with this. Neither risk nor cost can justify these products for the vast majority of people. Lack of efficacy against infection and transmission, and the equivalent benefits of natural immunity, obviate mandatory therapeutics. With the many gene-based pharmaceuticals planned, a new era of pathology lies ahead. We should pause, reflect, and reaffirm essential freedoms, welcome the end of the COVID-19 pandemic, embrace natural immunity, and lift all mandated medical therapy.

Early-career school psychologists’ risk assessment self-efficacy: An Australian perspective

Assessment and management of youth suicide risk is a key role for school psychologists. However, prior research indicates that psychologists commonly lack confidence and feel unprepared when they graduated to conduct risk assessments. This qualitative study explored nine Victorian early-career school psychologists’ role in risk assessment, and their self-perceived preparedness, self-efficacy, postgraduate training experiences and methods used to assess risk. Results identified that the frequency of student suicidal ideation and acute mental health presentations exceeded participants’ expectations. Participants identified confidence in assessing risk, but less confidence in the follow-up actions. Participants reported employing comprehensive risk assessment practices and most received exposure to risk assessment during training. Key factors identified for building risk assessment preparedness and confidence were supervision, experience, professional development and research. As participants identified core risk assessment competencies that may require further coverage in curricula, these findings have important implications for universities to maximise graduates’ risk assessment preparedness.

Adoption of out-of-pocket cost caps: an Australian perspective.

Adoption of out-of-pocket cost caps: an Australian perspective.

OP14 Cost-Utility Analysis Of Regorafenib For Patients With Hepatocellular Carcinoma Who Progressed On Sorafenib Treatment

IntroductionIn the RESORCE trial, regorafenib was shown to provide overall survival (OS) benefit for patients with hepatocellular carcinoma (HCC) that has progressed on sorafenib treatment. Subsequently, it was approved by the Therapeutic Goods Administration for the treatment of patients with HCC who were previously treated with sorafenib; however, regorafenib is still not recommended by the Pharmaceutical Benefits Advisory Committee in Australia. We aimed to assess the cost effectiveness of regorafenib as a second-line therapy for patients with HCC who progressed on sorafenib from an Australian healthcare perspective.MethodsWe developed a Markov model to compare the cost effectiveness of regorafenib with best supportive care (BSC) as a second-line therapy for HCC after treatment with sorafenib. The health outcomes of life-years and quality-adjusted life-years (QALYs) were derived from the RESORCE trial. Survival benefits sourced from the RESORCE trial were fitted with the parametric model to estimate survival beyond the follow-up period. Drug costs and costs associated with adverse events (AEs) were sourced from published literature and the Independent Health and Aged Care Pricing Authority cost report. Model validity was verified using probabilistic sensitivity analyses.ResultsThe incremental monthly cost of treatment with regorafenib was AUD19,273 (USD13,374), with an incremental life-year gain of 0.38, compared with BSC. The incremental QALYs gained with regorafenib were 0.24, resulting in a base-case incremental cost-effectiveness ratio (ICER) of AUD80,511 (USD55,872) per QALY. In the probabilistic sensitivity analyses across scenarios, the ICER remained above the conventional threshold of AUD50,000 (USD34,698) per QALY, with a zero probability of being cost effective at this willingness-to-pay threshold.ConclusionsAt the current price, second-line treatment with regorafenib in patients with HCC that has progressed on sorafenib was not cost effective at the conventional willingness-to-pay threshold from an Australian health-system perspective.

Comparative Evaluation of Road Pricing Schemes: A Simulation Approach (Australian Perspective)

Road network pricing and congestion charging continue to be debated as efficient instruments to address traffic congestion and emissions. For cities where the schemes have not been implemented yet, the impacts of these schemes are typically evaluated using transport simulation models to understand the impacts and design effective solutions before the schemes are deployed. This paper considers a simulation approach for the city of Melbourne in Australia to investigate the potential impacts of road network pricing on reducing private vehicle travel, road congestion, and vehicle emissions. The study uses a dynamic traffic simulation model developed for Melbourne using the AIMSUN modeling tool, which was extended for modeling road user pricing and congestion charging, including considerations and formulations of distance-based, delay-based, joint-distance-and-delay-based, and cordon-based schemes under low-cost, medium-cost, and high-cost regimes. The study’s contributions also include an extension of the modeling framework to include public transport options to allow for providing travelers with the option of choosing an alternative mode of transport if they do not wish to pay. A mesoscopic stochastic route choice modeling approach was adopted to examine the impact of road pricing inside a nominated charging zone within the network. The results showed it would be possible to achieve a reduction of 11% in vehicle count, a 20% reduction in travel time, a 13% reduction in emissions, and a 3% increase in travel speed within the proposed pricing zone under a high-cost pricing scenario. The results also showed a significant reduction in emissions resulting from shifting drivers who are not willing to pay the congestion charge to public transport. When 20% of car drivers shifted to public transport, carbon emissions were reduced by up to 30% and network performance improved by 45%, compared to the baseline scenario without pricing. The findings of this research provide important directions for policymakers in deciding on the type and scope of charging schemes to use and how these could reshape transportation taxation systems by moving away from taxes on vehicles through registration fees and towards user-pay taxations where travelers pay for the amount of travel they do or the pollution and emissions they are responsible for.

Positioning large language model artificial intelligence tools within discourse analysis

Artificial Intelligence (AI) tools based on Large Language Models (LLMs) such as ChatGPT has generated significant interested within the higher education sector. The threats, challenges and opportunities for its use in teaching and learning continue to be discussed widely, however it’s use within research and especially research involving marginalised perspectives is far less discussed. This panel will share how ChatGPT was used to add value to the conversations between researchers applying critical discourse analysis exploring Indigenous Australian perspectives with international students. As part of their study the researchers compared the efficacy of ChaptGPT and NVIVIO and the impacts on iterative discourse discussions between the researchers. While the data in this research revealed some very encouraging results, it also highlighted significant areas that need to be explored even further especially around ethical use of AI and untangling in-built biases within the tools’ algorithms.

Applications of seaweed extracts in agriculture: An Australian perspective

AbstractSociety depends on food production. However, agricultural productivity is greatly challenged by extreme climate events and volatility. Seaweed extracts (SWE) have a key role in food production and their use is central to improving agricultural productivity by increasing crop tolerance to stress, improving the efficiency of plant nutrient use, and by contributing to sustainable farm practices. The benefits of SWE to crops have previously been reviewed in the context of the northern hemisphere, but not since 2015 in Australia – specific to its crops and unique stressors. This review is focused on the scientific progress since 2015 and insights from Australian research related to: (i) SWE-stimulated plant responses, (ii) field research on SWE, (iii) optimising the use of SWE in agriculture. The review considers the effects of SWE (made from Durvillaea potatorum and Ascophyllum nodosum) in the field, across crops, seasons, regions, and farming systems in Australia, and research conducted in the laboratory under controlled conditions on model and crop plants at the molecular, cellular, and physiological levels. The results from the review highlight the role of SWE in plant priming responses in laboratory experiments and its association with improved plant tolerance in the field. The review discusses the field effects related to production and fruit quality. The uniqueness of the Australian research is the inclusion of the same SWE in laboratory and field research, and the characterisation of plant responses under challenged and un-challenged conditions. This information provides deeper insights into the actions of SWE and enables growers and agronomists to optimize their field application in Australian agriculture.

Costs associated with invasive Scedosporium and Lomentospora prolificans infections: a case-control study.

Little is known about the short- and long-term healthcare costs of invasive Scedosporium/Lomentospora prolificans infections, particularly in patient groups without haematological malignancy. This study investigated excess index hospitalization costs and cumulative costs of these infections. The predictors of excess cost and length of stay (LOS) of index hospitalization were determined. These estimates serve as valuable inputs for cost-effectiveness models of novel antifungal agents. A retrospective case-control study was conducted at six Australian hospitals. Cases of proven/probable invasive Scedosporium/L. prolificans infections between 2011 and 2021 (n = 34) were matched with controls (n = 66) by predefined criteria. Cost data were retrieved from activity-based costing systems and analysis was performed from the Australian public hospital perspective. All costs were presented in 2022 Australian dollars (AUD). Median regression analysis was used to adjust excess costs of index hospitalization whereas cumulative costs up to 1.5 years follow-up were estimated using interval-partitioned survival probabilities. Invasive Scedosporium/L. prolificans infections were independently associated with an adjusted median excess cost of AUD36 422 (P = 0.003) and LOS of 16.27 days (P < 0.001) during index hospitalization. Inpatient stay was the major cost driver (42.7%), followed by pharmacy cost, of which antifungal agents comprised 23.8% of the total cost. Allogeneic haematopoietic stem cell transplant increased the excess cost (P = 0.013) and prolonged LOS (P < 0.001) whereas inpatient death within ≤28 days reduced both cost (P = 0.001) and LOS (P < 0.001). The median cumulative cost increased substantially to AUD203 292 over 1.5 years in cases with Scedosporium/L. prolificans infections. The economic burden associated with invasive Scedosporium/L. prolificans infections is substantial.