Treatment In Australia Research Articles

Valuing families' preferences for drug treatment: a discrete choice experiment.

The burden on family members of those who are dependent on illicit drugs is largely unidentified, despite the presence of significant negative financial, health and social impacts. This makes it difficult to provide appropriate services and support. This study aimed to assess the preferences for treatment attributes for heroin dependence among family members affected by the drug use of a relative and to obtain a measure of the intangible economic benefit. Discrete choice experiment. Data were analysed using mixed logit which accounted for repeated responses. Australia. Eligible participants were Australian residents aged 18+ years with a relative with problematic drug use. Complete data on 237 respondents were analysed; 21 invalid responses were deleted. Participant preference for likelihood of staying in treatment, family conflict, own health status, contact with police and monetary contribution to a charitable organization providing treatment. All attributes were significant, and the results suggest that there was a preference for longer time in treatment, less family discord, better own health status, less likelihood of their relative encountering police and, while they were willing to contribute to a charity for treatment to be available, they prefer to pay less, not more. In order of relative importance, participants were willing to pay an additional A$4.46 [95% confidence interval (CI)=3.33-5.60] for treatment which resulted in an additional 1% of heroin users staying in treatment for longer than 3months, A$42.00 (95% CI=28.30-55.69) to avoid 5days per week of family discord, A$87.94 (95% CI=64.41-111.48) for treatment options that led to an improvement in their own health status and A$129.66 (95% CI=53.50-205.87) for each 1% decline in the chance of police contact. Drug treatment in Australia appears to have intangible benefits for affected family members. Families are willing to pay for treatment which reduces family discord, improves their own health, increases time in treatment and reduces contact with police.

Association between ribociclib and changes in creatinine in patients with hormone receptor positive metastatic breast cancer.

Combination ribociclib and aromatase inhibitors are currently the preferred treatment in Australia for newly diagnosed hormone receptor positive metastatic breast cancer in the absence of visceral crisis. In our case series of 32 patients, 28% experienced grade 1 elevations in creatinine, a toxicity that was under-recognised in large phase III studies. Creatinine rise appears to be due to a reversible inhibition of renal efflux transporters rather than an acute kidney injury in the majority of cases.

Evolution of Silcrete Heat Treatment in Australia—a Regional Pattern on the South-East Coast and Its Evolution over the Last 25 ka

We document long-term evolution in the rate of heat treatment in Eastern Australia and explore them as a technological response to dynamic industrial and social contexts that developed in the last 25 millennia. We employed methods previously used in Africa but novel in Australia to infer long-term directional changes in the relative frequency of silcrete artefacts that were heat-treated. Our methods involved independent and cross-verifying tests of the presence or absence of heat treatment, employing visual classifications and surface roughness measures. These methods revealed a coherent series of increases over time in the landscapes around Sydney, so that Late Holocene assemblages displayed higher rates of heat treatment than terminal Pleistocene or Early Holocene ones. We hypothesise that the directional trend towards greater frequencies of heat-treated artefacts on Australia’s eastern seaboard is explicable in terms of the context of technological shifts towards microlith production superimposed onto an even longer term process of lithic resource depletion, perhaps compounded with the development of political barriers to the redistribution of knappable stone.

Efficacy of rTMS as an outpatient procedure for Major Depressive Disorder: a description of clinical outcomes in a real-world, decentralised, multi-clinic Australian TMS service

Background: Transcranial Magnetic Stimulation (TMS) is increasingly being used in clinical practice around the world and in Australia for the treatment of depression, Unusually, the majority of TMS programs in Australia operate on an inpatient model due to the lack of an outpatient funding mechanism. However, outpatient TMS is gradually utilised to a greater degree although to date no studies have explored the real world outcomes of rTMS treatment in Australia, especially across a multiple clinic environment where there is a need to maintain consistency of standards of practice.

Changes in Body Mass Index and Rates of Death and Transplant in Hemodialysis Patients: A Latent Class Joint Modeling Approach.

The relationship between body mass index (BMI) and patient survival in end-stage kidney disease is not well understood and has been the subject of much debate over recent years. This study used a latent class joint modeling approach to identify latent groups that underpinned associations between patterns of change in BMI during hemodialysis and two competing events: transplant and death without transplant. We included all adult patients who initiated chronic hemodialysis treatment in Australia or New Zealand between 2005 and 2014. There were 16,414 patients included in the analyses; 2,365 (14%) received a transplant, 5,639 (34%) died before transplant, and 8,410 (51%) were administratively censored. Our final model characterized patients based on five broad patterns of weight change (BMI trajectories): "late BMI decline" (about 2 years after commencing hemodialysis); "rapid BMI decline" (immediately after commencing hemodialysis); "stable and normal/overweight BMI"; "stable and morbidly obese BMI"; or "increasing BMI." Mortality rates were highest among classes with declining BMI, and the timing of weight loss coincided with the timing of increases in mortality. Within the two stable BMI classes, death rates were slightly lower among the morbidly obese. The findings from this descriptive analysis suggest a paradoxical association between obesity and better survival. However, they also suggest that the shape of the BMI trajectory is important, with stable BMI trajectories being beneficial. Future research should be aimed at understanding the causes of weight changes during dialysis, to determine whether there could be strategies to improve patient survival.

The future of gallstone treatment in Australia

The future of gallstone treatment in Australia

Reintervention and Survival After Limited Lung Resection for Lung Cancer Treatment in Australia

To investigate the risk and predictors of reintervention (surgery or radiotherapy) after limited resection for lung cancer. A population-based, all-inclusive study using linked data from the New South Wales Admitted Patient Data Collection and Death Register included all patients undergoing limited resection for lung cancer between July 1, 2002, and March 31, 2014. Univariate and adjusted competing risk analyses were used to estimate the effect of potential factors for risk of reintervention within 6 months and 24 months of the initial surgery. The overall 5-year survival for lung cancer patients undergoing limited lung resection was 52% (49% to 54%); for patients aged 70 years or more, the survival rate was 44% (40% to 47%). Reintervention occurred in 6.2% by 6 months and 11.3% by 24 months after the surgery. Younger age, surgery in private hospitals, and fewer comorbidities were independently associated with increased risk of reintervention. Patients who had the surgery performed in high surgical volume hospitals had 49% lower risk of reintervention within the first 6 months (95% confidence interval: 0.30 to 0.85). The effect of hospital surgical volume was attenuated by 24 months (hazard ratio 0.87, 95% confidence interval: 0.60 to 1.28). Patients undergoing reintervention within 6 months or 24 months had a twofold (1.52 to 2.57) and 2.3-fold (1.89 to 2.83) increased risk of death, respectively. The reintervention rate within 6 or 24 months of initial limited lung cancer resection was modest, but there was considerable variation among hospitals. Reintervention was not a benign event and wasassociated with lower survival in an Australian population.

Societal preferences for fertility treatment in Australia: a stated preference discrete choice experiment

Objective: To investigate preferences for fertility treatment from the Australian general population with the aims of calculating the willingness to pay in tax contribution for attributes (characteristics) that make up treatment and for an “ideal” fertility treatment program. We also assessed whether willingness-to-pay varies by the relationship status or sexual orientation of the patient.Methods: A stated preference discrete choice experiment was administered to a panel of 801 individuals representative of the Australian general population. Seven attributes of fertility treatment under three broad categories were included: outcome, process, and cost. Attributes were identified through published literature, focus group discussions, expert knowledge, and a pilot study. A Bayesian fractional experimental design was used, and data analysis was performed using a generalized multinomial logit model. Further analyses included interaction terms and latent class modeling.Results: Six of the seven attributes influenced the choice of a treatment program. Under process attributes, individuals preferred: continuity of care of clinic staff, where patients are seen by the same doctor but different nurses at each visit; “alternative” treatments being offered to all patients; and onsite clinic counseling and peer-support groups. Personalization and tailoring of the treatment journey were not important. Among outcome attributes, the improved success rate of having a baby per cycle and significant side-effects were considered important. Cost of treatment also influenced the choice of treatment program. Individual preferences for fertility treatment were not associated with patients’ relationship status or sexual orientation. Latent class modeling revealed sub-groups with distinct fertility treatment preferences.Conclusion: This study provides important insights into the attributes that influence the preferences of fertility treatment in Australia. It also estimates socially-inclusive willingness-to-pay values in tax contributions for an “ideal” package of treatment. The results can inform economic evaluations of fertility treatment programs.

Beyond interferon side effects: What residual barriers exist to DAA hepatitis C treatment for people who inject drugs?

Recent advances in the efficacy and tolerability of hepatitis C treatments and the introduction of a universal access scheme for the new Direct Acting Antiviral (DAA) therapies in March 2016, has resulted in a rapid increase in the uptake of hepatitis C treatment in Australia. Despite these positive developments, recent data suggest a plateauing of treatment numbers, indicating that more work may need to be done to identify and address ongoing barriers to hepatitis C treatment access and uptake. This paper aims to contribute to our understanding of the ongoing barriers to DAA therapies, with a focus on people who inject drugs. The paper draws on participant interview data from a qualitative research study based on a participatory research design that included a peer researcher with direct experience of both hepatitis C DAA treatment and injecting drug use at all stages of the research process. The study’s findings show that residual barriers to DAA treatment exist at personal, provider and system levels and include poor venous access, DAA treatments not considered ‘core-business’ by opioid substitution treatment (OST) providers, and patients having to manage multiple health and social priorities that interfere with keeping medical appointments such as childcare and poor access to transport services. Further, efforts to increase access to and uptake of DAA hepatitis C treatment over time will require a focus on reducing stigma and discrimination towards people who inject drugs as this remains as a major barrier to care for many people.

National characteristics and trends in antiretroviral treatment in Australia can be accurately estimated using a large clinical cohort

ObjectivesCohort studies are often used as a national surveillance tool to monitor trends in HIV treatment and morbidity outcomes. However, there are limited studies validating the accuracy of using cohorts as a representation of the overall HIV-positive population. We compared data from a large Australian HIV-positive cohort study (Australian HIV Observational Database [AHOD]) and a 10% longitudinal sample from Australia's subsidized prescription medication scheme (Pharmaceutical Benefits Scheme [PBS]) to assess the use of cohorts for providing representative data for surveillance and monitoring purposes. Study Design and SettingBasic demographics and treatment information from July 1, 2013, to March 31, 2016, were divided into half-yearly periods to compare HIV trends between AHOD (n = 2,488) and PBS (n = 18,409) patients. ResultsIn both data sets, most patients were men, aged above 50 years, and primarily resided in New South Wales. Both data sets revealed a significant shift toward the increased use of integrase strand transfer inhibitors and a gradual decline in the use of protease inhibitors and nonnucleoside reverse-transcriptase inhibitors among the treated population in Australia. Similarly, a substantial increase in the use of once daily, single-tablet, fixed-dose combination regimens was also observed. ConclusionOur results show that observational cohort studies can serve as useful surrogate surveillance tools for monitoring patient characteristics and HIV treatment trends.

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.

Predicting Intention to Use Nicotine Replacement Therapy in People Attending Residential Treatment for Substance Dependence

Objective: Nicotine replacement therapy (NRT) is recommended as a frontline smoking cessation tool for people attending mental health and substance dependence treatment services. Previous research suggests that NRT is underutilized in these settings. To improve the use of NRT among people attending residential treatment for substance use disorders, it is important that the factors influencing smokers’ decisions to use NRT are understood. The study aimed to examine (1) smoking cessation strategies used by participants in previous quit attempts, (2) participants’ attitudes toward NRT (i.e., safety concerns and perceived efficacy), and (3) the predictors of participants’ intention to use NRT to support future quit attempts. Methods: Participants completed a cross-sectional survey that examined their smoking behaviors, previous experiences using smoking cessation strategies, attitudes and beliefs regarding NRT, and intention to use NRT as part of future quit attempts (N = 218). All participants were attending residential treatment for substance use disorders provided by We Help Ourselves, a large provider of specialist alcohol and other drug treatment in Australia. Results: The majority of respondents (98%) reported that they had smoked regularly in their lifetime, and 89% were current smokers. Forty-five percent of the current smokers reported that they had previously used NRT to support a quit attempt, with 54% reporting that they intended to use NRT to support a future quit attempt. Intentions to use NRT were not related to the participants’ mental health status or the participants’ perceptions regarding the safety or potential drawbacks associated with using NRT. However, participants were more likely to report that they would use NRT to support future quit attempts if they were female, had previously used NRT, and perceived NRT to be effective. Conclusions: Improving the use of evidence-based smoking cessation strategies within substance use treatment continues to be a priority. To enhance the use of NRT among consumers attending mental health and addiction treatment services, NRT should be universally offered. Future research should consider strategies that help to improve participants’ positive perceptions regarding the efficacy of NRT.

Assessment of the societal and individual preferences for fertility treatment in Australia: study protocol for stated preference discrete choice experiments

IntroductionIn Australia, societal and individual preferences for funding fertility treatment remain largely unknown. This has resulted in a lack of evidence about willingness to pay (WTP) for fertility treatment by...

Medical Experimentation and Indigenous Intergenerational Memory in the Context of Twentieth-Century Hansen's Disease Treatment in Australia

For several decades, Indigenous people have claimed they, or their relatives, were the subjects of medical experimentation in the twentieth century, particularly in Hansen's disease (leprosy) institutions. On two occasions, specific cases have been investigated in the public domain, both finding no grounds to support allegations. This article critiques the methodology of these inquiries, arguing their conclusions were untenable. It explores twentieth-century practices of Hansen's disease chemotherapy, concluding that human experimentation, subject to its different definitions, frequently took place in Australia. In an apparent paradox, while doctors sought therapeutic outcomes for their patients, the experiments, to varying degrees, infringed human rights, and were often dangerous and painful. The legacy of such remembered experiences has contributed to Indigenous peoples' unease with non-Indigenous health interventions in recent times.

Medical Experimentation and Indigenous Intergenerational Memory in the Context of Twentieth-Century Hansen's Disease Treatment in Australia

Medical Experimentation and Indigenous Intergenerational Memory in the Context of Twentieth-Century Hansen's Disease Treatment in Australia

‘Beyond the willing & the waiting’ — The role of peer-based approaches in hepatitis C diagnosis & treatment

This commentary seeks to examine the role, value and importance of peer-based programmatic approaches for ensuring the effective roll-out of the new hepatitis C (HCV) treatments among those most affected — that is, people who inject drugs (PWID).The authors examine recent approaches to HCV treatment in Australia including the provision of universal access to the new DAA regimens regardless of acquisition, genotype or severity of disease. These approaches are contextualised within wider global strategies to support HCV elimination as a public health threat by 2030 (WHO, 2016).Despite the unprecedented opportunity presented by the availability of the new treatments, the fact remains that those most affected by hepatitis C are still largely hidden and disconnected from the health system and are likely to stay that way without targeted education and support.There is a need to for greater investment in new and innovative HCV+ PWID peer education approaches for HCV diagnosis and treatment that add value to existing models of care to improve pathways and support people across their entire treatment journey.Key components include expanding existing peer-based programmes and developing new innovative peer initiatives, supporting the development of the PWID peer workforce, developing new, targeted peer education resources and promoting linkages and partnerships between peer based and HCV treatment service providers in primary and community settings.Our approach to HCV elimination needs to take account of people’s broader lives, their vulnerabilities, their life journeys and their potential points of connection, engagement and access. Peer-based organisations and networks provide that unique point of engagement and access for those HCV+ PWID for whom the health system is an unfamiliar even forbidding place or for whom hepatitis C can be but one of many overwhelming issues in the lives.

P20 Monitoring the uptake of hepatitis C: direct acting antiviral treatment in Australia

P20 Monitoring the uptake of hepatitis C: direct acting antiviral treatment in Australia

Estimated Healthcare Costs of Melanoma in Australia Over 3Years Post-Diagnosis.

Skin cancer exerts a large and growing burden on health systems. With new pharmacotherapies for metastatic melanoma now available, a contemporary understanding of the cost burden of melanoma control is warranted. To comprehensively assess the healthcare costs of malignant melanoma diagnosis and treatment in Australia, over 3years after diagnosis. We developed a decision-analytic model and micro-costing method to estimate the mean cost per patient for melanoma, incorporating all diagnostic and treatment modalities used in Australia (2017 AU$). By using the de-identified 10% sample of Medicare Benefits Scheme, we analysed health service use and supplemented our analyses with published estimates. We took a health system cost perspective, and addressed input uncertainty with sensitivity analyses. The mean annual cost per patient for melanoma stage 0/I/II was AU$1681 (US$1175) rising to AU$37,729 (US$26,365) for stage III resectable, and AU$115,109 (US$80,440) for stage III unresectable/IV. Three-year costs for stage III unresectable/IV were AU$187,720. Nationally, the annual estimated cost for treatment of all new cases of in situ and invasive melanomas was AU$201 million (95% CI: AU$187 to AU$216 million). When we included treatments for presumptive melanoma later found to be benign lesions, the estimated annual cost burden reached AU$272 million. With rapidly rising treatment costs, there is a need to consider a comprehensive melanoma control strategy that includes primary prevention of skin cancers and cost-effective sun protection initiatives.

An Australian Mohs external quality assurance program.

Background: Mohs micrographic surgery (MMS) has been shown to be an effective treatment for non‐melanoma skin cancer.1 Squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) are the most common type of skin cancers worldwide with an increasing incidence in both men and women. Treating SCC and BCC, together make up the greatest cost of cancer treatment in Australia: an estimated total of $AU345 million per year. MMS provides distinct advantages over traditional excisional surgery. It offers tissue‐sparing treatment of cutaneous neoplasms with a higher cure rate; 99% for primary BCC and 97% for primary SCC,2 and has been shown to be cost‐effective compared to traditional excisional surgery.3-5 The MMS technique involves mapping and staining the excised tissue and a specialised tissue sectioning process that enables visualisation of virtually all tissue margins and the precise localisation of any residual tumour. If any residual tumour is detected, the above process is repeated until the margin is tumour‐free. The resulting defect is then ready for repair as appropriate for the particular site. A key component of Mohs surgery is that the Mohs surgeon removing the tumour also examines the histological slides, thus eliminating the communication errors that can occur in a multidisciplinary laboratory approach. Therefore, the success rate of this procedure is dependent on the accurate microscopic evaluation of carefully mapped specimens. The Mohs surgeon must be able to translate abnormal findings on the tissue map into appropriate sequential tumour removal.6 A critical component of the technique is the surgeon's skill in interpreting histological specimens, and yet few studies have analysed Mohs surgeons’ capacity to read frozen sections.7 A small number of published studies have investigated the concordance of Mohs surgeons’ interpretation of frozen sections with that of dermatopathologists. The published concordance rates have been very high, i.e. above 95%.7-9 Nevertheless, no formal external quality assurance program (EQA) assessing the Mohs surgeon's diagnostic accuracy of interpreting frozen section existed in Australia previously. In 2012 the Mohs surgeon group was formed as a specialist subgroup of the Australasian College of Dermatologists (ACD). Part of the group's aim was to establish formal EQA for diagnostic Mohs frozen sections to maintain acceptable standards for the histological diagnostic capabilities of its Mohs surgeon members. In addition to maintaining standards, the group also aimed to have an educational and continued professional development aspect as well as to create a teaching library of Mohs frozen section slides. The American College of Mohs Surgeons (ACMS) has successfully run a diagnostic quality control exam on a frozen section dermatopathology program. Initially this was run annually at the ACMS annual scientific meeting, with physical slides and microscopes set up for members to undertake the program. In 2014 the ACMS ran their program for the first time as entirely computer based with virtual images. At its 2014 Annual Advisory Committee meeting the ACD Mohs surgeon group decided to establish its own diagnostic frozen section program. Hence, it was decided that an external and independent quality assurance program would be set up in conjunction with the well‐established Royal College of Pathologists Australia Quality Assurance Program (RCPAQAP). This alliance aimed to create an independent assessment of the proficiency testing in a professional and truly unbiased manner. In addition, the alliance allowed for a cost‐effective program that would be completely computer based from its inception, i.e. the pilot Mohs module for the purpose of EQA.

Publish or perish: Dr Victor Webster and cardiazol treatment in Western Australia, 1937-1938.

To examine the role of Dr Victor Henry Webster (1905-1980) in the introduction of cardiazol therapy to Western Australia in November 1937. A range of primary and secondary sources were consulted. Webster experimented with cardiazol treatment at Heathcote Reception Home, and published his findings in April 1938, at the same time as Ellery and Lear, but was not able to publish his results in a nationally-recognised journal. As a result, his contribution to early cardiazol treatment in Australia has been largely forgotten. Webster made a genuine contribution to the introduction of cardiazol treatment in Australia, and his story illustrates the need to publish early findings of new physical therapies.