Jean Spinks

Cross-country comparisons of technical efficiency of health production: a demonstration of pitfalls

It has been proposed that cross-country comparisons of the technical efficiency of health production, estimated using data envelopment analysis (DEA), have useful applications for policy makers. In theory such an analysis utilizes measures of the socioeconomic determinants of health relevant to all social policy, not just health policy. Using OECD and WHO data, this article critically analyses a number of outstanding theoretical questions regarding the use of DEA in this setting. It concludes that until such questions are addressed, the resultant implications for policy will be based on misleading information.

Policy implications of complementary and alternative medicine use in Australia: data from the National Health Survey.

OBJECTIVES The objective of this study was to investigate the drivers of complementary and alternative medicine (CAM) use in the general population in Australia and to identify key policy implications. DATA AND METHODS The National Health Survey 2007/2008, a representative survey of the Australian population, provides information on CAM use (practitioners and products) in the last 12 months. All adult respondents (N=15,779) aged 18 years or older are included in this study. Logistic regression is employed to determine the effect of socio-economic, condition-specific, health behavior variables, and private health insurance status on CAM use. RESULTS In addition to socio-economic variables known to affect CAM use, individuals who have a chronic condition, particularly a mental health condition, are more likely to use CAM. There does not appear to be a correlation between CAM use and more frequent General Practitioner use; however, ancillary private health insurance is correlated with a greater likelihood of CAM use, as expected. CONCLUSIONS The Australian government does not currently intervene in the CAM market in a systematic way. CAM is clearly considered to be a legitimate and important component of health care for many Australians, despite the limited availability of clinical evidence for its efficacy and safety. Policy interventions may include the regulation of CAM products, practitioners, and information as well as providing subsidies for cost-effective modalities.

A new model to evaluate the long-term cost effectiveness of orphan and highly specialised drugs following listing on the Australian Pharmaceutical Benefits Scheme: the Bosentan Patient Registry

Abstract Background: Pharmaceutical subsidy schemes are under increasing pressure to evaluate the cost effectiveness of new highly specialised and orphan drugs for universal subsidy. In the absence of longer-term outcome data, drug sponsors often present modelled data, which can carry a significant level of uncertainty over longer-term projections. Risk-sharing schemes between drug sponsor and government may provide an acceptable method of balancing the uncertainty of longer-term cost effectiveness with the public demand for equitable and timely access to new drugs. Methods: The Bosentan Patient Registry (BPR) is an example of a unique risk-sharing model utilised in Australia aiming to provide clinical evidence to support the modelled predictions, with the registry survival outcomes linked to future price. Concomitant medication, health and vital status data was collected from clinicians, government health departments and death registries. Results: The BPR has identified a number of issues surrounding registry governance, ethics and patient privacy, and the collection of timely and accurate data, which need to be addressed for the development of a generic registry model for systematic evaluation. Conclusion: The success of a generic drug registry model based on the BPR will be enhanced by addressing a number of operational issues identified during the implementation of this project. Material in this paper was presented in an oral presentation to the National Medicines Symposium: Quality Use of Medicines, 7–9 June 2006, Canberra, Australia.

Complementary and alternative medicine (CAM) use and quality of life in people with type 2 diabetes and/or cardiovascular disease

OBJECTIVES To quantify the association between complementary and alternative medicine (CAM) use and quality of life in a population with type 2 diabetes and/or cardiovascular disease, accounting for demographics, socioeconomic status, health and lifestyle factors. DESIGN AND SETTING Data are from a purpose-designed survey of 2915 individuals aged 18 years and over, all with type 2 diabetes and/or cardiovascular disease (CVD), collected in 2010. Key variables are compared for comparability with nationally representative data. It was hypothesised that CAM use would be associated with higher quality of life, as measured by the Assessment of Quality of Life-4 dimension (AQoL-4D) instrument. Three key variables are used for CAM use in the previous twelve months. In the robustness analysis, CAM use is further disaggregated into the types of practitioner or product used, the frequency of use, the reason for use and expenditure on CAM. RESULTS CAM use is not associated with higher QoL for this sub-population, and in fact intensive use of CAM practitioners is associated with significantly lower QoL. CONCLUSIONS It is important not to assume that patients have sufficient information with which to make optimal choices regarding CAM use in the absence of accessible and relevant evidence-based guidance.

Are the economics of complementary and alternative medicine different to conventional medicine

Complementary and alternative medicine (CAM) is valued by consumers. In Australia, ‘out-of-pocket expenditure’ is estimated as being as high as AU

Patient and nurse preferences for nurse handover—using preferences to inform policy: a discrete choice experiment protocol

4.13 billion (US

Lost in the crowd? Using eye-tracking to investigate the effect of complexity on attribute non-attendance in discrete choice experiments.

3.12 billion) per year [1]. In the USA, estimates have ranged between US

Paying the right price for pharmaceuticals: a case study of why the comparator matters

27.0 billion and US

Measuring the Efficiency of Health Services in Lower‐Income Countries: The Case of Papua New Guinea

34.4 billion for out-of-pocket expenditure [2] and, in England, out-of-pocket expenditure on six of the most established CAM therapies has been estimated at over GB£450 million [3]. Given the levels of expenditure and the consequent outcome and policy implications, there is now a growing amount of health economics literature in this area. As with the ana lysis of other aspects of the healthcare system, a number of different perspectives and methodologies are available for health-economics ana lysis of CAM use. As research into the economics of CAM is still in its early stages compared with conventional medicine, the ana lysis is currently limited by the amount and type of available data. However, as social, clinical and economic research into CAM use continues to expand [4], so, too, do the opportunities for larger-scale data collection and ana lysis. The ana lysis of available administrative data on CAM is an obvious place to start. The majority of CAM use in most countries is funded by private expenditure and, therefore, limited administrative data exist for the estimation of total expenditure on CAM by the community. CAM use may also be subsidized by private health insurers, whose claims data are of potential use in estimating the effect of changes in the utilization rates of CAM, in relation to the type and amount of subsidy of different CAM therapies. Some literature already exists using these data [5–7]. One of the most interesting aspects of using claims data is that they provide some evidence on the utilization patterns of certain CAM therapies for governments who are interested in including CAM on national health subsidy schemes [8]. Certain types of administrative data may also be used to calculate and compare price elasticities of demand for different CAM therapies with those of conventional health services [9]. This is of interest to both private and public health insurers, as well as CAM practitioners, as ana lysis of this nature demonstrates how price differentials and changes between products can affect relative rates of utilization. One question that the ana lysis of administrative data may be able to illuminate is whether CAM is more often used as a substitute for conventional medicine or as a complement [10]. This has important ramifications for the economic evaluation of CAM using cost–effectiveness analyses or similar techniques, as it is important to identify whether the costs associated with CAM should be treated as an addition to conventional medicine or as a cost offset (substitute) [11]. Of particular interest are high-prevalence chronic conditions, such as diabetes or cardiovascular disease, for Jean Spinks

‘You don’t throw these things out:’ an exploration of medicines retention and disposal practices in Australian homes

Introduction Nursing bedside handover in hospital has been identified as an opportunity to involve patients and promote patient-centred care. It is important to consider the preferences of both patients and nurses when implementing bedside handover to maximise the successful uptake of this policy. We outline a study which aims to (1) identify, compare and contrast the preferences for various aspects of handover common to nurses and patients while accounting for other factors, such as the time constraints of nurses that may influence these preferences.; (2) identify opportunities for nurses to better involve patients in bedside handover and (3) identify patient and nurse preferences that may challenge the full implementation of bedside handover in the acute medical setting. Methods and analysis We outline the protocol for a discrete choice experiment (DCE) which uses a survey design common to both patients and nurses. We describe the qualitative and pilot work undertaken to design the DCE. We use a D-efficient design which is informed by prior coefficients collected during the pilot phase. We also discuss the face-to-face administration of this survey in a population of acutely unwell, hospitalised patients and describe how data collection challenges have been informed by our pilot phase. Mixed multinomial logit regression analysis will be used to estimate the final results. Ethics and dissemination This study has been approved by a university ethics committee as well as two participating hospital ethics committees. Results will be used within a knowledge translation framework to inform any strategies that can be used by nursing staff to improve the uptake of bedside handover. Results will also be disseminated via peer-reviewed journal articles and will be presented at national and international conferences.