Rupendra Shrestha

Access to general practitioner services amongst underserved Australians: a microsimulation study

BackgroundOne group often identified as having low socioeconomic status, those living in remote or rural areas, are often recognised as bearing an unequal burden of illness in society. This paper aims to examine equity of utilisation of general practitioner services in Australia.MethodsUsing the 2005 National Health Survey undertaken by the Australian Bureau of Statistics, a microsimulation model was developed to determine the distribution of GP services that would occur if all Australians had equal utilisation of health services relative to need.ResultsIt was estimated that those who are unemployed would experience a 19% increase in GP services. Persons residing in regional areas would receive about 5.7 million additional GP visits per year if they had the same access to care as Australians residing in major cities. This would be a 18% increase. There would be a 20% increase for inner regional residents and a 14% increase for residents of more remote regional areas. Overall there would be a 5% increase in GP visits nationally if those in regional areas had the same access to care as those in major cities.ConclusionParity is an insufficient goal and disadvantaged persons and underserved areas require greater access to health services than the well served metropolitan areas due to their greater poverty and poorer health status. Currently underserved Australians suffer a double disadvantage: poorer health and poorer access to health services.

Prospective comparison of the cost-effectiveness of clinical whole-exome sequencing with that of usual care overwhelmingly supports early use and reimbursement

Purpose:To undertake the first prospective cost-effectiveness study of whole-exome sequencing (WES) as an early, routine clinical test for infants with suspected monogenic disorders.Methods:Cost data for diagnosis-related investigations and assessments were collected for a prospective, sequential clinical cohort of infants (N = 40) who underwent singleton WES in parallel to usual diagnostic care. We determined costs per patient, costs per diagnosis, and incremental costs per additional diagnosis for three alternative strategies for integrating WES into the diagnostic trajectory. We performed a sensitivity analysis to examine the robustness of estimates and bootstrapping (500 replications) to examine their distributions.Results:Standard care achieved an average cost per diagnosis of AU

Diagnostic Impact and Cost-effectiveness of Whole-Exome Sequencing for Ambulant Children With Suspected Monogenic Conditions

27,050 (US

Health problems and retirement due to ill-health among Australian retirees aged 45-64 years

21,099) compared with AU

A within-trial cost-effectiveness analysis of primary care referral to a commercial provider for weight loss treatment, relative to standard care—an international randomised controlled trial

5,047 (US

Economic impacts of illness in older workers: quantifying the impact of illness on income, tax revenue and government spending.

3,937) for singleton WES. If WES had been performed after exhaustive standard investigation, then there would have been an incremental cost per additional diagnosis of AU

Towards a holistic understanding of poverty: a new multidimensional measure of poverty for Australia

8,112 (US

The personal and national costs of lost labour force participation due to arthritis: an economic study

6,327). Using WES to replace some investigations decreases this incremental cost to AU

The financial vulnerability of individuals with diabetes

2,622 (US

Freedom poverty: A new tool to identify the multiple disadvantages affecting those with CVD

2,045), whereas using it to replace most investigations results in a savings per additional diagnosis of AU