The potential for tobacco control to reduce PBS costs for smoking-related cardiovaccular disease

Objective: To estimate Pharmaceutical Benefits Scheme (PBS) subsidies for drugs to treat smoking-related cardiovascular disease (CVD) in 2001-02, and over the period of the government's Intergenerational Report (IGR), assuming current smoking prevalence rates and a 5% absolute reduction.

Design and setting: An Australian epidemiological study, using prescribing data, aetiological fraction methodology, and IGR trends.

Main outcome measures: Estimated smoking-related PBS subsidy costs in 2001-02 and predicted cumulative subsidies until 2041-42, under current and reduced smoking prevalence assumptions.

Results: The PBS costs of smoking-related CVD in 2001-02 were $126 million, 9.77% of the cost of drugs for CVD and 2.96% of total PBS subsidies. The cumulative difference in these costs over the 40-year period with a 5% drop in smoking prevalence was predicted to be $4.5 billion, a 17% reduction. The saving would be $1.14 billion discounting future costs at 5% per year.

Conclusions: Further investment in tobacco control interventions could curb the increasing cost of the PBS and contribute to government efforts to ensure the viability of Australia's healthcare-financing programs. The net present value of a campaign to reduce smoking prevalence was estimated at $1 billion, with an internal rate of return of 33%.

The cost of seasonal respiratory illnesses in Australian children: the dominance of patient and family costs and implications for vaccine use

Respiratory viral infections are one of the next group of diseases likely to be targeted for prevention in childhood by the use of vaccines. To begin collecting necessary epidemiology and cost information about the illnesses caused by these viruses, we conducted a prospective cohort study in 118 Melbourne children between 12 and 71 months of age during winter and spring 2001. We were interested in calculating an average cost per episode of community-managed acute respiratory disease, in identifying the key cost drivers of such illness, and to identify the proportion of costs borne by the patient and family. There were 202 community-managed influenza-like illnesses identified between July and December 2001, generating 89 general practitioner visits, and 42 antibiotic prescriptions. The average cost of community-managed episodes (without hospitalisation) was $241 (95% CI $191 to $291), with the key cost drivers being carer time away from usual activities caring for the ill child (70% of costs), use of non-prescription medications (5.4%), and general practice visits (5.0%). The patient and family met 87per cent of total costs. The lowest average cost occurred in households from the highest income bracket. Acute respiratory illness managed in the community is common, with the responsibility for meeting the cost of episodes predominantly borne by the patient and family in the form of lost productivity. These findings have implications for preventive strategies in children, such as the individual use of, or implementation of public programs using, currently available vaccines against influenza and vaccines under development against other viral respiratory pathogens.

Obesity prevention and public health

More than 22 million children under five are now obese or overweight. Globally, an estimated 10% of school-aged children, between five and 17 years old, are overweight or obese, and the situation is getting worse. Although recognised clinically for some time as an important condition that increases risk of ill-health in affected individuals, it is only recently, that obesity has been recognised as a population-wide problem that requires preventive action. Obesity is a major contributor to diseases and disability, the associated health costs are enormous, obesity has already reached epidemic proportions in many countries, and incidence is continuing to increase in children and adults. Disturbingly the epidemic is not confined to developed countries, with many developing countries and those in transition affected. While recognised as a major population health problem, our understanding of the causes of the epidemic is poor, there has been relatively little population-based research that has focused on the prevention of unhealthy weight gain, and as a consequence knowledge regarding how and where best to intervene is limited. This book draws together the existing literature and expertise and with a view to helping set the agenda for public health action. The book is divided into three sections. Part 1 provides an overview of the context of the problem. It examines the epidemiology of obesity, the role of behavioural factors, socio-cultural factors and environmental factors in the obesity epidemic. Part 2 reviews interventions across a range of key settings and in different population groups - drawing on existing research that has aimed to increase physical activity, promote healthy eating and prevent obesity at a population level. Given how little research there is that has specifically examined the effectiveness of interventions aimed at preventing obesity per se, Part 3 explores potential opportunities to prevent obesity

Are the potential benefits of a community-based participatory approach to public health research worth the potential cost?

Much of public health research is conducted in a community setting or is designed to target particular population groups. Community-based participatory research (CBPR) is gaining recognition as good practice in studies of this type(Flicker et al 2007). Its merit is based on the inclusion of the community as active participants at all stages of the research process (Goodman 2006). The focus on justice and equity in this approach is seen to contribute to a range of additional potential research benefits including increased relevance and sustainability of interventions arising from the research ( Blumenthal 2004; Wallestein 2006) However, it is widely acknowledged that adoption of a consciously CBPR approach requires additional expertise. time and resources from researchers and from communities (Tanjasiri et al 2002; Massaro & Claiborne 2001; Israel et al 1998). Adoption of CBPR is also limited by existing infrastructures which are supportive of more· traditional models of research. Changes to professional development programs, funding guidelines and criteria. grant review processes and ethics requirements are needed to support increased application of this approach (Israel et al 2001). As all research resources are limited, the potential additional benefits offered by CBPR over and above a more traditional research approach need to be weighed against the potential additional costs involved. Changes to research infrastructure are unlikely to occur until the costs and
benefits of a consciously CBPR approach as compared to a more traditional research approach can be demonstrated.

This is an exploratory paper that summarises the arguments put forward to date in relation to CBPR. A research case study and an evaluation framework are then used for a conceptual analysis of differences in the potential costs and benefits of the two approaches. Firstly, the paper describes the differences between traditional and consciously CBPR approaches. The reported benefits of CBPR are then outlined, followed by a discussion of the potential costs. Finally, the potential costs are compared to the potential benefits of using a CBPR approach, using a case study of existing research.

The pricing and underwriting costs of Japanese REIT IPOs

This study investigates 40 Japanese REIT IPOs during 2001 to 2006 and finds evidence that higher final offer prices are reflected in higher underpricing levels by such IPOs. There is also some evidence that the engagement of one of the big three Japanese underwriting firms suggests less money is left on the table. Economies of scale in underwriting fees for Japanese REIT IPOs are also found. Specifically, the percentage underwriting fees decrease with higher amounts of equity capital sought but the percentage fee decreases at a diminishing rate.

Promoting transportation cycling for women : the role of bicycle infrastructure

Objective.
Females are substantially less likely than males to cycle for transport in countries with low bicycle transport mode share. We investigated whether female commuter cyclists were more likely to use bicycle routes that provide separation from motor vehicle traffic.
Methods.
Census of cyclists observed at 15 locations (including off-road bicycle paths, on-road lanes and roads with no bicycle facilities) within a 7.4 km radius of the central business district (CBD) of Melbourne, Australia, during peak commuting times in February 2004.
Results.
6589 cyclists were observed, comprising 5229 males (79.4%) and 1360 females (20.6%). After adjustment for distance of the bicycle facility from the CBD, females showed a preference for using off-road paths rather than roads with no bicycle facilities (odds ratio [OR] = 1.43, 95% confidence interval [CI]: 1.12, 1.83), or roads with on-road bicycle lanes (OR = 1.34, 95% CI: 1.03, 1.75).
Conclusions.
Consistent with gender differences in risk aversion, female commuter cyclists preferred to use routes with maximum separation from motorized traffic. Improved cycling infrastructure in the form of bicycle paths and lanes that provide a high degree of separation from motor traffic is likely to be important for increasing transportation cycling amongst under-represented population groups such as women.

Prevalence and cost of musculoskeletal disorders: a population-based, public hospital system healthcare consumption approach.

Objective: To use a population-level, public-hospital approach to compare the prevalence and cost of musculoskeletal diseases (MSD) with other clinical specialties.

Methods: A healthcare utilization survey of 4 million individual records over 4 years, from all major public hospitals in the state of Victoria (estimated population 4.8 million residents in 2000/01) from 1997/98 to 2000/01. Main outcome measures were inpatient episodes of care, bed-days, and outpatient clinic encounters. MSD was defined as the combination of orthopedics and rheumatology.

Results: After obstetrics, MSD was the most frequent outpatient service, with orthopedics accounting for 9.9% of all visits in 2000/01. The proportion of MSD outpatient encounters (on average 11.6% of the total) was constant over the study period. Among 26 medical specialties, MSD had the sixth highest number of inpatient episodes (6.2% in 2000/01), following renal dialysis (14.6%), general surgery (8.2%), obstetrics (7.6%), gastroenterology (7.1%), and general medicine (6.7%). MSD was the fifth highest consumer of bed-days, occupying on average 7.7% of all beds per annum in the period 1997/98 to 2000/01, behind psychiatry (10.1%), respiratory medicine (8.5%), rehabilitation (8.3%), and general medicine (7.8%). MSD was the third most-costly discipline in 2000/01, with total costs of over A dollars 169 million (9.7% of total inpatient costs that year), behind respiratory medicine (11.6%) and general surgery (11.5%).

Conclusion: Compared to other diseases, MSD consumes a substantial proportion of healthcare resources in Victorian public hospitals. These data have important implications for allocation of healthcare resources, clinical care pathways, and prevention strategies.

Decision making to support an integrated infrastructure supply chain industrial ecological approach within public private partnerships

Supply chains are complex adaptive systems for which final performance depends upon numerous interdependent decisions made by numerous firms which synthesise inputs from various resources systems.  The dynamic interdependent behaviour of social, economic, material and informational resource systems within eco-industrial settings that support the built environment life cycle supply chains can be studied at the supply chain level.  The impact of megaprojects is significant and holds promise to explore the impact of decisions on various systems as it combines project and system boundaries.  Megaoprojects considered as major events within systems can produce critical revolutionary impacts on the systems within which they are embedded.  The decisions that are made on megaprojects are central to risk management.  typically major infrastructure projects are procured through a form of public private partnership (PPP).  The core principle of PPP is value for money which refers to the best available outcome attempting to take account of all benefits, costs and risks over the whole life of the procurement.  In this paper the focus is on Australia where there has been considerable acitivity in the use of PPPs.  With recent national infrastucture packages proposed to stimulate the economy due to the global financial crisis, decision modelling on risks is a revelant and critical matter not only in practice but also in the research community.  PPPs encourage the whole-of-lifecycle approach in the procurement and management of public sector assets by transparently recognising the costs and risks associated with the whole life of the required service or facility, thus integrated whole of life supply chains can be considered.  By creating a single point of responsibility for an entire project from inception through operation, a strong incentive is created for thinking about the effects that a design or construction decision will have on the effectiveness and efficiency of managing and maintaining a facility during its operational life.  The decision to procure holistic supply chains becomes a much more viable commercial reality in the PPP environment than previously considered in the usual commercial construction spot transactional approach.  These types of decisions tend to be imprecise, approximate and complex requireing justification and reasoning logic rather than the classical 'truth' logic.  The purpose of this paper is to develop a theoretical decision framework which combines interdependency and multi-values logic for supply chain procurement modelling.

Improving collaboration between private psychiatrists, the public mental health sector and general practitioners : evaluation of the Partnership Project

Objectives: We describe the evaluation of the Partnership Project, which was designed to improve linkages between public and private sector mental health services. We consider the Project's key elements: a Linkage Unit, designed to improve collaborative arrangements for consumers and promote systems-level and cultural change; and the expansion of private psychiatrists' roles to include supervision and training, case conferencing and secondary consultation. The evaluation aimed to describe the impacts and outcomes of these elements.

Method: The evaluation used de-identified data from the Linkage Unit database, the Project's billing system, and the Health Insurance Commission (HIC). It drew on consultations with key stakeholders (semistructured interviews with 36 key informants, and information from a forum attended by over 40 carers and a meeting of five public sector and three private sector psychiatrists) and a series of case studies.

Results: The Linkage Unit facilitated 224 episodes of collaborative care, many of which had positive outcomes for providers, consumers and carers. It had a significant impact at a systems level, raising consciousness about collaboration and influencing procedural changes. Thirty-two private psychiatrists consented to undertaking expanded roles, and the Project was billed $78 032 accordingly. Supervision and training were most common, involving 16 psychiatrists and accounting for approximately 80% of the total hours and cost. Commonwealth expenditure on private psychiatrists' participation in the expanded roles was not associated with a reduction in benefits paid by the HIC. Key informants were generally positive about the expanded roles.

Conclusions: The Project represented a considered, innovative approach to dealing with poor collaboration between the public mental health sector, private psychiatrists and GPs. The Linkage Unit achieved significant systems-level and cultural change, which has the potential to be sustained. Expanded roles for private psychiatrists, particularly supervision and training, may improve collaboration, and warrant further exploration in terms of costs and benefits.

An optimal transportation routing approach using GIS-based dynamic traffic flows

This paper examines the value of real-time traffic information gathered through Geographic Information Systems for achieving an optimal vehicle routing within a dynamically stochastic transportation network. We present a systematic approach in determining the dynamically varying parameters and implementation attributes that were used for the development of a Web-based transportation routing application integrated with real-time GIS services. We propose and implement an optimal routing algorithm by modifying Dijkstra’s algorithm in order to incorporate stochastically changing traffic flows. We describe the significant features of our Web application in making use of the real-time dynamic traffic flow information from GIS services towards achieving total costs savings and vehicle usage reduction. These features help users and vehicle drivers in improving their service levels and productivity as the Web application enables them to interactively find the optimal path and in identifying destinations effectively.

The pricing of infrastructure initial public offerings : evidence from Australia

This paper explores first-day returns on infrastructure entity initial public offerings (IPOs) in Australia from 1996 to 2007. While a good deal has been written on the first-day returns of industrial and mining company IPOs and Real Estate Investment Trust IPOs, first-day returns of infrastructure entity IPOs have yet to be reported in the literature. The study uses ordinary least squares regression analysis to identify factors that might influence the percentage first-day returns theoretically available to investing subscribers and factors that might influence the aggregate amount of money left to subscribers by issuers. The study finds that first-day returns, on average, are not significantly different from zero. There is evidence, however, that suggests higher dividend yields and higher percentage direct costs of capital raising influence these first-day returns. The study also finds that infrastructure entity IPOs that seek to raise more equity capital leave less money on the table for subscribing investors.

The economic burden of ill health due to diet, physical inactivity, smoking, alcohol and obesity in the UK : an update to 2006-07 NHS costs

Background: Estimates of the economic cost of risk factors for chronic disease to the NHS provide evidence for prioritization of resources for prevention and public health. Previous comparable estimates of the economic costs of poor diet, physical inactivity, smoking, alcohol and overweight/obesity were based on economic data from 1992–93.

Methods: Diseases associated with poor diet, physical inactivity, smoking, alcohol and overweight/obesity were identified. Risk factor-specific population attributable fractions for these diseases were applied to disease-specific estimates of the economic cost to the NHS in the UK in 2006–07.

Results: In 2006–07, poor diet-related ill health cost the NHS in the UK £5.8 billion. The cost of physical inactivity was £0.9 billion. Smoking cost was £3.3 billion, alcohol cost £3.3 billion, overweight and obesity cost £5.1 billion.

Conclusion: The estimates of the economic cost of risk factors for chronic disease presented here are based on recent financial data and are directly comparable. They suggest that poor diet is a behavioural risk factor that has the highest impact on the budget of the NHS, followed by alcohol consumption, smoking and physical inactivity.

Critical uncertainty factors for efficient risk allocation in privately financed public infrastructure projects in Australia

Risk allocation in privately financed public infrastructure projects, commonly referred to as public-private partnership (PPP) projects, is a challenging job due to the nature of incomplete contracting. Choosing a risk allocation strategy could be viewed as the process of deciding the proportion of risk management attributable to the public and private partners based on a series of characteristics of the risk management service transaction in question. These characteristics can be related to the various uncertainty factors. In this study, uncertainty factors have been grouped into Institutional, Social and industrial, Economic, and Project-specific categories and examined in order to achieve efficient risk allocation and minimize risk management-related costs in a long-term view. Critical uncertainty factors for the allocation of three major risks have been identified through an industry-wide survey in Australia. These identified critical uncertainty factors are expected to help decision-makers from both public and private sectors choose efficient allocation strategies for major risks. Future research directions are also set out.