Assessing cost-effectiveness in obesity (ACE-Obesity) : an overview of the ACE approach, economic methods and cost results

Background : The aim of the ACE-Obesity study was to determine the economic credentials of interventions which aim to prevent unhealthy weight gain in children and adolescents. We have reported elsewhere on the modelled effectiveness of 13 obesity prevention interventions in children. In this paper, we report on the cost results and associated methods together with the innovative approach to priority setting that underpins the ACE-Obesity study.

Methods : The Assessing Cost-Effectiveness (ACE) approach combines technical rigour with 'due process' to facilitate evidence-based policy analysis. Technical rigour was achieved through use of standardised evaluation methods, a research team that assembles best available evidence and extensive uncertainty analysis. Cost estimates were based on pathway analysis, with resource usage estimated for the interventions and their 'current practice' comparator, as well as associated cost offsets. Due process was achieved through involvement of stakeholders, consensus decisions informed by briefing papers and 2nd stage filter analysis that captures broader factors that influence policy judgements in addition to cost-effectiveness results. The 2nd stage filters agreed by stakeholders were 'equity', 'strength of the evidence', 'feasibility of implementation', 'acceptability to stakeholders', 'sustainability' and 'potential for side-effects'.

Results : The intervention costs varied considerably, both in absolute terms (from cost saving [6 interventions] to in excess of AUD50m per annum) and when expressed as a 'cost per child' estimate (from <AUD1.0 [reduction of TV advertising of high fat foods/high sugar drinks] to >AUD31,000 [laparoscopic adjustable gastric banding for morbidly obese adolescents]). High costs per child reflected cost structure, target population and/or under-utilisation.

Conclusions : The use of consistent methods enables valid comparison of potential intervention costs and cost-offsets for each of the interventions. ACE-Obesity informs policy-makers about cost-effectiveness, health impact, affordability and 2nd stage filters for important options for preventing unhealthy weight gain in children. In related articles cost-effectiveness results and second stage filter considerations for each intervention assessed will be presented and analysed.

Economic transition and commercial property markets : China and Poland

This paper discusses the economic transition and the property market emergence in transition economies. It compares the Chinese property market with the Polish market. It preliminarily examines market emergence and maturity in the context of economic transition, comparing the transitions with the emphasis placed on commercial property markets especially their formation and behaviour. Supply and demand for commercial space in China and Poland are also contrasted. As commercial property market behaviour is somewhat driven by market structure formation process and the business cycle, the transition has provided a “common ground” that enables similarities between the property markets in China and Poland. The challenge for state intervention is mainly due to the agency problem which is also a problem in mature markets; it appears that transitional economies do share common features in their emerging property markets. This paper suggests state intervention in market formation and emergence is necessary and essential. However the actual formation and behaviour of property markets have some distinctive characteristics. Value or implication of the study include: knowing the stage of market emergence is essential for making investment decisions, especially when identifying markets with varying backgrounds. This paper is also relevant to policy-makers in the process of facilitating transitions in emerging markets.

Economic transition and commercial property cycles in China

Drawn from a recently completed study, this paper aims at a better understanding of commercial property cycles in the transitional economy of China. It examines the behaviour of the property submarket system in China and considers structural changes in the socio-economic system as a primary factor in addressing the research problem. The study suggests that the underlying social and economic structure has greatly determined market behaviour. It finds that radical changes can alter the formal structure (the designed structure) of the market system, including the property market structure, but cannot alter the informal structure (i.e. the emergent structure) at the similar rate. As the study shows, cycles in the commercial property market in the economic transition is largely a key resulting feature of the continuous structural change both at formal and informal levels in a way that is often imbalanced and not always consistently changing together. The same situation also applies to the transformation of inner-city built form, which is featured by a delayed change of physical building stock against the space demand trend that is underpinned by the socio-economic transition. Put simply, there is a supply lag, mainly in the form of changing land use and building stock replacement, against economic change (the business cycle). This affects the level of effective demand for office space and hence becomes a major force in shaping current office cycles.

Measuring the economic impact of falls prevention interventions

The objective of this paper is to assess the appropriateness of available health economic models and concepts in the development of a best practice model to assess community based multifactorial falls prevention programs. To this end, a critical review and synthesis of contemporary published and unpublished  methodological approaches to economic evaluation of health initiatives in general and falls prevention initiatives in particular, has been carried out. The review  indicates that costs, time and utility all need to be taken into consideration when economically evaluating a falls prevention program.

A recommended approach that takes into account a full consideration of relevant costs and benefits associated with falls prevention programs is outlined. This approach can help demonstrate the true relative efficacy of preventing falls over the treatment of their consequences.

Wool industry : a decade of turbulence : an examination of some of the factors contributing to the crisis within Australia's wool industry, and the resulting economic, social and demographic effects on a small isolated rural community

A central issue of this thesis has been an examination of the effects that the current wool crisis has had on the Balmoral district, an area almost solely devoted to the production of wool and wool sheep. Examines the methods being utilised to try to alleviate some of these effects.

Aid, economic reform, and public sector fiscal behaviour in developing countries

This paper looks at interactions between foreign development aid, economic reform, and public sector fiscal behavior. It proposes a model of the public sector fiscal response to aid inflows, which allows for changes in structural relationships due to an exogenously imposed program of economic reform. This model is applied to 1960–99 time series data for the Philippines, which embarked on an IMF- and World Bank-funded structural adjustment program in 1980. Estimates of structural and reduced-form equations paint a dismal picture of the effectiveness of foreign aid to, and the structural adjustment program in, the Philippines so far as fiscal impacts are concerned. Both bilateral and multilateral aid inflows, and the presence of an economic reform program, are associated with decreases in public fixed capital expenditure, decreases in taxation and other recurrent revenue, and decreases in public sector saving. Multilateral aid also appears to be highly fungible.

Animal migration : linking models and data beyond taxonomic limits

An international workshop on animal migration was held at the Lorentz Center in Leiden, The Netherlands, 2–6 March 2009, bringing together leading theoreticians and empiricists from the major migratory taxa, aiming at the identification of cutting-edge questions in migration research that cross taxonomic borders.

A role for glutathione in the pathophysiology of bipolar disorder and schizophrenia? Animal models and relevance to clinical practice.

The tripeptide, glutathione (glutamylcysteinylglycine) is the primary endogenous free radical scavenger in the human body. When glutathione (GSH) levels are reduced there is an increased potential for cellular oxidative stress, characterised by an increase and accruement of reactive oxygen species (ROS). Oxidative stress has been implicated in the pathology of schizophrenia and bipolar disorder. This could partly be caused by alterations in dopaminergic and glutamatergic activity that are implicated in these illnesses. Glutamate and dopamine are highly redox reactive molecules and produce ROS during normal neurotransmission. Alterations to these neurotransmitter pathways may therefore increase the oxidative burden in the brain. Furthermore, mitochondrial dysfunction, as a source of oxidative stress, has been documented in both schizophrenia and bipolar disorder. The combination of altered neurotransmission and this mitochondrial dysfunction leading to oxidative damage may ultimately contribute to illness symptoms. Animal models have been established to investigate the involvement of glutathione depletion in aspects of schizophrenia and bipolar disorder to further characterise the role of oxidative stress in psychopathology. Stemming from preclinical evidence, clinical studies have recently shown antioxidant precursor treatment to be effective in schizophrenia and bipolar disorder, providing a novel clinical angle to augment often suboptimal conventional treatments.