Economic implications of obesity among people with atherothrombotic disease

Objective: The purpose of this study was to ascertain the impact of obesity on the cost of disease management in people with or at high risk of atherothrombotic disease from a governmental perspective using a bottom-up approach to cost estimation. In addition, the aim was also to explore the causes of any differences found.

Method: The health-care costs of obesity were estimated from 2819 participants recruited into the nationwide Australian REACH Registry with established atherothrombotic disease or at least three risk factors for atherothrombosis. Enrollment was in 2004, through primary care general practices. Information was collected on the use of cardiovascular drugs, hospitalizations and ambulatory care services. Bottom-up costing was undertaken by assigning unit costs to each health-care item, based on Australian Government-reimbursed figures 2006-2007. Linear-mixed models were used to estimate associations between direct medical costs and body mass index (BMI) categories.

Results: Annual pharmaceutical costs per person increased with increasing BMI category, even after adjusting for gender, age, living place, formal education, smoking status, hypertension and diabetes. Adjusted annual pharmaceutical costs of overweight and obese participants were higher (7 (P0.004) and 144 (0.001), respectively) than those of the normal weight participants. This was due to participants in higher BMI categories receiving more pharmaceuticals than normal weight participants. There was no significant change across the BMI categories in annual ambulatory care costs and annual hospital costs.

Conclusion: In these participants with or at high risk of atherothrombotic disease, annual pharmaceutical costs were greater in participants of higher BMI category, but there was not such a gradient in the annual hospital or ambulatory care costs. The greater cardiovascular pharmaceutical costs for participants of higher BMI categories remained even after adjusting for a range of demographic factors and comorbidities. Our results suggest that these costs are explained by the higher number of drugs used among people with atherothrombotic disease. Further investigation is needed to understand the reasons for this level of drug use.

Why invest in a national public health program for stroke? An example using Australian data to estimate the potential benefits and cost implications

Objectives: Stroke is the world’s second leading cause of death in people aged over 60 years. Approximately 50,000 strokes occur annually in Australia with numbers predicted to increase by about one third over 10-years. Our objectives were to assess the economic implications of a public health program for stroke by: (1) predicting what potential health-gains and cost-offsets could be achieved; and (2) determining the net level of annual investment that would offer value-for-money.

Methods: Lifetime costs and outcomes were calculated for additional cases that would benefit if ‘current practice’ was feasibly improved, estimated for one indicative year using: (i) local epidemiological data, coverage rates and costs; and (ii) pooled effect sizes from systematic reviews.

Interventions: blood pressure lowering; warfarin for atrial fibrillation; increased access to stroke units; intravenous thrombolysis and aspirin for ischemic events; and carotid endarterectomy. Value-for-money threshold: AUD$30,000/DALY recovered.

Results: Improved, prevention and management could prevent about 27,000 (38%) strokes in 2015. In present terms (2004), about 85,000 DALYs and AUD$1.06 billion in lifetime cost-offsets could be recovered. The net level of annual warranted investment was AUD$3.63 billion.

Conclusions: Primary prevention, in particular blood pressure lowering, was most effective. A public health program for stroke
is warranted

The 6-PACK programme to decrease falls and fall-related injuries in acute hospitals : protocol for an economic evaluation alongside a cluster randomised controlled trial

Background Falls are a common hospital occurrence complicating the care of patients. From an economic perspective, the impact of in-hospital falls and related injuries is substantial. However, few studies have examined the economic implications of falls prevention interventions in an acute care setting. The 6-PACK programme is a targeted nurse delivered falls prevention programme designed specifically for acute hospital wards. It includes a risk assessment tool and six simple strategies that nurses apply to patients classified as high-risk by the tool.
Objective To examine the incremental cost-effectiveness of the 6-PACK programme for the prevention of falls and fall-related injuries, compared with usual care practice, from an acute hospital perspective.
Methods and design The 6-PACK project is a multicentre cluster randomised controlled trial (RCT) that includes 24 acute medical and surgical wards from six hospitals in Australia to investigate the efficacy of the 6-PACK programme. This economic evaluation will be conducted alongside the 6-PACK cluster RCT. Outcome and hospitalisation cost data will be prospectively collected on approximately 16 000 patients admitted to the participating wards during the 12-month trial period. The results of the economic evaluation will be expressed as ‘cost or saving per fall prevented’ and ‘cost or saving per fall-related injury prevented’ calculated from differences in mean costs and effects in the intervention and control groups, to generate an incremental cost-effectiveness ratio (ICER).
Discussion This economic evaluation will provide an opportunity to explore the cost-effectiveness of a targeted nurse delivered falls prevention programme for reducing in-hospital falls and fall-related injuries. This protocol provides a detailed statement of a planned economic evaluation conducted alongside a cluster RCT to investigate the efficacy of the 6-PACK programme to prevent falls and fall-related injuries.

Novel and effective treatment modality for medically unexplained symptoms

Medically unexplained symptoms (MUS) confound physicians, and the incidence and prevalence of these conditions is poorly documented.  This is not least due to the complex nature of MUS and mimicry of morbidity with conditions that have common clinical assessment and treatment modalities, e.g. migraine headaches which stress headaches commonly are misdiagnosed as.  Effective treatment modalities for MUS have been more or less non-existent.  In the following we present a modality for the assessment, diagnosis and treatment of MUS that in our experience leads to cure, at least in better than half of these cases measured in terms of allowing the individual back to work.  These results are at least twice as high as those described hitherto (see below), and yet, our treatment modality is beset with many obstacles, not the least of which is the intrasigence of a system that will not and/or can not understand why this modality is so much better than what they are able to offer.  The most importance obstacle is financing, as this modality requires long term and committed financing to work.  The economic implications of not dealing with these issues are described.

Implementing climate change policies consistent with integrated coastal zone management : a case study of Victoria, Australia

Whilst the proliferation of publications on climate change science is remarkable and makes the updating of responses to impacts of climate change on coastal environments daunting, the area of policy responses is even more confusing and complex. This is because policy responses do not need to consider the science of climate change alone but also have to weigh up the social and economic implications of the impact of climate change on coastal communities. In a federated nation such as Australia this has the added complication of three tiers of Government (Federal, State and local) having to interact in order to co-ordinate any policy responses. These complications should be aided by the internationally accepted concept of Integrated Coastal Zone Management (ICZM) which has been prevalent in Australian coastal planning and management for several decades. This paper uses the State of Victoria, Australia as a case study of how Governments are responding to these challenges through using the principles of ICZM. The paper will review recent inquires and investigations in Australia and canvas the policy responses to these reviews, concentrating on the State of Victoria. The paper analyses how consistent these evolving policy responses are with ICZM and suggests lessons for other jurisdictions arising from the Victorian experience.

Depression as a predictor of work resumption following myocardial infarction (MI): a review of recent research evidence

Background Depression often coexists with myocardial infarction (MI) and has been found to impede recovery through reduced functioning in key areas of life such as work. In an era of improved survival rates and extended working lives, we review whether depression remains a predictor of poorer work outcomes following MI by systematically reviewing literature from the past 15 years.

Methods Articles were identified using medical, health, occupational and social science databases, including PubMed, OVID, Medline, Proquest, CINAHL plus, CCOHS, SCOPUS, Web of Knowledge, and the following pre-determined criteria were applied: (i) collection of depression measures (as distinct from 'psychological distress') and work status at baseline, (ii) examination and statistical analysis of predictors of work outcomes, (iii) inclusion of cohorts with patients exhibiting symptoms consistent with Acute Coronary Syndrome (ACS), (iv) follow-up of work-specific and depression specific outcomes at minimum 6 months, (v) published in English over the past 15 years. Results from included articles were then evaluated for quality and analysed by comparing effect size.

Results Of the 12 articles meeting criteria, depression significantly predicted reduced likelihood of return to work (RTW) in the majority of studies (n = 7). Further, there was a trend suggesting that increased depression severity was associated with poorer RTW outcomes 6 to 12 months after a cardiac event. Other common significant predictors of RTW were age and patient perceptions of their illness and work performance.

Conclusion Depression is a predictor of work resumption post-MI. As work is a major component of Quality of Life (QOL), this finding has clinical, social, public health and economic implications in the modern era. Targeted depression interventions could facilitate RTW post-MI.

Challenges to providing work integrated learning to international business students at Australian universities

Purpose – The purpose of this paper is to report on a three-year Australian study of international business and accounting students and the transition to employment. For international students seeking to differentiate themselves in a highly competitive global labour market, foreign work experience is now an integral part of the overseas study “package”. Work-integrated learning (WIL) is seen to provide critical “employability” knowledge and skills, however, international students have low participation rates. The high value placed on WIL among international students poses challenges for Australia as well as opportunities. Understanding the issues surrounding international students and WIL is closely linked to Australia’s continued success in the international education sector which has broad, long-term, social and economic implications.Design/methodology/approach – This paper draws on 59 interviews with a range of stakeholders including international students, universities, government, employers and professional bodies. Central to the paper is an in-depth case study of WIL in the business and accounting discipline at one Australian university.Findings – Providing international students with access to discipline-related work experience has emerged as a critical issue for Australian universities. The study finds that enhancing the employability skills of internationals students via integrated career education, a focus on English language proficiency and “soft skills” development are central to success in WIL. Meeting the growing demand for WIL among international students requires a multipronged approach which hinges on cooperation between international students, universities, employers and government.Originality/value – This project aims to fill a critical knowledge gap by advancing theories in relation to international students and WIL. While there is a significant body of research in the fields of international education and WIL, there is an absence of research exploring the intersection between the two fields. The study will contribute to the advancement of knowledge in both fields by exploring the emerging issue of WIL and international students.

Determinants of non-life insurance expenditure in developed and developing countries: an empirical investigation

The determinants of non-life insurance expenditure in a panel data set covering 36 developed countries and 31 developing countries for the period 2000–2011 are analysed. Results of our instrumental variable analysis indicate that economic freedom, income, bank development, urbanization, culture and law systems are the key drivers of the non-life insurance expenditure across countries. However, their impacts differ significantly between the groups of developed and developing countries, suggesting that the heterogeneity among countries in terms of the level of development plays an important role. The global financial crisis is also found to influence the direction of those effects, especially in developed countries. The article yields useful policy and economic implications for governments and multinational non-life insurance companies with regard to the development of the non-life insurance sector, an important engine for economic growth and prosperity.

Construction industry performance measurement with carbon reduction

The research developed non-parametric approaches for measuring construction industry performance in sustainable development. The research results support the improvement of value added and the reduction of carbon emissions, which have positive environmental and economic implications in the Australian construction industry.

Exploratory economic analyses of two primary care mental health projects : implications for sustainability

We evaluated an Internet-based psychological intervention supported by either general practitioners or psychologists (Panic Online), and a Primary-care Evidence-based Psychological-interventions (PEP) strategy which involves training GPs to deliver specific psychological interventions.

Economic modelling suggests that Panic Online is cost-effective when supported by either GPs or psychologists.

Threshold analysis of the psychological training of GPs suggests that a modest effect size for clinical benefit would be sufficient to provide an acceptable cost-effectiveness ratio.

The sustainability of these approaches depends on a range of factors, including funding, workforce availability, and acceptability to consumers and health care providers.

Widening development prescriptions: policy implications of an index of sustainable economic welfare (SEW) for Thailand

Over the past three decades, Thailand has recorded consistently high levels of economic growth, making it one of the most successful economies in the world during this period. However, economic growth has associated costs that can also reduce social welfare. This study will estimate an Index of Sustainable Economic Welfare (ISEW) for Thailand over a twenty-five year period, 1975–1999. This paper concludes that even low-middle income countries are beginning to approach the point at which economic growth produces both diminishing and, at times, negative welfare returns as the costs of achieving growth begin to outweigh the associated benefits. These results are important for policy makers and highlight the importance of widening policy prescriptions in order to increase social welfare. However, the policy guidelines that are suggested must be critically accepted before being adopted due to possible weaknesses of the ISEW approach.

Complex interventions or complex systems? Implications for health economic evaluation

Health researchers commonly use the notion of complexity to indicate the problems faced in evaluating the effectiveness of many non-drug interventions.^1-3 However, although it is rarely delineated, complexity has two meanings. In the first it is a property of the intervention, and in the second it is a property of the system in which the intervention is implemented. We examine the implications of these two views for economic evaluation.

Economic linkages across commodity futures : hedging and trading implications

We investigate cross-market trading dynamics in futures contracts written on seemingly unrelated commodities that are consumed by a common industry. On the Tokyo Commodity Exchange, we find such evidence in natural rubber (NR), palladium (PA) and gasoline (GA) futures markets. The automobile industry is responsible for more than 50% of global demand for each of these commodities. VAR estimation reveals short-run cross-market interaction between NR and GA, and from NR to PA. Cross-market influence exerted by PA is felt in longer dynamics, with PA volatility (volume) affecting NR (GA) volume (volatility). Our findings are robust to lag-specification, volatility measure, and consistent with full BEKK-GARCH estimation results. Further analysis, which benchmarks against silver futures market, TOCOM index and TOPIX transportation index, confirms that our results are driven by a common industry exposure, and not a commodity market factor. A simple trading rule that incorporates short-run GA and long-run PA dynamics to predict NR return yields positive economic profit. Our study offers new insights into how commodity and equity markets relate at an industry level, and implications for multi-commodity hedging.