Cost-effectiveness analysis of screening for lung cancer with low dose spiral CT (computed tomography) in the Australian setting

Introduction:
Low dose spiral computed tomography (CT) is a sensitive screening tool for lung cancer that is currently being evaluated in both non-randomised studies and randomised controlled trials.
Methods:
We conducted a quantitative decision analysis using a Markov model to determine whether, in the Australian setting, offering spiral CT screening for lung cancer to high risk individuals would be cost-effective compared with current practice. This exploratory analysis was undertaken predominantly from the perspective of the government as third-party funder. In the base-case analysis, the costs and health outcomes (life-years saved and quality-adjusted life years) were calculated in a hypothetical cohort of 10,000 male current smokers for two alternatives: (1) screen for lung cancer with annual CT for 5 years starting at age 60 year and treat those diagnosed with cancer or (2) no screening and treat only those who present with symptomatic cancer.
Results:
For male smokers aged 60–64 years, with an annual incidence of lung cancer of 552 per 100,000, the incremental cost-effectiveness ratio was $57,325 per life-year saved and $105,090 per QALY saved. For females aged 60–64 years with the same annual incidence of lung cancer, the cost-effectiveness ratio was $51,001 per life-year saved and $88,583 per QALY saved. The model was used to examine the relationship between efficacy in terms of the expected reduction in lung cancer mortality at 7 years and cost-effectiveness. In the base-case analysis lung cancer mortality was reduced by 27% and all cause mortality by 2.1%. Changes in the estimated proportion of stage I cancers detected by screening had the greatest impact on the efficacy of the intervention and the cost-effectiveness. The results were also sensitive to assumptions about the test performance characteristics of CT scanning, the proportion of lung cancer cases overdiagnosed by screening, intervention rates for benign disease, the discount rate, the cost of CT, the quality of life in individuals with early stage screen-detected cancer and disutility associated with false positive diagnoses. Given current knowledge and practice, even under favourable assumptions, reductions in lung cancer mortality of less than 20% are unlikely to be cost-effective, using a value of $50,000 per life-year saved as the threshold to define a “cost-effective” intervention.
Conclusion:
The most feasible scenario under which CT screening for lung cancer could be cost-effective would be if very high-risk individuals are targeted and screening is either highly effective or CT screening costs fall substantially.

Why educators should bring an end to pedagogy

As Australia is moving towards a national curriculum there are also activities to nationalise teacher education. This involves various departments of state and federal governments, third-party bodies funded by government such as the Curriculum Corporation and Teaching Australia, and non-government organisations such as the Business Council of Australia. These agencies are producing models and principles which aim on establishing standards of best practice for how they want teachers to teach. Within all of this activity the term ‘pedagogy’ is often employed to represent aspects of these best practices. Examples include ‘productive pedagogies’, ‘new pedagogies’, ‘pedagogical content knowledge’ and ‘pedagogical strategies’. However these are all means only without any end purposes which identify them as being valuable for education. In this paper I will argue that in order to have educative value teachers themselves must exercise a degree of professional autonomy to bring their own end purposes to their choice of pedagogy.

Management of service level agreement for service-oriented content adaptation platform

It is paramount to provide seamless and ubiquitous access to rich contents available online to interested users via a wide range of devices with varied characteristics. Recently, a service-oriented content adaptation scheme has emerged to address this content-device mismatch problem. In this scheme, content adaptation functions are provided as services by third-party providers. Clients pay for the consumed services and thus demand service quality. As such, negotiating for the QoS offers, assuring negotiated QoS levels and accuracy of adapted content version are essential. Any non-compliance should be handled and reported in real time. These issues elevate the management of service level agreement (SLA) as an important problem. This chapter presents prior work, important challenges, and a framework for managing SLA for service-oriented content adaptation platform.

Towards an understanding of the impact of advertising on data leaks

Recent investigations have determined that many Android applications in both official and non-official online markets expose details of the user's mobile phone without user consent. In this paper, for the first time in the research literature, we provide a full investigation of why such applications leak, how they leak and where the data is leaked to. In order to achieve this, we employ a combination of static and dynamic analysis based on examination of Java classes and application behaviour for a data set of 123 samples, all pre-determined as being free from malicious software. Despite the fact that anti-virus vendor software did not flag any of these samples as malware, approximately 10% of them are shown to leak data about the mobile phone to a third-party; applications from the official market appear to be just as susceptible to such leaks as applications from the non-official markets.

Android applications : Data leaks via advertising libraries

Recent studies have determined that many Android applications in both official and non-official online markets expose details of the users' smartphones without user consent. In this paper, we explain why such applications leak, how they leak and where the data is leaked to. In order to achieve this, we combine static and dynamic analysis to examine Java classes and application behaviour for a set of popular, clean applications from the Finance and Games categories. We observed that all the applications in our data set which leaked information (10%) had third-party advertising libraries embedded in their respective Java packages.

Contributory factors to patient safety incidents in primary care: protocol for a systematic review

BACKGROUND: Organisations need to systematically identify contributory factors (or causes) which impact on patient safety in order to effectively learn from error. Investigations of error have tended to focus on taking a reactive approach to learning from error, mainly relying on incident-reporting systems. Existing frameworks which aim to identify latent causes of error rely almost exclusively on evidence from non-healthcare settings. In view of this, the Yorkshire Contributory Factors Framework (YCFF) was developed in the hospital setting. Eighty-five percent of healthcare contacts occur in primary care. As a result, this review will build on the work that produced the YCFF, by examining the empirical evidence that relates to the contributory factors of error within a primary care setting. METHODS/DESIGN: Four electronic bibliographic databases will be searched: MEDLINE, Embase, PsycInfo and CINAHL. The database search will be supplemented by additional search methodologies including citation searching and snowballing strategies which include reviewing reference lists and reviewing relevant journal table of contents, that is, BMJ Quality and Safety. Our search strategy will include search combinations of three key blocks of terms. Studies will not be excluded based on design. Included studies will be empirical studies conducted in a primary care setting. They will include some description of the factors that contribute to patient safety. One reviewer (SG) will screen all the titles and abstracts, whilst a second reviewer will screen 50% of the abstracts. Two reviewers (SG and AH) will perform study selection, quality assessment and data extraction using standard forms. Disagreements will be resolved through discussion or third party adjudication. Data to be collected include study characteristics (year, objective, research method, setting, country), participant characteristics (number, age, gender, diagnoses), patient safety incident type and characteristics, practice characteristics and study outcomes. DISCUSSION: The review will summarise the literature relating to contributory factors to patient safety incidents in primary care. The findings from this review will provide an evidence-based contributory factors framework for use in the primary care setting. It will increase understanding of factors that contribute to patient safety incidents and ultimately improve quality of health care.

Association between perception of fault for the crash and function, return to work and health status 1 year after road traffic injury: a registry-based cohort study

Objectives To establish the association between the patient's perception of fault for the crash and 12-month outcomes after non-fatal road traffic injury.Setting Two adult major trauma centres, one regional trauma centre and one metropolitan trauma centre in Victoria, Australia.Participants 2605 adult, orthopaedic trauma patients covered by the state's no-fault third party insurer for road traffic injury, injured between September 2010 and February 2014.Outcome measures EQ-5D-3L, return to work and functional recovery (Glasgow Outcome Scale—Extended score of upper good recovery) at 12 months postinjury.Results After adjusting for key confounders, the adjusted relative risk (ARR) of a functional recovery (0.57, 95% CI 0.46 to 0.69) and return to work (0.92, 95% CI 0.86 to 0.99) were lower for the not at fault compared to the at fault group. The ARR of reporting problems on EQ-5D items was 1.20–1.35 times higher in the not at fault group. Conclusions Patients who were not at fault, or denied being at fault despite a police report of fault, experienced poorer outcomes than the at fault group. Attributing fault to others was associated with poorer outcomes. Interventions to improve coping, or to resolve negative feelings from the crash, could facilitate better outcomes in the future.

Generic drugs: international trends and policy developments in Australia

Public and private third-party payers in many countries encourage or mandate the use of generic drugs. This article examines the development of generics policy in Australia, against the background of a description of international trends in this area, and related experiences of reference pricing programs. The Australian generics market remains underdeveloped due to a historical legacy of small Pharmaceutical Benefits Scheme price differentials between originator brands and generics. It is argued that policy measures open to the Australian government can be conceived as clustering around two different approaches: incremental changes within the existing regulatory framework, or a shift towards a high volume/low price role of generics which would speed up the delivery of substantial cost savings, and could provide enhanced scope for the financing of new, patented drugs.

Reconsidering the scope of the equitable mortgage arising from deposit of title documents

This article examines the underlying fairness of applying equitable security presumptions to the deposit of title documents belonging to third parties. It argues that within such transactions, the focus of the equitable jurisdiction must be upon the intention of the owner of the title documents rather than presumptions arising from the fact of the deposit. It suggests that there is no logic in applying equitable presumptions, founded on the principles of part performance, to infer a security intention in transactions involving third party title documents. The fact that the parties to a loan advance may have intended to create a mortgage between themselves does not mean that the third party owner of the title documents also intended to create a mortgage. In third party transactions, the objectives of the equity jurisdiction are best achieved through a comprehensive assessment of the intention of all parties and the abolition of presumptions based upon the bare fact of title deposit.

The need to vent and dissatisfactory self-service technology encounters

Reports of customer dissatisfaction with self-service technologies (SSTs) are becoming increasingly common. The SST context is characterised by customer participation in service production and delivery, independently of service personnel. With no opportunity for humanto- human interaction, feelings of customer irritation and frustration can have a tendency to build-up in dissatisfactory SST encounters. If SSTs do not perform as promised, customers can become angry and frustrated, and do not have the security or reassurance of human service personnel. With this in mind, it is argued that customers’ “need to vent” will be an important predictor of customers’ complaint behaviours (CCBs), i.e., voice, negative word of mouth, negative “word of mouse”, third party action, false loyalty and exit, in dissatisfactory SST encounters. The “need to vent” is defined as the need, when one has a problem, to seek relief by expressing one’s problem / “getting it off one’s chest”. This construct has been subject to little conceptual or empirical scrutiny, and to the researchers’ knowledge, has not been previously operationalised or measured. This paper begins to address this gap by presenting a conceptual model and hypotheses depicting the relationships between the need to vent and CCBs in the context of SSTs.

Consumer complaint behaviour in sport consumption: a theoretical model

In this study, traditional consumer complaint behaviours (CCBs) are re-examined in an experiential context; specifically, the consumption of live sport. It is proposed that these behaviours are not motivated by the “traditional” antecedents, and further, that they are not enacted with the purpose of reducing dissonance. Instead, it would appear that traditional CCBs, such as private responses, direct voicing and third party action take on a more functional role in the sport consumption experience. The possibility exists that for some spectators, these CCBs, which have been traditionally classified as negative, actually contribute to overall enjoyment of, and satisfaction with, a sport consumption experience. A review of literature in the area is presented, and a theoretical model of CCB in the experiential context is offered.

Green decisions : demographics and consumer understanding of environmental labels

This research examined the demographic profiles of Australian green consumers in relation to their satisfaction of environmental labelling. It examined consumers’ understanding of labelling and empirically investigated the association of demographic profile of consumers with their attitudes towards such labels. The results indicated that some of the demographic variables were significant, which is largely consistent with earlier findings by other researchers in this area. Label dissatisfaction was higher in the older and middle age respondents. However, some respondents disagreed that labels were accurate while commenting that labels were easy to understand. The key issue arising from the findings is that in order to provide perception of accuracy in labels, it is an option to use Type I or Type III labelling on products. These labels are, arguably, more credible because they are endorsed by third party labelling experts. This would come at a cost and for green products that use third party labelling, they will also have to bear in mind to keep the prices competitive.

A conceptual model for security outsourcing

This research analyses the current literature on IT security outsourcing and the organisational attitudes towards this approach to determine the applicability of outsourcing IT security in a commercial environment. A conceptual model is developed as the main goal of research which provides guidance in the process of outsourcing IT security functions to a third-party security service provider. The research conducted has established a complete process for outsourcing IT security.

Colorectal cancer screening in Australia: an economic evaluation of a potential biennial screening program using faecal occult blood tests

Objective: To evaluate whether the introduction of a national, co-ordinated screening program using the faecal occult blood test represents 'value-for-money' from the perspective of the Australian Government as third-party funder.  Methods: The annual equivalent costs and consequences of a   biennial screening program in 'steady-state' operation were estimated for the Australian population using 1996 as the reference year. Disability-adjusted life years (DALYs) and the years of life lost (YLLs) averted, and the health service costs were modelled, based on the epidemiology and the costs of colorectal cancer in Australia together with the mortality reduction achieved in randomised controlled trials. Uncertainty in the model was examined using Monte Carlo simulation methods. Results: We estimate a minimum or 'base program' of screening those aged 55 to 69 years could avert 250 deaths per annum (95% uncertainty interval 99–400), at a gross cost of $A55 million (95% UI $A46 million to $A96 million) and a gross incremental cost-effectiveness ratio of $A17,000/DALY (95% UI $A13,000/DALY to $A52,000/DALY). Extending the program to include 70 to 74-year-olds is a more effective option (cheaper and higher health gain) than including the 50 to 54-year-olds. Conclusions: The findings of this study support the case for a national program directed at the 55 to 69-year-old age group with extension to 70 to 74-year-olds if there are sufficient resources. The pilot tests recently announced in Australia provide an important opportunity to consider the age range for screening and the sources of uncertainty, identified in the modelled evaluation, to assist decisions on implementing a full national program.