Cost of stroke in Australia from a societal perspective: results from the north east Melbourne stroke incidence study (NEMESIS)

Background and Purpose—— Accurate information about resource use and costs of stroke is necessary for informed health service planning. The purpose of this study was to determine the patterns of resource use among stroke patients and to estimate the total costs (direct service use and indirect production losses) of stroke (excluding SAH) in Australia for 1997.

Methods—— An incidence-based cost-of-illness model was developed, incorporating data obtained from the North East Melbourne Stroke Incidence Study (NEMESIS). The costs of stroke during the first year after stroke and the present value of total lifetime costs of stroke were estimated.

Results—— The total first-year costs of all first-ever-in-a lifetime strokes (SAH excluded) that occurred in Australia during 1997 were estimated to be A$555 million (US$420 million), and the present value of lifetime costs was estimated to be A$1.3 billion (US$985 million). The average cost per case during the first 12 months and over a lifetime was A$18 956 (US$14 361) and A$44 428 (US$33 658), respectively. The most important categories of cost during the first year were acute hospitalization (A$154 million), inpatient rehabilitation (A$150 million), and nursing home care (A$63 million). The present value of lifetime indirect costs was estimated to be A$34 million.

Conclusions—— Similar to other studies, hospital and nursing home costs contributed most to the total cost of stroke (excluding SAH) in Australia. Inpatient rehabilitation accounts for {approx}27% of total first-year costs. Given the magnitude of these costs, investigation of the cost-effectiveness of rehabilitation services should become a priority in this community.

Prolactin, body condition and the cost of good parenting: an interyear study in a long-lived seabird, Gould's Petrel (Pterodroma leucoptera)

1. The pituitary hormone prolactin is thought to play an important role in the promotion of parental care in birds and mammals. The level of care parents provide is, however, likely to be influenced by additional factors, such as their physiological condition at the time of breeding.

2. We examined relationships between parental body condition, plasma prolactin levels and reproductive performance in Gould's Petrels (Pterodroma leucoptera), a long-lived seabird. We predicted that parental body condition would correlate positively with both prolactin level and parenting intensity, as measured by the quality of the chick they produced. We also examined the effects of parenting intensity on parental body condition and reproductive success in the subsequent breeding season.

3. Body condition of male parents positively correlated with prolactin levels at the start of their second protracted incubation bout. The body condition of both parents correlated positively with the body condition of their chick at its peak mass. However, producing a good-quality chick did not negatively affect parental body condition or reproductive success the following year.

4. These results suggest that prolactin reinforces parental behaviour in parents in good body condition, which facilitates production of good-quality chicks. Moreover, good-quality parents consistently produce good-quality chicks with no apparent trade-off to their physical condition.

Cost of reproduction in the Queensland fruit fly: Y-model versus lethal protein hypothesis

The trade-off between lifespan and reproduction is commonly explained by differential allocation of limited resources. Recent research has shown that the ratio of protein to carbohydrate (P : C) of a fly's diet mediates the lifespan–reproduction trade-off, with higher P : C diets increasing egg production but decreasing lifespan. To test whether this P : C effect is because of changing allocation strategies (Y-model hypothesis) or detrimental effects of protein ingestion on lifespan (lethal protein hypothesis), we measured lifespan and egg production in Queensland fruit flies varying in reproductive status (mated, virgin and sterilized females, virgin males) that were fed one of 18 diets varying in protein and carbohydrate amounts. The Y-model predicts that for sterilized females and for males, which require little protein for reproduction, there will be no effect of P : C ratio on lifespan; the lethal protein hypothesis predicts that the effect of P : C ratio should be similar in all groups. In support of the lethal protein hypothesis, and counter to the Y-model, the P : C ratio of the ingested diets had similar effects for all groups. We conclude that the trade-off between lifespan and reproduction is mediated by the detrimental side-effects of protein ingestion on lifespan.

Workplace "bargaining" and the wages/working time nexus: counting the cost of decentralisation

The impact of deregulation on dispersion of earnings in Victoria has been
acknowledged in the findings of the recent task force enquiry into industrial relations in Victoria. This paper argues that the link between hours worked and rates of pay has played a significant role in this increased dispersion. Drawing upon detailed analysis of hours and wages in Victorian agreements, data is presented on declining take-home pay flowing from the loss of penalty rates. This, we argue, is attributable to
the lack of substantive and procedural protections available to Victorian workers under schedule 1A of the Workplace Relations Act, and formerly under the Victorian Employee Relations Act, 1992. We contrast these findings with collective agreements trading off penalty rates certified by the Australian Industrial Relations Commission, and Australian Workplace Agreements approved by the Office of the Employment
Advocate. We conclude by suggesting there is a scale of fair outcomes attached to the wages/hours trade-off, directly attributable to the various institutional mechanisms now influencing Australian wage determination.

Pharmaceutical benefits in Australia and Sweden: welfare policy and the cost of prescription drugs

Pharmaceutical benefits provide a stable framework within which consumers, prescribers, suppliers, pharmacists and other actors undertake transactions. The state in effect delivers a good that enhances individual autonomy. A major reason for the legitimacy enjoyed by pharmaceutical benefits in both Australia and Sweden is that these programs have strong attributes of universalism (rather than targeting). Sweden's predominantly public health system allows greater scope for pharmaceutical policy innovation. Australia's Pharmaceutical Benefits Scheme (PBS), while historically resilient and effective, is now wedged precariously between traditional considerations of equity and public health on the one hand, and constant pressure for increased marketisation on the other.

Aging effects on the metabolic and cognitive energy cost of interlimb coordination

Many everyday motor tasks have high metabolic energy demands, and some require extended practice to learn the required coordination between limbs. Eight older (73.1 6 4.4 years) and 8 younger (23.3 6 5.9) men practiced a  high-energy two-hand coordination task with both 1808 and 908 target  relative phase. The older group showed greater performance error in both conditions, and performance at 908 was strongly attracted to antiphase coordination (1808). In a retention test one week following the acquisition trials, the older group had learned the 1808 condition but did not learn the 908 condition. Metabolic energy cost was not different between groups, but the older men showed higher heart rate and both conditions imposed  greater cognitive demands as revealed in auditory probe reaction time. Older adults’ motor learning may be inhibited by elevated heart rate at the same  oxygen cost, increased cognitive cost, and an attraction toward more  established low-energy in-phase or antiphase coordination.

The cost of recovery protocols in web-based database systems

The cost of recovery protocols is important with respect to system performance during normal operation and failure in terms of overhead, and time taken to recover failed transactions. The cost of recovery protocols for web database systems has not been addressed much. In this paper, we present a quantitative study of cost of recovery protocols. For this purpose, we use an experiment setup to evaluate the performance of two recovery algorithms, namely the, two-phase commit algorithm and log-based algorithm. Our work is a step towards building reliable protocols for web database systems.

Lifetime cost of stroke subtypes in Australia: findings from the North East Melbourne stroke incidence study (NEMESIS)

Background and Purpose-: Little is known about any variations in resource use and costs of care between stroke subtypes, especially nonhospital costs. The purpose of this study was to describe the patterns of resource use and to estimate the first-year and lifetime costs for stroke subtypes.

Methods-: A cost-of-illness model was used to estimate the total first-year costs and lifetime costs of stroke subtypes for all strokes (subarachnoid hemorrhages excluded) that occurred in Australia during 1997. For each subtype, average cost per case during the first year and the present value of average cost per case over a lifetime were calculated. Resource use data obtained in the North East Melbourne Stroke Incidence Study (NEMESIS) were used.

Results-: The present value of total lifetime costs for all strokes was Aus $1.3 billion (US $985 million). Total lifetime costs were greatest for ischemic stroke (72%; Aus $936.8 million; US $709.7 million), followed by intracerebral hemorrhage (26%; Aus $334.5 million; US $253.4 million) and unclassified stroke (2%; Aus $30 million; US $22.7 million). The average cost per case during the first year was greatest for total anterior circulation infarction (Aus $28 266). Over a lifetime, the present value of average costs was greatest for intracerebral hemorrhage (Aus $73 542), followed by total anterior circulation infarction (Aus $53 020), partial anterior circulation infarction (Aus $50 692), posterior circulation infarction (Aus $37 270), lacunar infarction (Aus $34 470), and unclassified stroke (Aus $12 031).

Conclusions-: First-year and lifetime costs vary considerably between stroke subtypes. Variation in average length of total hospital stay is the main explanation for differences in first-year costs.

Determination of yield and erosion damage functions using subjectively elicited data: application to small holder tea in Sri Lanka

Tea has been Sri Lanka's major export earner for several decades. However, soil erosion on tea-producing land has had considerable on-site and off-site effects. This study quantifies soil erosion impacts for smallholder tea farms in Sri Lanka by estimating a yield damage function and an erosion damage function using a subjective elicitation technique. The Mitscherlich-Spillman type of function was found to yield acceptable results. The study indicates that high rates of soil erosion require earlier adoption of soil conservation measures than do low rates of erosion. Sensitivity analysis shows the optimum year to change to a conservation practice is very sensitive to the discount rate but less sensitive to the cost of production and price of tea.

Estimating the user cost of soil erosion in tea smallholdings in Sri Lanka

Soil erosion in developing countries is a widespread problem causing considerable economic damage. It still remains an intractable problem in many countries. Available research findings on costs of soil erosion indicate them to be high. Soil erosion continues to be a problem due to the difficulties of estimating the economic damages and attendant difficulties in developing effective control policies. This paper considers soil to be a nonrenewable resource and estimates the marginal user costs using a yield damage function. Results indicate user costs to be low for individual farms. The low user costs are due to some of the assumptions made with respect to a number of parameters such as prices of tea, costs, and technological developments. The results also indicate that marginal user costs are sensitive to prices, soil depth and soil loss.

It's time to determine the cost of a healthy diet in Australia

Economic factors are important determinants of food security. In terms of food access, financial resources determine an individual’s ability to procure food; on the supply side, the cost of food is equally important. The interplay of these two factors, financial resources and cost, is perhaps the most immediate and important determinant of what people do (or do not) put into their shopping trolleys or purchase at the takeaway and ultimately eat – if you cannot afford it you cannot eat it even if you want to!

The cost of storing checkpoints to multiple volatile storage locations using at-least-k semantics

Using the volatile memory of other computers within a system to store checkpoints is an alternative to the traditional approach of using stable storage. The objective of this study is to develop a storage mechanism using at-least-k delivery semantics. This semantics allows data to be saved to a minimum number of computers simultaneously using group communications, without requiring that each group computer successfully acknowledge the receipt. The new storage mechanism is implemented in the GENESIS checkpointing facility v2.0. The results showed that at-least-k storage mechanisms provide low storage latency times; however, the incurred execution overheads on the applications executing within the system are higher than that when using remote stable storage to store checkpoints.

Reduction of fuel consumption in an industrial glass melting furnace

Reduction of fuel consumption in glass melting furnaces can cut the cost of production, and tackle the global warming. This paper presents three independent solutions to reduce the fuel consumption in industrial glass melting furnaces. The solutions include air preheating, raw material preheating, and improving the insulation of combustion space refractory. Energy balance equations are derived and used to identify the effects of each solution. The results indicate that the three solutions reduce the fuel consumption by 9.5%, 17%, and 34%, respectively.

Tendering for low cost generics in Australia

An Australian federal government committee recently proposed, as a cost-saving measure, the introduction of sealed-bid competitive tendering to exclusively supply the Pharmaceutical Benefits Scheme with specific generic medicines. A similar plan involved an open tender to supply generic products below a government set price, also linked with a reduced patient co-payment as an incentive. These proposals represented an opportunity to encourage the price of generic pharmaceuticals to move closer to the marginal cost of production—a process that could be subsequently applied to innovative (or brand-name) patented medicines in a therapeutic class with many competitors. This article examines these tendering proposals, particularly in relation to the potential for increased involvement of generic pharmaceutical manufacturers in the Australian market.

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.