Routine Measurement of Health-Related Quality of Life in Assessing Cost-Effectiveness in Secondary Health Care

Aims: The aims of this study were 1) to identify and describe health economic studies that have used quality-adjusted life years (QALYs) based on actual measurements of patients' health-related quality of life (HRQoL); 2) to test the feasibility of routine collection of health-related quality of life (HRQoL) data as an indicator of effectiveness of secondary health care; and 3) to establish and compare the cost-utility of three large-volume surgical procedures in a real-world setting in the Helsinki University Central Hospital, a large referral hospital providing secondary and tertiary health-care services for a population of approximately 1.4 million. Patients and methods: So as to identify studies that have used QALYs as an outcome measure, a systematic search of the literature was performed using the Medline, Embase, CINAHL, SCI and Cochrane Library electronic databases. Initial screening of the identified articles involved two reviewers independently reading the abstracts; the full-text articles were also evaluated independently by two reviewers, with a third reviewer used in cases where the two reviewers could not agree a consensus on which articles should be included. The feasibility of routinely evaluating the cost-effectiveness of secondary health care was tested by setting up a system for collecting HRQoL data on approximately 4 900 patients' HRQoL before and after operative treatments performed in the hospital. The HRQoL data used as an indicator of treatment effectiveness was combined with diagnostic and financial indicators routinely collected in the hospital. To compare the cost-effectiveness of three surgical interventions, 712 patients admitted for routine operative treatment completed the 15D HRQoL questionnaire before and also 3-12 months after the operation. QALYs were calculated using the obtained utility data and expected remaining life years of the patients. Direct hospital costs were obtained from the clinical patient administration database of the hospital and a cost-utility analysis was performed from the perspective of the provider of secondary health care services. Main results: The systematic review (Study I) showed that although QALYs gained are considered an important measure of the effectiveness of health care, the number of studies in which QALYs are based on actual measurements of patients' HRQoL is still fairly limited. Of the reviewed full-text articles, only 70 reported QALYs based on actual before after measurements using a valid HRQoL instrument. Collection of simple cost-effectiveness data in secondary health care is feasible and could easily be expanded and performed on a routine basis (Study II). It allows meaningful comparisons between various treatments and provides a means for allocating limited health care resources. The cost per QALY gained was 2 770 for cervical operations and 1 740 for lumbar operations. In cases where surgery was delayed the cost per QALY was doubled (Study III). The cost per QALY ranges between subgroups in cataract surgery (Study IV). The cost per QALY gained was 5 130 for patients having both eyes operated on and 8 210 for patients with only one eye operated on during the 6-month follow-up. In patients whose first eye had been operated on previous to the study period, the mean HRQoL deteriorated after surgery, thus precluding the establishment of the cost per QALY. In arthroplasty patients (Study V) the mean cost per QALY gained in a one-year period was 6 710 for primary hip replacement, 52 270 for revision hip replacement, and 14 000 for primary knee replacement. Conclusions: Although the importance of cost-utility analyses has during recent years been stressed, there are only a limited number of studies in which the evaluation is based on patients own assessment of the treatment effectiveness. Most of the cost-effectiveness and cost-utility analyses are based on modeling that employs expert opinion regarding the outcome of treatment, not on patient-derived assessments. Routine collection of effectiveness information from patients entering treatment in secondary health care turned out to be easy enough and did not, for instance, require additional personnel on the wards in which the study was executed. The mean patient response rate was more than 70 %, suggesting that patients were happy to participate and appreciated the fact that the hospital showed an interest in their well-being even after the actual treatment episode had ended. Spinal surgery leads to a statistically significant and clinically important improvement in HRQoL. The cost per QALY gained was reasonable, at less than half of that observed for instance for hip replacement surgery. However, prolonged waiting for an operation approximately doubled the cost per QALY gained from the surgical intervention. The mean utility gain following routine cataract surgery in a real world setting was relatively small and confined mostly to patients who had had both eyes operated on. The cost of cataract surgery per QALY gained was higher than previously reported and was associated with considerable degree of uncertainty. Hip and knee replacement both improve HRQoL. The cost per QALY gained from knee replacement is two-fold compared to hip replacement. Cost-utility results from the three studied specialties showed that there is great variation in the cost-utility of surgical interventions performed in a real-world setting even when only common, widely accepted interventions are considered. However, the cost per QALY of all the studied interventions, except for revision hip arthroplasty, was well below 50 000, this figure being sometimes cited in the literature as a threshold level for the cost-effectiveness of an intervention. Based on the present study it may be concluded that routine evaluation of the cost-utility of secondary health care is feasible and produces information essential for a rational and balanced allocation of scarce health care resources.

Management implications of climate change impacts of fisheries resources

This application was developed in response to the widely recognised concern that climate change will result in changes to marine life and ecosystems, and hence fisheries, throughout Australia with tropical marine ecosystems in northern Australia identified as being particularly vulnerable. These changes are predicted to vary spatially depending on local climate and biophysical processes. Northern Australia is one of three major Australian regions predicted to be impacted. The project addresses the important FRDC strategic challenge of improving the management of aquatic natural resources to ensure their sustainability through research and management that accounts for the effects that climate change may have on the resources.

GRDC Improving crop and farm water use efficiency in Australia

Project Objectives: 1. Improving yield and water use efficiency of the wheat crop, the backbone of the Australia grains industry, by better matching management, variety, soil and climate. The aim is thus increasing kg grain/ha per mm evapotranspiration and kg grain/ha per mm rain. 2. Improving land and water productivity and profit by better arrangement of the components of the cropping system. This involves better allocation of farm resources (land, water, machinery, labour) and identifying strategies that account for trade-offs between profit and risk. The aim is thus improving $/ha per year and mm rain in a risk framework.

Fisheries resources of the Bohle River, Queensland.

The fisheries resources of the Bohle River and its small catchment area adjacent Townsville, north Queensland, were investigated through available literature, scientific research surveys and analysis of commercial and recreational catch and effort data. Research surveys produced a total of 4383 fish from the waters of the Bohle River during 1997-1998. These were classified into 104 fish species from 49 families. Gillnetting, cast netting, fish trapping and crab potting techniques were used in the estuarine waters of the Bohle River with freshwater reaches in the upper catchment surveyed by electrofishing. This range of survey techniques was used to estimate the relative abundance of ten commercially and recreationally important species: Barramundi (Lates calcarifer), king threadfin (Polydactylus macrochir), blue threadfin (Eleutheronema tetradactylum), mangrove jack (Lutjanus argentimaculatus), banded and spotted grunter (Pomadasys kaakan and Pomadasys argenteus), pikey and yellowfin bream (Acanthopagrus berda and Acanthopagrus australis), tilapia (Oreochromis spp.), jungle perch (Kuhlia rupestris) and mud crab (Scylla serrata). The results of each survey method are discussed with a focus on spatial and temporal patterns in diversity and catch rate.

A multi-field bio-economic model of irrigated grain-cotton farming systems.

We present a participatory modelling framework that integrates information from interviews and discussions with farmers and consultants, with dynamic bio-economic models to answer complex questions on the allocation of limited resources at the farm business level. Interviews and discussions with farmers were used to: describe the farm business; identify relevant research questions; identify potential solutions; and discuss and learn from the whole-farm simulations. The simulations are done using a whole-farm, multi-field configuration of APSIM (APSFarm). APSFarm results were validated against farmers' experience. Once the model was accepted by the participating farmers as a fair representation of their farm business, the model was used to explore changes in the tactical or strategic management of the farm and results were then discussed to identify feasible options for improvement. Here we describe the modelling framework and present an example of the application of integrative whole farm system tools to answer relevant questions from an irrigated farm business case study near Dalby (151.27E - 27.17S), Queensland, Australia. Results indicated that even though cotton crops generates more farm income per hectare a more diversified rotation with less cotton would be relatively more profitable, with no increase in risk, as a more cotton dominated traditional rotation. Results are discussed in terms of the benefits and constraints from developing and applying more integrative approaches to represent farm businesses and their management in participatory research projects with the aim of designing more profitable and sustainable irrigated farming systems.

Australian Timber Pole Resources for Energy Networks. A review

More than 5 million timber utility poles are currently in-service throughout Australia’s energy networks. Most were produced from select native forest-grown hardwood species having the required structural characteristics and naturally-durable heartwood. Anecdotal evidence suggests that up to 70% of the timber poles that are currently in-service were installed over the 20 years following the end of World War Two, and these poles are likely to require replacement or remedial maintenance over the next decade. The purposes of this review were to clarify the supply and demand situation for traditional timber poles, and to investigate alternatives in terms of their potential availability and suitability.

RF plasma polymerised thin films from natural resources

Plasma polymerisation is an effective tool for fabrication of thin films from volatile organic monomers. RF plasma assisted deposition is used for one-step, chemical-free polymerisation of nonsynthetic materials derived directly from agricultural produces. By varying the deposition parameters, especially the input RF power, the film properties can be tailored for a range of uses, including electronics or biomedical applications. The fabricated thin films are optically transparent with refractive index close to that of glass. Given the diversity of essential oils, this paper compares the chemical and physical properties of thin films fabricated from several commercially exploited essential oils and their components. It is interesting to note that some of the properties can be tailored for various applications even though the chemical structure of the derived polymer is very similar. The obtained material properties also show that the synthesised materials are suitable as encapsulating layers for biodegradable implantable metals.

Queensland Coastal Wetland Resources: The Whitsunday Region

This report provides key resource data for the ongoing assessment of the requirement for additional Marine Protected Areas (e.g. FHAs under the Queensland Fisheries Act 1994) in regions of high fish habitat value in the Whitsunday Region from Gloucester Island to Cape Hillsborough (hereafter referred to as the Study Area). The study also provides baseline information on the coastal wetlands within this Study Area for consideration in the Ramsar site nomination process. The project aimed to: 1. document and map the coastal wetland communities of the Study Area; 2. document levels of existing disturbance to and protection of the wetlands; 3. examine existing recreational, indigenous and commercial fisheries resources in the region; 4. evaluate the conservation values of the areas investigated from the viewpoint of fisheries productivity and as habitat for important and/or threatened species for future FHA/MPA declaration.

Queensland Coastal Wetland Resources: Round Hill Head to Tin Can Inlet

The wetland resources of the Queensland coastline have been mapped by the Resource Condition and Trend Unit, Fisheries Group, Department of Primary Industries Queensland. This process is being undertaken in order to provide a baseline dataset for Fish Habitat Area (FHA) declaration, Ramsar site nomination and continued monitoring of these important fish habitats. This report summarises the results of the mapping undertaken from Round Hill Head to Tin Can Inlet. The study was undertaken in order to: 1. document and map the coastal wetland communities from Round Hill Head (24°S) to Tin Can Inlet (26°S); 2. document levels of existing disturbance to and protection of the wetlands; 3. examine existing recreational and commercial fisheries in the region; and 4. evaluate the conservation values of the areas investigated from the viewpoint of fisheries productivity and as habitat for important and/or threatened species.

Stand structural dynamics on pristine and managed boreal peatlands

The objectives of this study were to investigate the stand structure and succession dynamics in Scots pine (Pinus sylvestris L.) stands on pristine peatlands and in Scots pine and Norway spruce (Picea abies (L.) Karst.) dominated stands on drained peatlands. Furthermore, my focus was on characterising how the inherent and environmental factors and the intermediate thinnings modify the stand structure and succession. For pristine peatlands, the study was based on inventorial stand data, while for drained peatlands, longitudinal data from repeatedly measured stands were utilised. The studied sites covered the most common peatland site types in Finland. They were classified into two categories according to the ecohydrological properties related to microsite variation and nutrient levels within sites. Tree DBH and age distributions in relation to climate and site type were used to study the stand dynamics on pristine sites. On drained sites, the Weibull function was used to parameterise the DBH distributions and mixed linear models were constructed to characterise the impacts of different ecological factors on stand dynamics. On pristine peatlands, both climate and the ecohydrology of the site proved to be crucial factors determining the stand structure and its dynamics. Irrespective of the vegetation succession, enhanced site productivity and increased stand stocking they significantly affected the stand dynamics also on drained sites. On the most stocked sites on pristine peatlands the inter-tree competition seemed to also be a significant factor modifying stand dynamics. Tree age and size diversity increased with stand age, but levelled out in the long term. After drainage, the stand structural unevenness increased due to the regeneration and/or ingrowth of the trees. This increase was more pronounced on sparsely forested composite sites than on more fully stocked genuine forested sites in Scots pine stands, which further undergo the formation of birch and spruce undergrowth beneath the overstory as succession proceeds. At 20-30 years after drainage the structural heterogeneity started to decrease, indicating increased inter-tree competition, which increased the mortality of suppressed trees within stand. Peatland stands are more dynamic than anticipated and are generally not characterized by a balanced, self-perpetuating structure. On pristine sites, various successional pathways are possible, whereas on drained sites the succession has more uniform trend. Typically, stand succession proceeds without any distinct developmental stages on pristine peatlands, whereas on drained peatlands, at least three distinct stages could be identified. Thinnings had only little impact on the stand succession. The new information on stand dynamics may be utilised, e.g. in forest management planning to facilitate the allocation of the growth resources to the desired crop component by appropriate silvicultural treatments, as well as assist in assessing the effects of the climate change on the forested boreal peatlands.

Comparative growth and biomass allocation of two varieties of cat's claw creeper, Dolichandra unguis-cati (Bignoniaceae) in Australia

Introduced as an ornamental vine, cat's claw creeper Dolichandra unguis-cati (syn. Macfadyena unguis-cati) has invaded coastal and subcoastal areas of subtropical eastern Australia. Two varieties have been indentified, one of which ('short-pod') is found throughout south-eastern Australia, while the other ('long-pod') appears to be restricted to several sites in south-eastern Queensland. We compared the growth and biomass allocation patterns of the two varieties in the field over a 22-month period to determine if a higher growth rate and/or more efficient allocation of biomass may contribute to this disparity in distribution. The long-pod variety produced greater aboveground and total biomass than the short-pod variety in both riparian and non-riparian zones. Belowground the two varieties produced a similar number of tubers and overall biomass, though the long-pod variety allocated a smaller portion of its carbon belowground. High growth rates and greater biomass allocation aboveground are characteristic of invasive species, allowing them to outcompete and crowd out existing vegetation. There was no significant site by variety interaction, an indication of consistency in variety performance across riparian and non-riparian sites. Results from our study suggest that differences in growth and biomass allocations are unlikely to have contributed to the disparity in distribution of the two varieties. Despite currently occupying a relatively small range, the long-pod variety may be a more adept invader than the short-pod variety, and could become more prevalent in the future. © 2012 CSIRO.

Corporate Social Responsibility (CSR) in junior and mid-tier Australian resources companies operating in developing nations - beyond the public relations offensive

NIt is now widely accepted that corporations have a responsibility to benefit society, as well as generate profit. This study used institutional theory to explore how the complex and contested notion of corporate social responsibility is understood and practiced by junior and mid-tier Australian resources companies operating in the world's most impoverished countries. The study found that CSR meaning and practice in this large but little researched group of companies was shaped by complex pressures at the global, industry, organisational and individual levels. Importantly, the study also revealed striking contradictions and ambiguities between participants' CSR aspirations and their actions and accountability.

Response of Tribolium castaneum and Rhyzopertha dominica to various resources, near and far from grain storage

Tribolium castaneum (Herbst) and Rhyzopertha dominica (F.) are common cosmopolitan pests of stored grain and grain products. We evaluated the relative attraction of T.castaneum and R.dominica to wheat, sorghum and cotton seeds in the field, near grain storage facilities and well away from storages in southern and central Queensland using multiple trapping techniques. The results show that T.castaneum is more strongly attracted to linted cotton seed relative to wheat, whereas R.dominica did not respond to cotton seed at all and was attracted only to wheat. Significantly more adults of T.castaneum (10-15 times) were attracted to traps placed on the ground, near grain storage, than to equivalent traps that were suspended (1.5m above the ground) nearby. These results suggest that Tribolium beetles detect and respond to resources towards the end of their dispersal flight, after which they localize resources while walking. By contrast R.dominica was captured only in suspended traps, which suggests they fly directly onto resources as they localize them. The ability of both species to colonize and reproduce in isolated resource patches within the relatively short time of 1month is illustrated by the returns from the traps deployed in the field (at least 1km from the nearest stored grain) even though they caught only a few beetles. The results presented here provide novel insights about the resource location behaviours of both T.castaneum and R.dominica. In particular, the relationship of T.castaneum with non-cereal resources that are not conventionally associated with this species suggests an emphasis on these other resources in investigating the resource location behaviour of these beetles. This new perspective on the ecology of T. castaneum highlights the potential role of non-cereal resources (such as the lint on cotton seed) in the spread of grain pest infestations.