Cost-effectiveness analysis of a kidney and cardiovascular disease treatment program in an Australian aboriginal population

The objective of the study was to assess, from a health service perspective, whether a systematic program to modify kidney and cardiovascular disease reduced the costs of treating end-stage kidney failure. The participants in the study were 1,800 aboriginal adults with hypertension, diabetes with microalbuminuria or overt albuminuria, and overt albuminuria, living on two islands in the Northern Territory of Australia during 1995 to 2000. Perindopril was the primary treatment agent, and other medications were also used to control blood pressure. Control of glucose and lipid levels were attempted, and health education was offered. Evaluation of program resource use and costs for follow-up periods was done at 3 and 4.7 years. On an intention-to-treat basis, the number of dialysis starts and dialysis-years avoided were estimated by comparing the fate of the treatment group with that of historical control subjects, matched for disease severity, who were followed in the before the treatment program began. For the first three years, an estimated 11.6 person-years of dialysis were avoided, and over 4.7 years, 27.7 person-years of dialysis were avoided. The net cost of the program was $1,210 more per person per year than status quo care, and dialyses avoided gave net savings of $1.0 million at 3 years and $3.4 million at 4.6 years. The treatment program provided significant health benefit and impressive cost savings in dialysis avoided. (C) 2005 by the National Kidney Foundation, Inc.

Database and narratological representation of Australian Aboriginal knowledge as information visualisation using a game engine

Current database technologies do not support contextualised representations of multi-dimensional narratives. This paper outlines a new approach to this problem using a multi-dimensional database served in a 3D game environment. Preliminary results indicate it is a particularly efficient method for the types of contextualised narratives used by Australian Aboriginal peoples to tell their stories about their traditional landscapes and knowledge practices. We discuss the development of a tool that complements rather than supplants direct experience of these traditional knowledge practices.

Performing traditional knowledge using a game engine: Communicating and sharing Australian Aboriginal knowledge practices

This paper challenges current practices in the use of digital media to communicate Australian Aboriginal knowledge practices in a learning context. It proposes that any digital representation of Aboriginal knowledge practices needs to examine the epistemology and ontology of these practices in order to design digital environments that effectively support and enable existing Aboriginal knowledge practices in the real world. Central to this is the essential task of any new digital representation of Aboriginal knowledge to resolve the conflict between database and narrative views of knowledge (L. Manovich, 2001). This is in order to provide a tool that complements rather than supplants direct experience of traditional knowledge practices (V. Hart, 2001). This paper concludes by reporting on the recent development of an advanced learning technology that addresses this.

Competing "Host" Discourses: Appropriation of Australian Aboriginal Culture in the Tourism Borderzones

Thesis (Ph.D.)--University of Washington, 2016-08

The economic feasibility of price discounts to improve diet in Australian Aboriginal remote communities

OBJECTIVE: To estimate the cost-effectiveness of fiscal measures applied in remote community food stores for Aboriginal Australians.

METHODS: Six price discount strategies on fruit, vegetables, diet drinks and water were modelled. Baseline diet was measured as 12 months' actual food sales data in three remote Aboriginal communities. Discount-induced changes in food purchases were based on published price elasticity data while the weight of the daily diet was assumed constant. Dietary change was converted to change in sodium and energy intake, and body mass index (BMI) over a 12-month period. Improved lifetime health outcomes, modelled for the remote population of Aboriginal and Torres Strait Islanders, were converted to disability adjusted life years (DALYs) saved using a proportional multistate lifetable model populated with diet-related disease risks and Aboriginal and Torres Strait Islander rates of disease.

RESULTS: While dietary change was small, five of the six price discount strategies were estimated as cost-effective, below a $50,000/DALY threshold.

CONCLUSION: Stakeholders are committed to finding ways to reduce important inequalities in health status between Aboriginal and Torres Strait Islanders and non-Indigenous Australians. Price discounts offer potential to improve Aboriginal and Torres Strait Islander health. Verification of these results by trial-based research coupled with consideration of factors important to all stakeholders is needed.