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.

Cost-effectiveness of cognitive-behavioural therapy and drug interventions for major depression

Objective: Antidepressant drugs and cognitive–behavioural therapy (CBT) are effective treatment options for depression and are recommended by clinical practice guidelines. As part of the Assessing Cost-effectiveness – Mental Health project we evaluate the available evidence on costs and benefits of CBT and drugs in the episodic and maintenance treatment of major depression.

Method: The cost-effectiveness is modelled from a health-care perspective as the cost per disability-adjusted life year. Interventions are targeted at people with major depression who currently seek care but receive non-evidence based treatment. Uncertainty in model inputs is tested using Monte Carlo simulation methods.

Results: All interventions for major depression examined have a favourable incremental cost-effectiveness ratio under Australian health service conditions. Bibliotherapy, group CBT, individual CBT by a psychologist on a public salary and tricyclic antidepressants (TCAs) are very cost-effective treatment options falling below $A10 000 per disability-adjusted life year (DALY) even when taking the upper limit of the uncertainty interval into account. Maintenance treatment with selective serotonin re-uptake inhibitors (SSRIs) is the most expensive option (ranging from $A17 000 to $A20 000 per DALY) but still well below $A50 000, which is considered the affordable threshold.

Conclusions: A range of cost-effective interventions for episodes of major depression exists and is currently underutilized. Maintenance treatment strategies are required to significantly reduce the burden of depression, but the cost of long-term drug treatment for the large number of depressed people is high if SSRIs are the drug of choice. Key policy issues with regard to expanded provision of CBT concern the availability of suitably trained providers and the funding mechanisms for therapy in primary care.

A causal analysis for the expenditure data of business travelers

Determining the causal relation among attributes in a domain
is a key task in the data mining and knowledge discovery. In this
paper, we applied a causal discovery algorithm to the business traveler
expenditure survey data [1]. A general class of causal models is adopted in
this paper to discover the causal relationship among continuous and discrete variables. All those factors which have direct effect on the expense
pattern of travelers could be detected. Our discovery results reinforced
some conclusions of the rough set analysis and found some new conclusions which might significantly improve the understanding of expenditure behaviors of the business traveler.

Victorian local government reforms 1992-1999, revisited: implication for trade unions

Between 1992 and 1999 the Victorian State Government, Led by Jeff Kennett, set about implementing the most extensive public sector reform program ever witnessed in Australia, part of which involved significant changes in the organisation and operation of Local government. Although Local government had traditionally been 'the blind spot' in governmental arrangements, within three years of assuming office Local government had undergone major structural and operational change. This paper revisits this period by examining four elements of the reform agenda including the factors driving the reform, the Kennett government's approach to Local government reform, the expected outcomes sought by this government, and the policies implemented in Local government to achieve the expected outcomes. The paper identifies a number of implications for trade unions arising from this reform agenda and concludes that further investigation is warranted in this area.

Does the Triple P-Positive Parenting Program provide value for money?

Objective: The aim of the present study was to investigate the economic case for the implementation of the Triple P-Positive Parenting Program on a population basis in Queensland, Australia, in order to reduce the prevalence of conduct disorder in children. Method: Threshold analysis was undertaken together with a limited cost-effectiveness analysis. Results: The Triple P-Positive Parenting Program is a dominant intervention; that is, it costs less than the amount it saves, until the reduction in prevalence falls below 7% where net costs become positive. Conclusions: Triple P is likely to be a worthwhile use of limited health funds. The economic case is promising, but further research is required to confirm the study results.

Childhood obesity - a sign of commercial success, but a market failure.

'Obesogenic' products, such as energy dense foods, passive entertainment products, cars, and labour-saving devices, are widely available and heavily promoted. Because they are highly consumed and very profitable, obesity becomes the inevitable consequence of their commercial successes. Contemporary market forces heavily favour behaviours for short-term preferences (i.e. over-consumption and underactivity) over long-term preferences (i.e. healthy weight) and this is especially true for children. Hence, if the market, as the main mechanism for determining choices, results in outcomes, which make our children worse off, as is occurring with childhood obesity, then the market has failed to sustain and promote social and individual goals. This is a serious market failure. In the current obesogenic environment, expecting adults, let alone children, to make food and activity choices in their own best long-term interests is, therefore, demonstrably flawed. We argue that significant government intervention is needed to correct this market failure, as has been done for other major health problems.

USGS Topographic Maps over a Hillshaded Digital Elevation Model

http://digitalcommons.colby.edu/atlasofmaine2005/1013/thumbnail.jpg