Outcome valuation in the economic evaluation of healthcare

University of Technology, Sydney. Faculty of Business.Economic evaluation of healthcare interventions (such as pharmaceuticals, medical devices and technologies) considers both the effect of the intervention on patients, and the costs borne by the government and often the individual themselves. This simultaneous consideration of costs and benefits is now standard practice in reimbursement decisions, both in Australia and elsewhere. This thesis focuses on the assessment of benefits, specifically how we place a value on the health changes patients experience as a result of a health care intervention. There is a well-established framework for how outcomes are valued in health care, but this framework is built on a number of contentious assumptions. For example, health is assumed to be the sole outcome of a healthcare system, and society is assumed to be inequality-neutral. This thesis identifies and explains these assumptions and then focuses on testing two of them in the empirical chapters. The overall aim of the thesis is to explore the extent to which the current framework reflects population preferences, and whether the framework can be adapted to be more reflective of population preferences. The empirical chapters in this thesis consider these issues, using a discrete choice experiment (DCE). For reasons presented in Chapters 3 and 4, this technique offers very attractive properties for answering these types of questions. The standard approach to valuing health outcomes uses the quality-adjusted life year, in which the value of a health profile is the product of quality of life and length of life. For this to be operationalised, we need to be able to describe health states in a way which captures all relevant dimensions of quality of life that are important to people, and then we need to assign values to health states. This thesis argues that the current methods for assigning values to health states are very onerous for survey respondents, and prone to significant bias. Standard valuation techniques require the respondent to identify preferences around quality of life through the acceptance of a risk of death, or the reduction of life expectancy to alleviate poor quality of life. However, these fail to control for issues such as risk-aversion or time preference. The first empirical analysis uses a DCE to value health states for the SF-6D, a health state valuation instrument that is based on the very widely used quality of life instrument the SF-36. The use of a DCE aims to remove (or control for) these biases. This chapter represents a methodological advance through the use of a DCE, and produces the first Australian algorithm for the SF-6D. The second empirical analysis considers the assumption that the value of health improvement is independent of who receives it. Therefore, it is conventional for an extra year in full health to be regarded as being of the same value to society independent of who receives it. The chapter results suggest that the average respondent prefers giving additional health to people with low life expectancies, carers, and non-smokers even if it reduces total health for society as a whole. The chapter concludes by identifying how these preferences might be integrated into economic evaluation. This thesis explores two areas in which the conventional approach to outcome valuation in economic evaluation are subject to concern. It demonstrates how these concerns might be overcome by augmenting the existing framework with relatively easily-collected stated preference data, and offers a template for other analyses exploring other parts of how health outcomes should be valued

Effect of women cooperatives on livelihood of members in Abia state, Nigeria

Effect of women cooperatives on the livelihood of their members was assessed using descriptive statistics. The study covered Ohafia, Umuahia and Aba Agricultural Zones in Abia State. Respondents comprised 180 members of cooperatives (cooperators) and 180 non-members (non- cooperators) respectively for comparison, giving a sample size of 360. Data collected were analyzed using descriptive statistical tools such as means scores, percentages, frequencies and tables. Results showed that all (100%) of the respondents were literates but 93.3% were married, while age range of the respondents was 40 – 59 years. About one half (50%) and 36% of the respondents were farmers and traders respectively. Effect of the cooperatives on the livelihood of members revealed that 74% of the cooperators acquired higher educational qualification as against 44% of the non-cooperators. Similarly, 66.7% of the cooperators and 23% of the non-cooperators lived in houses with rugged palours. Cooperative members had about seven (7) contacts with Agricultural Extension Agents (AEAs) per month while non- cooperators had about three contacts with AEAs per month. Cooperators earned 50 – 90.9% higher income (N21,000 – N 30,000/ month) than non- cooperators (N 11,000 – N 20,000/ month ). Consequently, cooperators had 100 children in higher institutions as against 48 children of non-cooperators suggesting that cooperators are economically advantaged over non- cooperators. From the foregoing, it is concluded that membership of women cooperatives is a roadmap to improved livelihood of rural women and their farm families and therefore should be encouraged among the rural women.Keywords: Women Cooperatives, Livelihood Activities, Effect on Members

Of Ruptures and Raptures: Locating Ideology with LiDAR Imagery

Archaeological praxis necessarily requires at least one object (an artifact; a piece of technology or something that functions as an object) to articulate and explain ideologies from the past. The problem is that the object of ideological desire is abstract and difficult to locate in the archaeological record in reified form. Historical Archaeologist Mark P. Leone attempted to locate such an object several times while conducting archaeological investigations into historical Mormonism, Mormon historical ecology, and technologies employed by Mormons in the arid American West. It is posited here that the object of Mormon ideological desire in the archaeological record within capitalism can be identified and located if certain assumptions and definitions are accepted from philosopher Slavoj Žižek and if one deconstructs a myth. There is a presupposition that if one deconstructs a myth, one stands an increased chance of discovering evidence of the truth behind it. Historical landscape archaeology landscape analysis of LiDAR imagery in GIS facilitated the interpretation of a local legend (a myth), archival maps, records, and Mormon land-use patterns in two historic landscapes‒Grovont, Wyoming/Mormon Row Historic District (48TE1444) and the Little Colorado River basin in Arizona‒leading to the identification and location of the sublime object of Mormon ideology

The Three Neurogenetic Phases of Human Consciousness.

ABSTRACT This paper is an organization and conceptualization of a genetic account of human consciousness and to establish an initial list of the neurogenetic correlates of consciousness (NgCC). This will be accomplished by establishing networks of genes that are involved in the multiple facets of the process of human consciousness. The methodology utilized in this work is the evaluation of a small number of genes that have been researched experimentally in order to understand their role in brain development and function. The results demonstrate that most neurogenetic genes can be categorized into three phases: the emergence of neuron-based consciousness, the continuum of neuron-based consciousness, and the neurodegeneration of consciousness. This work also revealed that some genes have a function in more than one of the neurogenetic phases. As of now a starting point has been established in terms of identifying some NgCC but there is room for expansion as there are likely to be hundreds of more genes that have yet to be identified or the function pertaining to human consciousness has not yet been fully understood

Using AI-Enhanced Social Robots to Improve Children’s Healthcare Experiences

This paper describes a new research project that aims to develop an autonomous and responsive social robot designed to help children cope with painful procedures in hospital emergency departments. While this is an application domain where psychological interventions have been previously demonstrated to be effective at reducing pain and distress using a variety of devices and techniques, in recent years, social robots have been trialled in this area with promising initial results. However, until now, the social robots that have been tested have generally been teleoperated, which has limited their flexibility and robustness, as well as the potential to offer personalized, adaptive procedural support. Using co-design techniques, this project plans to define and validate the necessary robot behaviour together with participant groups that include children, parents and caregivers, and healthcare professionals. Identified behaviours will be deployed on a robot platform, incorporating AI reasoning techniques that will enable the robot to adapt autonomously to the child’s behaviour. The final robot system will be evaluated through a two-site clinical trial. Throughout the project, we will also monitor and analyse the ethical and social implications of robotics and AI in paediatric healthcare

Effects of malathion and carbendazim on Amazonian freshwater organisms: comparison of tropical and temperate species sensitivity distributions

The risk assessment of pesticides for freshwater ecosystems in the Amazon has relied on the use of toxicity data and water quality criteria derived for temperate regions due to a lack of ecotoxicological studies performed with indigenous species. This leaves an unknown margin of uncertainty for the protection of Amazonian ecosystems, as differences in environmental conditions and species sensitivity are not taken into account. To address this issue, the acute toxic effects of malathion (an organophosphorus insecticide) and carbendazim (a benzimidazole fungicide) were assessed on five fish and five freshwater invertebrates endemic to the Amazonian region. Subsequently, the intrinsic sensitivity of Amazonian and temperate freshwater species was compared using the species sensitivity distribution (SSD) concept. Amazonian species sensitivity to malathion was found to be similar to that of their temperate counterparts, with LC50 values ranging between 111 and 1507 μg/l for fish species and 2.1–426 μg/l for arthropod species. However, Amazonian fish appeared to be slightly less sensitive for carbendazim than temperate fish with LC50 values ranging between 1648 and 4238 μg/l, and Amazonian invertebrates were found to be significantly more resistant than their temperate counterparts, with LC50 values higher than 16000 μg/l. The results of this study suggest that for these compounds, the use of water quality criteria derived with laboratory toxicity data for temperate species will result in a sufficient protection level for Amazonian freshwater organisms. Recommendations for further research include the validation of threshold concentrations derived with temperate standard test species and with the SSD model with semi-field experiments considering larger assemblages of indigenous species under local environmental conditions