Analysis of uncertainty in health care cost-effectiveness studies: an introduction to statistical issues and methods

Cost-effectiveness analysis is now an integral part of health technology assessment and addresses the question of whether a new treatment or other health care program offers good value for money. In this paper we introduce the basic framework for decision making with cost-effectiveness data and then review recent developments in statistical methods for analysis of uncertainty when cost-effectiveness estimates are based on observed data from a clinical trial. Although much research has focused on methods for calculating confidence intervals for cost-effectiveness ratios using bootstrapping or Fieller’s method, these calculations can be problematic with a ratio-based statistic where numerator and=or denominator can be zero. We advocate plotting the joint density of cost and effect differences, together with cumulative density plots known as cost-effectiveness acceptability curves (CEACs) to summarize the overall value-for-money of interventions. We also outline the net-benefit formulation of the cost-effectiveness problem and show that it has particular advantages over the standard incremental cost-effectiveness ratio formulation

Early analysis of the Australian COVID-19 epidemic

As of 1 May 2020, there had been 6808 confirmed cases of COVID-19 in Australia. Of these, 98 had died from the disease. The epidemic had been in decline since mid-March, with 308 cases confirmed nationally since 14 April. This suggests that the collective actions of the Australian public and government authorities in response to COVID-19 were sufficiently early and assiduous to avert a public health crisis – for now. Analysing factors that contribute to individual country experiences of COVID-19, such as the intensity and timing of public health interventions, will assist in the next stage of response planning globally. We describe how the epidemic and public health response unfolded in Australia up to 13 April. We estimate that the effective reproduction number was likely below one in each Australian state since mid-March and forecast that clinical demand would remain below capacity thresholds over the forecast period (from mid-to-late April)

Public Say Food Regulatory Policies to Improve Health in Western Australia Are Important: Population Survey Results

Objective: To investigate the level of support among Western Australian adults for food control policies to improve diet, reduce obesity and protect the environment. Methods: Attitudes towards government food control policies on food labelling, food advertising, and the supply of environmentally friendly food data were pooled from two Nutrition Monitoring Survey Series telephone surveys of 2,147 adults aged 18–64 years collected in 2009 and 2012. Descriptive and logistic regression analyses were conducted using survey module of STATA 12.Results: The majority of adults believe it is important that government regulates food policy options under consideration: nutrition information on food labels (97% versus 2% who think it is not important);health rating on food labels (95% versus 3%); food advertising (83% versus 11%); and the supply of environmentally friendly food (86% versus 9%).Conclusions: Community perception is that government control or regulation of food labelling, food advertising and the supply of environmentally friendly food is important. Implications: Curbing excess weight gain and related disease burden is a public health priority. Australian governments are considering food regulatory interventions to assist the public to improve their dietary intake. These findings should provide reassurance to government officials considering these regulatory measures

Footing the bill: the introduction of Medicare Benefits Schedule rebates for podiatry services in Australia

The introduction of Medicare Benefits Schedule items for allied health professionals in 2004 was a pivotal event in the public funding of non-medical primary care services. This commentary seeks to provide supplementary discussion of the article by Menz (Utilisation of podiatry services in Australia under the Medicare Enhanced Primary Care program, 2004-2008 Journal of Foot and Ankle Research 2009, 2:30), by placing these findings within the context of the podiatry profession, clinical decision making and the broader health workforce and government policy

3-Dimensional Facial Analysis-Facing Precision Public Health.

Precision public health is a new field driven by technological advances that enable more precise descriptions and analyses of individuals and population groups, with a view to improving the overall health of populations. This promises to lead to more precise clinical and public health practices, across the continuum of prevention, screening, diagnosis, and treatment. A phenotype is the set of observable characteristics of an individual resulting from the interaction of a genotype with the environment. Precision (deep) phenotyping applies innovative technologies to exhaustively and more precisely examine the discrete components of a phenotype and goes beyond the information usually included in medical charts. This form of phenotyping is a critical component of more precise diagnostic capability and 3-dimensional facial analysis (3DFA) is a key technological enabler in this domain. In this paper, we examine the potential of 3DFA as a public health tool, by viewing it against the 10 essential public health services of the "public health wheel," developed by the US Centers for Disease Control. This provides an illustrative framework to gage current and emergent applications of genomic technologies for implementing precision public health

Tenure, mobility and retention of nurses in Queensland, Australia: 2001 and 2004

[Abstract]: Aim: Data were collected on tenure, mobility and retention of the nursing workforce in Queensland to aid strategic planning by the Queensland Nurses’ Union. Background: Shortages of nurses negatively affect the health outcomes of patients. Population rise is increasing the demand for nurses in Queensland. The supply of nurses is affected by recruitment of new and returning nurses, retention of the existing workforce and mobility within institutions. Methods: A self-reporting, postal survey was undertaken of Queensland Nurses Union members from the major employment sectors of aged care, public acute and community health and private acute and community health. Results: Only 60% of nurses had been with their current employer more than five years. In contrast 90% had been nursing for five years or more and most (80%) expected to remain in nursing for at least another five years. Breaks from nursing were common and part-time positions in the private and aged care sectors offered flexibility. Conclusion: The study demonstrated a mobile nursing workforce in Queensland although data on tenure and future time in nursing suggested that retention in the industry was high. Concern is expressed for replacement of an aging nursing population