2^nd World Congress on Health Economics Policy & Outcomes Research June 29-30, 2017 Madrid, Spain

Biography:

Gary Young is Director of the Northeastern University Center for Health Policy and Healthcare Research, as well as Professor of Strategic Management and Healthcare Systems, Northeastern University.  His research generally covers management, legal, and policy issues affecting the delivery of healthcare services.  Much of his recent research focuses on measuring and evaluating the performance of healthcare providers, particularly for quality of care, and the potential for using financial incentives to improve providers’ performance on quality metrics. Dr. Young has received research funding from both government agencies and private foundations, including the National Science Foundation, Agency for Healthcare Research and Quality, and the Robert Wood Johnson Foundation.  He has published in such journals as the New England Journal of Medicine, Journal of the American Medical Association, Health Affairs, Medical Care, Journal of Health Economics, and Academy of Management Journal.

Abstract:

This study investigated whether vertical integration of hospitals and physicians is associated with better care for patients with cardiac conditions.  A dramatic change in the U.S. hospital industry is the integration of hospital and physicians through hospital acquisition of physician practices. Yet, there is little evidence regarding whether this form of vertical integration leads to better operational performance of hospitals.  The study was conducted as an observational investigation based on a pooled, cross-sectional database.  The study sample comprised over 300 hospitals in the State of California. The time frame for the study was 2010 to 2012.  The key performance measure was hospitals’ degree of compliance with performance criteria set out by the federal government for managing patients with cardiac conditions.   These criteria relate to the types of clinical tests and medications that hospitals should follow for cardiac patients but hospital compliance requires require the cooperation of a hospital’s physicians.   Data for this measure was obtained from a federal web site that presents performance scores for U.S. hospitals.  The key independent variable was the percentage of cardiologists that a hospital employs (versus cardiologists who are affiliated but not employed by the hospital). Data for this measure was obtained from the State of California which requires hospitals to report financial and operation data each year including numbers of employed physicians.  Other characteristics of hospitals (e.g., information technology for cardiac care, volume of cardiac patients) were also evaluated as possible complements or substitutes for physician employment by hospitals.  Additional sources of data included the American Hospital Association and the U.S. Census.  Empirical models were estimated with generalized estimating equations (GEE).  Findings suggest that physician employment is positively associated with better hospital performance for cardiac care.  However, findings also suggest that information technology is a substitute for physician employment.    

Recent Publications

1. Alexander, J.A. & Young, G.J. 2016. Health Professionals and Organizations – Moving toward True Symbiosis. In Hoff, T.J., Sutcliffe, K.M, & Young, G.J. (Eds.), The HealthCare Professional Workforce: Understanding Human Capital in a Changing Industry. New York, New York:  Oxford University Press.
2. Baker, L.C., Bundorf, M. K., & Kessler, D.P., 2014. Vertical integration: Hospital ownership of physician practices is associated with higher prices and spending. Health Affairs, 33(5): 756-763.
3. Forbes, S.J. & Lederman, M., 2009. Adaptation and vertical integration in the airline industry. The American Economic Review, 99(5): 1831-1849.
4. Friedberg, M.W., Chen, P.G., White, C., Jung, O., Raaen, L., Hirschman, S., Hach, E., Stevens, C., Ginsburg, P.B., Casalino, L.P., Tutty, M., Vargo, C., Lipinski, L.  2015. Effects of Health Care Payment Models on Physician Practice in the United States. Santa Monica, CA: RAND Corporation.
5. Young, G. J., Nyaga, G. N., & Zepeda, D., 2016. Hospital employment of physicians and supply chain performance: An empirical investigation. Health Care Management Review, 41(3): 244-255. 

Biography:

Barbara Mascialino works at Health Economics and Outcome Research Manager at Thermo Fisher Scientific Immuno Diagnostics in Sweden. Barbara is a nuclear physicist with more than 15 years of experience in epidemiology, modelling and data analysis.

Abstract:

Colonoscopy represents the gold standard in case of suspected colonic pathology. However, availability is limited and it brings about avoidable risks for the patients and important costs. F-Calprotectin is a fecal marker of intestine inflammation capable to differentiate between organic and functional intestinal disorder and could therefore potentially, be used as a pre-endoscopic tool to identify patients that   could potentially avoid a colonoscopy. The purpose of this observational prospective study was to quantify in a Secondary Care (SC) setting in Zaragoza (Spain) the burden of colonoscopy in 87 consecutive unselected patients referred to colonoscopy either by Primary Care (PC) or SC doctors (gastroenterologists, or other specialists), and to evaluate the economic impact associated with the pre-endoscopic usage of F-Calprotectin.

Methodology: Diagnosis was established by colonoscopic investigation, and F-Calprotectin levels were evaluated by means of EliA Calprotectin 2 at both the recommended 50 mcg/g, and at the optimal 234.5 mcg/g cut-offs (sensitivity=69%, specificity=87%). Real-life data (including diagnosis, costs, colonoscopy-related complications, and resource utilization) were prospectively collected. Three scenarios (S) were compared: the actual situation (S1) and two simulations (S2=considering patients sent to colonoscopy by PC doctors only, S3=all patients) in which F-Calprotectin is used to select which patients require further investigations.

Findings: In S1, 71 patients (81.6%) were declared healthy after colonoscopy. Using the optimal cut-off, the actual total cost for visits and procedures was 75875€ (average cost/patient 872€); 4.6% of the patients experienced colonoscopy-related complications, which accounted for 7.9% of the total costs. F-Calprotectin reduces the average cost/patient by 250€ (29%) in S2, and by 427€ (49.0%) in S3. The table summarizes the main economic and health effect results at both cut-offs.

Conclusion: Results show that the usage of F-Calprotectin as pre-endoscopic diagnostic tool is associated with less colonoscopies, less complications, and important cost savings ascribable to reduced resource utilization.

Biography:

Cristina Paez Aviles has a doctoral degree on Nanosciences from the University of Barcelona, Spain. After obtaining her degree as Biotechnology Engineer by the Army Polytechnic School ESPE in Quito-Ecuador (2012), she went to Barcelona to complete a Master degree in Pharmaceutics Industry and Biotechnology from the University Pompeu Fabra (2013). Her research is focused on the processes and ecosystems of innovation, challenges of technology transfer and commercialization for Nanobiotechnologies and Nanomedicine with a multi-KET approach in European and Latin American regional innovation systems. Additional research interests include innovation in medical devices, entrepreneurship and innovation in developing societies.

Abstract:

The current aim to successfully overcome the valley-of-death for emergent technologies is leading to the reassessment of several priority action lines in technological-based public policies. In this regard, Horizon 2020 is fostering the cross-fertilization of Key Enabling Technologies (KETs), considered strategic for the economic growth of Europe. The relevance of this convergent process lies on the improvement or creation of new unique product properties or technology features, which could not have been obtained with a single technology. In the field of healthcare, this scenario could strongly change the healthcare landscape by improving biomedical systems offering personalized, less invasive, smart oriented, and energy harvesting solutions.

The present work analyses several strategies developed in EU-funded nanotechnology projects with healthcare applications in order to identify those characteristics that foster the cross-fertilization of KETs. For that end, the composition and structure of the innovation ecosystem was analysed, as well as the absorptive capacities and dynamic capabilities of five different types of participant organisations. Network and text mining techniques were complemented with interviews of project leaders. Principal findings showed that the degree of clustering of the network as well as the technological diversity of projects are important factors to consider in order to foster the successful cross-fertilization in nano-related projects.

Additionally, it was evidenced that cross-fertilization of KETs is being boosted by organisations that apply of nano-related knowledge in their processes, highlighting the importance of enhancing the capacity to absorb external knowledge, and the ability to integrate and reconfigure this knowledge

and competences in a changing environment. These several contributions have scope to diverse organizations involved in the sector and that aim to foster the interdisciplinary integration of technologies and collaboration in healthcare. This study could also guide policy makers for reshaping and improving nanotechnology related priority lines and health economic policies.

Biography:

Jacqueline Alcalde has her expertise in developing, implement and manages innovative programs supported by the evidence. Her principal’s tools are evaluation and implementation research. She is teaching evaluation, design programs based on evidence and log frame to master and doctoral students. She and her colleagues are doing effort to integrate health personnel (operative and management) and researcher for developing useful research and improve programs implementation.

Abstract:

Strategic priority setting and implementation of strategies to reduce maternal mortality are key to the post MDG 2015 agenda. This article highlights the feasibility and the advantages of using a systematized tacit knowledge approach, using data from maternal health program personnel, to identify local challenges to implementing policies and programs to inform the post MDG era. Communities of practice, conceived as groups of people sharing professional interests, experiences and knowledge, were formed with diverse health personnel implementing maternal health programs in Mexico and Nicaragua. Participants attended several workshops and developed different online activities aiming to strengthen their capacities to acquire, analyze, adapt and apply research results and to systematize their experience and knowledge of the actual implementation of these programs. Concept mapping, a general method designed to organize and depict the ideas of a group on a particular topic, was used to manage, discuss and systematize their tacit knowledge about implementation problems of the programs they work in. Using a special online concept mapping platform, participants prioritized implementation problems by sorting them in conceptual clusters and rating their importance and feasibility of solution. Two hundred and thirty one participants from three communities of practice in each country registered on the online concept mapping platform and 200 people satisfactorily completed the sorting and rating activities. Participants further discussed these results to prioritize the implementation problems of maternal health programs. Our main finding was a great similarity between the Mexican and the Nicaraguan general results highlighting the importance and the feasibility of solution of implementation problems related to the quality of healthcare. The use of rigorously organized tacit knowledge of health personnel proved to be a feasible and useful tool for prioritization to inform implementation priorities in the post MDG agenda.

Biography:

Cecile BLEIN has been Graduated from january 2009 as Economist Doctor, from the National University of Lyon. She obtained, as part of her thesis, the public health prize awarded by the French mutual society of the Rhône. Then she started working in the Regional Health Agency in charge of prospective payment for health facilities. Presently she has been working at HEVA company as a health economist based in Lyon, France for 6 years where she has continued his research.

Abstract:

Different published clinical studies have demonstrated the non-inferiority of trastuzumab subccutaneous (SC) administration versus intravenous (IV) in terms of efficacy, safety and preference in the treatment of patients with HER2 positive [1-2] . Health facilities wanted to have a multicenter evaluation, using data collected in real life, of the economic impact generated beween the two administrations forms.

A sampling plan from 9 health facilities have been conducted to collect economic consumables data for breast cancer patients care pathway’s (all stages) under trastuzumab (IV versus SC). The economic perspective retained was health facilities.

Multicentric evaluation collected 417 questionnaires describing the care pathway of 411 patients, including 245 patients treated within a SC administration form (60%) versus 167 patients within an IV form (40%).

The average cost of consumables for preparation and administration, expressed in euro 2016, is €1.35 VAT (± €0.47) with the SC routes and €12.42 VAT (± €2.20) with the IV routes. Per patient SC administration resulted in significantly cost saving of €11.07 VAT (± €1.36).

The average transport cost for a patient treated within a SC administration form is €17.57 VAT(± €13.97) and €22.22 VAT (± €13.93) within an IV form. This cost is significantly lower by €4.65 VAT(± €13.95) for the SC form. This result is induced by the correlation existing between the patient mode of transport (light health vehicle or personal transport) and the administration form. A more important mode of hospital exit per light health vehicle for the IV form is significantly observed.

Biography:

Siriporn Pooripussarakul is a PhD student in pharmacy administration, Faculty of Pharmacy, Mahidol University, Thailand. She has got the scholarship from the Thailand Research Fund through the Royal Golden Jubilee Ph.D. Program. She has her expertise in economic analysis of vaccine and health intervention. She also has clinical experience in chronic disease. Her interested area is evaluating economic outcomes of health interventions.

Abstract:

Statement of the Problem: The introduction of new vaccines depends on various criteria, including policies, clinical guidelines and economic considerations. Various stakeholders have differing criteria they view as important in selecting new vaccines. This study aimed to determine vaccine attributes importance to various stakeholders for new vaccine adoption in Thailand, using the best–worst scaling (BWS) method.

Methodology & Theoretical Orientation: Seven vaccine attributes with three levels each, identified from a literature review and semi-structured interviews, were categorized into burden of disease, age group, budget impact, fever from vaccine, severity of disease, vaccine effectiveness and cost of vaccine. Main-effects orthogonal design was used to identify 18 scenarios. A postal survey was conducted among policy makers, healthcare professionals and healthcare administrators during October 2013 and January 2014. Respondents were asked to choose the most important and the least important choices in each scenario. Importance weights were estimated by a conditional logistic regression. Then the relative attribute importance was calculated by the difference between the maximum and minimum coefficient for each attribute divided by the sum of all differences.

Findings: A total of seventy respondents completed the questionnaires. The attribute with highest importance for all groups was severity of disease (35.86%). Fever from vaccine (16.71%), burden of disease (13.48%) and budget impact (12.81%) were not much different importance from each other. For policy makers and healthcare professionals, the attributes with high importance were severity of disease (35.03% and 35.89%), fever from vaccine (22.88% and 16.08%) and burden of disease (14.82% and 15.25%), respectively; whereas the attributes with high importance for healthcare administrators were severity of disease (32.53%), budget impact (15.07%) and fever from vaccine (14.99%), respectively.

Conclusion & Significance: The BWS method makes it possible to take into account multiple criteria from multiple stakeholders for new vaccine adoption. The results revealed the alignment of a desire for high protection against severe disease together with concerns about budget impact and safety of vaccine.

Biography:

Delaram Ghodsi is a nutritionist in Department of Community Nutrition at Faculty of Nutrition Sciences and Food Technology, SBMU, Tehran, Iran. Her areas of expertise are designing, planning and evaluation of the community-based nutritional program. She conducted the first comprehensive evaluation, including policy analysis, process and effect evaluation, and cost analysis, of one national nutritional program in Iran. She is working on development and implementation of nutrition strategies to improve children nutritional status, based on the results and challenges found in the evaluation study.

Abstract:

Statement of the Problem: Evidences support that using supplementary foods is good strategy for combating malnutrition in children. In Iran, in the supportive section of a national nutritional program for improvement of nutritional status of children under 6years, monthly food supplement is distributed targeting malnourished/growth retarded children. This study aimed to reports impacts and cost results from this food distribution program in two provinces: Semnan and Qazvin, Iran.

Methodology & Theoretical Orientation: Monthly implementation costs of the program, including food basket, staff, training and education material, travel, and capital, were calculated using accounting records and key informant interviews, in 2014. An activity-based costing (ABC) was applied to calculate monthly program implementation costs per child. To measure the effect of the program, 362 children under coverage of the program and 409 matched children under coverage of Primary Health Care (PHC) system were studies as intervention and control group, respectively. Weight and height of children in both groups were measured at the baseline of the study and 6 month thereafter.

Findings: Although there was improvement in nutritional status of children in both groups at the end of the study, there were not significant differences in anthropometric indices at the end of the study compared to the beginning between two groups (P>0.05). The implementation cost, was   31.5$ per child (the average exchange rate for 2013). About 58.5% of the total cost of the programs was accounted for food baskets. As a proportion of the overall costs, food baskets were the largest component, followed by capital.

Conclusion & Significance: Based on the results, food component is the highest portion of monthly implementation cost. The implementation cost of the program per child is partially low due to implementation of the program via PHC. This program could be more efficient if it was implemented properly by using PHC capacity.

   Recent Publications

1. Ghodsi, D., Omidvar, N., Rashidian, A., Raghfar, H., Eini-Zinab, H., & Ebrahimi, M. (2016). Key Informants’ Perceptions on the Implementation of a National Program for Improving Nutritional Status of Children in Iran. Food and Nutrition Bulletin, 2017; 38(1):: 78-91

1.       Wilford R, Golden K, Walker DG. Cost-effectiveness of community-based management of acute malnutrition in Malawi. Health Policy and Planning. 2012;27(2):127-37.

2.       Tekeste A, Wondafrash M, Azene G, Deribe K. Cost effectiveness of community-based and in-patient therapeutic feeding programs to treat severe acute malnutrition in Ethiopia. Cost effectiveness and resource allocation : C/E. 2012;10:4.

3.       Purwestri RC, Scherbaum V, Inayati DA, Wirawan NN, Suryantan J, Bloem MA, et al. Cost analysis of community-based daily and weekly programs for treatment of moderate and mild wasting among children on Nias Island, Indonesia. Food and Nutrition Bulletin. 2012;33(3):207-16.

4.       Davis G, Serrano EL, McFerren M, Fournellier J, Baral R, Badirwang KF, et al. Cost-Effectiveness of Nutrition Education Programs for Limited-Resource Youth. Journal of Nutrition Education and Behavior. 2012;44(4, Supplement):S91-S2.

5.       Bachmann MO. Cost-effectiveness of community-based treatment of severe acute malnutrition in children. Expert Rev Pharmacoecon Outcomes Res. 2010;10(5):605-12.

Biography:

Sikander Ailawadhi has expertise in the field of plasma cell disorders, specifically Multiple Myeloma and focuses on clinical drug development as well as a special interest in secondary data analysis looking at outcome disparities and healthcare economics. He has accumulated vast experience in the area of disparities in healthcare utilization and outcomes by patient race and ethnicity and how the management, access and effects of therapeutic interventions may be different for various patient subgroups. Several of his research projects focusing on healthcare economics, cost-effectiveness and outcome disparities have been recognized in the form of presentations at national and international meetings as well as peer-reviewed publications.

Abstract:

Background: Cost of cancer care is projected to reach $173 billion by 2020, a 39% increase from 2010. Several factors including psychiatric (psych) comorbidities contribute to this increase. Within the oncology setting, 29-38% of the patients (pts) are reported to have mood disorders and 15% have major depression. Depression alone is associated with increased healthcare utilization in pts with breast, colon, lung and prostate cancers. A 2015 report noted that the presence of at least one psychiatric comorbidity in 300 Leukemia pts was associated with an extra $55,000 per pt in just one year. Similarly, in pts treated with systemic steroids, the incidence of neuropsychiatric disorders can be as high as 75%. However, no such data is available for MM, where more than 90% of pts are treated with steroids, likely increasing risk for mood problems and impacting treatment cost. As such, the aim of our study was to analyze the SEER-Medicare database for healthcare utilization trends and acute cost of care (cost incurred during 6 months after MM diagnosis) in MM pts with or without psych comorbidities.

Methods: Pts diagnosed with MM between 1991-2010 with continuous Medicare coverage (1 year prior to diagnosis-date of death/end of 2012) were included. Pts were categorized as: MM with any psych disorder (MM+P), MM with depression (MM+D) and MM only. Presence of ≥1 inpatient (ipt) or ≥2 outpatient (opt) ICD9 diagnosis codes were used to assign pts to the psych categories. Within MM+P and MM+D groups were subdivided by presence of psych or depression diagnosis prior to MM (MM+P PRE or MM+D PRE). Medicare claims adjusted for inflation (2013) within the first 6 months (mth)/total MM care were summed by drug and total charges. Univariate and multivariate logistic regression models (adjusted for age, year, sex, race, and the Charlson Comorbidity Index; CCI) were performed to determine associations with ipt, opt, and any emergency department (ED) charges after MM diagnosis. Associations between psych conditions prior to MM diagnosis and costs of care after MM diagnosis were assessed using univariate and multivariate proportional odds models.

Results: The study population included 36,007 eligible MM pts with a median follow-up of 1.8 years. 15168 (42%) pts had a psych condition at any time (MM+P), while 9355 (26%) were diagnosed prior to MM diagnosis (MM+P PRE). Depression was present in 8421 pts (23%), 4546 (13%) of those occurring prior to MM diagnosis. In comparison to MM pts, MM+P and MM+D pts tended to be female, White, and had a higher CCI (all p<0.001). When compared to MM pts, those with MM+P PRE and MM+D PRE had significantly higher incidence of MM-related complications (hypercalcemia, renal dysfunction, anemia, fractures and dialysis) at the time of or after MM diagnosis and also required increased overall care (all p<0.001). Both, MM+P and MM+D had higher odds of ipt visits (OR 1.48 and 1.41, resp., p<0.001), ED care (OR 1.48 and 1.37, resp., p<0.001) and opt visits (OR 1.25 and 1.22, resp., p<0.001) as compared to MM only pts. Cost of care analysis showed that MM+P and MM+D pts had a significantly higher cost of opt (OR 1.36 and 1.39, resp., p<0.001), ipt (OR 1.49 and 1.54, resp., p<0.001) and total care (OR 1.52 and 1.55, resp., p<0.001) as compared to MM only pts during first 6 mth after MM diagnosis (Figure 1). Total costs of care for MM+P and MM+D were also higher than MM only but the differences were less significant. Cost of care differences existed within first 6 mth of MM diagnosis by pt race as well with MM+P among Hispanic and Asian pts being more strongly associated with higher costs than Whites and African-Americans (AA) (p<0.001). MM+D had similar trends but not significant after adjustment for multiple comparisons.

Conclusion: Psych comorbidities are associated with significant increase in healthcare utilization and cost of care in MM pts and may contribute to higher MM-related complications. More research is needed to study whether a multidisciplinary approach to identify and manage MM pts with psych conditions may help mitigate these trends.

Biography:

Sung W. Choi is an assistant professor of health administration at c Harrisburg School of Public Affairs. Dr. Choi earned a Ph.D. in Public Policy and Administration at George Washington University. His academic interests include Health Care Competition Policy, Health Care Financing, and HIV/AIDS financial Sustainability.

Abstract:

Context: Various forms of multi-hospital systems have become increasingly prevalent in the United States. One reason behind the proliferation is efficiency gain from health system affiliation, which may lower the price of care. The other is enhanced market power from affiliation, which may increase the price of care. This study explores the effects of health system affiliation on selected surgery pricing across different health system types.

Methods: Using a large private insurance claim database, the author identified 22,174 colectomy cases, 15,264 coronary artery bypass graft (CABG) cases, and 111,668 percutaneous coronary intervention (PCI) cases from 2002 to 2007. Health systems were categorized into four clusters: centralized physician/insurance health system (CPIHS), moderately centralized health system (MCHS), decentralized health system (DHS), and independent health system (IHS). The association between negotiated hospital price and health system type was examined.  

Results: Health system affiliation is significantly associated with lower price for less centralized health systems. The CABG and PCI prices in IHS were significantly lower than the prices in non-affiliated hospitals, by 15.6 percent and 13 percent respectively. For centralized health systems, affiliation is significantly associated with higher price. The risk-adjusted PCI price in CPIHS was 2.2 percent higher than in non-affiliated hospitals.

Implications: The current antitrust guidelines tend to emphasize the market share of merging parties, and pay less attention on the characteristics of merging parties. The results of this study suggest that antitrust review can be more effective by considering different health system types.
 

Recent Publications

1. Castel, A. D., Choi, S., Dor, A., Skillicorn, J., Peterson, J., Rocha, N., & Kharfen, M. (2015). Comparing cost-effectiveness of HIV testing strategies: targeted and routine testing in Washington, DC. PloS one, 10(10), e0139605.
2. Choi, S. (2015). Different Multi-hospital Types and Their Association with Pricing of Cardiac and Cancer Surgeries (Doctoral dissertation, THE GEORGE WASHINGTON UNIVERSITY).
3. Choi, S., Shin, J. (2009) Health Capital Measurement and Economic Cost of Disease: A Case of HIV/AIDS Prevalence in OECD Countries, with Jaeun Shin, The Korean Journal of Health Economics and Policy, 2009, 15(1), 41-58.

Biography:

Rosana Pacella Norman is a Senior Research Fellow at the Australian Centre for Health Services Innovation (AusHSI), at the Queensland University of Technology. She currently leads a large health economics project to reveal the social and economic benefits of optimal wound care across Australia. She also provides health economics expertise for Wound Management Innovation Collaborative Research Centre funded projects assessing cost-effectiveness. She is widely recognized for her leading role in burden of disease assessments carried out over the last 16 years and continues to serve as an expert advisor to the Global Burden of Disease Collaboration and the Australian and South African National Burden of Disease Studies. She has played an important role in Australia, and internationally, in building capacity in burden of disease, health services research and cost-effectiveness analysis among researchers who are employed or contracted by governments. She has published widely in leading international journals.

Abstract:

Statement of the Problem: Chronic wounds cost the Australian health system at least US$2⋅85 billion per year. Wound care services in Australia involve a complex mix of treatment options, health care sectors and funding mechanisms. It is clear that implementation of evidence-based care improves wound healing, reduces recurrence as well as hospitalisation due to complications, amputation and overall burden, yet the majority of Australians with chronic wounds do not receive evidence-based treatment. High initial treatment costs, inadequate reimbursement, poor financial incentives and lack of skilled health care professionals proficient in evidence-based practice are major barriers to the adoption of best practice. In order to secure funding for better services in a competitive environment, evidence of cost-effectiveness is required.

Methodology: This study developed Markov models to analyse the cost-effectiveness of implementing optimal care in comparison with the continuation of usual care for patients with chronic wounds in Australia. Optimal care was defined as wound care that follows the set of recommendations from the Australian official guidelines with full Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) reimbursement linked to services, devices and consumables. Findings: Economic modelling results demonstrate that implementing and funding best practice systems to manage chronic wounds is a cost-saving strategy in Australia and improves health outcomes. Probabilistic sensitivity analysis showed that optimal care always had a higher probability of costing less and generating more health benefits.

Conclusion & Significance: We recommend high-level policy development and investment in evidence-based care to improve affordability and support access to health professionals and multidisciplinary teams. Incentivising cost-effective evidence-based wound care within MBS and listing evidence-based wound products and services on MBS/PBS will not only ease patients’ financial burden but also save considerable costs for the Australian health system.

Recent Publications (minimum 5)

1. Norman RE, Gibb M, Dyer A, Prentice J, Yelland S, Cheng Q, Lazzarini P, Carville K, Innes-Walker K, Finlayson K, Edwards H, Burn E, Graves N. Improved wound management at lower costs: a sensible goal for Australia. International Wound Journal 2016; 13(3):303-16.
2. Cheng, Qinglu; Lazzarini, Peter; Gibb, Michelle; Derhy, Patrick; Kinnear, Ewan; Burn, Edward ; Graves, Nicholas; and Norman, Rosana E. A cost-effectiveness analysis of optimal care of diabetic foot ulcers in Australia. International Wound Journal 2016; doi: 10.1111/iwj.12653. [Epub ahead of print]
3. McCarthy,M.M., Taylor, P., Norman, RE., Pezzullo, L., Tucci, J. & Goddard, C., The lifetime economic and social costs of child maltreatment in Australia. Children and Youth Services Review (2016), doi: 10.1016/j.childyouth.2016.11.014.
4. Erskine, H; Norman RE; Ferrari AJ; Copeland WE; Whiteford H;  Scott JG. Long-Term Outcomes of Attention-Deficit/Hyperactivity Disorder and Conduct Disorder: A Systematic Review and Meta-Analysis. Journal of the American Academy of Child and Adolescent Psychiatry 2016;55(10):841–850.
5. Norman RE, Byambaa M, De R, Butchart A, Scott J and Vos T. The long-term health consequences of child physical abuse, emotional abuse, and neglect: a systematic review and meta-analysis. PLoS Medicine 2012; 98 11: e1001349.1-e1001349.31.

Biography:

Deanna Mulvihill has her expertise in evaluation and passion in improving the health and wellbeing. Her open and contextual evaluation model based on responsive constructivists creates new pathways for improving healthcare. She has built this model after years of experience in research, evaluation, teaching and administration  both in hospital and education institutions. The foundation is based on fourth generation evaluation (Guba& Lincoln, 1989) which is a methodology that utilizes the previous generations of evaluation: measurement, description and judgment. It allows for value-pluralism. This approach is responsive to all stakeholders and has a different way of focusing.

Abstract:

Statement of the Problem: Women who have experienced intimate partnerviolence (IPV) are at greater risk for physical and mental health problems including posttraumatic stress disorder (PTSD) and alcohol dependency. On their own IPV, PTSD and alcohol dependency result   in significant personal, social and economic cost and the impact of all three may compound these costs. Researchers have reported that women with these experiences are more difficult to treat; many do not access treatment and those who do, frequently do not stay because of difficulty maintaining helping relationships. However, these women’s perspective has not been previously studied. The purpose of this study is to describe the experience of seeking help for alcohol dependency by women with PTSD and a history of IPV in the context in which it occurs.

Methodology & Theoretical Orientation: An inter subjective ethnographic study using hermeneutic dialogue was utilized during participant observation, in- depth interviews and focus groups. An ecological framework was utilized to focus on the interaction between the counselors and the staff to understand this relationships and the context in which it occurs.

Findings: The women in this study were very active help seekers. They encountered many gaps in continuity of care including discharge because of relapse. Although the treatment center was a warm, healing and spiritual place, the women left the center without treatment for their trauma needs and many without any referral to address these outstanding issues.

Conclusion & Significance: Women with alcohol dependence and PTSD with a history of IPV want help however the health and social services do not always recognize their calls for help or their symptoms of distress. Recommendations are made for treatment centers to become trauma- informed that would help this recognition.

Biography:

Mesfin Genie is a PhD student in Economics at Ca Foscari University of Venice, Italy. He received a master degree in Health Economics and Management from the University of Bologna, Italy in 2015. He also received his Master of Science (MSc) in Economics from Addis Ababa University, Ethiopia in 2010. He has his expertise in applied microeconometrics and in analysis of stated preference data with special emphasis to healthcare.

Abstract:

Statement of the Problem: Kidney transplantation provides an expected survival advantage over dialysis treatment for patients with end--stage renal disease. Still, due to the disparity between large number of transplant candidates and scarcity of organs patients may face the trade-off between a long waiting list for a high quality kidney, or a "marginal'' organ transplanted immediately. Current allocation protocols do not explicitly take into consideration patients' preferences. The purpose of this study is to estimate candidates' time and risk preferences in kidney transplantation. Willingness to wait estimates for changes in transplant attributes are obtained and heterogeneous preferences are exploited through a mixture logit model.

Methodology: We study patients' time and risk preferences for kidney transplantation by means of a discrete choice experiment (DCE). We have the unique opportunity of running the experiment on the entire population of individuals actually waiting for a kidney transplant in an important hospital in Italy.

Findings: We find heterogeneity in time and risk preferences. Differences are not limited to mean values of willingness to wait (WTW) for better kidneys: we employ a mixed logit model to retrieve individual WTW and compare the entire distribution of preferences across different subgroups. We find that younger candidates are willing to wait longer than older candidates for extra year of graft survival and to give up augmented infectious and neoplastic risks. Moreover, patients with longer time on dialysis are willing to wait longer than the other patients to give up augmented infectious and neoplastic risks, and for an extra year of graft survival.

Conclusion & Significance: The implication for transplant practice is that accounting for individual preferences in kidney allocation algorithm would improve patients' satisfaction and efficiency of the donor receiver matching process.

Publications
1. Hole, Arne Risa. "Modeling heterogeneity in patients’ preferences for the attributes of a general practitioner appointment." Journal of health economics 27.4 (2008): 1078-1094.
2. Flynn, Terry Nicholas, et al. "Using discrete choice experiments to understand preferences for quality of life. Variance-scale heterogeneity matters." Social science & medicine 70.12 (2010): 1957-1965.
3. Davison, Sara N., Seija K. Kromm, and Gillian R. Currie. "Patient and health professional preferences for organ allocation and procurement, end-of-life care and organization of care for patients with chronic kidney disease using a discrete choice experiment." Nephrology Dialysis Transplantation (2010): gfq072.
4. Greene, William H., and David A. Hensher. "A latent class model for discrete choice analysis: contrasts with mixed logit." Transportation Research Part B: Methodological 37.8 (2003): 681-698.
5. de Bekker-Grob, Esther W., Mandy Ryan, and Karen Gerard."Discrete choice experiments in health economics: a review of the literature." Health economics 21.2 (2012): 145-172.
 

Biography:

Sushil Ranjan Howlader is the Professor in Institute of Health Economics, University of Dhaka, since 1998, and he was professor in the Department of Economics, University of Dhaka, from 1995 to 1998. He is the founder director of the Institute of Health Economics. He has a large number of articles and research works on economic and health economic issues, including economic evaluation and financing of healthcare. He worked as consultant and technical advisor for many organizations and the Ministry of Health and Family Planning, Government Republic of Bangladesh. He also worked for the health sector of  Ethiopia and Afghanistan as health economic consultant.

Abstract:

The disability-adjusted life years (DALYs) as the measure of utility loss caused by a disease or of disease burden is widely used at present for economic evaluation of health programs throughout the world. Although the measure has several advantages, it has some limitations too. It captures only the effect on health, although a disease can have effects on household income and engender medical and non-medical expenditures as well. It expresses the value of disease effect in terms of years and hence is not suitable for conducting economic evaluation because the other variable involved in evaluation is program cost that is always estimated in money. It also does not consider the opinions of the sick individuals about the effects of disease, which is highly necessary for computing utility. More importantly, the amount of GDP loss obtained using DALY measure is greatly underestimated if the disease or condition causes less mortality but high morbidity ( such as HIV/AIDS). In that case the program that is undertaken to eliminate a difficult disease or reduce its burden can rarely be justified because the cost may often exceed the estimated value of DALYs to be averted by the program. As such many essential programs will be rejected if the DALY criterion of evaluation is used.  This paper devises an alternative method of computing the three types of effects --- effect on health, on income and expenditure --- based on utilitarian approach and expressing the value in terms of utility and money. It also proposes a formula for conducting economic evaluation of a health program. The formula was applied to the selected patients of costly diseases of a hospital in Bangladesh and it was found that even a very expensive program is fully justified for addressing those diseases. The method was also used to assess the viability of undertaking a HIV/AIDS elimination program. The total value of the disease effects (VODE) as well as DALYs was calculated for selected patients under the program. Comparison reveals that the program is justified if it is judged based on VODE and not if judged based on DALY measure.

Biography:

Rafia works with national and international NGOs for around nine years then an academician. Her wishes to increase, ensure health care services by registered trained provider in the countries, with this view this frame work was make. Being a physician, academician and a researches, she fell this model will work for all developing countries.

Abstract:

Statement of the Problem: Worldwide there were 59.8million Health worker. About two third of them (39.5 million) provide health services. Worlds 57 countries were face an acute shortage. Different countries of the world address the problem with different strategies. None of strategy is establish as accurate solution. The purpose of this study is to describe among the changes if substitution is cope in the mainstream of health systems, people will get services at very low cost.

Methodology: A structured questioner was taken for in- depth interviews and focuses groups. A hypothetical framework was utilized to focus on the changes, crisis and policy implication. Findings: Manages and community people suggested if service provide at locality; it will ensure the accessibility, availability and continuity of services. Local people were prepare adjusted quality in terms of waiting time and privacy with ensure referral at higher facility.

Conclusion & Significance: Non-professionally qualified having pre-existing medical training, receive top-up training undertake placement for experience and skill.  Recommendation is for many diseases effective, cost-efficient interventions would exist.

Fig: Hypothetical frame work

Recent publication

1. WHO (2006). Global shortage of health workers and its impact
2. Syed Masud Ahmed1*The health workforce crisis in Bangladesh: shortage, inappropriate skill-mix and inequitable distribution(2011)
3. The Path to Universal Health Coverage in Bangladesh • http://dx.doi.org/10.1596/978-1-4648-0536-3
4. Rapid review of international evidence Report developed by The Evidence Centre for Skills for Health. Key changes in the Healthcare workforce 
5. Pascal Zurn, Mario Dal Poz, Barbara Stilwell & Orvill Adams. March 2002. Imbalances in the health workforce

Biography:

Qiao Yan master of medicine, psychological counselor, has been engaged in clinical and research work of mental illness for many years and carried out mental health education for college students for a long period, accumulating rich experience in the prevention, early recognition and diagnosis of mental diseases. She has been committed to the study on health economics problems of mental illness. According to the present situation of mental illness is easy to relapse and increase the family medical burden, She explores a community rehabilitation model of mental illness, which is suitable for Chinese economic level and health policy and is helpful to reduce the cost of medical treatment and optimize the relationship between cost and curative effect.

Abstract:

Statement of the problem: Severe psychosis, such as schizophrenia, because of its characteristics of long treatment cycle, easy to relapse and high disability rate, has become one of the diseases that consumes the most medical resources in china. The related research shows that psychosis ranked first in the overall burden of disease in china. The purpose of this study is to explore a community comprehensive rehabilitation model of mental illness, which can adapt to the economic level and health policy of China and can be popularized and applied.

Objective: To explore the effect of community comprehensive rehabilitation on chronic schizophrenia and evaluate the health economics value.

Methods: 90 patients with chronic schizophrenia were treated with community comprehensive rehabilitation for 1 years, and were followed up for 1 year. Other 90 patients with chronic schizophrenia were selected as control group and were observed with clinical efficacy and cost.

Results: Compared with the control group, the social function, treatment compliance, disease stable rate, family burden, life satisfaction, symptom assessment, hospitalization in the rehabilitation group were significantly better ((P<0.01), and the total cost in the 2 years was significantly reduced, mainly reflected in the cost of hospitalization, drug maintenance treatment, downtime losses of caregivers, public prevention and treatment (P<0.01).

Conclusion & Significance: Community comprehensive rehabilitation can improve the prognosis of patients with chronic schizophrenia and reduce the cost.