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Schofield DJ, Lim K, Tanton R, Veerman L, Kelly SJ, Passey M, Shrestha R. Economic impact of informal caring for a person with arthritis in Australia from 2015 to 2030: a microsimulation approach using national survey data. BMJ Open 2024; 14:e076966. [PMID: 38719327 PMCID: PMC11086496 DOI: 10.1136/bmjopen-2023-076966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 04/04/2024] [Indexed: 05/12/2024] Open
Abstract
OBJECTIVES To estimate the economic burden of informal caregivers not in the labour force (NILF) due to caring for a person with arthritis in Australia, with projections of these costs from 2015 to 2030. DESIGN Static microsimulation modelling using national survey data. SETTING Australia nationwide survey. PARTICIPANTS Participants include respondents to the Survey of Disability, Ageing and Carers who are informal carers of a person who has arthritis as their main chronic condition and non-carers. OUTCOME MEASURES Estimating the economic impact and national aggregated costs of informal carers NILF to care for a person with arthritis and projecting these costs from 2015 to 2030 in 5-year intervals. RESULTS On a per-person basis, when adjusted for age, sex and highest education attained, the difference in average weekly total income between informal carers and non-carers employed in the labour force is $A1051 (95% CI: $A927 to $A1204) in 2015 and projected to increase by up to 22% by 2030. When aggregated, the total national annual loss of income to informal carers NILF is estimated at $A388.2 million (95% CI: $A324.3 to $A461.9 million) in 2015, increasing to $A576.9 million (95% CI: $A489.2 to $A681.8 million) by 2030. The national annual tax revenue lost to the government of the informal carers NILF is estimated at $A99 million (95% CI: $A77.9 to $A126.4 million) in 2015 and is projected to increase 49% by 2030. CONCLUSION Informal carers NILF are economically worse off than employed non-carers, and the aggregated national annual costs are substantial. The future economic impact of informal carers NILF to care for a person with arthritis in Australia is projected to increase, with the estimated differences in income between informal carers and employed non-carers increasing by 22% from 2015 to 2030.
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Affiliation(s)
- Deborah J Schofield
- GenIMPACT: Centre of Economic Impacts of Genomic Medicine, Macquarie Business School, Macquarie University, North Ryde, New South Wales, Australia
| | - Katherine Lim
- GenIMPACT: Centre of Economic Impacts of Genomic Medicine, Macquarie Business School, Macquarie University, North Ryde, New South Wales, Australia
| | - Robert Tanton
- Communities in Numbers, Manton, New South Wales, Australia
| | - Lennert Veerman
- School of Medicine and Dentistry, Griffith University, Southport, Queensland, Australia
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Simon J Kelly
- National Centre for Social and Economic Modellig, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Megan Passey
- University Centre for Rural Health, University of Sydney, Lismore, New South Wales, Australia
| | - Rupendra Shrestha
- GenIMPACT: Centre of Economic Impacts of Genomic Medicine, Macquarie Business School, Macquarie University, North Ryde, New South Wales, Australia
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Ifediora C, Veerman L, Azuike E, Ekwochi U, Obiozor W. Outcomes from integrating anti-cervical cancer teachings into the curriculum of high schools in a South-Eastern Nigerian State. BMC Public Health 2022; 22:1914. [PMID: 36241979 PMCID: PMC9562070 DOI: 10.1186/s12889-022-14231-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 09/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Quests for the global elimination of cervical cancer and its related SDG goals by 2030 are achievable if realistic approaches for improving outcomes in LMICs are entrenched. Targeting teenage high schoolers in these countries, which largely lack universally-affordable anti-cervical cancer measures, can be a game-changer. This paper evaluates a 2019 Harvard-endorsed measure that integrated relevant teachings into the curricula of some Nigerian high schools, in what was a global-first. METHOD A 12-month, quasi-experimental (pre-and-post-tests) research that evaluated the impact of the above initiative on three public schools randomly selected from a pool of 261 in South-east Nigeria. The intervention was "exposure" to anti-cervical teachings, which included "repetitions" and "examination/assessments" designed to enhance "engagement". Both genders were among the 2,498 recruited participants. Data collections with questionnaires were at three different intervals over 12 months. RESULTS At Phase-1 (baseline), there were 1,699 (68.0%) responses, while Phases 2 (one-month post-intervention) and 4 (12-month post-intervention) had 1,797 (71.9%) and 500 (20.0%) responses, respectively. COVID-19 lockdowns washed out Phase-3 (six-month post-intervention). The majority in all groups were aged 15-19 years. Males dominated in phases 1 (55.9%) and 2 (67.3%), and females (65.6%) in Phase 4. Overall, there were increased knowledge on "General Awareness", "HPV Vaccinations", "Risk Factors" and "Symptoms", particularly between Phases 2 and 1. Levels at Phase-4 were higher than at Phase-2, with the exception of "Pap Smears", as knowledge gained in half of its assessing items became negative (reversed) at Phase-4. These observed changes were non-different between gender, age groups, and classes of high schools. Relative to Phase 2, knowledge changes at Phase-4 for questions associated with established myths ("spiritual attacks"; OR 0.39; CI 0.29-0.52 and "enemy poisons"; OR 0.49; CI 0.37-0.65) were reversed, even though they were originally increased significantly between Phases 2 and 1. CONCLUSION Anti-cervical cancer enlightenment interventions to teenage high school students were largely effective, but appears guaranteed if engagement-enhancing measures are maintained over time. Extra efforts should be put into debunking prevailing myths.
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Affiliation(s)
- Christian Ifediora
- Griffith University School of Medicine, Gold Coast, Australia. .,OCI (Onyebuchi Chris Ifediora) Foundation, Awka, Nigeria.
| | - Lennert Veerman
- Griffith University School of Medicine, Gold Coast, Australia
| | - Emmanuel Azuike
- School of Medicine, Chukwuemeka Odumegwu Ojukwu University, Uli, Nigeria
| | - Uchenna Ekwochi
- School of Medicine, Enugu State University of Science and Technology, Enugu, Nigeria
| | - Williams Obiozor
- School of Adult Education, Nnamdi Azikiwe University, Awka, Nigeria
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Ananthapavan J, Moodie M, Milat A, Veerman L, Whittaker E, Carter R. A cost-benefit analysis framework for preventive health interventions to aid decision-making in Australian governments. Health Res Policy Syst 2021; 19:147. [PMID: 34923970 PMCID: PMC8684630 DOI: 10.1186/s12961-021-00796-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 11/24/2021] [Indexed: 12/30/2022] Open
Abstract
Background Australian governments are increasingly mandating the use of cost–benefit analysis (CBA) to inform the efficient allocation of government resources. CBA is likely to be useful when evaluating preventive health interventions that are often cross-sectoral in nature and require Cabinet approval prior to implementation. This study outlines a CBA framework for the evaluation of preventive health interventions that balances the need for consistency with other agency guidelines whilst adhering to guidelines and conventions for health economic evaluations. Methods We analysed CBA and other evaluation guidance documents published by Australian federal and New South Wales (NSW) government departments. Data extraction compared the recommendations made by different agencies and the impact on the analysis of preventive health interventions. The framework specifies a reference case and sensitivity analyses based on the following considerations: (1) applied economic evaluation theory; (2) consistency between CBA across different government departments; (3) the ease of moving from a CBA to a more conventional cost-effectiveness/cost-utility analysis framework often used for health interventions; (4) the practicalities of application; and (5) the needs of end users being both Cabinet decision-makers and health policy-makers. Results Nine documents provided CBA or relevant economic evaluation guidance. There were differences in terminology and areas of agreement and disagreement between the guidelines. Disagreement between guidelines involved (1) the community included in the societal perspective; (2) the number of options that should be appraised in ex ante analyses; (3) the appropriate time horizon for interventions with longer economic lives; (4) the theoretical basis and value of the discount rate; (5) parameter values for variables such as the value of a statistical life; and (6) the summary measure for decision-making. Conclusions This paper addresses some of the methodological challenges that have hindered the use of CBA in prevention by outlining a framework that is consistent with treasury department guidelines whilst considering the unique features of prevention policies. The effective use and implementation of a preventive health CBA framework is likely to require considerable investment of time and resources from state and federal government departments of health and treasury but has the potential to improve decision-making related to preventive health policies and programmes. Supplementary Information The online version contains supplementary material available at 10.1186/s12961-021-00796-w.
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Affiliation(s)
- Jaithri Ananthapavan
- Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia. .,Global Obesity Centre, School of Health and Social Development, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia.
| | - Marj Moodie
- Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia.,Global Obesity Centre, School of Health and Social Development, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia
| | - Andrew Milat
- NSW Ministry of Health, New South Wales, Australia.,School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Lennert Veerman
- School of Medicine, Griffith University, Gold Coast, Australia
| | | | - Rob Carter
- Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia
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Wanjau MN, Kivuti-Bitok LW, Aminde LN, Veerman L. Stakeholder perceptions of current practices and challenges in priority setting for non-communicable disease control in Kenya: a qualitative study. BMJ Open 2021; 11:e043641. [PMID: 33795302 PMCID: PMC8023733 DOI: 10.1136/bmjopen-2020-043641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To explore the stakeholders' perceptions of current practices and challenges in priority setting for non-communicable disease (NCD) control in Kenya. DESIGN A qualitative study approach conducted within a 1-day stakeholder workshop that followed a deliberative dialogue process. SETTING Study was conducted within a 1-day stakeholder workshop that was held in October 2019 in Nairobi, Kenya. PARTICIPANTS Stakeholders who currently participate in the national level policymaking process for health in Kenya. OUTCOME MEASURE Priority setting process for NCD control in Kenya. RESULTS Donor funding was identified as a key factor that informed the priority setting process for NCD control. Misalignment between donors' priorities and the country's priorities for NCD control was seen as a hindrance to the process. It was identified that there was minimal utilisation of context-specific evidence from locally conducted research. Additional factors seen to inform the priority setting process included political leadership, government policies and budget allocation for NCDs, stakeholder engagement, media, people's cultural and religious beliefs. CONCLUSION There is an urgent need for development aid partners to align their priorities to the specific NCD control priority areas that exist in the countries that they extend aid to. Additionally, context-specific scientific evidence on effective local interventions for NCD control is required to inform areas of priority in Kenya and other low-income and middle-income countries. Further research is needed to develop best practice guidelines and tools for the creation of national-level priority setting frameworks that are responsive to the identified factors that inform the priority setting process for NCD control.
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Affiliation(s)
- Mary Njeri Wanjau
- School of Nursing Sciences, University of Nairobi, Nairobi, Kenya
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | | | - Leopold Ndemnge Aminde
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia
- Non-Communicable Disease Unit, Clinical Research Education, Networking & Consultancy, Douala, Cameroon
| | - Lennert Veerman
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia
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5
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Skinner A, Walker P, Atkinson JA, Whitehead R, Roselli T, West M, Bright M, Heffernan M, McDonnell G, Veerman L, Prodan A, Thomas DP, Burton S. Policy options for endgame planning in tobacco control: a simulation modelling study. Tob Control 2021; 30:77-83. [PMID: 31857491 DOI: 10.1136/tobaccocontrol-2019-055126] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 10/28/2019] [Accepted: 11/04/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate the potential impacts of several tobacco control interventions on adult daily smoking prevalence in the Australian state of Queensland, using a system dynamics model codeveloped with local and national stakeholders. METHODS Eight intervention scenarios were simulated and compared with a reference scenario (business as usual), in which all tobacco control measures currently in place are maintained unchanged until the end of the simulation period (31 December 2037). FINDINGS Under the business as usual scenario, adult daily smoking prevalence is projected to decline from 11.8% in 2017 to 5.58% in 2037. A sustained 50% increase in antismoking advertising exposure from 2018 reduces projected prevalence in 2037 by 0.80 percentage points. Similar reductions are projected with the introduction of tobacco wholesaler and retailer licensing schemes that either permit or prohibit tobacco sales by alcohol-licensed venues (0.65 and 1.73 percentage points, respectively). Increasing the minimum age of legal supply of tobacco products substantially reduces adolescent initiation, but has minimal impact on smoking prevalence in the adult population over the simulation period. Sustained reductions in antismoking advertising exposure of 50% and 100% from 2018 increase projected adult daily smoking prevalence in 2037 by 0.88 and 1.98 percentage points, respectively. CONCLUSIONS These results suggest that any prudent approach to endgame planning should seek to build on rather than replace existing tobacco control measures that have proved effective to date. Additional interventions that can promote cessation are expected to be more successful in reducing smoking prevalence than interventions focussing exclusively on preventing initiation.
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Affiliation(s)
- Adam Skinner
- Decision Analytics, Sax Institute, Sydney, New South Wales, Australia
| | - Pippy Walker
- Decision Analytics, Sax Institute, Sydney, New South Wales, Australia
- The Australian Prevention Partnership Centre, Sax Institute, Sydney, New South Wales, Australia
- Menzies Centre for Health Policy, University of Sydney, Sydney, New South Wales, Australia
| | - Jo-An Atkinson
- Decision Analytics, Sax Institute, Sydney, New South Wales, Australia
- The Australian Prevention Partnership Centre, Sax Institute, Sydney, New South Wales, Australia
- School of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Rebecca Whitehead
- Preventive Health Branch, Department of Health, Brisbane, Queensland, Australia
| | - Tim Roselli
- Preventive Health Branch, Department of Health, Brisbane, Queensland, Australia
| | - Mark West
- Preventive Health Branch, Department of Health, Brisbane, Queensland, Australia
| | - Margaret Bright
- Preventive Health Branch, Department of Health, Brisbane, Queensland, Australia
| | - Mark Heffernan
- Dynamic Operations, Mona Vale, New South Wales, Australia
| | - Geoff McDonnell
- The Australian Prevention Partnership Centre, Sax Institute, Sydney, New South Wales, Australia
| | - Lennert Veerman
- Cancer Research Division, Cancer Council New South Wales, Sydney, New South Wales, Australia
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Ante Prodan
- Decision Analytics, Sax Institute, Sydney, New South Wales, Australia
- School of Computing, Engineering and Mathematics, Western Sydney University, Sydney, New South Wales, Australia
| | - David P Thomas
- Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Suzan Burton
- School of Business, Western Sydney University, Sydney, New South Wales, Australia
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6
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Goldsbury DE, Weber MF, Yap S, Rankin NM, Ngo P, Veerman L, Banks E, Canfell K, O’Connell DL. Health services costs for lung cancer care in Australia: Estimates from the 45 and Up Study. PLoS One 2020; 15:e0238018. [PMID: 32866213 PMCID: PMC7458299 DOI: 10.1371/journal.pone.0238018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 08/02/2020] [Indexed: 11/19/2022] Open
Abstract
Background Of all cancer types, healthcare for lung cancer is the third most costly in Australia, but there is little detailed information about these costs. Our aim was to provide detailed population-based estimates of health system costs for lung cancer care, as a benchmark prior to wider availability of targeted therapies/immunotherapy and to inform cost-effectiveness analyses of lung cancer screening and other interventions in Australia. Methods Health system costs were estimated for incident lung cancers in the Australian 45 and Up Study cohort, diagnosed between recruitment (2006–2009) and 2013. Costs to June 2016 included services reimbursed via the Medicare Benefits Schedule, medicines reimbursed via the Pharmaceutical Benefits Scheme, inpatient hospitalisations, and emergency department presentations. Costs for cases and matched, cancer-free controls were compared to derive excess costs of care. Costs were disaggregated by patient and tumour characteristics. Data for more recent cases identified in hospital records provided preliminary information on targeted therapy/immunotherapy. Results 994 eligible cases were diagnosed with lung cancer 2006–2013; 51% and 74% died within one and three years respectively. Excess costs from one-year pre-diagnosis to three years post-diagnosis averaged ~$51,900 per case. Observed costs were higher for cases diagnosed at age 45–59 ($67,700) or 60–69 ($63,500), and lower for cases aged ≥80 ($29,500) and those with unspecified histology ($31,700) or unknown stage ($36,500). Factors associated with lower costs generally related to shorter survival: older age (p<0.0001), smoking (p<0.0001) and unknown stage (p = 0.002). There was no evidence of differences by year of diagnosis or sex (both p>0.50). For 465 cases diagnosed 2014–2015, 29% had subsidised molecular testing for targeted therapy/immunotherapy and 4% had subsidised targeted therapies. Conclusions Lung cancer healthcare costs are strongly associated with survival-related factors. Costs appeared stable over the period 2006–2013. This study provides a framework for evaluating the health/economic impact of introducing lung cancer screening and other interventions in Australia.
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Affiliation(s)
- David E. Goldsbury
- Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia
- * E-mail:
| | - Marianne F. Weber
- Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Sarsha Yap
- Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia
| | - Nicole M. Rankin
- Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Preston Ngo
- Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Lennert Veerman
- Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
- School of Medicine, Griffith University, Southport, Queensland, Australia
| | - Emily Banks
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| | - Karen Canfell
- Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
- Prince of Wales Clinical School, UNSW Medicine, Sydney, NSW, Australia
| | - Dianne L. O’Connell
- Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
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Lal A, Mantilla-Herrera AM, Veerman L, Backholer K, Sacks G, Moodie M, Siahpush M, Carter R, Peeters A. Correction: Modelled health benefits of a sugar-sweetened beverage tax across different socioeconomic groups in Australia: A cost-effectiveness and equity analysis. PLoS Med 2020; 17:e1003310. [PMID: 32726305 PMCID: PMC7390261 DOI: 10.1371/journal.pmed.1003310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pmed.1002326.].
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Ananthapavan J, Sacks G, Brown V, Moodie M, Nguyen P, Veerman L, Mantilla Herrera AM, Lal A, Peeters A, Carter R. Priority-setting for obesity prevention-The Assessing Cost-Effectiveness of obesity prevention policies in Australia (ACE-Obesity Policy) study. PLoS One 2020; 15:e0234804. [PMID: 32559212 PMCID: PMC7304600 DOI: 10.1371/journal.pone.0234804] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 06/02/2020] [Indexed: 12/27/2022] Open
Abstract
The aim of the ACE-Obesity Policy study was to assess the economic credentials of a suite of obesity prevention policies across multiple sectors and areas of governance for the Australian setting. The study aimed to place the cost-effectiveness results within a broad decision-making context by providing an assessment of the key considerations for policy implementation. The Assessing Cost-Effectiveness (ACE) approach to priority-setting was used. Systematic literature reviews were undertaken to assess the evidence of intervention effectiveness on body mass index and/or physical activity for selected interventions. A standardised evaluation framework was used to assess the cost-effectiveness of each intervention compared to a 'no intervention' comparator, from a limited societal perspective. A multi-state life table Markov cohort model was used to estimate the long-term health impacts (quantified as health adjusted life years (HALYs)) and health care cost-savings resulting from each intervention. In addition to the technical cost-effectiveness results, qualitative assessments of implementation considerations were undertaken. All 16 interventions evaluated were found to be cost-effective (using a willingness-to-pay threshold of AUD50,000 per HALY gained). Eleven interventions were dominant (health promoting and cost-saving). The incremental cost-effectiveness ratio for the non-dominant interventions ranged from AUD1,728 to 28,703 per HALY gained. Regulatory interventions tended to rank higher on their cost-effectiveness results, driven by lower implementation costs. However, the program-based policy interventions were generally based on higher quality evidence of intervention effectiveness. This comparative analysis of the economic credentials of obesity prevention policies for Australia indicates that there are a broad range of policies that are likely to be cost-effective, although policy options vary in strength of evidence for effectiveness, affordability, feasibility, acceptability to stakeholders, equity impact and sustainability. Implementation of these policies will require sustained co-ordination across jurisdictions and multiple government sectors in order to generate the predicted health benefits for the Australian population.
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Affiliation(s)
- Jaithri Ananthapavan
- Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Australia
- Global Obesity Centre, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Gary Sacks
- Global Obesity Centre, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Vicki Brown
- Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Australia
- Global Obesity Centre, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Marj Moodie
- Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Australia
- Global Obesity Centre, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Phuong Nguyen
- Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Australia
- Global Obesity Centre, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Lennert Veerman
- School of Medicine, Griffith University, Gold Coast, Australia
| | - Ana Maria Mantilla Herrera
- Queensland Centre for Mental Health Research, Brisbane, Australia
- School of Public Health, The University of Queensland, Brisbane, Australia
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | - Anita Lal
- Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Australia
- Global Obesity Centre, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Anna Peeters
- Global Obesity Centre, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Rob Carter
- Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Australia
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Khanal S, Veerman L, Ewen M, Nissen L, Hollingworth S. Availability, Price, and Affordability of Essential Medicines to Manage Noncommunicable Diseases: A National Survey From Nepal. Inquiry 2020; 56:46958019887572. [PMID: 31823665 PMCID: PMC6906349 DOI: 10.1177/0046958019887572] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this study was to evaluate the availability, price, and affordability
of essential noncommunicable disease (NCD) medicines in Nepal. A cross-sectional
survey was conducted in Nepal in 2015 using World Health Organization/Health
Action International (WHO/HAI) methodology. We collected data on the
availability and price of 60 essential NCD medicines from medicine distribution
outlets in both the public and private health care sectors in 6 regions.
Essential NCD medicines were more available in the private sector (78%) than the
public sector (60%). Furosemide tablets were the cheapest (NPR 0.6/10 tablets)
and streptokinase injections were the most expensive (NPR 2200/vial) drugs.
There was no significant difference (P > .05) in
availability and affordability of essential NCD medicines across the 6 survey
areas. Treating selected NCD conditions with medicines was generally affordable,
with 1 month of treatment costing no more than a day’s wage of the lowest paid
unskilled government worker. The lower availability of NCD medicines in the
public sector limits the effectiveness of the government’s policy of providing
free health services at public facilities. Although NCD medicines were generally
affordable, future health policy should aim to ensure improved equitable access
to NCD medicines, particularly in public facilities.
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Affiliation(s)
- Saval Khanal
- Nepal Health Research and Innovation Foundation, Lalitpur, Nepal.,School of Pharmacy, The University of Queensland, Brisbane, Australia
| | - Lennert Veerman
- School fo Medicine, Griffith University, Southport, Australia
| | - Margaret Ewen
- Health Action International, Amsterdam, The Netherlands
| | - Lisa Nissen
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
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Mounsey S, Veerman L, Jan S, Thow AM. The macroeconomic impacts of diet-related fiscal policy for NCD prevention: A systematic review. Econ Hum Biol 2020; 37:100854. [PMID: 32062400 DOI: 10.1016/j.ehb.2020.100854] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 01/19/2020] [Accepted: 01/20/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Diet-related fiscal policies are effective interventions to address non-communicable disease. However, despite these being economic policy instruments, there is little public health attention given to the evidence of macroeconomic impacts. This review aims to assess the global evidence for the macroeconomic impact of diet-related fiscal policies for non-communicable disease prevention on industry revenue, government revenue and employment. METHODS For this systematic review we comprehensively searched the bibliographic databases MEDLINE, OvidSP, EMBASE, Global Health, SCOPUS, CINAHL and ECONLIT, and Google Scholar for English peer-reviewed studies or grey literature, with no date cut-off. Global interventions with a focus on diet-related fiscal strategies were assessed for the outcomes of industry revenue, gross domestic product, government revenue and employment. We excluded non-English papers. FINDINGS Eleven studies met the inclusion criteria. All studies were on sugar sweetened beverage taxation and one also included an energy-dense food tax. Nine were modelling studies and two used interrupted time series analysis based on empirical evidence. One study found potential employment increases because of taxation; two found no significant job losses and eight found reduced employment. Taxes reduced sales volume and revenue within the sugar/beverage industry. Government revenue generation was positive in all studies. One study considered redistribution of consumer and government spending to other goods and services; INTERPRETATION: We found no robust evidence for negative macroeconomic impacts of diet-related fiscal policies, likely a reflection of the limited methodology used in the analyses. This review suggests that there is a need for more high-quality research into the macroeconomic impacts of diet related fiscal measures and similar to tobacco taxation, government should consider directing revenue generated towards complementary measures to generate employment and/or provide livelihood training for those affected.
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Affiliation(s)
- Sarah Mounsey
- Menzies Centre for Health Policy, University of Sydney Australia.
| | | | - Stephen Jan
- The George Institute for Global Health Australia
| | - Anne Marie Thow
- Menzies Centre for Health Policy, University of Sydney Australia
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Carter HE, Schofield DJ, Shrestha R, Veerman L. The productivity gains associated with a junk food tax and their impact on cost-effectiveness. PLoS One 2019; 14:e0220209. [PMID: 31329651 PMCID: PMC6645543 DOI: 10.1371/journal.pone.0220209] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 07/10/2019] [Indexed: 11/21/2022] Open
Abstract
Objective To estimate the productivity impacts of a policy intervention on the prevention of premature mortality due to obesity. Methods A simulation model of the Australian population over the period from 2003 to 2030 was developed to estimate productivity gains associated with premature deaths averted due to an obesity prevention intervention that applied a 10% tax on unhealthy foods. Outcome measures were the total working years gained, and the present value of lifetime income (PVLI) gained. Impacts were modelled over the period from 2003 to 2030. Costs are reported in 2018 Australian dollars and a 3% discount rate was applied to all future benefits. Results Premature deaths averted due to a junk food tax accounted for over 8,000 additional working years and a $307 million increase in PVLI. Deaths averted in men between the ages of 40 to 59, and deaths averted from ischaemic heart disease, were responsible for the largest gains. Conclusions The productivity gains associated with a junk food tax are substantial, accounting for almost twice the value of the estimated savings to the health care system. The results we have presented provide evidence that the adoption of a societal perspective, when compared to a health sector perspective, provides a more comprehensive estimate of the cost-effectiveness of a junk food tax.
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Affiliation(s)
- Hannah E. Carter
- Australian Centre for Health Services Innovation, Institute of Health and Biomedical Innovation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
- * E-mail:
| | - Deborah J. Schofield
- Centre for Economic Impacts of Genomic Medicine, Macquarie University, Sydney, New South Wales, Australia
| | - Rupendra Shrestha
- Centre for Economic Impacts of Genomic Medicine, Macquarie University, Sydney, New South Wales, Australia
| | - Lennert Veerman
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia
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Schofield D, Cunich M, Shrestha R, Passey M, Veerman L, Tanton R, Kelly S. The indirect costs of ischemic heart disease through lost productive life years for Australia from 2015 to 2030: results from a microsimulation model. BMC Public Health 2019; 19:802. [PMID: 31226965 PMCID: PMC6588908 DOI: 10.1186/s12889-019-7086-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 05/31/2019] [Indexed: 11/12/2022] Open
Abstract
Background Most studies measure the impact of ischemic heart disease (IHD) on individuals using quality of life metrics such as disability-adjusted life-years (DALYs); however, IHD also has an enormous impact on productive life years (PLYs). The objective of this study was to project the indirect costs of IHD resulting from lost PLYs to older Australian workers (45–64 years), government, and society 2015–2030. Methods Nationally representative data from the Surveys of Disability, Ageing and Carers (2003, 2009) were used to develop the base population in the microsimulation model (Health&WealthMOD2030), which integrated data from established microsimulation models (STINMOD, APPSIM), Treasury’s population and workforce projections, and chronic conditions trends. Results We projected that 6700 people aged 45–64 were out of the labour force due to IHD in 2015, increasing to 8100 in 2030 (21 increase). National costs consisted of a loss of AU$273 (US$263) million in income for people with IHD in 2015, increasing to AU$443 ($US426) million (62% increase). For the government, extra welfare payments increased from AU$106 (US$102) million in 2015 to AU$143 (US$138) million in 2030 (35% increase); and lost income tax revenue increased from AU$74 (US$71) million in 2015 to AU$117 (US$113) million in 2030 (58% increase). A loss of AU$785 (US$755) million in GDP was projected for 2015, increasing to AU$1125 (US$1082) million in 2030. Conclusions Significant costs of IHD through lost productivity are incurred by individuals, the government, and society. The benefits of IHD interventions include not only improved health but also potentially economic benefits as workforce capacity.
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Affiliation(s)
- Deborah Schofield
- Department of Economics, Faculty of Business and Economics, Centre for Economic Impacts of Genomic Medicine (GenIMPACT), Macquarie University, Sydney, NSW, 2109, Australia
| | - Michelle Cunich
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, The University of Sydney, and Sydney Health Economics, Sydney Local Health District, John Hopkins Drive, Camperdown, NSW, 2006, Australia.
| | - Rupendra Shrestha
- Department of Economics, Faculty of Business and Economics, Centre for Economic Impacts of Genomic Medicine (GenIMPACT), Macquarie University, Sydney, NSW, 2109, Australia.,Faculty of Pharmacy, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Megan Passey
- University Centre for Rural Health, School of Public Health, The University of Sydney, Lismore, NSW, 2480, Australia
| | - Lennert Veerman
- Cancer Council NSW, 153 Dowling Street, Woolloomooloo, NSW, 2011, Australia.,Griffith University, School of Medicine, Gold Coast campus, Southport, QLD, 4222, Australia
| | - Robert Tanton
- National Centre for Social and Economic Modelling, University of Canberra, Canberra, ACT, Australia
| | - Simon Kelly
- National Centre for Social and Economic Modelling, University of Canberra, Canberra, ACT, Australia
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Wanjau MN, Zapata-Diomedi B, Veerman L. Health promotion at the workplace setting: a protocol for a systematic review of effectiveness and sustainability of current practice in low-income and middle-income countries. BMJ Open 2019; 9:e027050. [PMID: 31122984 PMCID: PMC6538199 DOI: 10.1136/bmjopen-2018-027050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 04/16/2019] [Accepted: 04/17/2019] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Low-income and middle-income countries (LMICs) are experiencing a growing disease burden due to non-communicable diseases (NCDs). Changing behavioural practices, such as diets high in saturated fat, salt and sugar and sedentary lifestyles, have been associated with the increase in NCDs. Health promotion at the workplace setting is considered effective in the fight against NCDs and has been reported to yield numerous benefits. However, there is a need to generate evidence on the effectiveness and sustainability of workplace health promotion practice specific to LMICs. We aim to synthesise the current literature on workplace health promotion in LMICs focusing on interventions effectiveness and sustainability. METHODS AND ANALYSIS We will conduct a systematic review of published studies from LMICs up to 31 March 2019. We will search the following databases: EMBASE, MEDLINE, PubMed, Web of Science, Scopus, ProQuest and CINAHL. Two reviewers will independently screen potential articles for inclusion and disagreements will be resolved by consensus. We will appraise the quality and risk of bias of included studies using two tools from the Cochrane handbook for systematic reviews of interventions. We will present a narrative overview and assessment of the body of evidence derived from the comprehensive review of the studies. The reported outcomes will be summarised by study design, duration, intensity/frequency of intervention delivery and by the six-priority health promotion action areas set out in the Ottawa Charter. We will conduct a thematic analysis to identify the focus areas of current interventions. This systematic review protocol has been prepared according to the Preferred Reporting Items for Systematic reviews and Meta- analyses for Protocols 2015 statement. ETHICS AND DISSEMINATION This study does not require ethics approval. We will disseminate the results of this review through peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER CRD42018110853.
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Affiliation(s)
- Mary Njeri Wanjau
- School of Nursing, The University of Nairobi, Nairobi, Nairobi, Kenya
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Belen Zapata-Diomedi
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia
- Centre for Urban Research, RMIT University, Melbourne, Victoria, Australia
| | - Lennert Veerman
- School of Medicine, Griffith University, Southport, Queensland, Australia
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Schofield D, Cunich M, Shrestha R, Tanton R, Veerman L, Kelly S, Passey M. Indirect costs of depression and other mental and behavioural disorders for Australia from 2015 to 2030. BJPsych Open 2019; 5:e40. [PMID: 31530305 PMCID: PMC6520529 DOI: 10.1192/bjo.2019.26] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The impact of mental disorders has been assessed in relation to longevity and quality of life; however, mental disorders also have an impact on productive life-years (PLYs). AIMS To quantify the long-term costs of Australians aged 45-64 having lost PLYs because of mental disorders. METHOD The Survey of Disability, Ageing and Carers 2003, 2009 formed the base population of Health&WealthMOD2030 - a microsimulation model integrating output from the Static Incomes Model, the Australian Population and Policy Simulation Model, the Treasury and the Australian Burden of Disease Study. RESULTS For depression, individuals incurred a loss of AU$1062 million in income in 2015, projected to increase to AU$1539 million in 2030 (45% increase). The government is projected to incur costs comprising a 22% increase in social security payments and a 45% increase in lost taxes as a result of depression through its impact on PLYs. CONCLUSIONS Effectiveness of mental health programmes should be judged not only in terms of healthcare use but also quality of life and economic well-being. DECLARATION OF INTEREST None.
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Affiliation(s)
- Deborah Schofield
- Chair and Professor of Health Economics, Director, Centre for Economic Impacts of Genomic Medicine (GENImpact), Department of Economics, Faculty of Business and Economics, Macquarie University, Australia
| | - Michelle Cunich
- Research Fellow in Health Economics, The Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders; and Director, Sydney Health Economics, Sydney Local Health District, Charles Perkins Centre, The University of Sydney, Australia
| | - Rupendra Shrestha
- Senior Research Fellow, Health Economics, Faculty of Pharmacy, The University of Sydney; andCentre for Economic Impacts of Genomic Medicine (GENImpact), Department of Economics, Faculty of Business and Economics, Macquarie University, Australia
| | - Robert Tanton
- Professor, National Centre for Social and Economic Modelling, University of Canberra, Australia
| | - Lennert Veerman
- Senior Health Economist, Cancer Council NSW; and Professor of Public Health, School of Medicine, Griffith University, Gold Coast campus, Australia
| | - Simon Kelly
- Professor, National Centre for Social and Economic Modelling, University of Canberra, Australia
| | - Megan Passey
- Associate Professor, University Centre for Rural Health, School of Public Health, The University of Sydney, Australia
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Khanal S, Veerman L, Nissen L, Hollingworth S. Forecasting the amount and cost of medicine to treat type 2 diabetes mellitus in Nepal using knowledge on medicine usage from a developed country. Journal of Pharmaceutical Health Services Research 2019. [DOI: 10.1111/jphs.12265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Abstract
Objectives
This research was aimed to forecast the amount and cost of medicines required to treat people with type 2 diabetes mellitus (T2DM) in Nepal over 30 years.
Methods
We modelled the financial burden of T2DM medicines by estimating the cost of medicines to treat all cases of T2DM in Nepal over three decades based on the prevalence of T2DM in Nepal, the Nepalese costs of medicine and the T2DM medicine use profile of Australia.
Key findings
With the current T2DM prevalence trend, it would cost US$63–95 million in 2013 to purchase T2DM medicines for Nepal, if Nepalese receive the same mix of T2DM medicines as used in Australia. This cost is almost one-quarter of the total health budget of Nepal (US$308 million). The cost of medicines to treat T2DM is projected to triple between 2013 and 2043.
Conclusions
With the medicines for only T2DM projected to cost about 25% of the entire health budget, the planned health insurance seems unaffordable if patients are treated with the same medicines as those in one of the best healthcare systems in the world. The government needs to stimulate rational prescribing and secure additional funding through taxation, health insurance or health levy to provide such medicines and services.
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Affiliation(s)
- Saval Khanal
- Centre for Applied Health Economics, Griffith University, Nathan, QLD, Australia
- Nepal Health Research and Innovation Foundation, Lalitpur, Nepal
| | - Lennert Veerman
- School of Medicine, Griffith University, Southport, QLD, Australia
| | - Lisa Nissen
- School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
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Lal A, Herrera AMM, Veerman L, Moodie M, Carter R, Peeters A. Cost-effectiveness and equity impacts of a sugar sweetened beverage tax in Australia. Obes Res Clin Pract 2019. [DOI: 10.1016/j.orcp.2016.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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17
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Aminde LN, Atem JA, Kengne AP, Dzudie A, Veerman L. Body Mass Index – measured adiposity and population attributability of associated factors in Cameroon: A population-based study in sub-Saharan Africa. Obes Res Clin Pract 2019. [DOI: 10.1016/j.orcp.2016.10.202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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18
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Veerman L. Invited talk: Modelling the health impact of taxing sugared drinks in Australia and South Africa. Obes Res Clin Pract 2019. [DOI: 10.1016/j.orcp.2016.10.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Goldsbury DE, Yap S, Weber MF, Veerman L, Rankin N, Banks E, Canfell K, O’Connell DL. Health services costs for cancer care in Australia: Estimates from the 45 and Up Study. PLoS One 2018; 13:e0201552. [PMID: 30059534 PMCID: PMC6066250 DOI: 10.1371/journal.pone.0201552] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 07/17/2018] [Indexed: 11/26/2022] Open
Abstract
Background Cancer care represents a substantial and rapidly rising healthcare cost in Australia. Our aim was to provide accurate population-based estimates of the health services cost of cancer care using large-scale linked patient-level data. Methods We analysed data for incident cancers diagnosed 2006–2010 and followed to 2014 among 266,793 eligible participants in the 45 and Up Study. Health system costs included Medicare and pharmaceutical claims, inpatient hospital episodes and emergency department presentations. Costs for cancer cases and matched cancer-free controls were compared, to estimate monthly/annual excess costs of cancer care by cancer type, before and after diagnosis and by phase of care (initial, continuing, terminal). Total costs incurred in 2013 were also estimated for all people diagnosed in Australia 2009–2013. Results 7624 participants diagnosed with cancer were matched with up to three controls. The mean excess cost of care per case was AUD$1,622 for the year before diagnosis, $33,944 for the first year post-diagnosis and $8,796 for the second year post-diagnosis, with considerable variation by cancer type. Mean annual cost after the initial treatment phase was $4,474/case and the mean cost for the last year of life was $49,733/case. In 2013 the cost for cancers among people in Australia diagnosed during 2009–2013 was ~$6.3billion (0.4% of Gross Domestic Product; $272 per capita), with the largest costs for colorectal cancer ($1.1billion), breast cancer ($0.8billion), lung cancer ($0.6billion) and prostate cancer ($0.5billion). Conclusions The cost of cancer care is substantial and varies by cancer type and time since diagnosis. These findings emphasise the economic importance of effective primary and secondary cancer prevention strategies.
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Affiliation(s)
- David E. Goldsbury
- Cancer Research Division, Cancer Council NSW, Sydney, Australia
- * E-mail:
| | - Sarsha Yap
- Cancer Research Division, Cancer Council NSW, Sydney, Australia
| | - Marianne F. Weber
- Cancer Research Division, Cancer Council NSW, Sydney, Australia
- Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Lennert Veerman
- Cancer Research Division, Cancer Council NSW, Sydney, Australia
- Sydney School of Public Health, University of Sydney, Sydney, Australia
- School of Medicine, Griffith University, Southport, Queensland, Australia
| | - Nicole Rankin
- Cancer Research Division, Cancer Council NSW, Sydney, Australia
- Sydney Catalyst, NHMRC Clinical Trials Centre, Chris O’Brien Lifehouse Building, Camperdown, New South Wales, Australia
| | - Emily Banks
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Karen Canfell
- Cancer Research Division, Cancer Council NSW, Sydney, Australia
- Sydney School of Public Health, University of Sydney, Sydney, Australia
- Prince of Wales Clinical School, UNSW Medicine, Sydney, New South Wales, Australia
| | - Dianne L. O’Connell
- Cancer Research Division, Cancer Council NSW, Sydney, Australia
- Sydney School of Public Health, University of Sydney, Sydney, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
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Schofield D, Cunich M, Shrestha RN, Tanton R, Veerman L, Kelly S, Passey ME. The long-term economic impacts of arthritis through lost productive life years: results from an Australian microsimulation model. BMC Public Health 2018; 18:654. [PMID: 29793478 PMCID: PMC5968603 DOI: 10.1186/s12889-018-5509-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 04/25/2018] [Indexed: 11/10/2022] Open
Abstract
Background While the direct (medical) costs of arthritis are regularly reported in cost of illness studies, the 'true' cost to indivdiuals and goverment requires the calculation of the indirect costs as well including lost productivity due to ill-health. Methods Respondents aged 45-64 in the ABS Survey of Disability, Ageing and Carers 2003, 2009 formed the base population. We projected the indirect costs of arthritis using Health&WealthMOD2030 – Australia’s first microsimulation model on the long-term impacts of ill-health in older workers – which incorporated outputs from established microsimulation models (STINMOD and APPSIM), population and labour force projections from Treasury, and chronic conditions trends for Australia. All costs of arthritis were expressed in real 2013 Australian dollars, adjusted for inflation over time. Results We estimated there are 54,000 people aged 45-64 with lost PLYs due to arthritis in 2015, increasing to 61,000 in 2030 (13% increase). In 2015, people with lost PLYs are estimated to receive AU$706.12 less in total income and AU$311.67 more in welfare payments per week than full-time workers without arthritis, and pay no income tax on average. National costs include an estimated loss of AU$1.5 billion in annual income in 2015, increasing to AU$2.4 billion in 2030 (59% increase). Lost annual taxation revenue was projected to increase from AU$0.4 billion in 2015 to $0.5 billion in 2030 (56% increase). We projected a loss in GDP of AU$6.2 billion in 2015, increasing to AU$8.2 billion in 2030. Conclusions Significant costs of arthritis through lost PLYs are incurred by individuals and government. The effectiveness of arthritis interventions should be judged not only on healthcare use but quality of life and economic wellbeing.
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Affiliation(s)
- Deborah Schofield
- GenIMPACT: Centre for Economic Impacts of Genomic Medicine, Department of Economics, Faculty of Business and Economics, Macquarie University, Sydney, NSW, 2107, Australia
| | - Michelle Cunich
- The Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, Charles Perkins Centre, The University of Sydney, Sydney, NSW, 2006, Australia.
| | - Rupendra N Shrestha
- GenIMPACT: Centre for Economic Impacts of Genomic Medicine, Department of Economics, Faculty of Business and Economics, Macquarie University, Sydney, NSW, 2107, Australia
| | - Robert Tanton
- National Centre for Social and Economic Modelling, University of Canberra, Canberra, ACT, Australia
| | - Lennert Veerman
- School of Medicine, Griffith University, Gold Coast, QLD, Australia.,Cancer Council NSW, Woolloomooloo, NSW, 2011, Australia
| | - Simon Kelly
- National Centre for Social and Economic Modelling, University of Canberra, Canberra, ACT, Australia
| | - Megan E Passey
- University Centre for Rural Health, School of Public Health, The University of Sydney, Lismore, NSW, Australia
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Downs SM, Bloem MZ, Zheng M, Catterall E, Thomas B, Veerman L, Wu JHY. The Impact of Policies to Reduce trans Fat Consumption: A Systematic Review of the Evidence. Curr Dev Nutr 2017; 1:cdn.117.000778. [PMID: 29955689 PMCID: PMC5998794 DOI: 10.3945/cdn.117.000778] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 05/17/2017] [Accepted: 11/10/2017] [Indexed: 12/22/2022] Open
Abstract
Background: The consumption of industrially produced trans fatty acids (TFAs) has been associated with an increased risk of heart disease. In recognition of this, countries, states, and cities worldwide have implemented TFA policies aimed at reducing their availability in the food supply. Objective: This article aims to provide an update of the evidence of the effectiveness of policies aimed at reducing TFAs in the food supply. Methods: A systematic review of the literature from 2013 onward was conducted, building on a previously published review that examined the evidence of the impact of TFA policies worldwide from 2000 to 2012. Studies that were 1) empirical, 2) examined a TFA policy, and 3) examined the effect of the policy on TFA amounts and availability pre- and post-policy intervention were included. Modeling studies examining the impact of TFA policies on cardiovascular, equity, and economic outcomes were also included. Results: A total of 18 articles from the updated search were combined with 14 articles from the previous review (total = 32 articles). All types of TFA policies led to their reduction; however, trans fat bans had a larger impact (TFAs virtually eliminated) than did voluntary (range: 20-38% reduction in TFA intakes) or labeling (range: 30-74% reduction in TFA intakes, plasma serum, or breast-milk concentrations) approaches to reducing TFA amounts in the food supply. Product reformulation to reduce TFAs had variable effects on saturated fatty acid (SFA) contents in these foods; however, the combined amount of TFAs and SFAs declined in most products. Overall, the modeling studies indicated that TFA bans would reduce heart disease risk, benefit socioeconomically disadvantaged populations the most, and be cost-saving. Conclusions: Policies aimed at reducing TFAs in the food supply are effective and will likely reduce the burden of diet-related disease, particularly among the most vulnerable socioeconomic groups. Although all policy approaches lead to reductions in TFAs in foods, TFA bans are likely the most effective, economical, and equitable policy approach to reducing TFAs in the food supply.
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Affiliation(s)
- Shauna M Downs
- Department of Health Systems and Policy, School of Public Health, Rutgers University, New Brunswick NJ
| | - Milan Z Bloem
- Division of Human Nutrition, Wageningen University, Wageningen, Netherlands
| | - Miaobing Zheng
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Elise Catterall
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Beth Thomas
- National Heart Foundation of Australia, Brisbane, Australia
| | - Lennert Veerman
- Cancer Research Division, Cancer Council NSW, Sydney, Australia
| | - Jason HY Wu
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
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Khanal S, Veerman L, Nissen L, Hollingworth S. Use of Healthcare Services by Patients with Non-Communicable Diseases in Nepal: A Qualitative Study with Healthcare Providers. J Clin Diagn Res 2017; 11:LC01-LC05. [PMID: 28764203 DOI: 10.7860/jcdr/2017/25021.9970] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 02/20/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The healthcare systems in many Low-and Middle-Income Countries (LMICs) like Nepal have long focused on preventing and treating infectious diseases. Little is known about their preparedness to address the increasing prevalence of Non-Communicable Diseases (NCDs). AIM This study aimed to investigate the use of healthcare services by patients with NCDs in Nepal. MATERIALS AND METHODS Nine healthcare providers (including health assistants, pharmacy assistants, nurse, specialised nurse, practicing pharmacists, chief hospital pharmacist, doctors and specialised doctor) from Pokhara, Nepal, were recruited using purposive sampling. In depth interviews about the magnitude of NCDs, first point of care, screening and diagnosis, prevention and management, follow-up, and healthcare system responses to NCD burden were conducted. Data were thematically analysed with a deductive approach. RESULTS Although the healthcare system in Nepal is still primarily focused on communicable infectious diseases, healthcare providers are aware of the increasing burden of NCDs and NCD risk factors. The first points of care for patients with NCDs are government primary healthcare facilities and private pharmacies. NCDs are often diagnosed late and opportunistically. NCD prevention and treatment is unaffordable for many people. There are no government sponsored NCD screening programs. CONCLUSION There are problems associated with screening, diagnosis, treatment and follow-up of patients with NCDs in Nepal. Healthcare providers believe that the current healthcare system in Nepal is inadequate to address the growing problem of NCDs. The health system of Nepal will face challenges to incorporate programs to prevent and treat NCDs in addition to the pre-existing communicable diseases.
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Affiliation(s)
- Saval Khanal
- Consultant and International Relation Officer, Global Health Initiative, Sankalpa Foundation, Kaski, Pokhara, Nepal; PhD Student, School of Pharmacy, The University of Queensland, Wooloongabba, Australia
| | - Lennert Veerman
- Senior Research Fellow, The Cancer Council NSW, Sydney, Australia: Honorary Senior Fellow, School of Public Health, The University of Queensland, Herston, Australia
| | - Lisa Nissen
- Professor and Head, School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
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Lal A, Mantilla-Herrera AM, Veerman L, Backholer K, Sacks G, Moodie M, Siahpush M, Carter R, Peeters A. Modelled health benefits of a sugar-sweetened beverage tax across different socioeconomic groups in Australia: A cost-effectiveness and equity analysis. PLoS Med 2017; 14:e1002326. [PMID: 28654688 PMCID: PMC5486958 DOI: 10.1371/journal.pmed.1002326] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 05/17/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND A sugar-sweetened beverage (SSB) tax in Mexico has been effective in reducing consumption of SSBs, with larger decreases for low-income households. The health and financial effects across socioeconomic groups are important considerations for policy-makers. From a societal perspective, we assessed the potential cost-effectiveness, health gains, and financial impacts by socioeconomic position (SEP) of a 20% SSB tax for Australia. METHODS AND FINDINGS Australia-specific price elasticities were used to predict decreases in SSB consumption for each Socio-Economic Indexes for Areas (SEIFA) quintile. Changes in body mass index (BMI) were based on SSB consumption, BMI from the Australian Health Survey 2011-12, and energy balance equations. Markov cohort models were used to estimate the health impact for the Australian population, taking into account obesity-related diseases. Health-adjusted life years (HALYs) gained, healthcare costs saved, and out-of-pocket costs were estimated for each SEIFA quintile. Loss of economic welfare was calculated as the amount of deadweight loss in excess of taxation revenue. A 20% SSB tax would lead to HALY gains of 175,300 (95% CI: 68,700; 277,800) and healthcare cost savings of AU$1,733 million (m) (95% CI: $650m; $2,744m) over the lifetime of the population, with 49.5% of the total health gains accruing to the 2 lowest quintiles. We estimated the increase in annual expenditure on SSBs to be AU$35.40/capita (0.54% of expenditure on food and non-alcoholic drinks) in the lowest SEIFA quintile, a difference of AU$3.80/capita (0.32%) compared to the highest quintile. Annual tax revenue was estimated at AU$642.9m (95% CI: $348.2m; $1,117.2m). The main limitations of this study, as with all simulation models, is that the results represent only the best estimate of a potential effect in the absence of stronger direct evidence. CONCLUSIONS This study demonstrates that from a 20% tax on SSBs, the most HALYs gained and healthcare costs saved would accrue to the most disadvantaged quintiles in Australia. Whilst those in more disadvantaged areas would pay more SSB tax, the difference between areas is small. The equity of the tax could be further improved if the tax revenue were used to fund initiatives benefiting those with greater disadvantage.
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Affiliation(s)
- Anita Lal
- Centre for Population Health Research, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
- * E-mail:
| | | | - Lennert Veerman
- Cancer Council NSW, Woolloomooloo, New South Wales, Australia
| | - Kathryn Backholer
- Centre for Population Health Research, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
| | - Gary Sacks
- Centre for Population Health Research, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
| | - Marjory Moodie
- Centre for Population Health Research, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
| | - Mohammad Siahpush
- Department of Health Promotion, Social & Behavioral Health, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Rob Carter
- Centre for Population Health Research, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
| | - Anna Peeters
- Centre for Population Health Research, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
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Cobiac LJ, Tam K, Veerman L, Blakely T. Taxes and Subsidies for Improving Diet and Population Health in Australia: A Cost-Effectiveness Modelling Study. PLoS Med 2017; 14:e1002232. [PMID: 28196089 PMCID: PMC5308803 DOI: 10.1371/journal.pmed.1002232] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 01/06/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND An increasing number of countries are implementing taxes on unhealthy foods and drinks to address the growing burden of dietary-related disease, but the cost-effectiveness of combining taxes on unhealthy foods and subsidies on healthy foods is not well understood. METHODS AND FINDINGS Using a population model of dietary-related diseases and health care costs and food price elasticities, we simulated the effect of taxes on saturated fat, salt, sugar, and sugar-sweetened beverages and a subsidy on fruits and vegetables, over the lifetime of the Australian population. The sizes of the taxes and subsidy were set such that, when combined as a package, there would be a negligible effect on average weekly expenditure on food (<1% change). We evaluated the cost-effectiveness of the interventions individually, then determined the optimal combination based on maximising net monetary benefit at a threshold of AU$50,000 per disability-adjusted life year (DALY). The simulations suggested that the combination of taxes and subsidy might avert as many as 470,000 DALYs (95% uncertainty interval [UI]: 420,000 to 510,000) in the Australian population of 22 million, with a net cost-saving of AU$3.4 billion (95% UI: AU$2.4 billion to AU$4.6 billion; US$2.3 billion) to the health sector. Of the taxes evaluated, the sugar tax produced the biggest estimates of health gain (270,000 [95% UI: 250,000 to 290,000] DALYs averted), followed by the salt tax (130,000 [95% UI: 120,000 to 140,000] DALYs), the saturated fat tax (97,000 [95% UI: 77,000 to 120,000] DALYs), and the sugar-sweetened beverage tax (12,000 [95% UI: 2,100 to 21,000] DALYs). The fruit and vegetable subsidy (-13,000 [95% UI: -44,000 to 18,000] DALYs) was a cost-effective addition to the package of taxes. However, it did not necessarily lead to a net health benefit for the population when modelled as an intervention on its own, because of the possible adverse cross-price elasticity effects on consumption of other foods (e.g., foods high in saturated fat and salt). The study suggests that taxes and subsidies on foods and beverages can potentially be combined to achieve substantial improvements in population health and cost-savings to the health sector. However, the magnitude of health benefits is sensitive to measures of price elasticity, and further work is needed to incorporate potential benefits or harms associated with changes in other foods and nutrients that are not currently modelled, such as red and processed meats and fibre. CONCLUSIONS With potentially large health benefits for the Australian population and large benefits in reducing health sector spending on the treatment of non-communicable diseases, the formulation of a tax and subsidy package should be given a more prominent role in Australia's public health nutrition strategy.
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Affiliation(s)
- Linda J. Cobiac
- Centre for Health Policy, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- * E-mail:
| | - King Tam
- School of Public Health, The University of Queensland, Herston, Queensland, Australia
| | - Lennert Veerman
- School of Public Health, The University of Queensland, Herston, Queensland, Australia
| | - Tony Blakely
- Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme, Department of Public Health, University of Otago, Wellington, Wellington, New Zealand
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Wu JHY, Zheng M, Catterall E, Downs S, Thomas B, Veerman L, Barendregt JJ. Contribution of Trans-Fatty Acid Intake to Coronary Heart Disease Burden in Australia: A Modelling Study. Nutrients 2017; 9:nu9010077. [PMID: 28106762 PMCID: PMC5295121 DOI: 10.3390/nu9010077] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 01/12/2017] [Accepted: 01/13/2017] [Indexed: 11/21/2022] Open
Abstract
Trans-fatty acids (TFAs) intake has been consistently associated with a higher risk of coronary heart disease (CHD) mortality. We provided an updated assessment of TFA intake in Australian adults in 2010 and conducted modeling to estimate CHD mortality attributable to TFA intake. Data of the 2011–2012 National Nutrition and Physical Activity Survey was used to assess TFA intake. The CHD burden attributable to TFA was calculated by comparing the current level of TFA intake to a counterfactual setting where consumption was lowered to a theoretical minimum distribution of 0.5% energy. The average TFA intake among adults was 0.59% energy, and overall 10% of adults exceeded the World Health Organization (WHO) recommended limit of 1% energy. Education and income were moderately and inversely associated with TFA intake (p-value ≤ 0.001), with one in seven adults in the lowest income and education quintile having >1% energy from TFA. Australia had 487 CHD deaths (95% uncertainty interval, 367–615) due to TFA exposure, equivalent to 1.52% (95% uncertainty limits: 1.15%–1.92%) of all CHD mortality. The relative impact of TFA exposure on CHD mortality in Australia is limited, but, in absolute terms, still substantial. Policies aimed at reducing industrial TFA exposure can reduce socioeconomic inequalities in health and may therefore be desirable.
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Affiliation(s)
- Jason H Y Wu
- The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney 2042, Australia.
| | - Miaobing Zheng
- The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney 2042, Australia.
| | - Elise Catterall
- The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney 2042, Australia.
| | - Shauna Downs
- Earth Institute and Institute of Human Nutrition, Columbia University, New York, NY 10025, USA.
| | - Beth Thomas
- National Heart Foundation of Australia, Heart Health & Research, Brisbane 4006, Australia.
| | - Lennert Veerman
- School of Public Health, the University of Queensland, Brisbane 4006, Australia.
| | - Jan J Barendregt
- School of Public Health, the University of Queensland, Brisbane 4006, Australia.
- Epigear International, Sunrise Beach 4567, Australia.
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Schofield D, Shrestha RN, Cunich MM, Passey ME, Veerman L, Tanton R, Kelly SJ. The costs of diabetes among Australians aged 45-64 years from 2015 to 2030: projections of lost productive life years (PLYs), lost personal income, lost taxation revenue, extra welfare payments and lost gross domestic product from Health&WealthMOD2030. BMJ Open 2017; 7:e013158. [PMID: 28069621 PMCID: PMC5223630 DOI: 10.1136/bmjopen-2016-013158] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To project the number of people aged 45-64 years with lost productive life years (PLYs) due to diabetes and related costs (lost income, extra welfare payments, lost taxation revenue); and lost gross domestic product (GDP) attributable to diabetes in Australia from 2015 to 2030. DESIGN A simulation study of how the number of people aged 45-64 years with diabetes increases over time (based on population growth and disease trend data) and the economic losses incurred by individuals and the government. Cross-sectional outputs of a microsimulation model (Health&WealthMOD2030) which used the Australian Bureau of Statistics' Survey of Disability, Ageing and Carers 2003 and 2009 as a base population and integrated outputs from two microsimulation models (Static Incomes Model and Australian Population and Policy Simulation Model), Treasury's population and labour force projections, and chronic disease trends data. SETTING Australian population aged 45-64 years in 2015, 2020, 2025 and 2030. OUTCOME MEASURES Lost PLYs, lost income, extra welfare payments, lost taxation revenue, lost GDP. RESULTS 18 100 people are out of the labour force due to diabetes in 2015, increasing to 21 400 in 2030 (18% increase). National costs consisted of a loss of $A467 million in annual income in 2015, increasing to $A807 million in 2030 (73% increase). For the government, extra annual welfare payments increased from $A311 million in 2015 to $A350 million in 2030 (13% increase); and lost annual taxation revenue increased from $A102 million in 2015 to $A166 million in 2030 (63% increase). A loss of $A2.1 billion in GDP was projected for 2015, increasing to $A2.9 billion in 2030 attributable to diabetes through its impact on PLYs. CONCLUSIONS Individuals incur significant costs of diabetes through lost PLYs and lost income in addition to disease burden through human suffering and healthcare costs. The government incurs extra welfare payments, lost taxation revenue and lost GDP, along with direct healthcare costs.
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Affiliation(s)
- Deborah Schofield
- Faculty of Pharmacy, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- Murdoch Children's Research Institute, Royal Children's Hospital Flemington Road, Parkville, Victoria, Australia
- Garvan Institute of Medical Research, Sydney, New South Wales, Australia
| | - Rupendra N Shrestha
- Faculty of Pharmacy, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Michelle M Cunich
- Faculty of Pharmacy, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Megan E Passey
- University Centre for Rural Health, School of Public Health, The University of Sydney, Lismore, New South Wales, Australia
| | - Lennert Veerman
- Faculty of Medicine and Biomedical Sciences, School of Public Health, University of Queensland, Brisbane, Queensland, Australia
| | - Robert Tanton
- National Centre for Social and Economic Modelling, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Simon J Kelly
- National Centre for Social and Economic Modelling, University of Canberra, Canberra, Australian Capital Territory, Australia
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Khanal S, Veerman L, Nissen L, Hollingworth S. Forecasting the quantity and cost of medicines to treat non-communicable diseases in low- and middle-income countries: Applying knowledge on medicine use from developed countries. Res Social Adm Pharm 2017; 13:257-258. [DOI: 10.1016/j.sapharm.2016.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 07/31/2016] [Indexed: 10/21/2022]
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Aminde LN, Veerman L. Interventions for the prevention of cardiovascular diseases: a protocol for a systematic review of economic evaluations in low-income and middle-income countries. BMJ Open 2016; 6:e013668. [PMID: 28003298 PMCID: PMC5223679 DOI: 10.1136/bmjopen-2016-013668] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 11/07/2016] [Accepted: 12/01/2016] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Low-income and middle-income countries (LMICs) are experiencing a growing disease burden due to cardiovascular and other chronic non-communicable diseases. Interventions for the control of these diseases are paramount; however, these countries are faced with competing health and financial needs. There is an urgent need for quality evidence on cost-effective strategies to address these chronic diseases. We aim to synthesise the current literature on economic evaluations of interventions for primary and secondary cardiovascular disease prevention in LMICs. METHODS AND ANALYSIS A systematic review of studies (published and unpublished) in LMICs up to 30 October 2016 will be conducted. The following databases will be searched: PubMed/MEDLINE, EMBASE, SCOPUS, CINAHL, Web of Science, EconLit, NHS Economic Evaluations Database (NHS EED). Data sources specific to African literature, such as the WHO AFROLIB, Africa Index Medicus and African Journals online (AJOL) as well as grey literature, will also be searched. 2 reviewers shall independently screen potential articles for inclusion and disagreements shall be resolved by consensus. Quality appraisal of studies shall be done using Drummond's checklist for economic evaluation of studies. A descriptive synthesis of the evidence obtained is planned. The primary outcomes will be costs per life years gained or unit of clinical outcome, cost per quality-adjusted life years or disability-adjusted life years. This systematic review protocol has been prepared according to the Preferred Reporting Items for Systematic reviews and Meta-analyses for Protocols (PRISMA-P) 2015 statement. ETHICS AND DISSEMINATION Ethics approval is not required considering that this is a protocol for a systematic review of published studies. Results from this review will be disseminated via conference presentations and peer-reviewed journal publications. TRIAL REGISTRATION NUMBER CRD42016043510.
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Affiliation(s)
- Leopold Ndemnge Aminde
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Non-communicable Diseases Unit, Clinical Research Education, Networking & Consultancy (CRENC), Douala, Cameroon
| | - Lennert Veerman
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
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Veerman L. The impact of sugared drink taxation and industry response. Lancet Public Health 2016; 2:e2-e3. [PMID: 29249476 DOI: 10.1016/s2468-2667(16)30039-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 12/01/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Lennert Veerman
- The University of Queensland, School of Public Health, Herston, QLD 4006, Australia.
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Veerman L. Risk factor modelling with the Proportional Multi-State Life Table model. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw171.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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31
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Schofield D, Shrestha RN, Cunich MM, Tanton R, Veerman L, Kelly SJ, Passey ME. Economic costs of chronic disease through lost productive life years (PLYs) among Australians aged 45-64 years from 2015 to 2030: results from a microsimulation model. BMJ Open 2016; 6:e011151. [PMID: 27660315 PMCID: PMC5051341 DOI: 10.1136/bmjopen-2016-011151] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES To project the number of older workers with lost productive life years (PLYs) due to chronic disease and resultant lost income; and lost taxes and increased welfare payments from 2015 to 2030. DESIGN, SETTING AND PARTICIPANTS Using a microsimulation model, Health&WealthMOD2030, the costs of chronic disease in Australians aged 45-64 were projected to 2030. The model integrates household survey data from the Australian Bureau of Statistics Surveys of Disability, Ageing and Carers (SDACs) 2003 and 2009, output from long-standing microsimulation models (STINMOD (Static Incomes Model) and APPSIM (Australian Population and Policy Simulation Model)) used by various government departments, population and labour force growth data from Treasury, and disease trends data from the Australian Burden of Disease and Injury Study (2003). Respondents aged 45-64 years in the SDACs 2003 and 2009 formed the base population. MAIN OUTCOME MEASURES Lost PLYs due to chronic disease; resultant lost income, lost taxes and increased welfare payments in 2015, 2020, 2025 and 2030. RESULTS We projected 380 000 (6.4%) people aged 45-64 years with lost PLYs in 2015, increasing to 462 000 (6.5%) in 2030-a 22% increase in absolute numbers. Those with lost PLYs experience the largest reduction in income than any other group in each year compared to those employed full time without a chronic disease, and this income gap widens over time. The total economic loss due to lost PLYs consisted of lost income modelled at $A12.6 billion in 2015, increasing to $A20.5 billion in 2030-a 62.7% increase. Additional costs to the government consisted of increased welfare payments at $A6.2 billion in 2015, increasing to $A7.3 billion in 2030-a 17.7% increase; and a loss of $A3.1 billion in taxes in 2015, increasing to $A4.7 billion in 2030-a growth of 51.6%. CONCLUSIONS There is a need for greater investment in effective preventive health interventions which improve workers' health and work capacity.
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Affiliation(s)
- Deborah Schofield
- Faculty of Pharmacy, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- Murdoch Children's Research Institute, Royal Children's Hospital Flemington Road, Parkville, Victoria, Australia
- Garvan Institute of Medical Research, Victoria Street, Darlinghurst, Sydney, New South Wales, Australia
| | - Rupendra N Shrestha
- Faculty of Pharmacy, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Michelle M Cunich
- Faculty of Pharmacy, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Robert Tanton
- National Centre for Social and Economic Modelling, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Lennert Veerman
- Faculty of Medicine and Biomedical Sciences, School of Public Health, University of Queensland, Brisbane, Queensland, Australia
| | - Simon J Kelly
- National Centre for Social and Economic Modelling, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Megan E Passey
- University Centre for Rural Health, School of Public Health, The University of Sydney, Lismore, New South Wales, Australia
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Yu Y, Yang Y, Li Z, Zhou B, Zhao Y, Yuan S, Zhang R, Sebranek M, Veerman L, Li M, Gong E, Chen S, Ma W, Huang L, Cho K, Leeder S, Yan L. The association between medical students' lifestyles and their attitudes towards preventive counseling in different countries. BMC Public Health 2015; 15:1124. [PMID: 26566890 PMCID: PMC4644286 DOI: 10.1186/s12889-015-2458-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 10/26/2015] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Preventive counselling is an effective approach to reducing the prevalence of non-communicable diseases. Studies have shown that there is a positive association between healthy behaviors of Colombian medical students and favorable attitudes towards preventive counselling. However, there is limited research that explores this relationship in different countries. The current study aimed to determine how the health behaviors of medical students from China, U.S., and Australia, are associated with attitudes towards preventive counseling. METHODS Students from five Chinese medical schools, Duke University in the U.S., and the University of Queensland in Australia, completed a 32-item, self-reported online survey. The survey was used to examine the prevalence of healthy behaviors and their association with attitudes towards preventive counseling. The target sample size was 150 students from each grade, or 450 students in total from different medical universities. Logistic regression analyses were used to assess the association between health behaviors and attitudes towards preventive counseling, stratified by grade and adjusted by gender. RESULTS A positive association was found between healthy behaviors and attitudes towards preventive counseling for all medical students. There are significant differences among medical students' self-reported health behaviors and their attitudes towards preventive counselling from three different countries (P < 0.05). Chinese medical students were more positive in stress control (OR > 1) and more passive in limiting their smoking and alcohol behaviors compared to medical students in Duke University. However, compared to medical students in University of Queensland, five Chinese medical students were more passive in stress control (OR < 1). CONCLUSION Based on the finding that healthy behaviors are positively related to favorable attitudes towards preventative counselling, medical students should adopt targeted courses and training in preventive counseling and develop healthy lifestyles.
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Affiliation(s)
- Yan Yu
- Xi'an Jiaotong University School of Medicine, No.76#, West Yanta Road, Xi'an, 710061, Shaanxi, China.
| | - Yuxuan Yang
- Xi'an Jiaotong University School of Medicine, No.76#, West Yanta Road, Xi'an, 710061, Shaanxi, China.
| | - Zhifang Li
- Changzhi Medical College, Changzhi, Shanxi Province, China.
| | - Bo Zhou
- First Hospital of China Medical University, Shenyang, Liaoning Province, China.
| | - Yi Zhao
- Ningxia Medical University, Yinchuan, Ningxia Hui Autonomous Region, China.
| | - Shen Yuan
- Xi'an Jiaotong University School of Medicine, No.76#, West Yanta Road, Xi'an, 710061, Shaanxi, China.
| | - Ruijuan Zhang
- Xi'an Jiaotong University School of Medicine, No.76#, West Yanta Road, Xi'an, 710061, Shaanxi, China.
| | | | - Lennert Veerman
- School of Public Health, the University of Queensland, St Lucia, Brisbane, Australia.
| | - Mu Li
- School of Public Health, the University of Sydney, Sydney, Australia.
| | - Enying Gong
- Children's Hospital Los Angeles, Los Angeles, CA, USA.
| | - Shu Chen
- Children's Hospital Los Angeles, Los Angeles, CA, USA.
| | - Wenjie Ma
- Children's Hospital Los Angeles, Los Angeles, CA, USA.
| | - Liping Huang
- School of Public Health, the University of Sydney, Sydney, Australia.
| | - KaWing Cho
- Children's Hospital Los Angeles, Los Angeles, CA, USA.
| | - Stephen Leeder
- Menzies Centre for Health Policy, School of Public Health, the University of Sydney, Sydney, Australia.
| | - Lijing Yan
- Duke Global Health Institutesss, Duke University, Durham, USA.
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Khanal S, Nissen L, Veerman L, Hollingworth S. Pharmacy workforce to prevent and manage non-communicable diseases in developing nations: The case of Nepal. Res Social Adm Pharm 2015; 12:655-9. [PMID: 26481826 DOI: 10.1016/j.sapharm.2015.09.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 09/18/2015] [Indexed: 11/30/2022]
Abstract
Non-communicable diseases (NCDs, e.g. cardiovascular diseases, cancer, chronic respiratory diseases and diabetes mellitus) are the main causes of mortality and morbidity in developing countries, including Nepal. Nearly half of the deaths in Nepal are caused by NCDs. Nepal lacks adequate human resources to prevent and manage NCDs, but the skills and expertise of pharmacists in Nepal are underused. There is evidence from many countries that pharmacists can contribute substantially to the prevention and management NCD. We aim to describe the opportunities and challenges for pharmacists to prevent and manage NCDs in Nepal. Pharmacists can contribute by screening and monitoring NCDs; counseling on lifestyle; providing medication therapy management services; promoting public health; and providing other pharmaceutical services. Challenges to the implementation of some of these activities in the current context include inadequate training of pharmacists in NCD prevention and management, the cost of pharmaceutical services to patients and government, and the existing health care service delivery model. There is a need for health services research to determine how pharmacists can be best used to prevent and manage NCDs in Nepal.
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Affiliation(s)
- Saval Khanal
- School of Pharmacy, The University of Queensland, Australia; Sankalpa Foundation, Pokhara, Kaski, Nepal.
| | - Lisa Nissen
- School of Clinical Sciences, Queensland University of Technology, Australia
| | - Lennert Veerman
- School of Public Health, The University of Queensland, Australia
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Khanal S, Veerman L, Hollingworth S, Nissen L. Shift in disease burden from communicable to non-communicable diseases: aiming to achieve Universal Health Coverage in Nepal. Perspect Public Health 2015; 135:177-8. [PMID: 26148895 DOI: 10.1177/1757913915586654] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Schofield D, Cunich M, Kelly S, Passey ME, Shrestha R, Callander E, Tanton R, Veerman L. The impact of diabetes on the labour force participation, savings and retirement income of workers aged 45-64 years in Australia. PLoS One 2015; 10:e0116860. [PMID: 25706941 PMCID: PMC4338208 DOI: 10.1371/journal.pone.0116860] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 12/15/2014] [Indexed: 12/05/2022] Open
Abstract
Background Diabetes is a debilitating and costly condition. The costs of reduced labour force participation due to diabetes can have severe economic impacts on individuals by reducing their living standards during working and retirement years. Methods A purpose-built microsimulation model of Australians aged 45-64 years in 2010, Health&WealthMOD2030, was used to estimate the lost savings at age 65 due to premature exit from the labour force because of diabetes. Regression models were used to examine the differences between the projected savings and retirement incomes of people at age 65 for those currently working full or part time with no chronic health condition, full or part time with diabetes, and people not in the labour force due to diabetes. Results All Australians aged 45-65 years who are employed full time in 2010 will have accumulated some savings at age 65; whereas only 90.5% of those who are out of the labour force due to diabetes will have done so. By the time they reach age 65, those who retire from the labour force early due to diabetes have a median projected savings of less than $35,000. This is far lower than the median value of total savings for those who remained in the labour force full time with no chronic condition, projected to have $638,000 at age 65. Conclusions Not only does premature retirement due to diabetes limit the immediate income available to individuals with this condition, but it also reduces their long-term financial capacity by reducing their accumulated savings and the income these savings could generate in retirement. Policies designed to support the labour force participation of those with diabetes, or interventions to prevent the onset of the disease itself, should be a priority to preserve living standards comparable with others who do not suffer from this condition.
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Affiliation(s)
- Deborah Schofield
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - Michelle Cunich
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
- * E-mail:
| | - Simon Kelly
- National Centre for Social and Economic Modelling, University of Canberra, Canberra, Australia
| | - Megan E. Passey
- University Centre for Rural Health–North Coast, School of Public Health, University of Sydney, Sydney, Australia
| | - Rupendra Shrestha
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - Emily Callander
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - Robert Tanton
- National Centre for Social and Economic Modelling, University of Canberra, Canberra, Australia
| | - Lennert Veerman
- School of Population Health, University of Queensland, Brisbane, Queensland, Brisbane, Australia
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Veerman L, Akbar D, Barendregt JJ, Smith P. Making urban transport less obesogenic: The effect of a bridge on bicycle commuting. Obes Res Clin Pract 2014. [DOI: 10.1016/j.orcp.2014.10.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sànchez-Riera L, Carnahan E, Vos T, Veerman L, Norman R, Lim SS, Hoy D, Smith E, Wilson N, Nolla JM, Chen JS, Macara M, Kamalaraj N, Li Y, Kok C, Santos-Hernández C, March L. The global burden attributable to low bone mineral density. Ann Rheum Dis 2014; 73:1635-45. [DOI: 10.1136/annrheumdis-2013-204320] [Citation(s) in RCA: 107] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Schofield D, Cunich MM, Shrestha RN, Passey ME, Veerman L, Callander EJ, Kelly SJ, Tanton R. The economic impact of diabetes through lost labour force participation on individuals and government: evidence from a microsimulation model. BMC Public Health 2014; 14:220. [PMID: 24592931 PMCID: PMC3975899 DOI: 10.1186/1471-2458-14-220] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 02/21/2014] [Indexed: 11/30/2022] Open
Abstract
Background Diabetes is a costly and debilitating disease. The aim of the study is to quantify the individual and national costs of diabetes resulting from people retiring early because of this disease, including lost income; lost income taxation, increased government welfare payments; and reductions in GDP. Methods A purpose-built microsimulation model, Health&WealthMOD2030, was used to estimate the economic costs of early retirement due to diabetes. The study included all Australians aged 45–64 years in 2010 based on Australian Bureau of Statistics’ Surveys of Disability, Ageing and Carers. A multiple regression model was used to identify significant differences in income, government welfare payments and taxation liabilities between people out of the labour force because of their diabetes and those employed full time with no chronic health condition. Results The median annual income of people who retired early because of their diabetes was significantly lower (AU$11 784) compared to those employed full time without a chronic health condition who received almost five times more income. At the national level, there was a loss of AU$384 million in individual earnings by those with diabetes, an extra AU$4 million spent in government welfare payments, a loss of AU$56 million in taxation revenue, and a loss of AU$1 324 million in GDP in 2010: all attributable to diabetes through its impact on labour force participation. Sensitivity analysis was used to assess the impact of different diabetes prevalence rates on estimates of lost income, lost income taxation, increased government welfare payments, and reduced GDP. Conclusions Individuals bear the cost of lost income in addition to the burden of the disease. The Government endures the impacts of lost productivity and income taxation revenue, as well as spending more in welfare payments. These national costs are in addition to the Government’s direct healthcare costs.
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Affiliation(s)
| | - Michelle M Cunich
- NHMRC Clinical Trials Centre, Sydney Medical School, The University of Sydney, Sydney, Australia.
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Schofield DJ, Cunich M, Shrestha RN, Callander EJ, Passey ME, Kelly SJ, Tanton R, Veerman L. The impact of diabetes on the labour force participation and income poverty of workers aged 45-64 years in Australia. PLoS One 2014; 9:e89360. [PMID: 24586716 PMCID: PMC3930716 DOI: 10.1371/journal.pone.0089360] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 01/21/2014] [Indexed: 11/22/2022] Open
Abstract
Objective To quantify the poverty status and level of disadvantage experienced by Australians aged 45–64 years who have left the labour force due to diabetes in 2010. Research Design and Methods A purpose-built microsimulation model, Health&WealthMOD2030, was used to estimate the poverty status and level of disadvantage of those aged 45–64 years who prematurely retire from the workforce due to diabetes. A multiple regression model was used to identify significant differences in rates of income poverty and the degree of disadvantage between those out of the labour force due to diabetes and those employed full- or part-time with no diabetes. Results 63.9% of people aged 45–64 years who were out of the labour force due to diabetes were in poverty in 2010. The odds of being in poverty for those with no diabetes and employed full-time (OR of being in poverty 0.02 95%CI: 0.01–0.04) or part-time (OR of being in poverty 0.10 95%CI: 0.05–0.23) are significantly lower than those for persons not in the labour force due to diabetes. Amongst those with diabetes, those who were able to stay in either full- or part-time employment were as much as 97% less likely to be in poverty than those who had to retire early because of the condition. Sensitivity analysis was used to assess impacts of different poverty line thresholds and key socioeconomic predictors of poverty. Conclusions This study has shown that having diabetes and not being in the labour force because of this condition significantly increases the chances of living in poverty. Intervening to prevent or delay the onset of diabetes is likely to improve their living standards.
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Affiliation(s)
- Deborah J. Schofield
- NHMRC Clinical Trials Centre, University of Sydney, Australia
- School of Public Health, University of Sydney, Australia
| | - Michelle Cunich
- NHMRC Clinical Trials Centre, University of Sydney, Australia
- * E-mail:
| | | | | | - Megan E. Passey
- University Centre for Rural Health – North Coast, School of Public Health, University of Sydney, Australia
| | - Simon J. Kelly
- National Centre for Social and Economic Modelling, University of Canberra, Australia
| | - Robert Tanton
- National Centre for Social and Economic Modelling, University of Canberra, Australia
| | - Lennert Veerman
- School of Population Health, University of Queensland, Brisbane, Queensland, Australia
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Holm AL, Veerman L, Cobiac L, Ekholm O, Diderichsen F. Cost-effectiveness of preventive interventions to reduce alcohol consumption in Denmark. PLoS One 2014; 9:e88041. [PMID: 24505370 PMCID: PMC3914889 DOI: 10.1371/journal.pone.0088041] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 01/02/2014] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION Excessive alcohol consumption increases the risk of many diseases and injuries, and the Global Burden of Disease 2010 study estimated that 6% of the burden of disease in Denmark is due to alcohol consumption. Alcohol consumption thus places a considerable economic burden on society. METHODS We analysed the cost-effectiveness of six interventions aimed at preventing alcohol abuse in the adult Danish population: 30% increased taxation, increased minimum legal drinking age, advertisement bans, limited hours of retail sales, and brief and longer individual interventions. Potential health effects were evaluated as changes in incidence, prevalence and mortality of alcohol-related diseases and injuries. Net costs were calculated as the sum of intervention costs and cost offsets related to treatment of alcohol-related outcomes, based on health care costs from Danish national registers. Cost-effectiveness was evaluated by calculating incremental cost-effectiveness ratios (ICERs) for each intervention. We also created an intervention pathway to determine the optimal sequence of interventions and their combined effects. RESULTS Three of the analysed interventions (advertising bans, limited hours of retail sales and taxation) were cost-saving, and the remaining three interventions were all cost-effective. Net costs varied from € -17 million per year for advertisement ban to € 8 million for longer individual intervention. Effectiveness varied from 115 disability-adjusted life years (DALY) per year for minimum legal drinking age to 2,900 DALY for advertisement ban. The total annual effect if all interventions were implemented would be 7,300 DALY, with a net cost of € -30 million. CONCLUSION Our results show that interventions targeting the whole population were more effective than individual-focused interventions. A ban on alcohol advertising, limited hours of retail sale and increased taxation had the highest probability of being cost-saving and should thus be first priority for implementation.
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Affiliation(s)
- Astrid Ledgaard Holm
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- * E-mail:
| | - Lennert Veerman
- School of Population Health, The University of Queensland, Brisbane, Australia
| | - Linda Cobiac
- School of Population Health, The University of Queensland, Brisbane, Australia
| | - Ola Ekholm
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Finn Diderichsen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Holm AL, Veerman L, Cobiac L, Ekholm O, Diderichsen F. Cost-effectiveness of changes in alcohol taxation in Denmark: a modelling study. Cost Eff Resour Alloc 2014; 12:1. [PMID: 24405884 PMCID: PMC3914680 DOI: 10.1186/1478-7547-12-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 01/02/2014] [Indexed: 01/16/2023] Open
Abstract
Introduction Excessive alcohol consumption is a public health problem in many countries including Denmark, where 6% of the burden of disease is due to alcohol consumption, according to the new estimates from the Global Burden of Disease 2010 study. Pricing policies, including tax increases, have been shown to effectively decrease the level of alcohol consumption. Methods We analysed the cost-effectiveness of three different scenarios of changed taxation of alcoholic beverages in Denmark (20% and 100% increase and 10% decrease). The lifetime health effects are estimated as the difference in disability-adjusted life years between a Danish population that continues to drink alcohol at current rates and an identical population that changes their alcohol consumption due to changes in taxation. Calculation of cost offsets related to treatment of alcohol-related diseases and injuries, was based on health care system costs from Danish national registers. Cost-effectiveness was evaluated by calculating cost-effectiveness ratios (CERs) compared to current practice. Results The two scenarios of 20% and 100% increased taxation could avert 20,000 DALY and 95,500 DALY respectively, and yield cost savings of -€119 million and -€575 million, over the life time of the Danish population. Both scenarios are thus cost saving. The tax decrease scenario would lead to 10,100 added DALY and an added cost of €60 million. For all three interventions the health effects build up and reach their maximum around 15–20 years after implementation of the tax change. Conclusion Our results show that decreased taxation will lead to an increased burden of disease and related increases in health care costs, whereas both a doubling of the current level of alcohol taxation and a scenario where taxation is only increased by 20% can be cost-saving ways to reduce alcohol related morbidity and mortality. Our results support the growing evidence that population strategies are cost-effective and should be considered for policy making and prevention of alcohol abuse.
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Abstract
Concern about the overconsumption of unhealthy foods is growing worldwide. With high global rates of noncommunicable diseases related to poor nutrition and projections of more rapid increases of rates in low- and middle-income countries, it is vital to identify effective but low-cost interventions. Cost-effectiveness studies show that individually targeted dietary interventions can be effective and cost-effective, but a growing number of modeling studies suggest that population-wide approaches may bring larger and more sustained benefits for population health at a lower cost to society. Mandatory regulation of salt in processed foods, in particular, is highly recommended. Future research should focus on lacunae in the current evidence base: effectiveness of interventions addressing the marketing, availability, and price of healthy and unhealthy foods; modeling health impacts of complex dietary changes and multi-intervention strategies; and modeling health implications in diverse subpopulations to identify interventions that will most efficiently and effectively reduce health inequalities.
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Affiliation(s)
- Linda J Cobiac
- School of Population Health, The University of Queensland, Herston, Queensland, 4006 Australia.
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Abstract
Implications for practise and research: Ara and colleagues studied the effectiveness and cost-effectiveness of weight-reducing drugs and found that they provide statistically significant weight loss and are worth the investment. The analysis contains several unwarranted assumptions, notably around the amount of weight lost, subsequent weight regained and the permanency of weight loss. Definitive conclusions cannot be drawn from this study.
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Affiliation(s)
- Lennert Veerman
- School of Population Health, University of Queensland, Herston Road, Herston,QLD 4006, Australia.
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Ditsuwan V, Veerman L, Suvapan D, Bertram M, Vos T. Long-term health consequences of road traffic injuries: a representative cohort study in Thailand. Inj Prev 2011. [DOI: 10.1136/ip.2010.029215.180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Cobiac LJ, Vos T, Veerman L. Authors' response. Heart 2011. [DOI: 10.1136/hrt.2010.217802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Ditsuwan V, Veerman L, Bertram M, Vos T. A historical perspective on sobriety checkpoints in Thailand: is there evidence for effectiveness? Inj Prev 2010. [DOI: 10.1136/ip.2010.029215.187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Cobiac L, Vos T, Veerman L. Cost-effectiveness of Weight Watchers and the Lighten Up to a Healthy Lifestyle program. Aust N Z J Public Health 2010; 34:240-7. [DOI: 10.1111/j.1753-6405.2010.00520.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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