The Centre for Clinical Change and Health Care Research is currently collaborating on the following Health Economics research projects:

 

An economic evaluation of the effects of botulinum-toxin-A combined with intensive rehabilitation compared botulinum-toxin-A alone.

This economic evaluation is being undertaken by Professor Julie Ratcliffe and forms part of a large randomised controlled trial study recently funded by the National Health and Medical Research Council (NHMRC) to investigate impaired arm and hand function which is a common and often devastating problem for stroke survivors. Regaining lost movement in the arm/hand is more difficult to achieve than walking, with only 5% of people with hemiplegia regaining functional use of their hand. This devastating outcome could potentially be addressed, however we do not yet know how to best increase movement in the arm and hand after stroke for patients with spasticity.There is a lack of randomized controlled trials of botulinum toxin A(BoNT-A) with a group who does not receive therapy in some dose, and so whether gains were achieved through BoNT-A or a combination of the BoNT-A and therapy cannot be determined from the studies to date.


No previous comparative effectiveness trials have been conducted to provide clinicians and patients with the necessary information to make decisions about what will improve spasticity and function after stroke. An important component of this study will be to examine and compare the cost effectiveness and efficacy of the most common interventions used clinically. Using a pragmatic clinical trial design, this study will include all clinically relevant patient subgroups, and compare the routine comparator interventions of BoNT-A alone to BoNT-Aplus best-practice therapy for cost and outcome. To ensure applicability, this project will use clinician therapy providers to ensure utility and relevance of any findings- this design is central to ensuring the relevance of trial results to both clinical and policy decisions. In this way, the project will address the NHMRC Clinical Practice Guidelines for Stroke and the National Stroke Foundation Priority Area for Research by comparing the clinical and cost-effectiveness of treatments for spasticity.

 

 

Key collaborators

La Trobe University, University of South Australia, University of Sydney.

Key contacts

Lead investigator: Associate Professor Natasha Lannin
Key Researchers: Professor Louise Ada, Doctor Coralie English and Professor Maria Crotty

Key outcomes

NHMRC Project grant: $1,036,700

 

A health economic model for the development and evaluation of innovations in aged care

Professor Julie Ratcliffe and colleagues are working with aged care industry partners on a study which will develop and apply a comprehensive health economics model to the evolution, implementation and evaluation of consumer directed care in a community aged care setting. The health economics model will incorporate an investigation of preferences, health and quality of life outcomes and cost effectiveness.

A mixed methods approach comprising qualitative interviews and a discrete choice experiment (DCE) will be applied to determine the attitudes and preferences of older people, their informal carers and staff engaged in the provision of community aged care for CDC. The cost effectiveness of CDC will be evaluated by comparing incremental changes in resource use, costs and health and quality of life outcomes relative to the existing traditional model of service delivery (Provider Directed Care - PDC). The extent of change over time in psychological well-being and self-management abilities of older people and their informal carers as a consequence of exposure to CDC will be measured.

The proposed framework will have wide applicability in the future development and economic evaluation of new innovations across the Aged Care sector. The study is due to be completed in 2015.

 

 

Key collaborators

Monash University, University of Sydney, University of Queensland, Helping Hand Aged Care, Resthaven, ACH Group, HammondCare, Catholic Community Services

Key contacts

Lead investigator: Professor Julie Ratcliffe
Key Researchers: Dr Billingsley Kaambwa, Ms Nikki McCaffrey

Key outcomes

ARC linkage funding granted: $579,539 (inclusive of aged care partner contributions)

Adolescent population health: application of Best-Worst Scaling Discrete Choice Experiments to value health states for use in economic evaluation

Professor Julie Ratcliffe, Dr Elisabeth Huynh, Dr Gang Chen, Dr Terry Flynn, Dr Katherine Stevens, Professor John Brazier, Professor Michael Sawyer and Dr Rachel Roberts have worked on this two year project funded by the NHMRC project grants scheme to develop and apply best-worst scaling discrete choice experiment methods to obtain health state values directly from adolescents for the CHU9D, a generic preference based measure of health for application with children and adolescents.

The availability of an adolescent-specific scoring algorithm for the CHU9D enables the health state values of adolescents to be incorporated directly into an economic evaluation study through calculation of the incremental QALY gains associated with new treatment and preventive programs targeted for this age group.

This study has facilitated the systematic incorporation of the views of a large sample of young people in the Australian community to be incorporated directly into the health care priorities decision-making process. This project is now  completed.

Researchers interested in using the Australian adolescent specific scoring algorithm for the CHU9D should contact Dr Gang Chen: gang.chen@flinders.edu.au for more details.

 

 

Key collaborators

University of Technology Sydney, University of Adelaide, University of Sheffield


Key contacts

Lead investigator: Professor Julie Ratcliffe
Key Researcher: Mr Gang Chen

Key outcomes

NHMRC funding granted: $174,313

Economic evaluation of OPAL (Obesity Prevention and Lifestyle)

Professor Julie Ratcliffe is leading the economic evaluation component of a study to assess the effectiveness of OPAL, a significant new childhood obesity prevention initiative supported by both State and Federal governments.

The overall aim of OPAL is to improve eating and activity patterns of children from families and communities in OPAL regions and thereby increase the proportion of children in the healthy weight range. The economic analysis of the OPAL program will assess the cost effectiveness of the intervention by comparing the total costs of the intervention with the primary measures of health outcome for the economic analysis: [1] the prevalence of healthy weight in children aged 4-5 years, 10-12 years and 13-15 years of age and [2] the quality adjusted life years (QALYs) gained as measured by the Child Health Utility 9D (CHU9D) instrument.

The time horizon for the economic analysis will reflect that of the overall evaluation (5 years). An economic modelling approach will also be used to extrapolate the likely longer term costs and benefits of OPAL. This study is due to be completed in 2015.

 

 

Key collaborators

PANORAMA Physical Activity and Nutrition Observatory: Research and Monitoring Alliance

Key contacts

Lead investigator: Professor Julie Ratcliffe
 

Key outcomes

South Australian Department of Health funding:$4,554,000

 

 

Economic evaluation of acupuncture to improve live birth rates for women undergoing IVF

This economic evaluation is currently being undertaken by Professor Julie Ratcliffe and forms part of a large randomised controlled trial study recently funded by the National Health and Medical Research Council (NHMRC) to investigate the clinical and cost effectiveness of acupuncture to improve live birth rates for IVF.

The primary hypothesis to be investigated is that women undergoing IVF plus acupuncture compared with a placebo control and standard care will demonstrate an increase in live birth rates. The secondary hypotheses are women undergoing IVF plus acupuncture compared with a placebo control and standard care will demonstrate: an increase in clinical pregnancy rates, reduced miscarriage, and improved quality of life and self efficacy.

This study will add significantly to the evidence base to allow conclusions to be made on the cost effectiveness of acupuncture to improve reproductive outcomes. The study results will inform policy makers, health care providers and women and men to make informed choices about the clinical and cost effectiveness of acupuncture to improve reproductive and other health outcomes. The study is due to be completed in 2015.

 

 


Key collaborators 

University of Western Sydney   University of New South Wales

Flinders University

Key contacts

Lead investigator:  Assoc Prof Caroline Smith, University of Western Sydney

Professor Julie Ratcliffe 

Dr Billy Kaambwa

Key outcomes

NHMRC funding granted:$629,181

Engaging the public in healthcare decision making: Quantifying preferences for healthcare through Citizens' Juries

 

The study aims to promote public engagement and quantifies preferences in key areas of relevance to the industry partners (Queensland Health and Southern Adelaide Health Service). A series of choice experiments and citizens' juries will be used.

The project will facilitate identification and application of optimal methods for engaging the public in healthcare decision-making, provide guidance on the appropriate population groups to consider when eliciting consumer preferences, and provide direct public input to guide health policy. The approach will be able to be applied to different policy areas. The study is due to be completed in 2014.

 

 


Key collaborators

 

Griffith University    Queensland Health   Southern Adelaide Health Service    National Institute for Health and Clinical Excellence (NICE)

Key contacts

Lead investigator Professor Paul Scuffham, Griffith University

Professor Julie Ratcliffe 

Key outcomes

Australian Research Council (ARC) Linkage funding:$547,288