Dr. Kevin H.

ABSTRACT: Illicit heroin use is a worldwide problem, with significant health and social costs.
Treatment is known to be effective in changing heroin use habits, but it often needs to be
provided over a lifetime, with people cycling in and out of treatment. It is therefore important to
capture a long-term perspective on heroin use careers. The aim of this project was to build a
lifetime microsimulation model of heroin using careers. This paper describes the conceptual
logic of… Show more

ABSTRACT: Illicit heroin use is a worldwide problem, with significant health and social costs.
Treatment is known to be effective in changing heroin use habits, but it often needs to be
provided over a lifetime, with people cycling in and out of treatment. It is therefore important to
capture a long-term perspective on heroin use careers. The aim of this project was to build a
lifetime microsimulation model of heroin using careers. This paper describes the conceptual
logic of the model, the input parameters and the verification and validation results. A
microsimulation model was chosen as the most appropriate simulation platform with 9 states,
and 111,400 individuals (aged between 18 and 60) each with gender, HIV (human
immunodeficiency virus) and HCV (hepatitis C) status, and treatment history. Probabilities
associated with crime commission and individually calculated lengths of stay in each state were
determined from multiple datasets. The model included costs associated with treatment
provision, healthcare services, criminal activity, life years lost, and family benefit of treatment.
The final model represented 42 years of a heroin use career for a cohort based on Australian
(New South Wales) data. Individuals cycle into and out of heroin using states (including
abstinence), as well as treatment and prison states. We were able to build a stable, tractable
model and verified all parameters. Validation against external data sources revealed high validity.
While there are limitations associated with any model, the heroin career model now has the
potential to be used for simulations of alternate policy scenarios.
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Background
The overarching goal of health policies is to maximize health and societal benefits. Economic evaluations can play a vital role in assessing whether or not such benefits occur. This paper reviews the application of modelling techniques in economic evaluations of drug and alcohol interventions with regard to (i) modelling paradigms themselves; (ii) perspectives of costs and benefits and (iii) time frame.

Methods
Papers that use modelling approaches for economic… Show more

Background
The overarching goal of health policies is to maximize health and societal benefits. Economic evaluations can play a vital role in assessing whether or not such benefits occur. This paper reviews the application of modelling techniques in economic evaluations of drug and alcohol interventions with regard to (i) modelling paradigms themselves; (ii) perspectives of costs and benefits and (iii) time frame.

Methods
Papers that use modelling approaches for economic evaluations of drug and alcohol interventions were identified by carrying out searches of major databases.

Results
Thirty eight papers met the inclusion criteria. Overall, the cohort Markov models remain the most popular approach, followed by decision trees, Individual based model and System dynamics model (SD). Most of the papers adopted a long term time frame to reflect the long term costs and benefits of health interventions. However, it was fairly common among the reviewed papers to adopt a narrow perspective that only takes into account costs and benefits borne by the health care sector.

Conclusions
This review paper informs policy makers about the availability of modelling techniques that can be used to enhance the quality of economic evaluations for drug and alcohol treatment interventions. Show less

Objective:
To evaluate the impact of the National Perinatal Depression Initiative on access to Medicare services for women at risk of perinatal mental illness.

Method:
Retrospective cohort study using difference-in-difference analytical methods to quantify the impact of the National Perinatal Depression Initiative policies on Medicare Benefits Schedule mental health usage by Australian women giving birth between 2006 and 2010. A random sample of women of reproductive age enrolled… Show more

Objective:
To evaluate the impact of the National Perinatal Depression Initiative on access to Medicare services for women at risk of perinatal mental illness.

Method:
Retrospective cohort study using difference-in-difference analytical methods to quantify the impact of the National Perinatal Depression Initiative policies on Medicare Benefits Schedule mental health usage by Australian women giving birth between 2006 and 2010. A random sample of women of reproductive age enrolled in Medicare who had not given birth where used as controls. The main outcome measures were the proportions of women giving birth each month who accessed a Medicare Benefits Schedule mental health items during the perinatal period (pregnancy through to the end of the first postnatal year) before and after the introduction of the National Perinatal Depression Initiative.

Conclusion:
In the 2 years following its introduction, the National Perinatal Depression Initiative was found to have increased access to Medicare funded mental health services in particular groups of women. However, an overall increase across all groups did not reach statistical significance. Further studies are needed to assess the impact of the National Perinatal Depression Initiative on women during childbearing years, including access to tertiary care, the cost-effectiveness of the initiative, and mental health outcomes. It is recommended that new mental health policy initiatives incorporate a planned strategic approach to evaluation, which includes sufficient follow-up to assess the impact of public health strategies. Show less

Importance The unprecedented increase in multiple births during the past 3 decades is a major public health concern and parallels the uptake of medically assisted conception. The economic implications of such births are not well understood.

Objectives To conduct a comprehensive economic and health services assessment of the frequency, duration, and cost of hospital admissions during the first 5 years of life for singleton, twin, and higher-order multiple (HOM) children and to examine… Show more

Importance The unprecedented increase in multiple births during the past 3 decades is a major public health concern and parallels the uptake of medically assisted conception. The economic implications of such births are not well understood.

Objectives To conduct a comprehensive economic and health services assessment of the frequency, duration, and cost of hospital admissions during the first 5 years of life for singleton, twin, and higher-order multiple (HOM) children and to examine the contribution of assisted reproductive technology (ART) to the incidence and cost of multiple births.

Design, Setting, and Participants A retrospective population cohort study using individually linked birth, hospital, and death records among 233 850 infants born in Western Australia between October 1993 and September 2003, and followed up to September 2008.

Exposures Multiple-gestation delivery and ART conception.

Main Outcomes and Measures Odds of stillbirth, prematurity and low birth weight, frequency and length of hospital admissions, the mean costs by plurality, and the independent effect of prematurity on childhood costs.

Conclusions and Relevance Compared with singletons, multiple-birth infants consume significantly more hospital resources, particularly during the neonatal period and first year of life. A significant proportion of the clinical and economic burden associated with multiple births can be prevented through single-embryo transfer. Increasing ART use worldwide and persistently high ART multiple-birth rates in several countries highlight the need for strategies that encourage single-embryo transfer. The costs from this study can be generalized to other settings. Show less

STUDY QUESTION
Do singletons conceived following assisted reproduction technologies (ARTs) have significantly different hospital utilization, and therefore costs, compared with non-ART children during the first 5 years of life?
SUMMARY ANSWER
ART singletons have longer hospital birth-admissions and a small increased risk of re-admission during the first 5 years of life resulting in higher costs of hospital care.

Objective
To systematically quantify the impact of consumer cost on assisted reproduction technology (ART) utilization and numbers of embryos transferred.

Design
Ordinary least squared (OLS) regression models were constructed to measure the independent impact of ART affordability—measured as consumer cost relative to average disposable income—on ART utilization and embryo transfer practices.

Setting
Not applicable.

Patient(s)
Women undergoing ART… Show more

Objective
To systematically quantify the impact of consumer cost on assisted reproduction technology (ART) utilization and numbers of embryos transferred.

Design
Ordinary least squared (OLS) regression models were constructed to measure the independent impact of ART affordability—measured as consumer cost relative to average disposable income—on ART utilization and embryo transfer practices.

Setting
Not applicable.

Patient(s)
Women undergoing ART treatment.

Intervention(s)
None.

Main Outcome Measure(s)
OLS regression coefficient for ART affordability, which estimates the independent effect of consumer cost relative to income on utilization and number of embryos transferred.

Result(s)
ART affordability was independently and positively associated with ART utilization with a mean OLS coefficient of 0.032. This indicates that, on average, a decrease in the cost of a cycle of 1 percentage point of disposable income predicts a 3.2% increase in utilization. ART affordability was independently and negatively associated with the number of embryos transferred, indicating that a decrease in the cost of a cycle of 10 percentage points of disposable income predicts a 5.1% increase in single-embryo transfer cycles.

Conclusion(s)
The relative cost that consumers pay for ART treatment predicts the level of access and number of embryos transferred. Policies that affect ART funding should be informed by these findings to ensure equitable access to treatment and clinically responsible embryo transfer practices. Show less

This paper empirically examines the determinants of micro business start-up in Vietnam, with the emphasis on the role of remittances, using rich household survey data from 2002, 2004 and 2006. Using probit regression, this paper documents the positive and significant role of domestic remittances on the propensity to start up a new business. In addition, hhousehold and community characteristics also play a significant role in the entrepreneurial start-up process. Furthermore, we examine the role… Show more

This paper empirically examines the determinants of micro business start-up in Vietnam, with the emphasis on the role of remittances, using rich household survey data from 2002, 2004 and 2006. Using probit regression, this paper documents the positive and significant role of domestic remittances on the propensity to start up a new business. In addition, hhousehold and community characteristics also play a significant role in the entrepreneurial start-up process. Furthermore, we examine the role of remittances from the perspective of relaxing liquidity constraints for existing household businesses, finding that domestic remittances have played a role in boosting revenue growth between 2004 and 2006. In contrast, overseas remittances have neither role in stimulating the transition to entrepreneurship nor business growth. The findings are robust under various model specifications and estimation methods. Show less

STUDY QUESTION
What was the impact on access to assisted reproductive technology (ART) treatment by different socioeconomic status (SES) groups after the introduction of a policy that increased patient out-of-pocket costs?
SUMMARY ANSWER
After the introduction of a policy that increased out-of-pocket costs in Australia, all SES groups experienced a similar percentage reduction in fresh ART cycles per 1000 women of reproductive age. Higher SES groups experienced a progressively greater… Show more

STUDY QUESTION
What was the impact on access to assisted reproductive technology (ART) treatment by different socioeconomic status (SES) groups after the introduction of a policy that increased patient out-of-pocket costs?
SUMMARY ANSWER
After the introduction of a policy that increased out-of-pocket costs in Australia, all SES groups experienced a similar percentage reduction in fresh ART cycles per 1000 women of reproductive age. Higher SES groups experienced a progressively greater reduction in absolute numbers of fresh ART cycles due to existing higher levels of utilization. Show less

STUDY QUESTION
Given similar socio-demographic profiles and costs of healthcare, why has Australia been significantly more successful than the UK in reducing the assisted reproductive technology (ART) multiple birth rate?
SUMMARY ANSWER
The Australian model of supportive public ART funding, permissive clinical guidelines and an absence of published clinic league tables has enabled Australian fertility specialists to act collectively to achieve rapid and widespread adoption of single… Show more

STUDY QUESTION
Given similar socio-demographic profiles and costs of healthcare, why has Australia been significantly more successful than the UK in reducing the assisted reproductive technology (ART) multiple birth rate?
SUMMARY ANSWER
The Australian model of supportive public ART funding, permissive clinical guidelines and an absence of published clinic league tables has enabled Australian fertility specialists to act collectively to achieve rapid and widespread adoption of single embryo transfer (SET). Show less

Background
Almost all assisted reproductive technology (ART) and intrauterine insemination (IUI) treatments performed in Australia are subsidized through the Australian Government’s universal insurance scheme, Medicare. In 2010 restrictions on the amount Medicare paid in benefits for these treatments were introduced, increasing patient out-of-pocket payments for fresh and frozen embryo ART cycles and IUI. The aim of this study was to evaluate the impact of the policy on access to treatment… Show more

Background
Almost all assisted reproductive technology (ART) and intrauterine insemination (IUI) treatments performed in Australia are subsidized through the Australian Government’s universal insurance scheme, Medicare. In 2010 restrictions on the amount Medicare paid in benefits for these treatments were introduced, increasing patient out-of-pocket payments for fresh and frozen embryo ART cycles and IUI. The aim of this study was to evaluate the impact of the policy on access to treatment, savings in Medicare benefits and the number of ART conceived children not born.

Methods
Pooled quarterly cross-sectional Medicare data from 2007 and 2011 where used to construct a series of Ordinary Least Squares (OLS) regression models to evaluate the impact of the policy on access to treatment by women of different ages. Government savings in the 12 months after the policy was calculated as the difference between the predicted and observed Medicare benefits paid.


Conclusions
The introduction of the policy resulted in a significant reduction in fresh ART cycles in the first 15 months after its introduction. Further evaluation on the long term impact of the policy with regard access to treatment and on clinical practice, particularly the number of embryos transferred, is crucial to ensuring equitable access to fertility treatment and the health and welfare of ART children. Show less

Abstract
This paper explores a new angle on effectiveness of ODA in growth of the Vietnam economy of Vietnam by employing growth accounting framework to calculate the contribution of ODA in economic growth in the period of 1993-2006. This paper is structured as follows: part I will highlight some major developments and statistics of ODA up to date; part II will present empirical estimation of the contribution of ODA
in the growth accounting framework; part III will present major findings… Show more

Abstract
This paper explores a new angle on effectiveness of ODA in growth of the Vietnam economy of Vietnam by employing growth accounting framework to calculate the contribution of ODA in economic growth in the period of 1993-2006. This paper is structured as follows: part I will highlight some major developments and statistics of ODA up to date; part II will present empirical estimation of the contribution of ODA
in the growth accounting framework; part III will present major findings and concluding remarks Show less