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Although it is a relatively young academic field, health economics has a very significant history in Australia. AHES was established in the late 1970s through the efforts of economists at the Australian National University, most notably Professor John Deeble. After a one day conference for economists interested in health, the Australian Health Economists Group was formed, which went on to become the Australian Health Economics Society in 1984. This makes AHES one of the longest established health economics associations internationally. Even before that, health economists had had a significant impact on the landscape of health policy in Australia, with a seminal paper by John Deeble and Dick Scotton published in 1968 in the Australian Economic Review. This paper was fundamental in the formation of Medibank, the original architecture of Australia’s universal health insurance scheme. The current DRG system and hospital funding arrangements, as well as the key role of health technology assessment in reimbursement decisions through PBAC and MSAC are other areas where the contribution of health economists has been very important.

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Ms Chunzhou Mu*, Professor Jane Hall CHERE, University of Technology, Sydney
Geographic variation in GP use is a persistent finding across Australia. Some of this variation may be warranted, reflecting differences in, for example, population health status. However, variation may also be indicative of health care inefficiency and inequity. This paper examines the amount of geographic variation in GP use, and the factors that influence that variation. Results suggest that health care needs, age, obesity, lower socio-economic status are significant drivers of health care use. The availability of more GPs is also associated with higher GP use but the supply of more specialists reduces the use of GPs. A better understanding of the sources of the geographic variation can inform policy interventions to prioritise resource allocation and improve health care delivery efficiency.

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The aim of paper is to assess the level of income needed in retirement to maintain a satisfactory life and slow the rate of health decline. This is an alternative to the usual assessment of the adequacy of income in retirement based on pre-retirement income replacement. Using the HILDA data from Australia, this paper estimates the short and long term health effects of retirement accounting for the simultaneity of health and retirement in an instrumental variable panel data econometric model. We initially assume that human, and financial capital is exogenous at retirement. The results suggest that retirement has a positive effect on health and wellbeing initially but in the longer term has a negative effect on health mitigated by pension income and wealth. Health in the bottom income quintile wears out a good deal faster after retirement than does health in the top quintile, and in the bottom quintile men’s health deteriorates more rapidly than women’s health.

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Cost-effectiveness analyses are primarily used to provide evidence for policy and funding decisions before health interventions are implemented. Retrospective economic evaluations have received less attention in the literature. By making use of data collected post-implementation, retrospective cost-effectiveness analyses of vaccine programs may substantially reduce uncertainty and provide a better assessment of the value for money achieved. As a case study, we conducted a retrospective economic evaluation to assess the cost-effectiveness of the nationally funded 7-valent pneumococcal conjugate vaccine (PCV7) program in Australia. This is the first study specifically designed to evaluate the cost-effectiveness of an existing vaccine program in Australia. We designed a static, deterministic model that describes transitions between health states for a population over time. We investigated health-related outcomes on which PCV7 may have had an impact, primarily invasive and non-invasive pneumococcal disease. We applied a healthcare perspective and included costs for the vaccination program as well as healthcare utilisation. Quality-of-life utility weight estimates were attached to the different health states in the model. The primary outcome calculated was an incremental cost per Quality Adjusted Life Year (QALY) gained. We conducted one-way and probabilistic sensitivity analysis, and examined a number of different scenarios. In the scenario where observed declines in all health outcomes were attributed to PCV7, the ICER was below A$50,000 per QALY gained. However, in scenarios where only declines with more robust evidence for attribution to the program were included, the cost-effectiveness was less clear-cut. We discuss how our results compare to previous pre-implementation cost-effectiveness studies on PCV7 in Australia, and how methodological choices impact on cost-effectiveness results. Retrospective cost-effectiveness analysis can provide important insight in our understanding of the value for money achieved by vaccination efforts.

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Type 1 diabetes mellitus (T1DM) patients can decide how they administer insulin – typically, by injection or insulin pump. The development of continuous glucose monitors offers sensor-augmented insulin pump therapy (SAP) as the gold-standard therapy option. While SAP delivers improved glycaemic control and therefore reduces the risk of diabetes-related health complications, cost-effectiveness has only been demonstrated in a subset of patients prone to severe hypoglycaemia. The Australian Government does not currently subsidise SAP. Funding for SAP is now on the political agenda with both the Coalition and Labor Party announcing funding schemes for patients under the age of 21 if elected in 2016. The Medical Services Advisory Committee will need to review the health economics of the proposed subsidies. Therefore, it is timely to examine cost-effectiveness of SAP in adolescents with T1DM who often experience difficulties adhering to treatment, resulting in costly complications and influencing long-term disease management. We use a novel approach – a Discrete Choice Experiment survey – to apply consumer choice theory and determine treatment benefits to adolescent patients, generating additional quality-of-life measures. A sample of 200 adolescent patients with T1DM in Western Australia will be recruited to the survey. Initially, focus groups will be held to identify the appropriate treatment attributes for inclusion in the survey. Demographic information will be collected to assess the impact of family structures, education levels and private health insurance on treatment choices. A multinomial logit analysis will provide quantitative insight into the relative importance of each treatment attribute for male and female adolescent patients. Parents will also be asked to complete a Discrete Choice survey with a cost attribute to determine how a financial burden influences final treatment decisions. Preliminary results will be available in September 2016.

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Presenter Ying Chen, Victorian Department of Health

Abstract
This presentation provides an overview of linked hospital administrative datasets available for researchers from the Victorian Department of Health. It highlights the enhanced value that data linkage adds to research using hospital administrative data, leading to greater possibilities in answering a broader range of research questions. The advantages and limitations of the Victorian linked hospital administrative data are also discussed and the current barriers and challenges around data linkages are explored.

The Victorian Data Linkages Unit (VDL) was established in 2009 with combined funding from the Australian and Victorian Governments as the Victorian node in the national Population Health Research Network (PHRN), to build a data linkage infrastructure capable of securely managing health information for health and medical research.

The Victorian Data Linkage Map contains enduring links between key hospital datasets and mortality datasets. In addition, VDL has responded to the needs of the researchers as well as government programs in undertaking the project specific linkages linking key hospital datasets to other health datasets. VDL has developed sophisticated data linkage methods and strategies by using privacy preserving methods to link together records pertaining to the same individual within or across different administrative datasets. De-identification and encryption rules are applied to remove identifying information about patients, service providers and service dates. The hospital datasets are enriched with socio-economic-geospatial indicators at small area level.

The benefits of hospital administrative data linkage are recognised as a resource for public good. However, there are also constraints that limit linkage of hospital administrative data to other datasets for research purposes. The barriers include current legislative framework governing collection and disclosure of information, insufficient common identifiers across data collections, quality of data collections, and different perspectives of data custodians versus researchers.