Insomnia treatment in New Zealand.

AIM: To describe insomnia treatment in New Zealand and estimate the annual societal costs of insomnia among New Zealanders aged 20-59 years. METHOD: Twenty-one interviews were conducted with insomnia treatment providers in New Zealand using a snowballing recruitment method. Information from the interviews and the international literature was used to estimate treatment profiles, availability, uptake and costs, as the basis for a decision analytic model with micro costing of each potential outcome. Sensitivity analyses were conducted with 10,000 Monte Carlo simulations randomly varying between each model parameter between minimum and maximum estimates. RESULTS: The treatment provider interviews highlighted the unstructured nature of insomnia treatment in New Zealand. The net cost of treating a person with insomnia was estimated to be -$482. The net annual benefit (saving) for treating insomniacs aged between 20-59 yrs was estimated at $21.8 million. CONCLUSION: The estimated total societal costs per QALY gained by treating insomnia is substantially lower than the average QALY cost-effectiveness threshold ($6,865) of PHARMAC funding decisions for new pharmaceuticals. Thus, these analyses strongly support the cost-effectiveness of insomnia treatment.

Insomnia - treatment pathways, costs and quality of life.

BACKGROUND: Insomnia is perhaps the most common sleep disorder in the general population, and is characterised by a range of complaints around difficulties in initiating and maintaining sleep, together with impaired waking function. There is little quantitative information on treatment pathways, costs and outcomes. The aims of this New Zealand study were to determine from which healthcare practitioners patients with insomnia sought treatment, treatment pathways followed, the net costs of treatment and the quality of life improvements obtained. METHODS: The study was retrospective and prevalence based, and was both cost effectiveness (CEA) and a cost utility (CUA) analysis. Micro costing techniques were used and a societal analytic perspective was adopted. A deterministic decision tree model was used to estimate base case values, and a stochastic version, with Monte Carlo simulation, was used to perform sensitivity analysis. A probability and cost were attached to each event which enabled the costs for the treatment pathways and average treatment cost to be calculated. The inputs to the model were prevalence, event probabilities, resource utilisations, and unit costs. Direct costs and QALYs gained were evaluated. RESULTS: The total net benefit of treating a person with insomnia was $482 (the total base case cost of $145 less health costs avoided of $628). When these results were applied to the total at-risk population in New Zealand additional treatment costs incurred were $6.6 million, costs avoided $28.4 million and net benefits were $21.8 million. The incremental net benefit when insomnia was "successfully" treated was $3,072 per QALY gained. CONCLUSIONS: The study has brought to light a number of problems relating to the treatment of insomnia in New Zealand. There is both inadequate access to publicly funded treatment and insufficient publicly available information from which a consumer is able to make an informed decision on the treatment and provider options. This study suggests that successful treatment of insomnia leads to direct cost savings and improved quality of life.

Economic evaluation of third-line treatment with alemtuzumab for chronic lymphocytic leukaemia.

OBJECTIVE: The objective of this study was to compare the potential economic efficiency of third-line treatment of chronic lymphocytic leukaemia (CLL) with alemtuzumab versus fludarabine, cyclophosphamide and rituximab (FCR). METHODS: The target population for this study were patients with CLL who were able to tolerate third-line treatment with either FCR or alemtuzumab. The perspective used was that of the New Zealand Pharmaceutical Management Agency (PHARMAC)/District Health Board. Health outcomes considered were survival time from commencement of treatment and quality-adjusted life-years (QALYs) gained. Average costs and outcomes and incremental cost per patient treated, per survival month and per QALY gained, were calculated. All costs were presented in 2006 New Zealand dollars. RESULTS: Base-case direct medical costs for alemtuzumab per treatment regimen per patient were $NZ15 303 lower than those for FCR. The average direct medical cost per survival month gained for alemtuzumab was $NZ3144 and for FCR was $NZ4101, and the average direct medical cost per QALY gained was $NZ46,016 and for FCR was $NZ60,012. CONCLUSION: Third-line treatment of eligible patients with alemtuzumab was found to be $NZ15,303 less costly than FCR per patient.

Hitting home: a survey of housing conditions of homes used for long-term care in Ontario.

A telephone survey of a random sample of 811 long-term home care clients from three geographically distinct regions in Ontario was conducted to illuminate the living and working conditions in households receiving long-term care services. The median age of clients was 77 years and 75 percent were female. The majority had not completed high school. Almost half were widowed, had income levels of dollar 20,000 (Canadian) or less, and lived alone. Approximately one-third needed help with most basic activities of daily living. The vast majority could not bathe or dress themselves. More than three-quarters needed help with preparing meals, housekeeping, and shopping. Few clients could perform yardwork and home repairs. Many clients' homes required major and minor repairs, were not suitable in size, were not affordable, and lacked important household amenities. More than 30 percent required modifications to enable clients to live and be cared for comfortably and safely, and half the clients had not completed these because of exorbitant costs. Overall, many clients were living in homes less than optimal for domestic life and long-term care provision. These results highlight significant gaps in care provision and a need to link housing to health and social service policies.

Consumer access to health information on the internet: health policy implications.

BACKGROUND: Providers of health care usually have much better information about health and health care interventions than do consumers. The internet is an important and rapidly evolving source of global health-related information and could provide a means of correcting for asymmetric information. However, little is known about who accesses this information and how it is used in New Zealand. The aims of this research were to: determine the nature of the health information sought, how respondents use the information, how helpful they perceive the information to be, and the self-assessed value of such information. METHODS: The researchers conducted an anonymous five minute telephone and mall intercept survey of randomly selected Wellington residents who had searched for health-related information on the internet. Investigators entered the data into an Excel spreadsheet and transferred it to SPSS for data cleaning, data exploration and statistical analysis. Search time costs were based on the opportunity cost of income foregone and respondents were asked to provide a money value for the information found. RESULTS: Eighty-three percent of respondents accessed the internet from home, and 87% conducted the search for themselves. Forty-five percent of people were looking for general health and nutrition information, 42% for data about a specific illness and 40% for a medicine. After finding the information, 58% discussed it with a family member/friend/workmate, 36% consulted a general practitioner, 33% changed their eating or drinking habits, and 13% did nothing. Respondents found the information very quick to find and useful. It took them on average 0.47 hours and cost $12 (opportunity cost of time) to find the information. The average value of the data found was $60 and the net benefit to the consumer was $48 ($60 - $12). CONCLUSION: The results of this research could assist providers of health information via the internet to tailor their websites to better suit users' needs. Given the high perceived value of internet health information (greater than the average general practitioner fee) and the fact that some of the information found may be unreliable or even unsafe a valuable public health policy initiative would be to provide an improved New Zealand health information website containing information on how to evaluate data sourced from the world-wide-web and links to a range of useful and trustworthy health information sites.

Long-term health effects of repeated exposure to multiple vaccines.

The health of 155 former workers in a US military research program who had received multiple vaccines and 265 matched community controls was assessed. The study population was mostly male (83%) and elderly (median age, 69 years). Multiply immunized (MIP) subjects received vaccines and/or skin tests (median = 154) over a median of 17.3 years; interval from start of immunizations to survey completion was 15-55 years (mean = 43.1 years). MIP subjects characterized themselves as slightly less healthy than controls (P = 0.057). Fatigue (but no other symptom) was reported more frequently in the MIP group (P = 0.011), but was not associated with number of injections, number of vaccines, or time in program. No differences between MIP and control groups were seen for numerous self-reported medical conditions. Several statistically significant abnormalities were seen in clinical laboratory tests among MIP subjects, but none appeared to be clinically significant. A significant difference in frequency of monoclonal spikes and/or paraprotein peaks between MIP (12.5%) and control (4.5%) groups (RR = 2.7, P < 0.003) was observed; no associations with lifestyle, vaccine exposure, or medical conditions were found.

A randomized trial of two public health nurse follow-up programs after early obstetrical discharge: an examination of breastfeeding rates, maternal confidence and utilization and costs of health services.

OBJECTIVES: To determine whether the outcomes of routine home visiting by public health nurses (PHN) after early obstetrical discharge differ from those of a screening telephone call designed to identify mothers who need further intervention. METHODS: Primiparas delivering a singleton infant and eligible for postpartum follow-up were randomized to a home visit or screening telephone call. Data were collected by telephone from 733 participants located at two tertiary care centres in Ontario. Outcomes included maternal confidence at two weeks, health problems of the infants between discharge and four weeks postpartum, breastfeeding rates at six months and costs of the two models. RESULTS: Differences between the samples at the two sites necessitated stratified analyses. No differences were detected between the groups in maternal confidence (p = 0.96), health problems of infants (p = 0.87), or rates of breastfeeding at six months (p = 0.22). However, at both sites the cost of routine home visits was found to be higher than that of screening by telephone. CONCLUSION: Although universal access to postpartum support is important, the results suggest that a routine home visit is not always necessary to identify the women who need it. These results can be generalized only to low-risk women and infants.