Professor Glenn Salkeld

B.Bus, G Dip Health Economics, MPH, PhD

Head of School

Room 319A
Edward Ford Building (A27)
The University of Sydney
NSW 2006

Phone: +61 2 9036 9262
Fax: +61 2 9036 9019
Mobile:+61 401 100 440

http://www.health.usyd.edu.au/step/
http://www.health.usyd.edu.au/shdg/
http://www.health.usyd.edu.au/source/index.php

(Update details)

Research Interests

Glenn Salkeld has a PhD in health economics and a background in health service administration and public health. He has taught health economics to postgraduate students in medicine, public health and economics for 12 years. More recently Glenn has worked with WHO and colleagues at the University of Newcastle in establishing short courses in applying the principles of evidence based medicine and economics to the selection and reimbursement of pharmaceuticals. Glenn was a member of the PBAC economics subcommittee for 6 years and also provides expert advice for the Medicare Services Advisory Committee. His research interests include the application of discrete choice methods for measuring patient preferences, modeling the costs, risks harms and benefits of screening, the valuation of outcomes in surgery and the impact of economic evaluation on health care policy.

Affiliated

Member, Social and Public Health Economics Research Group

Chief Investigator,
Screening and Diagnostic Test Evaluation Program (STEP)
NHMRC Program Grant (2002-2006)

Co Director
Surgical Outcomes Research Centre (SOuRCe)
Central Sydney Area Health Service

Teaching area

Glenn coordinates the health economics stream within the School of Public Health. Courses taught include:

USyd:

MPH and Graduate Certificate in Population Health Research Methods "Economic Evaluation"
MPH "Key Issues in Health Economics","Microeconomics", "Pharmacoeconomics"

Contributing lecturer in the following MPH courses: Approaches to Problems in Public Health

USyd Medical Program:
Health Economics Community Doctor theme sessions within Block 9

Singapore Institute of Management - Master of Health Science
(Management) "Health Economics" module.

WHO sponsored short courses in "Economics, Evidence and Drug Selection" - South Africa, Hungary, India

Publications

Peer Reviewed/Refereed Journal Articles

Howard K, Salkeld G, White S, McDonald S, Chadban S, Craig JC, Cass A. The cost-effectiveness of increasing kidney transplantation and home-based dialysis. Nephrology. 2009;14(1):123-132

Howard K, Salkeld G. Does attribute framing in discrete choice experiments influence willingness to pay? Results from a discrete choice experiment in screening for colorectal cancer. Vlaue in Health. 2009;12(2):354-363

Entwistle VA, Carter SM, Flitcroft KL, Irwig L, McCaffery K, Salkeld G. Communicating about screening: a proposed new direction. BMJ 2008;337:a1591.

Mackenzie, R., Chapman, S., Salkeld, G., Holding, S. Media influence on Herceptin subsidization in Australia: application of the rule of rescue? J. Roy Soc Med. 2008;101(6):305-312.

Howard, K., Salkeld, G., McCaffery, K., Irwig, L. HPV triage testing or repeat PAP smear for the management of atypical squamous cells (ASCUS) on PAP smear: Is there evidence of process utility? Health Economics 2008;17:593-605.

Lee, B.B., King, M.T., Simpson, J.M., Haran, M.J., Stockler, M.R., Marial, O., Salkeld, G. Validity, Responsiveness, and Minimal Important Difference for the SF-6D Health Utility Scale in a Spinal cord Injured Population. Value in Health 2008;11(4):680-688.

Salkeld G, Henry D, Hill S, Lang D, Freemantle N, et al. What Drives Health-Care Spending Priorities? An International Survey of Health-Care Professionals. PLoS Medicine 2007.

Irwig L, McCaffery K, Salkeld G. and Bossuyt P. Informed choice for screening: implications for evaluation. BMJ 2006;332:1148-50.

Howard K, Salkeld G, Irwig L, Adelstein B. High participation rates are not necessary for cost-effective colorectal cancer screening. J Med Screen 2005;12:96-102.

Barratt A, Howard K, Irwig L, Salkeld G, Houssami N. Model of outcomes of screening mammography: information to support informed choices. BMJ 2005;330(7497):936.

Salkeld G, Solomon M, Butow P, Short L. Discrete choice experiment to measure patient preferences for the surgical management of colorectal cancer. British Journal of Surgery 2005;92:742-7.

Salkeld G, Quine S, Cameron ID. What constitutes success in preventive health care? A case study in assessing the benefits of hip protectors. Social Science & Medicine 2004;59:1591-1601.

Salkeld G, Solomon M, Short L and Butow P. A matter of trust- patient's views on decision making in colorectal cancer. Health Expectations 2004;7(2):104-114.

Taylor RS, Drummond MF, Salkeld G, Sullivan SD. Inclusion of cost effectiveness in licensing requirements of new drugs: the fourth hurdle. BMJ 2004;329:972-5.

Salkeld G, Solomon MJ, Short L, Ryan M, Ward J. Evidence-based consumer choice: a case study in colorectal cancer screening. Aust N Z J Public Health 2003; 27: 449-55.

Cameron ID, Cumming RG, Kurrle SE, Quine S, Lockwood K, Salkeld G, Finnegan T. A randomised trial of hip protector use by frail older women living in their own homes. Injury Prevention 2003;9:138-141.

Howard K and Slakeld G. Home bowel cancer tests and informed choice - is current information sufficient? Australian New Zealand Journal of Public Health 2003;27:513-16.

Adelston BA, Trevena L, Barratt A and Salkeld G. Pilot program evaluation can improve bowel cancer screening. Australian and New Zealand Journal of Public Health. 2003;27:265-66.

Salkeld G and Solomon M. An economics perspective on evidence based patient choice in surgery. Australian and New Zealand Journal of Surgery 2003;73:427-430.

Solomon M, Pager C, Keshava A, Findlay M, Butow P, Salkeld G and Roberts R. What do patients want? Patient preferences and surrogate decision-making in the treatment of colorectal cancer. Diseases of the Colon and Rectum 2003;46:1351-7.

Cameron I, Cumming R, Kurrle S, Quine S, Salkeld G, Finnegan T. A randomised trial of hip protector use by frail older women living in their own homes. Injury Prevention 2003;9:138-141.

Adelstein BA, Trevena L, Barratt A, Salkeld G. Is home screening for bowel cancer a good idea? ANZ J Pub Health. 2003;27:265-6

Salkeld G, Solomon MJ, Short L, Ward J. Measuring the importance of attributes that influence consumer attitudes to colorectal cancer screening. ANZ J Surg 2003; 73: 128-132.

Davey HM, Barratt AL, Davey E, Butow PN, Redman S, Houssami N, Salkeld G. Medical tests: women`s reported and referred decision-making roles and preferences for information on benefits, side-effects and false results. Blackwell Science Ltd Health Expectations.2002;5:330-340

Craig J, Barratt A, Cumming R, Irwig L, Salkeld G. A feasibility study of the early detection and treatment of renal disease by mass screening. Internal Medicine Journal. 2002;32:6-14.

Barratt A, Irwig L, Salkeld G, Houssami N, Glasziou P. Benefits, harms and costs of screening mammography in women over 70 years of age: a systematic review". Medical Journal of Australia. 2002;176:266-272

Cumming RG, Thomas M, Szonyi G, Frampton G, Salkeld G, Clemson L. Adherence to occupational therapist recommendations for home modifications for fall prevention. American Journal of Occupational Therapy 2001;55(6):641-648

Cameron ID, Stafford B, Cumming RG, Birks C, Kurrle SE, Lockwood K , Quine S, Finnegan T, Salkeld G, Hip protectors improve falls self-efficacy, Age and Ageing 2000;29:57-62.

Cumming RG, Salkeld G, Thomas M, Szonyi G. Prospective study of the impact of fear of falling on activities of daily living, SF-36 scores, and nursing home admission. Journal of Gerontology 2000;55A(5):M299-M305.

Salkeld G, Cameron ID, Cumming RG, Easter S, Seymour J, Kurrle SE, Quine S. Quality of life related to fear of falling and hip fracture in older women: a time trade off study. British Medical Journal 2000;320:341-46.

Salkeld G, M Ryan and L Short. The veil of experience: do consumers prefer what they know best? Health Economics 2000;9:267-270.

Salkeld G, Cumming RG, O\'Neill E, Thomas M, Szonyi G, Westbury C. The cost effectiveness of a home hazard reduction program to reduce falls among older persons. Australian and New Zealand Journal of Public Health 2000;24(3):265-71.

Bruce T, Salkeld G, Solomon M, Short L, Ward J. A randomised trial of telephone versus postcard prompts to enhance response rate in a phased population-based study about community preferences. Australian and New Zealand Journal of Public Health 2000;24(4):456-457

Cumming RG, Thomas M, Szonyi G, Salkeld G, O'Neill E, Westbury C, Frampton G. Home visits by an occupational therapist for assessment and modification of environmental hazards: a randomized trial of falls prevention. Journal of the American Geriatric Society 1999;47:1397-1402.

Birks C, Lockwood K, Cameron I, Kurrle S, Burnside W, Easter S, Venman J, Cumming R, Quine S, Salkeld G, Finnegan T. Hip protectors: results of a users survey. Australasian Journal on Ageing 1999;18(1):23-26.

Salkeld G. What are the benefits of preventive health care? Health Care Analysis 1998;6:106-12.

Morrell S, Kerr C, Driscoll T, Taylor R, Salkeld G. and Corbett S. Best estimate of the magnitude of mortality due to occupational exposure to hazardous substances. Occupational Environmental Medicine 1998;55:634-41.

Johnston S, Salkeld G, Sanderson K, Issakidis C, Teesson M. and Buhrich N. Intensive case management: a cost-effectiveness analysis. Australian and New Zealand Journal of Psychiatry 1998;32:551-59.

Other publications

Salkeld, G, and Mooney, G, What's fair in screening?, Cancer Forum, 22 (1), March 1998: 39-42.

Editorials

Adelstein BA, Trevena LJ, Barratt A, Salkeld G. Pilot program evaluation can improve bowel cancer screening. [Editorial] Australian & New Zealand Journal of Public Health. 2003; 27(3): 265-6

Letters to Editor

Henry D and Salkeld G. Bridges to Iran [letter]. The Lancet 2003;361:438.

Projects

Informed Decisions for Policymakers: Discrete Choice Modelling

Salkeld G and Butow P.
This study will further develop the application of choice-based decision techniques, such as discrete choice modelling, to inform public policy on community preferences for screening. The application of discrete choice modelling (DCM) to screening will be used to determine what factors of screening (such as the cost, harms, benefits and the process of screening itself) are important to consumers and by how much. This information will help policymakers design screening programs that best meet the needs of the community.

Using health economics to strengthen ties between evidence, policy and practice in chronic disease

Jan S, Clarke P, Howard K, Salkeld G, Chalmers JP, Leeder SR

There is a major shortage of researchers with health economics expertise in Australia. This grant will provide training and development for a team of health economists to research chronic diseases covering issues such as: What is the value for money from investment in different treatments? How do such diseases affect the economic circumstances of families? How do we ensure that strategies to address illness work in practice and can be sustained? How do these issues get put on the policy agenda?

NHMRC Capacity Building Grant. 2009 - 2013

Measuring Individual Preferences for Preventive Goods: the Application of Conjoint Analysis to Colorectal Cancer Screening

Salkeld G, Ward J, Solomon M, Short L, Irwig L and Macaskill P.
Discrete choice modelling (DCM) is a technique relatively new to the evaluation of health care services in Australia. This NHMRC-funded project uses DCM in a survey of men and women aged 50-70 years and living in the Central Sydney Health Area to find out whether they would choose to be screened for colorectal cancer and, if so, what attributes of screening matter most to them. The study is also exploring the reliability of the DCM technique in a group of people who have not been screened for colorectal cancer.

Examination of the Costs of Different Diagnostic Strategies as Proposed in the NHS Guidelines for the Diagnosis of Symptomatic Women

Salkeld, G.
This project funded by the NHMRC National Breast Cancer Centre estimates 1) the costs of clinical management of women presenting with symptoms which may be breast cancer and 2) the costs of mammography, ultrasonography and fine needle aspiration biopsy in the context of clinical practice guidelines for the diagnosis of women presenting with symptoms which may be breast cancer.

Measuring patient preferences for treatment of colorectal cancer using discrete choice modeling

Salkeld G, Solomon M, Short L and Butow P.

The aims of this project are:

To determine which characteristics of colorectal cancer treatment patients regard as being important.
To quantify the kind of trade-offs patients make between these characteristics.
To explore how variations in levels of these characteristics influence their choice of treatment.
To recommend ways in which discrete choice modeling can be used to help patients make treatment choices.

The project has been conducted in three stages, they are 1) Focus groups; 2) A self administered questionnaire on CRC treatment and 3) discrete choice survey.

For stage 2, 215 CRC patients consented to be sent a self completed questionnaire. 175 questionnaires were completed and returned, giving a response rate of 80%. The data were analysed using factor analysis to discern the most important attributes to a patient of their surgical management for colorectal cancer. Four attributes were selected for the third and final stage of the study, a discrete choice survey. Those four attributes were: the surgeon having had specialised training in CRC, communication, health service delivery (type of hospital) and information on their treatment.

In stage 3, one hundred and three patients completed an initial discrete choice questionnaire as well as a repeat interview 2 weeks later (test retest reliability). Data analysis was completed at the end of 2002.

Evidence-based patient choice in surgery

Salkeld G.
Evidence based patient choice (EBPC) encapsulates two movements in western health care systems. The first is the role of evidence-based information. The second is the centrality of individual patient choices and values. In practice, EBPC may lead to greater involvement of the individual patient in deliberations about appropriate forms of clinical management. Economics recognizes that there will always be asymmetry of information between surgeon and patient due to the complexities of synthesizing probabilistic information on the outcomes of treatment. For this reason an agency relationship exists whereby the surgeon supplies information to a patient and it is the patient who decides treatment (or where the choice is made to transfer the responsibility of a treatment decision back to the surgeon). In its most paternalistic form, the surgeon gathers medical information from a patient and decides upon treatment without considering patient preferences. Evidence based patient choice represents a shift away from a paternalistic model to one that actively considers the values, wishes and desires of patients.

Evidence-based patient choice throws out a challenge; how do surgeons get behind patient values and translate this into actual treatment choices? A research program is being designed around issues relating to evidence-based patient choice in surgery.

HPV testing Decision Aid for women with Minor Atypia on Pap smear (The IMAP Study)

McCaffery K, Irwig L, Howard K, Davey E, Barratt A, Salkeld G, Lewicka M, Weisberg E.

This study will compare the psychosocial outcomes of different management strategies for women with a mildly abnormal Pap smear: (a) usual care (repeat Pap smear), (b) HPV testing, a new management proposed for this group, and (c) the choice of either management using a decision aid to support women to make their preferred choice. The study will assess psychosocial and quality of life outcomes and will model the effectiveness of each management strategy.

A Decision Aid in the management of patients with locally advanced rectal cancer

Butow P, Solomon M, Whelen T, Salkeld G, Tattersall M, Rhuby G, Young J.

This project is a collaboration between the Surgical Outcomes Research Centre in Australia and Dr Tim Whelen, in Canada, and is developing a decision aid for patients with locally advanced rectal cancer deciding whether or not to have adjuvant chemo/radiotherapy before or after their surgery. The aid will be on a computer screen used interactively in the surgical consultation, with patients provided with the same material in a booklet form to take home. The decision aid was piloted in 2003, and a randomized controlled trial in 2004.

Virtual Colonoscopy Project

Howard K, Salkeld G.
In Australia, conventional colonoscopy is the diagnostic test of choice for the investigation of patients suspected of having colorectal disease. The number of colonoscopy procedures reimbursed through the nations universal health insurance scheme, Medicare, has risen exponentially over recent years. This rise has occurred in spite of a 20% reduction in the Medicare fee schedule in 2002. However, an alternative diagnostic test, a virtual colonoscopy, could potentially offer a cheaper and less invasive means of diagnosing colorectal disease. Virtual colonoscopy (VC) is a non-invasive procedure performed by a helical CT scan of the colon. In 2002, a National Bowel Cancer Screening Pilot Program has been established in Australia. If successful, these pilots will be a forerunner to a national mass colorectal cancer (CRC) screening program. Hence the Australian government is keen to explore whether resources should be allocated to virtual colonoscopy as a possible alternative to conventional colonoscopy in some patients. For this reason, a trial of the diagnostic accuracy of virtual colonoscopy and conventional colonoscopy is being conducted as part of the screening pilot of FOBTs (faecal occult blood tests). The trial will assess the diagnostic accuracy of the two procedures, the costs as well as patient preferences in a group of patients suspected of having colorectal disease. A discrete choice study of patient preferences for VC compared to conventional colonoscopy is being conducted to inform policy makers and clinicians about optimal service delivery for the investigation of patients suspected of having colorectal disease.

The use of evidence by policy makers in cancer screening programs.

Salkeld G, Flitcroft K.

This qualitative PhD project involves interviews with key informants about how policies concerning colorectal cancer screening have come to be made. More specifically, it considers the importance of research evidence in decision-making about colorectal cancer screening in Austraila, New Zealand and the UK. A systematic review of the use of evidence about the benefits, harms and net benefits in screening criteria has been conducted as part of this project.

The University of Sydney - Sydney School of Public Health