Senior Lecturer, Health Economics
Researcher, Screening and Test Evaluation Program

Room 316A
Edward Ford Building (A27)
The University of Sydney
NSW 2006

Phone: +61 2 9351 2587
Fax: +61 2 9351 7420

http://www.health.usyd.edu.au/step/
http://www.health.usyd.edu.au/heconomics/

Teaching area

Kirsten coordinates the health economics stream within the School of Public Health.

MPH / MIPH program:
Public Health Principles and Practice (PUBH 5015)
Health Economic Evaluation (PUBH 5302)
Advanced Health Economic Evaluation (PUBH 5307)

Clinical Epidemiology program:
Clinical Health Economics (CEPI 5303)

USyd Medical Program:
Health Economics & Resource allocation (Block 9)

Publications

Projects

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

Evaluating the cost effectiveness of screening and surveillance strategies for chronic hepatitis B treatment vs. early detection of liver cancer

Robotin M, Kansil M, Clarke I, George J, Law M, Dore G, Howard K.

A model has been developed, and testing is to commence in August 07

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.

Community preferences for organ donation and allocation in Australia

K Howard, A/Prof S Jan, Prof A Cass, Dr. J Rose, Dr. S Chadban, Prof R. Allen.

Community preferences for organ donation and allocation in Australia. ARC Discovery Grant.

$240,000

2009 - 2011

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.

Cost-effectiveness of antibody induction immunosuppression in kidney transplantation

Morton RL, Howard K, Webster AC, Wong G, Craig JC.

Induction immunosuppression is perceived as an expensive therapy reserved for high-risk kidney transplant recipients. This study evaluated the cost-effectiveness of antibody induction comparing induction with Interleukin-2 receptor antagonists (IL2Ra) or polyclonal antibodies to standard therapy alone (no induction). A Markov model was developed to estimate costs and health outcomes, survival (life years saved, LYS) and quality-adjusted survival (QALYs) for the three alternative induction strategies. Outcome data were obtained from meta-analyses of randomized trials and large scale renal registries.

The attributes of kidney dialysis important to patients and carers

Morton RL, Howard K, Snelling P, Webster AC.

A qualitative study designed to uncover the characteristics of dialysis that are important to patients and carers. Three study populations will be interviewed: dialysis patients (including home and hospital haemodialysis and peritoneal dialysis), dialysis carers and patients with chronic kidney disease. A grounded theory approach will be used to analyse and code the data.

Patient INformation about Options for Treatment (PINOT). National audit of information provided to patients and carers regarding treatment options for Stage 5 chronic kidney disease (CKD)

Morton RL, Howard K, Snelling P, Webster AC.

A prospective study designed to describe the current Australian practice surrounding patient and carer education on treatment options for end stage kidney disease. All renal units will be invited to participate by completing a survey on new (incident) Stage 5 CKD patients between 1st July -30th September 2009.

Search strategies for economic evaluations in kidney dialysis and transplantation

Morton RL, Howard K, Webster AC.

Published economic evaluations are thinly spread through many journals. Studies described as cost effectiveness analyses or cost benefit analyses often do not fulfill the criteria of an economic evaluation (i.e. present both costs and health outcomes comparing alternatives). In the kidney dialysis and transplantation area we will identify the best search terms to elicit evaluations that meet a minimum quality standard, that would be useful for clinicians and policy makers to aid decision making. Defined search terms from Medline, EMBASE and Cochrane NHS EED databases will be compared to a hand search of the literature (gold standard) for the years 1995/96; 2000/01, and 2005/06, in the highest ranking journals from general medicine, nephrology and health economics. The sensitivity, specificity and precision (positive predictive value) of the search strategies in each database will be determined.

Meta-analysis of utility estimates for kidney dialysis and transplantation

Morton RL, Howard K, Webster AC.

A meta-regression of published utilities for kidney dialysis and transplantation will be undertaken. The relative importance of study population and elicitation method will be assessed.

Cost-effectiveness of Tacrolimus immunosuppression in kidney transplantation

Morton RL, Howard K, Webster AC, Wong G, Craig JC.

This economic evaluation will assess the costs and health outcomes of Tacrolimus compared to Cyclosporin immunosuppression for recipients of a kidney transplant.

Discrete choice experiments for dialysis modality decision making

Morton RL, Howard K.

Discrete choice experiments (DCE's) are a methodology for taking account of preferences that can be applied in the health care setting. DCE's have been shown to be sensitive to health outcomes such as survival and quality of life, as well as non-health outcomes or process attributes such as distance to a health centre. In the end stage kidney disease population we will determine the health attributes, assign levels to the characteristics, design choice scenarios and conduct choice experiments. Regression techniques will be used to analyse the responses.

Australian Screening Mammography Decision Aid Trial Online ( Mammography Decision Aid for women aged 40 years)

Mathieu E, Barratt A, Howard K, McGeechan K, Davey H, Houssami N.

This decision aid aims to help women around 40 years of age make an informed choice about whether to begin screening for breast cancer or wait until later (50 years). The decision aid is available on on-line at www.mammogram.med.usyd.edu.au. It has been evaluated in a randomized controlled trial conducted on-line and is now in publication process. The decision aid increased knowledge, and decreased the proportion of women who were undecided. The trial demonstrated the usefulness and feasibility of an on-line decision aid to help women make this decision.

Adolescent experiences and perspectives following transplantation

Tong A, Howard K, Morton RL, Craig JC.
Organ transplantation has improved survival for adolescents with kidney disease, but little is known about its impact on quality of life from their perspective. The uncertainty of graft survival, lifestyle and family readjustment, and treatment side effects significantly impact on the physical and psychosocial outcomes in transplant recipients. This project aims to examine adolescents' experiences and perceptions of their quality of life, to elicit strategies from them on ways to improve their quality of life, and to evaluate the health status and health-related quality of life in adolescents who have received a kidney transplant. In-depth, face-to-face interviews will be conducted with approximately 25-30 adolescent kidney transplant recipients (aged 12 - 18 years). The participants will be asked about their experiences and perspectives of transplantation and how it has impacted their quality of life. They will also be asked to suggest ways to improve care and support delivered to adolescent transplant recipients. The interviews will general qualitative data that will be thematically analysed to identify and understand recurring (and uncommon) adolescent experiences, needs and perspectives. The adolescents' health related quality of life will be evaluated using standard questionnaires that measure factors including physical functioning, mental health, self-esteem, general health perceptions and role functioning. Utility based quality of life will be assessed using the HUI2 multi-attribute utility instrument and the time trade off (TTO) method.

ACTIVE Dialysis: A Clinical Trial of InvesiVE Dialysis

Cass A, Perkovic V, Howard K, McDagar JW, Hawley C, Kerr PG.

*through the George Institute*

NHMRC Project Grant #571045. $1,248,175

People with kidney disease requiring dialysis have substantially reduced life expectancy and quality of life. Better treatments are therefore urgently required. ACTIVE Dialysis is a clinical trial that aims to assess whether increased duration of dialysis improves these critical outcomes for affected patients. A formal cost-effectiveness analysis will also be performed. The results of this study have the potential to improve the health and longevity of many thousands of Australians.

2009-2012

Exercise self-management to improve long-term functioning & prevent falls after hip fracture

Sherrington C, Clemson L, Lord SR, Howard K, Moseley AM, Vogler CM

*through the George Institute*

NHMRC Project Grant #570886. $809,875

Up to 20,000 older Australians suffer hip fractures each year. Many people don't fully recover. We have designed a self-management training program which incorporates individualised exercise prescription. This novel program is designed for people who have completed usual treatment and rehabilitation for hip fracture. We will conduct a well-designed randomised controlled trial to test the effects of this program on disability, falls and hospital readmissions and to assess its cost-effectiveness.

2009-2012