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Policy Points: The developmental origins understanding of mental illness suggests the possibility of prevention, through addressing childhood adversities.More than 43% of Indigenous Australian children aged 6 to 10 years have 6 or more risk factors for mental illness in adulthood, and 23% are experiencing current psychological distress.Substantial risk is already present in infancy (eg, 67% exposed to 3 or more stressful family life events, and 42.5% are not living with both birth parents).An integrated service system response that can both offer high‐level therapeutic services and address associated multiple adversities, from conception to late adolescence, is urgently needed to address current psychological distress in Indigenous Australian children and to reduce the future burden of mental illness. ContextMental illness is a high source of disease burden across the globe. Mental illness is now understood as largely developmental, with its genesis at least in part in adverse childhood experiences. We sought to estimate the prevalence of childhood risks for poor mental health in Indigenous Australian children, noting that Indigenous Australians by virtue of their history of traumatic colonization and dispossession, child removal, and racism are potentially at greater risk.MethodsWe conducted a descriptive study of the modifiable risks and adversities associated with mental illness in Australian Indigenous children (infancy to 10 years), using data from the Longitudinal Study of Indigenous Children (LSIC), a cohort of 1,671 infants enrolled in 2008 and followed up annually. Risk factors of interest were identified from a comprehensive literature review of childhood determinants of adult mental illness by Fryers and Brugha (2013). The age‐category prevalence of individual risks and a multiple‐risk score were computed using data extracted from 6 waves of LSIC.FindingsThe analytic data comprised 8,378 person‐observations from the first 6 waves. Children in LSIC experience high rates of adversities. In utero, nearly 50% were exposed to smoking and 22% to alcohol. As infants, 42.5% were not living with both birth parents. Over two‐thirds of survey children were in households that had experienced, in the previous 12 months, 3 or more major life events; 22% to 26% lived in households with a drug or alcohol problem; and 18% were exposed to domestic violence (41% were ever‐exposed to age 10). At school, nearly 40% of children were bullied. Over 45% of children aged 6 to 10 years were exposed to 6 or more risks for mental illness. Few children (< 2%) were exposed to low parental warmth and, despite the high exposure to adversities, less than 5% of children report low self‐confidence. This suggests considerable resilience. More than 1 in 4 children had conduct problems in the clinical range and more than 1 in 5 were experiencing high psychological distress.ConclusionsIndigenous children in Australia face extreme levels of multiple disadvantage, exposing many to current psychological distress and high risk of developing me...

Cost effectiveness and cost-utility analysis of a group-based diet intervention for treating major depression-the HELFIMED trial,

The evidence base was over 10 years old, reported only on patients with hip and knee problems, and on limited QoL outcome measures, and with inconsistent findings. A better understanding of the impact on QoL for patients waiting for specialist care could be gained by using standard timepoints in the waiting period, patients with other orthopaedic conditions, comprehensive QoL measures, as well as expectations, choices and perspectives of patients waiting for specialist care.

ObjectiveThis paper explores the economic value of rehabilitation to South Africa, using a costed example of cerebrovascular accident (CVA) (stroke) rehabilitation.DesignWe report an economic modelling approach using a worked cost‐effectiveness to validate the argument for the cost‐saving benefits of stroke rehabilitation.SettingSouth African health care, employing analysis of available secondary data from South African research and government reports.ParticipantsIn line with international trends in stroke epidemiology, we focused on people who were employed prior to having their stroke, with return‐to‐work as the desired rehabilitation outcome.InterventionsNot applicable.Main outcome measure(s)We used information on stroke rehabilitation and secondary data derived from grey and published literature, to determine if early stroke rehabilitation represents value for money from the government perspective. For our worked example, we used return‐to‐work rates, intervention costs, and the cost of rehabilitation services to estimate cost‐savings as a result of an individualized workplace intervention.ResultsThe cost of delivering the individualized intervention was estimated at R5633/patient. Combining survivor rates, return‐to‐work rate, and costs of the programme, a work intervention programme could result in a net saving of R133.1 million over 5 years (or about R26.6 per year (discount 3%).ConclusionThe value of rehabilitation should not be considered in terms of cost‐effectiveness alone, but also as an investment for the country. A staged, prioritized approach should be considered in future South African national health budget.

/ Waste management planning and implementation is not only a technological issue, but a social and political one as well. In this paper, we discuss a proposal to rethink certain aspects about waste management planning and implementation. Specifically, we present a framework whereby the ordinary citizen can proactively and constructively participate in the decision-making process. After briefly discussing the STOPER research team and certain limits inherent in current waste-management practices, we propose a mode of consultation known as the informed consensus approach. We assert that this approach incorporates social perceptions of key intervenors such as experts, decision makers, interest groups, and ordinary citizens and that this can enrich the decision-making process concerning complex environmental issues such as waste management. We focus our presentation on the results of the application of an informed consensus approach to waste management strategies in the municipality of Sherbrooke (Québec, Canada). KEY WORDS: Informed consensus; Public participation; Decision-making process; Social acceptability; Waste management

Background: Approximately 30% Australians suffer from arthritis and other musculoskeletal disorders. From 2003-2033 there is a predicted 223% increase in expenditure on health management of musculoskeletal disorders. There is evidence of increasing prevalence of orthopaedic complaints, in longer waiting lists for specialist consultations in public hospital outpatient clinics. Little is known about the costs and ramifications of waiting for orthopaedic consultations. Aim: Establish what is known about the direct and indirect costs of being placed on a waiting list for an orthopaedic consultation. Method: Patient and Outcome search strategy of Medline, Embase, Pubmed, NHS Economic evaluation database (NHS-EED) from each database inception date. Handsearching of reference lists of included papers alsooccurred. A realist synthesis framework underpinned the review, using a ubiquitous patient journey to map available literature on the impact of waiting. Hierarchy of evidence was reported using NHMRC criteria andarticles critically appraised using either the PEDRo or CASP criteria (relevant to the design). A purpose-built data extraction instrument was developed. Results: We identified 786 studies, of which 139 were relevant, including a systematic review (Hoogeboom et al) with 15 included articles which were added to the list of eligible papers (and the review itself deleted), leaving 153 included articles; 17 were relevant to the review. Fourteen papers reported on quality of life and four reported on costs, two of these papers reported on both and all were of low to moderate quality. The research was not based on a comprehensive understanding of the stages of waiting, and there were inconclusive outcomes for quality of life and cost. Conclusion: There is scant evidence of the impact on quality of life and costs of waiting for orthopaedic outpatient appointments. Future research should aim for improved methodological quality and use patientfocused quality of life measures, and validated measures of cost. Abbreviations: NHMRC – National Health and Medical Research Council; PROMS – Patient Related Outcome Measures; QoL – Quality of Life; WOMAC – Western Ontario and McMaster Universities Osteoarthritis Index; YLD – Years Lived With Disability

ImportanceThe growing global prevalence of autism spectrum disorder (ASD) is associated with increasing costs for support services. Ascertaining the effects of a successful preemptive intervention for infants showing early behavioral signs of autism on human services budgets is highly policy relevant.ObjectiveTo estimate the net cost impact of the iBASIS–Video Interaction to Promote Positive Parenting (iBASIS-VIPP) intervention on the Australian government.Design, Setting, and ParticipantsInfants (aged 12 months) showing early behavioral indicators of autism were recruited through community settings into the multicenter Australian iBASIS-VIPP randomized clinical trial (RCT), a 5- to 6-month preemptive parent-mediated intervention, between June 9, 2016, and March 30, 2018, and were followed up for 18 months to age 3 years. This economic evaluation, including cost analysis (intervention and cost consequences) and cost-effectiveness analyses of iBASIS-VIPP compared with usual care (treatment as usual [TAU]), modeled outcomes observed at age 3 through to 12 years (13th birthday) and was conducted from April 1, 2021, to January 30, 2023. Data analysis was conducted from July 1, 2021, to January 29, 2023.ExposuresiBASIS-VIPP intervention.Main Outcomes and MeasuresTo project the diagnostic trajectory and associated disability support costs drawing on the Australian National Disability Insurance Scheme (NDIS), the main outcome was the differential treatment cost of iBASIS-VIPP plus TAU vs TAU and disability-related government costs modeled to age 12 years, using a clinical diagnosis of ASD and developmental delay (with autism traits) at 3 years. Costs were calculated in Australian dollars and converted to US dollars. Economic performance was measured through the following: (1) differential net present value (NPV) cost (iBASIS-VIPP less TAU), (2) investment return (dollars saved for each dollar invested, taking a third-party payer perspective), (3) break-even age when treatment cost was offset by downstream cost savings, and (4) cost-effectiveness in terms of the differential treatment cost per differential ASD diagnosis at age 3 years. Alternate values of key parameters were modeled in 1-way and probabilistic sensitivity analysis, the latter identifying the likelihood of an NPV cost savings.ResultsOf the 103 infants enrolled in the iBASIS-VIPP RCT, 70 (68.0%) were boys. Follow-up data at age 3 years were available for 89 children who received TAU (44 [49.4%]) or iBASIS-VIPP (45 [50.6%]) and were included in this analysis. The estimated mean differential treatment cost was A $5131 (US $3607) per child  for iBASIS-VIPP less TAU. The best estimate of NPV cost savings was A $10 695 (US $7519) per child (discounted at 3% per annum). For each dollar invested in treatment, a savings of A $3.08 (US $3.08) was estimated; the break-even cost occurred at age 5.3 years (approximately 4 years after intervention delivery). The mean differential treatment cost per lower incident case of ASD was A $37 181 (US $26 138). We estimated that there was an 88.9% chance that iBASIS-VIPP would deliver a cost savings for the NDIS, the dominant third-party payer.Conclusions and RelevanceThe results of this study suggest that iBASIS-VIPP represents a likely good-value societal investment for supporting neurodivergent children. The estimated net cost savings were considered conservative, as they covered only third-party payer costs incurred by the NDIS and outcomes were modeled to just age 12 years. These findings further suggest that preemptive interventions may be a feasible, effective, and efficient new clinical pathway for ASD, reducing disability and the costs of support services. Long-term follow-up of children receiving preemptive intervention is needed to confirm the modeled results.