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Applications of stated preference discrete choice modelling (SPDCM) in health economics have been used to estimate consumer willingness to pay and to broaden the range of consequences considered in economic evaluation. This paper demonstrates how SPDCM can be used to predict participation rates, using the case of varicella (chickenpox) vaccination. Varicella vaccination may be cost effective compared to other public health programs, but this conclusion is sensitive to the proportion of the target population immunised. A choice experiment was conducted on a sample of Australian parents to predict uptake across a range of hypothetical programs. Immunisation rates would be increased by providing immunisation at no cost, by requiring it for school entry, by increasing immunisation rates in the community and decreasing the incidence of mild and severe side effects. There were two significant interactions; price modified the effect of both support from authorities and severe side effects. Country of birth was the only significant demographic characteristic. Depending on aspects of the immunisation program, the immunisation rates of children with Australian-born parents varied from 9% to 99% while for the children with parents born outside Australia they varied from 40% to 99%. This demonstrates how SPDCM can be used to understand the levels of attributes that will induce a change in the decision to immunise, the modification of the effect of one attribute by another, and subgroups in the population. Such insights can contribute to the optimal design and targeting of health programs.

The provision of home-based palliative care requires a substantial unpaid contribution from family and friends (i.e. informal care). The present cross-sectional descriptive study, conducted between September 2003 and April 2004, describes this contribution and the impact it has on those providing informal care. The participants were 82 informal carers of patients registered with two community palliative care services in Sydney, Australia (40% of eligible carers). Carers were interviewed to assess the care recipient's care needs, the care provided by the informal carer and the health status of the carer (using the 36-Item Short Form Health Survey). A number of open-ended questions asked about the impact of providing care and the type of support that carers would find helpful. Most carers reported that care recipients required help with household tasks and many needed assistance with personal activities of daily living, taking medications and organisational tasks. In the majority of cases, the principal carer provided all or most of this help. Although, on average, the physical health of carers was similar to that of the Australian population, their mental health scores were lower. Many carers reported effects on social and family relationships, restrictions on their participation in work and leisure activities, and a range of emotional reactions to their caring situation. The support carers said they would like included information and advice, in-home respite, help with household tasks, and financial support. The present study supports the view that effective support for carers must recognise the pre-existing relationship between carer and recipient, and the differing needs of individual carers.

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Within the health services research community there is a growing strength of feeling that ongoing partnerships between researchers and decision-makers are critically important to effective transfer and exchange of knowledge generated from health services research. A body of literature is emerging around this idea that favours a particular model of partnership based on decision-maker involvement in research. This model is also gaining favour among health research funding bodies internationally. We argue that it is premature for the health services community to privilege any particular model of partnership between researchers and decision-makers. Rather a diversity of models should be conceptualized, explored in theory and practice, and evaluated. We identify seven dimensions that could be used to describe and differentiate models of partnerships for knowledge exchange and illustrate how these dimensions could be applied to analysing partnerships, using three case studies from recent and ongoing health services research partnerships in Australia.

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The application of economic evaluation in healthcare, including vaccination programs, has increased exponentially since the 1980s. There are a number of aspects of economic evaluation of vaccine programs that present particular challenges to the analyst. These include the development of the appropriate epidemiological models from which to estimate the costs and benefits; the accurate prediction of uptake rates; the incorporation of quality adjusted survival gains; and the inclusion of intangible but nonetheless important benefits and costs associated with infectious disease and vaccination. The estimation of marginal intervention costs presents specific difficulties, especially for multivalent vaccines and valuing costs and benefits over time is heavily influenced by the choice of discount rate, which is still a controversial topic. Developments in the next 5years are likely to address all of these issues and result in more sophisticated and accurate models of vaccination programs. Expert Rev. Vaccines 2(5), 649-660 (2003) †