Stuart Peacock - Academia.edu (original) (raw)

Papers by Stuart Peacock

This paper seeks to make three contributions to the literature on supplier induced demand (SID). ... more This paper seeks to make three contributions to the literature on supplier induced demand (SID). They concern, firstly, the criterion for accepting or rejecting SID. Secondly, its theoretical basis and thirdly the results of two Australian studies designed to test the existence of SID in the Australian medical market.

The NHS Executive has recently implemented modifications to the weighted capitation formula for d... more The NHS Executive has recently implemented modifications to the weighted capitation formula for distributing Hospital and Community Health Service funds to health authorities in England. A major contribution to the changes was an analysis of the relative needs of geographical areas undertaken by a team of researchers from the University of York. That work investigated the link between social and

Health service funding mechanisms are pivotal in the pursuit of health system objectives, as they... more Health service funding mechanisms are pivotal in the pursuit of health system objectives, as they provide strong financial incentives for actors in the system to achieve policy goals. Underpinning funding mechanisms is a set of key economic principles, or objectives, that should guide their design and use: efficiency, equity, and accountability. The Australian health system has historically performed relatively poorly in relation to these objectives, with evidence of inefficiencies, inequities, and poor accountability in many areas of health services. The primary cause of these shortcomings may lie in the complex set of funding and delivery arrangements at the State and Federal levels of government. Potentially significant improvements in the performance of the health system would be available from the integration of the funding of services within a single tier of government, coupled with the development of a national weighted capitation approach to funding. To develop a national capitation funding model a number of unique factors require consideration, including the current fragmentation of services, the role of the private sector, the needs of indigenous populations, and the effects of rurality. The data available to develop a capitation model is of a level of detail and quality not readily found elsewhere. If policy statements promoting efficiency, accountability, and particularly equity are to be actively pursued, a national capitation model, based on robust methods should become a cornerstone of Australian health system reform.

The oncologist, 2015

Scientific advances have led to the discovery of novel treatments with high prices. The cost to p... more Scientific advances have led to the discovery of novel treatments with high prices. The cost to publicly fund high-cost drugs may threaten the sustainability of drug budgets in different health care systems. In oncology, there are concerns that health-benefit gains are diminishing over time and that the economic evidence to support funding decisions is too limited. To assess the additional costs and benefits gained from oncology drugs over time, we used treatment protocols and efficacy results from U.S. Food and Drug Administration records to calculate cost-effectiveness ratios for drugs approved to treat first- and second-line metastatic or advanced breast, colorectal, and non-small cell lung cancer during the years 1994-2013. We assessed reimbursement recommendations reached by health technology assessment agencies in the U.K., Australia, and Canada. Cost-effectiveness ratios were calculated for 50 drugs approved by the U.S. regulator. The more recent approvals were often based on...

Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC, 2015

To estimate the impact of implementing primary human papilloma virus liquid-based cytology (LBC) ... more To estimate the impact of implementing primary human papilloma virus liquid-based cytology (LBC) screening on four-year rates of referral for colposcopy in the British Columbia screening program. We used data on referral for colposcopy from an RCT (HPV FOCAL) comparing HPV testing every four years with LBC testing every two years. We also used data from population screening with conventional cytology among women aged 25 to 69. The predicted effect of adoption of either trial protocol on rates of referral for colposcopy was estimated using trial age-specific result and screening result-specific rates weighted by their screening program distribution. The cumulative age-specific rates of referral for colposcopy over four years were calculated. Use of HPV testing initially increased rates of referral for colposcopy in the trial, but over four years the cumulative rates of referral were similar to those for LBC except in women aged 25 to 29, in whom a substantial excess persisted. Four-y...

CCSM4 with ocean and land ecosystem and freely evolving atmospheric carbondioxide is used to quan... more CCSM4 with ocean and land ecosystem and freely evolving atmospheric carbondioxide is used to quantify the response of carbon fluxes and climate to changes in orbital forcing. Compared to the present-day simulation, the simulation with the Earth's orbital parameters from 115.000 years ago features significantly cooler northern high latitudes, but only moderately cooler southern high latitudes. This asymmetry is explained

MAU instruments seek to measure the ‘utility’ of health states in a way suitable for use in econo... more MAU instruments seek to measure the ‘utility’ of health states in a way suitable for use in economic evaluation studies and, in particular, cost utility analysis (CUA). The Assessment of Quality of Life, Mark 2 (AQoL 2) project was undertaken specifically to increase the sensitivity of measurement in the region of full health, where most other instruments, including the earlier AQoL 1 instrument are relatively insensitive. In sum, the AQoL 2 instrument estimates utility using a three stage procedure. Items are (i) weighted and combined using a multiplicative model to obtain dimension scores; (ii) these are similarly weighted and combined to obtain an initial AQoL score; (iii) this is then transformed econometrically to produce the final estimate of a health state utility. As with AQoL 1 the research program also sought to experiment with new methods for achieving this. AQoL 1 was the first instrument to use a multi level descriptive system with five dimensions of health separately m...

The AQoL program explored methodological innovations in MAU instrument construction using psychom... more The AQoL program explored methodological innovations in MAU instrument construction using psychometric methods to develop a descriptive system based upon handicap and the use of a multi level descriptive system in which latent dimension variables are constructed from individual items and which, in turn, create the latent AQoL variable. The paper reports chief results and discusses problems associated with negative utilities, spontaneous versus deliberative weights, framing effect bias. New validation procedures are used to test for the existence of a ‘strong interval property’, the defining characteristic of the QALY. One external validation test of the strong interval property is reported.

European Respiratory Journal

Plasma pro-surfactant protein B (pro-SFTPB) levels have recently been shown to predict the develo... more Plasma pro-surfactant protein B (pro-SFTPB) levels have recently been shown to predict the development of lung cancer in current and ex-smokers, but the ability of pro-SFTPB to predict measures of chronic obstructive pulmonary disease (COPD) severity is unknown. We evaluated the performance characteristics of pro-SFTPB as a biomarker of lung function decline in a population of current and ex-smokers. Plasma pro-SFTPB levels were measured in 2503 current and ex-smokers enrolled in the Pan-Canadian Early Detection of Lung Cancer Study. Linear regression was performed to determine the relationship of pro-SFTPB levels to changes in forced expiratory volume in 1 s (FEV1) over a 2-year period as well as to baseline FEV1 and the burden of emphysema observed in computed tomography (CT) scans. Plasma pro-SFTPB levels were inversely related to both FEV1 % predicted (p=0.024) and FEV1/forced vital capacity (FVC) (p<0.001), and were positively related to the burden of emphysema on CT scans (...

Health Economics

Prioritizing candidates for health-care expenditure using cost per Quality-Adjusted Life Year (QA... more Prioritizing candidates for health-care expenditure using cost per Quality-Adjusted Life Year (QALY) is a helpful but insufficient means of ranking alternative uses for scarce health-care funds at the local level. This is because QALYs do not by themselves capture all criteria decision makers need to take into account. Other criteria such as reducing inequalities, meeting national and local priorities and public acceptability also feature in the decision maker's utility function. Programme budgeting and marginal analysis (PBMA) is an established framework for systematic priority setting in which a 'weighted benefit score' for each option is calculated based on all relevant decision-making criteria. Ranking options as a ratio of cost to benefit is desirable and necessary to ensure efficiency. In this paper we review a number of approaches to scoring costs and benefits of options in a PBMA context. Several approaches rank by benefit score alone, rather than efficiency (cos...

BMJ (online)

What is the quality of life for survivors of cardiac arrest? A prospective study. Acad Emerg Med ... more What is the quality of life for survivors of cardiac arrest? A prospective study. Acad Emerg Med 1999;6:95-102. 16 Diggory P, Cauchi L, Griffith D, Jones V, Lawrence E, Mehta A, et al. The influence of new guidelines on cardiopulmonary resuscitation (CPR) decisions. Five cycles of audit of a clerk proforma which included a resuscitation decision. Resuscitation 2003;56:159-65.

Expert Review of Pharmacoeconomics & Outcomes Research

Economists' approaches to priority setting focus on the principles of opportunity cost, margi... more Economists' approaches to priority setting focus on the principles of opportunity cost, marginal analysis and choice under scarcity. These approaches are based on the premise that it is possible to design a rational priority setting system that will produce legitimate changes in resource allocation. However, beyond issuing guidance at the national level, economic approaches to priority setting have had only a moderate impact in practice. In particular, local health service organizations - such as health authorities, health maintenance organizations, hospitals and healthcare trusts - have had difficulty implementing evidence from economic appraisals. Yet, in the context of making decisions between competing claims on scarce health service resources, economic tools and thinking have much to offer. The purpose of this article is to describe and discuss ten evidence-based guidelines for the successful design and implementation of a program budgeting and marginal analysis (PBMA) prio...

BMC Health Services Research, 2015

Background: Health care decision making requires making resource allocation decisions among progr... more Background: Health care decision making requires making resource allocation decisions among programs, services, and technologies that all compete for a finite resource pool. Methods of priority setting that use explicitly defined criteria can aid health care decision makers in arriving at funding decisions in a transparent and systematic way. The purpose of this paper is to review the published literature and examine the use of criteria-based methods in 'real-world' health care allocation decisions.

Healthcare policy = Politiques de santé, 2010

Moral distress - the physical and emotional response to feeling prevented from carrying out ethic... more Moral distress - the physical and emotional response to feeling prevented from carrying out ethically proper action - can have serious consequences for health professionals and healthcare organizations. We investigated perceived moral distress qualitatively with managers in two BC health authorities.RESPONDENTS DESCRIBED CONDITIONS UNDER WHICH THEY EXPERIENCED DISTRESS: when they set priorities within highly resource-constrained environments, when they observed inequities between budget allocations and management responsibilities, and when organizational priorities did not align with their personal values. When coping proved insufficient, managers would respond by leaving positions, organizations or the healthcare field altogether.Respondents asked for leadership development and the creation of spaces in which moral distress could be openly discussed. However, formal training in priority setting did not appear to be helpful on its own. Rather, it increased managers' awareness of...

British journal of cancer, Jan 24, 2009

Although a key function of cancer genetics services is to provide risk information, to date there... more Although a key function of cancer genetics services is to provide risk information, to date there has been little consistency in the way in which breast cancer risk perception has been measured. The aims of the study were to measure estimates of (i) population risk, (ii) absolute risk and (iii) comparative risk of developing breast cancer for Ashkenazi Jewish women, and to determine predictors of breast cancer risk perception. Of 152 women, 107 (70%) completed all questions. The mean (s.d.) estimates for population risk, absolute risk and comparative risk were 22.7% (15.9), 31.8% (20.6) and 1.9-fold (1.9), respectively. Most women overestimated population risk. Women at population risk generally overestimated the population risk and their own absolute risk, yet understood they are at the same risk as the population. Those with a family history understood that they are at increased risk, but underestimated the extent to which their familial risk is increased. Anxiety, high estimation...

Health care management science, 2000