Glenn Salkeld | The University of Sydney (original) (raw)
Papers by Glenn Salkeld
Health Economics Review, 2015
The use of subgroups based on biological-clinical and socio-demographic variables to deal with po... more The use of subgroups based on biological-clinical and socio-demographic variables to deal with population heterogeneity is well-established in public policy. The use of subgroups based on preferences is rare, except when religion based, and controversial. If it were decided to treat subgroup preferences as valid determinants of public policy, a transparent analytical procedure is needed. In this proof of method study we show how public preferences could be incorporated into policy decisions in a way that respects both the multi-criterial nature of those decisions, and the heterogeneity of the population in relation to the importance assigned to relevant criteria. It involves combining Cluster Analysis (CA), to generate the subgroup sets of preferences, with Multi-Criteria Decision Analysis (MCDA), to provide the policy framework into which the clustered preferences are entered. We employ three techniques of CA to demonstrate that not only do different techniques produce different clusters, but that choosing among techniques (as well as developing the MCDA structure) is an important task to be undertaken in implementing the approach outlined in any specific policy context. Data for the illustrative, not substantive, application are from a Randomized Controlled Trial of online decision aids for Australian men aged 40-69 years considering Prostate-specific Antigen testing for prostate cancer. We show that such analyses can provide policy-makers with insights into the criterion-specific needs of different subgroups. Implementing CA and MCDA in combination to assist in the development of policies on important health and community issues such as drug coverage, reimbursement, and screening programs, poses major challenges -conceptual, methodological, ethical-political, and practical - but most are exposed by the techniques, not created by them.
Journal of the American Geriatrics Society, 1999
Journal of health services research & policy, Jan 10, 2015
Most guidelines for clinical practice, and especially those for the construction of decision supp... more Most guidelines for clinical practice, and especially those for the construction of decision support tools, assume that the individual person (the patient) needs to be in possession of information of particular sorts and amount in order to qualify as having made an 'informed decision'. This often implicitly segues into the patient having made a 'good decision'. In person-centred health care, whether, in what form, and with what weight, 'information' is included as a criterion of decision quality is a matter for the person involved, to decide in the light of their own values, preferences, and time and resource constraints.
The Medical journal of Australia, Jan 5, 2010
Bowel cancer kills over 4000 Australians each year. From the late 1980s to October 2005, research... more Bowel cancer kills over 4000 Australians each year. From the late 1980s to October 2005, research evidence guided the development of bowel cancer screening policy proposals, but political, financial and institutional constraints restricted implementation options. Since 2006, the Australian Government has provided a limited bowel cancer screening program, based on what the government deems it can afford, rather than on evidence of what is required to implement a successful population-based screening program. Even a partial program can be implemented in an evidence-based way, and failure to do so threatens to undermine the potential public health gains of a national bowel cancer screening program. To realise the expected public health gains from a national bowel cancer screening program, bowel cancer screening policy should return to its evidence-based beginnings, starting with an analysis of Australian age-specific cost-effectiveness data.
Journal of medical screening, 2005
In many countries high participation is an explicit target in screening programmes. The desire fo... more In many countries high participation is an explicit target in screening programmes. The desire for high participation often appears to drive screening policy, although it is increasingly recognized that encouraging high participation may impinge upon the rights of an individual to make an informed choice. One argument offered in support of high participation is that it improves the cost-effectiveness of screening. This is questionable on theoretical grounds, and empirically there are conflicting results. Two recent cost-effectiveness models of faecal occult blood test (FOBT) screening for colorectal cancer (CRC) showed that cost-effectiveness was improved, another showed that cost-effectiveness was worsened and a fourth indicated that cost-effectiveness was unaffected by increasing the participation rate. We assessed the extent to which different levels and patterns of participation affect cost-effectiveness, using decision modelling of three CRC screening with FOBT scenarios. We es...
The Medical journal of Australia, Jan 18, 2002
To assess the (i) benefits, (ii) harms and (iii) costs of continuing mammographic screening for w... more To assess the (i) benefits, (ii) harms and (iii) costs of continuing mammographic screening for women 70 years and over. (i) We conducted a MEDLINE search (1966 - July 2000) for decision-analytic models estimating life-expectancy gains from screening in older women. The five studies meeting the inclusion criteria were critically appraised using standard criteria. We estimated relative benefit from each model's estimate of effectiveness of screening in older women relative to that in women aged 50-69 years using the same model. (ii) With data from BreastScreen Queensland, we constructed balance sheets of the consequences of screening for women in 10-year age groups (40-49 to 80-89 years), and (iii) we used a validated model to estimate the marginal cost-effectiveness of extending screening to women 70 years and over. For women aged 70-79 years, the relative benefit was estimated as 40%-72%, and 18%-62% with adjustment for the impact of screening on quality of life. For women over...
The Medical journal of Australia, Jan 6, 1990
Population-based mammography screening is a highly specialized service which aims to improve the ... more Population-based mammography screening is a highly specialized service which aims to improve the early detection of breast cancer. This is achieved through the installation of a dedicated mix of medical technology and professional skills. It is therefore a resource-intensive activity so the benefits foregone by deploying these resources for mammography screening ought to be determined to investigate the relative efficiency of such a commitment. This paper describes the costing methodology used in the evaluation of the Sydney Breast X-ray Programme and presents the health service costs for the first 12 months of operation. In the first year when attendance was under 5000 it cost 118.93toscreenawoman,118.93 to screen a woman, 118.93toscreenawoman,13,817 to detect a cancer and 18,720todetectanimpalpablecancer.However,costsareexpectedtofallinsubsequentyearsasattendancereachescapacitylevel.Thefirstscreeningroundwilldetectprevalentcancers;costswillchangewithsubsequentscreeningroundsasincidentcancersaredetected.Wearecautiousinextrapolatingthecostsofanationalprogrammefromtheseresults.However,onthebasisofourdataanddisregardingtreatmentcosts,anationalprogrammewhichscreened7018,720 to detect an impalpable cancer. However, costs are expected to fall in subsequent years as attendance reaches capacity level. The first screening round will detect prevalent cancers; costs will change with subsequent screening rounds as incident cancers are detected. We are cautious in extrapolating the costs of a national programme from these results. However, on the basis of our data and disregarding treatment costs, a national programme which screened 70% of all Australian women over the age of 45 years every two years would add between 18,720todetectanimpalpablecancer.However,costsareexpectedtofallinsubsequentyearsasattendancereachescapacitylevel.Thefirstscreeningroundwilldetectprevalentcancers;costswillchangewithsubsequentscreeningroundsasincidentcancersaredetected.Wearecautiousinextrapolatingthecostsofanationalprogrammefromtheseresults.However,onthebasisofourdataanddisregardingtreatmentcosts,anationalprogrammewhichscreened7060 million and $100 million to the national health bill each year.
Studies in health technology and informatics, 2014
Most informatics activity is aimed at reducing unnecessary errors, mistakes and misjudgements at ... more Most informatics activity is aimed at reducing unnecessary errors, mistakes and misjudgements at the point of decision, insofar as these arise from inappropriate accessing and processing of data and information. Healthcare professionals use the results of scientific research, when available, and 'big data', when rigorously analysed, as inputs into the probability judgements that need to be made in decision making under uncertainty. But these judgements are needed irrespective of the state of 'the evidence' and personalised evidence on person/patient-important criteria is very often poor or lacking. This final stage in 'translation to the bedside' has received relatively little attention in the medical, nursing, or health informatics literature, until the recent appearance of 'cognitive informatics'. Positive experience and feed-back from several thousand students who have experienced exercises in assigning probabilities informs our future vision in wh...
Diseases of the colon and rectum, 2003
Clinicians often make decisions for their patients, despite evidence that suggests that correspon... more Clinicians often make decisions for their patients, despite evidence that suggests that correspondence between patient and clinician decision making is poor. The management of colorectal cancer presents difficult decisions because the impact of treatment on quality of life might overshadow its survival efficacy. This study investigated whether patients are able to trade survival for quality of life as a means to express their preference for treatment options and to compare their preferences with those expressed by clinicians. Patients undergoing curative surgery for colorectal cancer were interviewed postoperatively to elicit their preferences in four hypothetical treatment scenarios. A questionnaire was mailed to all Australian colorectal surgeons and medical oncologists that asked them to respond as if they themselves were patients. One hundred patients (91 percent), 43 colorectal surgeons (77 percent), and 103 medical oncologists (50 percent) participated. In all four scenarios, ...
Social science & medicine (1982), 2005
In this era of shared doctor-patient decision-making, eliciting and incorporating patients' t... more In this era of shared doctor-patient decision-making, eliciting and incorporating patients' treatment choices is essential to ensure all patients receive the treatment that is right for them. Clinicians and researchers should fully understand the many factors that influence and guide patients in their preferences for treatment. One of these influences is an individual's general risk propensity or willingness to take risks, yet there is little in the literature about methods for measuring risk propensity. A systematic review was undertaken to identify instruments that measure risk propensity and to appraise their validity and relevance for a clinical setting. Of 3546 articles, 139 were potentially relevant. From these, 14 instruments were identified. Eight measured risk propensity, whereas six measured personality traits associated with risk propensity. Most instruments demonstrated good internal reliability but their appropriateness for patients, particularly older adults, r...
Health Economics Review, 2015
The use of subgroups based on biological-clinical and socio-demographic variables to deal with po... more The use of subgroups based on biological-clinical and socio-demographic variables to deal with population heterogeneity is well-established in public policy. The use of subgroups based on preferences is rare, except when religion based, and controversial. If it were decided to treat subgroup preferences as valid determinants of public policy, a transparent analytical procedure is needed. In this proof of method study we show how public preferences could be incorporated into policy decisions in a way that respects both the multi-criterial nature of those decisions, and the heterogeneity of the population in relation to the importance assigned to relevant criteria. It involves combining Cluster Analysis (CA), to generate the subgroup sets of preferences, with Multi-Criteria Decision Analysis (MCDA), to provide the policy framework into which the clustered preferences are entered. We employ three techniques of CA to demonstrate that not only do different techniques produce different clusters, but that choosing among techniques (as well as developing the MCDA structure) is an important task to be undertaken in implementing the approach outlined in any specific policy context. Data for the illustrative, not substantive, application are from a Randomized Controlled Trial of online decision aids for Australian men aged 40-69 years considering Prostate-specific Antigen testing for prostate cancer. We show that such analyses can provide policy-makers with insights into the criterion-specific needs of different subgroups. Implementing CA and MCDA in combination to assist in the development of policies on important health and community issues such as drug coverage, reimbursement, and screening programs, poses major challenges -conceptual, methodological, ethical-political, and practical - but most are exposed by the techniques, not created by them.
Journal of the American Geriatrics Society, 1999
Journal of health services research & policy, Jan 10, 2015
Most guidelines for clinical practice, and especially those for the construction of decision supp... more Most guidelines for clinical practice, and especially those for the construction of decision support tools, assume that the individual person (the patient) needs to be in possession of information of particular sorts and amount in order to qualify as having made an 'informed decision'. This often implicitly segues into the patient having made a 'good decision'. In person-centred health care, whether, in what form, and with what weight, 'information' is included as a criterion of decision quality is a matter for the person involved, to decide in the light of their own values, preferences, and time and resource constraints.
The Medical journal of Australia, Jan 5, 2010
Bowel cancer kills over 4000 Australians each year. From the late 1980s to October 2005, research... more Bowel cancer kills over 4000 Australians each year. From the late 1980s to October 2005, research evidence guided the development of bowel cancer screening policy proposals, but political, financial and institutional constraints restricted implementation options. Since 2006, the Australian Government has provided a limited bowel cancer screening program, based on what the government deems it can afford, rather than on evidence of what is required to implement a successful population-based screening program. Even a partial program can be implemented in an evidence-based way, and failure to do so threatens to undermine the potential public health gains of a national bowel cancer screening program. To realise the expected public health gains from a national bowel cancer screening program, bowel cancer screening policy should return to its evidence-based beginnings, starting with an analysis of Australian age-specific cost-effectiveness data.
Journal of medical screening, 2005
In many countries high participation is an explicit target in screening programmes. The desire fo... more In many countries high participation is an explicit target in screening programmes. The desire for high participation often appears to drive screening policy, although it is increasingly recognized that encouraging high participation may impinge upon the rights of an individual to make an informed choice. One argument offered in support of high participation is that it improves the cost-effectiveness of screening. This is questionable on theoretical grounds, and empirically there are conflicting results. Two recent cost-effectiveness models of faecal occult blood test (FOBT) screening for colorectal cancer (CRC) showed that cost-effectiveness was improved, another showed that cost-effectiveness was worsened and a fourth indicated that cost-effectiveness was unaffected by increasing the participation rate. We assessed the extent to which different levels and patterns of participation affect cost-effectiveness, using decision modelling of three CRC screening with FOBT scenarios. We es...
The Medical journal of Australia, Jan 18, 2002
To assess the (i) benefits, (ii) harms and (iii) costs of continuing mammographic screening for w... more To assess the (i) benefits, (ii) harms and (iii) costs of continuing mammographic screening for women 70 years and over. (i) We conducted a MEDLINE search (1966 - July 2000) for decision-analytic models estimating life-expectancy gains from screening in older women. The five studies meeting the inclusion criteria were critically appraised using standard criteria. We estimated relative benefit from each model's estimate of effectiveness of screening in older women relative to that in women aged 50-69 years using the same model. (ii) With data from BreastScreen Queensland, we constructed balance sheets of the consequences of screening for women in 10-year age groups (40-49 to 80-89 years), and (iii) we used a validated model to estimate the marginal cost-effectiveness of extending screening to women 70 years and over. For women aged 70-79 years, the relative benefit was estimated as 40%-72%, and 18%-62% with adjustment for the impact of screening on quality of life. For women over...
The Medical journal of Australia, Jan 6, 1990
Population-based mammography screening is a highly specialized service which aims to improve the ... more Population-based mammography screening is a highly specialized service which aims to improve the early detection of breast cancer. This is achieved through the installation of a dedicated mix of medical technology and professional skills. It is therefore a resource-intensive activity so the benefits foregone by deploying these resources for mammography screening ought to be determined to investigate the relative efficiency of such a commitment. This paper describes the costing methodology used in the evaluation of the Sydney Breast X-ray Programme and presents the health service costs for the first 12 months of operation. In the first year when attendance was under 5000 it cost 118.93toscreenawoman,118.93 to screen a woman, 118.93toscreenawoman,13,817 to detect a cancer and 18,720todetectanimpalpablecancer.However,costsareexpectedtofallinsubsequentyearsasattendancereachescapacitylevel.Thefirstscreeningroundwilldetectprevalentcancers;costswillchangewithsubsequentscreeningroundsasincidentcancersaredetected.Wearecautiousinextrapolatingthecostsofanationalprogrammefromtheseresults.However,onthebasisofourdataanddisregardingtreatmentcosts,anationalprogrammewhichscreened7018,720 to detect an impalpable cancer. However, costs are expected to fall in subsequent years as attendance reaches capacity level. The first screening round will detect prevalent cancers; costs will change with subsequent screening rounds as incident cancers are detected. We are cautious in extrapolating the costs of a national programme from these results. However, on the basis of our data and disregarding treatment costs, a national programme which screened 70% of all Australian women over the age of 45 years every two years would add between 18,720todetectanimpalpablecancer.However,costsareexpectedtofallinsubsequentyearsasattendancereachescapacitylevel.Thefirstscreeningroundwilldetectprevalentcancers;costswillchangewithsubsequentscreeningroundsasincidentcancersaredetected.Wearecautiousinextrapolatingthecostsofanationalprogrammefromtheseresults.However,onthebasisofourdataanddisregardingtreatmentcosts,anationalprogrammewhichscreened7060 million and $100 million to the national health bill each year.
Studies in health technology and informatics, 2014
Most informatics activity is aimed at reducing unnecessary errors, mistakes and misjudgements at ... more Most informatics activity is aimed at reducing unnecessary errors, mistakes and misjudgements at the point of decision, insofar as these arise from inappropriate accessing and processing of data and information. Healthcare professionals use the results of scientific research, when available, and 'big data', when rigorously analysed, as inputs into the probability judgements that need to be made in decision making under uncertainty. But these judgements are needed irrespective of the state of 'the evidence' and personalised evidence on person/patient-important criteria is very often poor or lacking. This final stage in 'translation to the bedside' has received relatively little attention in the medical, nursing, or health informatics literature, until the recent appearance of 'cognitive informatics'. Positive experience and feed-back from several thousand students who have experienced exercises in assigning probabilities informs our future vision in wh...
Diseases of the colon and rectum, 2003
Clinicians often make decisions for their patients, despite evidence that suggests that correspon... more Clinicians often make decisions for their patients, despite evidence that suggests that correspondence between patient and clinician decision making is poor. The management of colorectal cancer presents difficult decisions because the impact of treatment on quality of life might overshadow its survival efficacy. This study investigated whether patients are able to trade survival for quality of life as a means to express their preference for treatment options and to compare their preferences with those expressed by clinicians. Patients undergoing curative surgery for colorectal cancer were interviewed postoperatively to elicit their preferences in four hypothetical treatment scenarios. A questionnaire was mailed to all Australian colorectal surgeons and medical oncologists that asked them to respond as if they themselves were patients. One hundred patients (91 percent), 43 colorectal surgeons (77 percent), and 103 medical oncologists (50 percent) participated. In all four scenarios, ...
Social science & medicine (1982), 2005
In this era of shared doctor-patient decision-making, eliciting and incorporating patients' t... more In this era of shared doctor-patient decision-making, eliciting and incorporating patients' treatment choices is essential to ensure all patients receive the treatment that is right for them. Clinicians and researchers should fully understand the many factors that influence and guide patients in their preferences for treatment. One of these influences is an individual's general risk propensity or willingness to take risks, yet there is little in the literature about methods for measuring risk propensity. A systematic review was undertaken to identify instruments that measure risk propensity and to appraise their validity and relevance for a clinical setting. Of 3546 articles, 139 were potentially relevant. From these, 14 instruments were identified. Eight measured risk propensity, whereas six measured personality traits associated with risk propensity. Most instruments demonstrated good internal reliability but their appropriateness for patients, particularly older adults, r...