Kim Dalziel

University of South Australia , Adelaide, South Australia, Australia

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Publications (18)33.83 Total impact

  • Kim Dalziel, Leonie Segal
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    ABSTRACT: There is a body of published research on the effectiveness of home visiting for the prevention of child maltreatment, but little in the peer reviewed literature on cost-effectiveness or value to society. The authors sought to determine the cost-effectiveness of alternative home visiting programmes to inform policy. All trials reporting child maltreatment outcomes were identified through systematic review. Information on programme effectiveness and components were taken from identified studies, to which 2010 Australian unit costs were applied. Lifetime cost offsets associated with maltreatment were derived from a recent Australian study. Cost-effectiveness results were estimated as programme cost per case of maltreatment prevented and net benefit estimated by incorporating downstream cost savings. Sensitivity analyses were conducted. 33 home visiting programmes were evaluated and cost-effectiveness estimates derived for the 25 programmes not dominated. The incremental cost of home visiting compared to usual care ranged from A$1800 to A$30 000 (US$1800-US$30 000) per family. Cost-effectiveness estimates ranged from A$22 000 per case of maltreatment prevented to several million. Seven of the 22 programmes (32%) of at least adequate quality were cost saving when including lifetime cost offsets. There is great variation in the cost-effectiveness of home visiting programmes for the prevention of maltreatment. The most cost-effective programmes use professional home visitors in a multi-disciplinary team, target high risk populations and include more than just home visiting. Home visiting programmes must be carefully selected and well targeted if net social benefits are to be realised.
    Archives of Disease in Childhood 07/2012; 97(9):787-98. · 3.05 Impact Factor
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    ABSTRACT: Home-visiting programs have been offered for more than sixty years to at-risk families of newborns and infants. But despite decades of experience with program delivery, more than sixty published controlled trials, and more than thirty published literature reviews, there is still uncertainty surrounding the performance of these programs. Our particular interest was the performance of home visiting in reducing child maltreatment. We developed a program logic framework to assist in understanding the neonate/infant home-visiting literature, identified through a systematic literature review. We tested whether success could be explained by the logic model using descriptive synthesis and statistical analysis. Having a stated objective of reducing child maltreatment-a theory or mechanism of change underpinning the home-visiting program consistent with the target population and their needs and program components that can deliver against the nominated theory of change-considerably increased the chance of success. We found that only seven of fifty-three programs demonstrated such consistency, all of which had a statistically significant positive outcome, whereas of the fifteen that had no match, none was successful. Programs with a partial match had an intermediate success rate. The relationship between program success and full, partial or no match was statistically significant. Employing a theory-driven approach provides a new way of understanding the disparate performance of neonate/infant home-visiting programs. Employing a similar theory-driven approach could also prove useful in the review of other programs that embody a diverse set of characteristics and may apply to diverse populations and settings. A program logic framework provides a rigorous approach to deriving policy-relevant meaning from effectiveness evidence of complex programs. For neonate/infant home-visiting programs, it means that in developing these programs, attention to consistency of objectives, theory of change, target population, and program components is critical.
    Milbank Quarterly 03/2012; 90(1):47-106. · 4.64 Impact Factor
  • Leonie Segal, Kim Dalziel
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    ABSTRACT: Child abuse and neglect are global problems that affect over 25 per cent of children and have serious health, social and economic consequences. Government and other agencies are heavily committed to the provision of services to address the consequences of abuse and neglect. In a climate of scarce resources, there is increasing interest in developing cost-effective strategies to prevent child maltreatment. Economic evaluation in the context of formal ‘priority setting’ can contribute to the development of an efficient child protection strategy and at the same time develop the arguments to support an increased investment in the prevention of child maltreatment. Key challenges arise from incompleteness of the evidence base of effective interventions and the considerable complexity of the cross-portfolio effects. The latter has resulted in the widespread failure to capture the full range of impacts, most notably intergenerational effects, quality of life and mortality. This means the benefits of investing in effective preventive strategies to address child maltreatment will be underestimated and too few resources allocated to this important task. Adoption of the proposed priority-setting framework and translation into action are likely to reduce child maltreatment and associated harms for children at risk now and in the future. Copyright © 2011 John Wiley & Sons, Ltd.‘There is increasing interest in developing cost-effective strategies to prevent child maltreatment’
    Child Abuse Review 07/2011; 20(4):274 - 289. · 0.56 Impact Factor
  • Kim Dalziel, Leonie Segal
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    ABSTRACT: • Economic evaluation of the Mediterranean diet for patients following first AMI (acute myocardial infarction). • A cost utility analysis was conducted, using a Markov model to describe health status, costs, quality of life and deaths to compare the Mediterranean diet to a prudent Western diet. • Program effectiveness was based on the Lyon Diet Heart Study. • Costs were estimated in AU, (and converted toAU, (and converted to US and €Euros) based on reported resource use. • Performance was measured as cost per quality adjusted life year (QALY) gained. • Extensive one-way sensitivity analyses were performed. • The Mediterranean diet was estimated to cost less and be more effective (dominant) compared with a prudent Western diet. • There was a mean gain in life years of 0.56 per person and a gain in quality adjusted life years of 0.61 per person. • Based on the published results from the Lyon Diet Heart Study, and conservative assumptions, the Mediterranean diet is cost saving for persons following first AMI when modeled over 10 years. • Policy makers and clinicians should strongly consider application of results to their own setting. KeywordsCost-effectiveness-economic analysis-Mediterranean diet-Myocardial infarction-Nutrition
    12/2010: pages 349-363;
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    Kim Dalziel, Leonie Segal, Rachelle Katz
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    ABSTRACT: To provide input to Australian and New Zealand government decision making regarding an optimal strategy to reduce the rate of neural tube defects (NTD). Standard comparative health economic evaluation techniques were employed for a set of intervention options for promoting folate/folic acid consumption in women capable of or planning a pregnancy. Evidence of effectiveness was informed by the international literature and costs were derived for Australia and New Zealand. Population-wide campaigns to promote supplement use and mandatory fortification were the most effective at reducing NTD, at an estimated 36 and 31 fewer cases per annum respectively for Australia and New Zealand, representing an 8 % reduction in the current annual NTD rate. Population-wide and targeted approaches to increase supplement use were cost-effective, at less than $AU 12,500 per disability-adjusted life year (DALY) averted ($US 9893, pound 5074), as was extending voluntary fortification. Mandatory fortification was not cost-effective for New Zealand at $AU 138,500 per DALY ($US 109 609, pound 56,216), with results uncertain for Australia, given widely varying cost estimates. Promoting a folate-rich diet was least cost-effective, with benefits restricted to impact on NTD. Several options for reducing NTD appear to fall well within accepted societal cost-effectiveness norms. All estimates are subject to considerable uncertainty, exacerbated by possible interactions between interventions, including impacts on currently effective strategies. The Australian and New Zealand governments have decided to proceed with mandatory fortification; it is hoped they will support a rigorous evaluation which will contribute to the evidence base.
    Public Health Nutrition 09/2009; 13(4):566-78. · 2.25 Impact Factor
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    ABSTRACT: Given resource scarcity, not all potentially beneficial health services can be funded. Choices are made, if not explicitly, implicitly as some health services are funded and others are not. But what are the primary influences on those choices? We sought to test whether funding decisions are linked to cost effectiveness and to quantify the influence of funding arrangements and community values arguments. We tested this via empirical analysis of 245 Australian health-care interventions for which cost-effectiveness estimates had been published. The likelihood of government funding was modelled as a function of cost effectiveness, patient/target group characteristics, intervention characteristics and publication characteristics, using multiple regression analysis. We found that higher cost effectiveness ratios were a significant predictor of funding rejection, but that cost effectiveness was not related to the level of funding. Intervention characteristics linked to funding and delivery arrangements and community values arguments were significant predictors of funding outcomes. Our analysis supports the hypothesis that funding and delivery arrangements influence both whether an intervention is funded and funding level; even after controlling for community values and cost effectiveness. It suggests that adopting partial priority setting processes without regard to opportunity cost can have the perverse effect of compounding allocative inefficiencies.
    Health Economics 05/2009; 19(4):449-65. · 2.23 Impact Factor
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    Leonie Segal, Kim Dalziel, Tom Bolton
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    ABSTRACT: The development and implementation of an evidence-based approach to health workforce planning is a necessary step to achieve access to best practice chronic disease management. In its absence, the widely reported failure in implementation of clinical best practice guidelines is almost certain to continue. This paper describes a demand model to estimate the community-based primary care health workforce consistent with the delivery of best practice chronic disease management and prevention. The model takes a geographic region as the planning frame and combines data about the health status of the regional population by disease category and stage, with best practice guidelines to estimate the clinical skill requirement or competencies for the region. The translation of the skill requirement into a service requirement can then be modelled, incorporating various assumptions about the occupation group to deliver nominated competencies. The service requirement, when compared with current service delivery, defines the gap or surplus in services. The results of the model could be used to inform service delivery as well as a workforce supply strategy.
    Implementation Science 02/2008; 3:35. · 2.37 Impact Factor
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    Kim Dalziel, Leonie Segal
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    ABSTRACT: The aim of this study was to evaluate the economic performance of 10 nutrition interventions. The interventions included Mediterranean Diet, Intensive Lifestyle Change (nutrition and physical activity) to Prevent Diabetes, Reduced Fat Diet for persons with IGT, Nutritional Counselling in GP (GP, general practice/primary care), Nurse Counselling in GP, Oxcheck Nurse Health Checks in GP, Gutbusters Workplace (for men), Talking Computer, Multi Media 2 fruit 5 veg Campaign and the FFFF (Fighting Fit, Fighting Fat) Media Campaign. Markov models were constructed in order to estimate economic performance expressed as cost per QALY (quality adjusted life year) gained. Data from original clinical trial reports were used to populate the models, supplemented by the wider literature where required. Performance of the Mediterranean Diet and Intensive Lifestyle Change to Prevent Diabetes interventions could be estimated with most certainty and both were highly cost-effective interventions, at AU $1020 (US $760, 410 pounds) and AU $1880 (US $1410, 750 pounds) per QALY gained, respectively. The media campaign interventions appear highly cost-effective at AU $46 (US $34, 18 pounds) for '2 fruit 5 veg' and AU $5600 (US $4200, 2200 pounds) per QALY gained for FFFF, but are associated with considerable uncertainty, and may be dominated under certain assumptions. Several interventions were cost-saving under plausible sets of assumptions, whereas a small number were potentially dominated. All interventions subject to economic evaluation appeared cost-effective relative to societal norms. Nutrition interventions can constitute a highly efficient component of a strategy to reduce the growing disease burden linked to over/poor nutrition. There is an urgent need for high-quality trial data from which economic performance of nutrition interventions can be modelled.
    Health Promotion International 01/2008; 22(4):271-83. · 1.94 Impact Factor
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    ABSTRACT: There is an increasing body of published cost-utility analyses of health interventions which we sought to draw together to inform research and policy. To achieve consistency in costing base and policy context, study scope was limited to Australian-based cost-effectiveness analyses. Through a comprehensive literature review we identified 245 health care interventions that met our study criteria. The median cost-effectiveness ratio was A$18,100 (approximately US$13,000) per QALY/DALY/LY (quality adjusted life year gained or, disability adjusted life year averted or life year gained). Some modalities tended to perform worse, such as vaccinations and diagnostics (median cost/QALY $58,000 and $68,000 respectively), than others such as allied health, lifestyle, in-patient interventions (median cost/QALY/DALY/LY all at approximately A$9,000 approximately US$6,500). Interventions addressing some diseases such as diabetes and impaired glucose tolerance or alcohol and drug dependence tended to perform well (median cost/QALY/DALY/LY < A$3,700, < US$5,000). Interventions targeting younger persons < 25 years (median cost/QALY/DALY/LY < A$41,200) tended to perform less well than those targeting adults > 25 years (median cost/QALY/DALY/LY < A$16,000). However, there was also substantial variation in the cost effectiveness of individual interventions within and across all categories. For any given condition, modality or setting there are likely to be examples of interventions that are cost effective and cost ineffective. It will be important for decision makers to make decisions based on the individual merits of an intervention rather than rely on broad generalisations. Further evaluation is warranted to address gaps in the literature and to ensure that evaluations are performed in areas with greatest potential benefit.
    Cost Effectiveness and Resource Allocation 01/2008; 6:9. · 0.87 Impact Factor
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    12/2007;
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    L Segal, K Dalziel
    International Journal of Obesity 07/2007; 31(7):1183-4; author reply 1185. · 5.22 Impact Factor
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    ABSTRACT: Background Given resource scarcity, not all potentially beneficial health services can be funded. Choices are made, if not explicitly, implicitly as some health services are funded and others are not. Objectives We sought to test whether decisions to subsidize health services are related to their cost-effectiveness and to quantify the influence of a range of other attributes related to the intervention, to broad funding arrangements and to community values. Methods We identified 245 Australian health care interventions for which cost/QALY/DALY or LY estimates had been published. From these studies we collated information on selected attributes related to the intervention, the population target and cost-effectiveness. The status of government subsidy was derived from government documents. We modelled the likelihood of government subsidy, i) yes or no; and ii) level of funding a) complete (meets all clinically indicated need) or b) partial, as a function of cost per QALY(DALY/LY), patient/target group characteristics (such as age group, target disease, whether the condition was contributed to by the patient) and intervention details (such as modality or purpose), using multiple regression analysis. Results We found that higher cost effectiveness ratios (poorer economic performance) was a significant predictor of an intervention not being subsidised, but that the size of impact was not large. Cost effectiveness did not however influence 'level of funding'. Variables related to funding and delivery arrangements - such as status as a pharmaceutical and potentially eligible for listing on the PBS (Pharmaceutical Benefits Schedule), or community values, (such as unable to reduce one's own health risk) were significant predictors of both decision to fund and level of funding. Conclusion/Discussion Our analysis supports the importance of funding arrangements in resource allocation, through its influence on both the decision to subsidize and the 'size of the program'. While cost-effectiveness influences in a small way whether an intervention receives a subsidy or not, it does not influence program level. Our study suggests that where funding arrangements deny a level playing field for health care interventions, but a rigorous approach to health care evaluation and priority setting in one sector (say pharmaceuticals), this rather than contributing to economic efficiency, may well crowd out other modalities, reducing overall health. This suggests partial priority setting processes that do not take into account opportunity cost may have the perverse effect of compounding allocative inefficiencies.
    06/2007;
  • Kim Dalziel, Leonie Segal
    Child & Family Social Work 01/2007; 12(4):434-435. · 0.93 Impact Factor
  • Kim Dalziel, Leonie Segal
    Obesity 10/2006; 14(9):1481-2. · 3.92 Impact Factor
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    ABSTRACT: This evaluation aimed to assess the economic performance of the Mediterranean diet for patients after a first acute myocardial infarction (AMI). A cost utility analysis using a Markov model was used to compare the Mediterranean diet to a prudent Western diet over a time frame of 10 years. After a systematic review of the literature, program effectiveness was based on the Lyon Diet Heart Study (605 patients, mean age 54 y, randomized to the Mediterranean diet delivered by a dietician and cardiologist, or a prudent Western diet). Costs were estimated in AU$ [and converted to US$ and Euros (euro)] based on the resource use to which published unit costs were applied. Cost and benefits were discounted at 5% per annum. The main outcome measure was cost per quality-adjusted life year (QALY) gained. Extensive 1-way sensitivity analyses were performed. The Mediterranean diet compared with a prudent Western diet was estimated to cost AU$1013 (US$703, euro579) per QALY gained per person. There was a mean gain in life years of 0.31/person and a gain in quality-adjusted life years of 0.40/person. Based on the published results from the Lyon Diet Heart Study and conservative assumptions, the Mediterranean diet is highly cost-effective for persons after a first AMI and represents an exceptional return on investment. Policy makers should strongly consider the generalizability of results to their own setting.
    Journal of Nutrition 08/2006; 136(7):1879-85. · 4.20 Impact Factor
  • Kim Dalziel, Leonie Segal, C Raina Elley
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    ABSTRACT: To evaluate the economic performance of the 'Green Prescription' physical activity counselling program in general practice. Cost utility analysis using a Markov model was used to estimate the cost utility of the Green Prescription program over full life expectancy. Program effectiveness was based on published trial data (878 inactive patients presenting to NZ general practice). Costs were based on detailed costing information and were discounted at 5% per anum. The main outcome measure is cost per quality adjusted life year (QALY) gained. Extensive one-way sensitivity analyses were performed along with probabilistic (stochastic) analysis. Incremental, modelled cost utility of the Green Prescription program compared with 'usual care' was dollar NZ2,053 per QALY gained over full life expectancy (range dollar NZ827 to dollar NZ37,516 per QALY). Based on the probabilistic sensitivity analysis, 90% of ICERs fell below dollar NZ7,500 per QALY. Based on a plausible and conservative set of assumptions, if decision makers are willing to pay at least dollar NZ2,000 per QALY gained the Green Prescription program is likely to represent better value for money than 'usual care'. The Green Prescription program performs well, representing a good buy relative to other published cost effectiveness estimates. Policy makers should consider encouraging general practitioners to prescribe physical activity advice in the primary care setting, in association with support from exercise specialists.
    Australian and New Zealand Journal of Public Health 03/2006; 30(1):57-63. · 1.64 Impact Factor
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    05/2005;
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    05/2005;

Publication Stats

122 Citations
33.83 Total Impact Points

Institutions

  • 2009–2012
    • University of South Australia 
      • School of Health Sciences
      Adelaide, South Australia, Australia
  • 2005–2009
    • Monash University (Australia)
      • Centre for Health Economics
      Melbourne, Victoria, Australia
  • 2006
    • University of Victoria
      Victoria, British Columbia, Canada