Deborah J Schofield

University of Sydney, Sydney, New South Wales, Australia

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Publications (87)198.86 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: IntroductionThe study aim was to develop a generic framework to derive the parameters to populate health-economic models for the rapid evaluation of new techniques and technologies in radiation oncology.MethodsA draft framework was developed through horizon scanning for relevant technologies, literature review to identify framework models, and a workshop program with radiation oncology professionals, biostatisticians, health economists and consumers to establish the Framework's structure. It was tested using four clinical protocols, comparing intensity modulated with 3D conformal therapy (post-prostatectomy, anal canal and nasopharynx) and image-guided radiation therapy techniques with off-line review of portal imaging (in the intact prostate).ResultsThe draft generic research framework consisted of five sequential stages, each with a number of components, and was assessed as to its suitability for deriving the evidence needed to populate the decision-analytic models required for the health-economic evaluations. A final Framework was established from this experience for use by future researchers to provide evidence of clinical efficacy and cost-utility for other novel techniques. The four clinical treatment sites tested during the project were considered suitable to use in future evaluations.Conclusions Development of a generic research framework to predict early and long-term clinical outcomes, combined with health-economic data, produced a generally applicable method for the rapid evaluation of new techniques and technologies in radiation oncology. Its application to further health technology assessments in the radiation oncology sector will allow further refinement and support its generalisability.
    Journal of Medical Imaging and Radiation Oncology 11/2014; · 0.98 Impact Factor
  • Emily J. Callander, Deborah J. Schofield
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    ABSTRACT: Longitudinal analysis of Wave 5 to 10 of the nationally representative Household, Income and Labour Dynamics in Australia dataset was undertaken to assess whether multidimensional poverty status can predict chronic income poverty. Of those who were multidimensionally poor (low income plus poor health or poor health and insufficient education attainment) in 2007, and those who were in income poverty only (no other forms of disadvantage) in 2007, a greater proportion of those in multidimensional poverty continued to be in income poverty for the subsequent 5 years through to 2012. People who were multidimensionally poor in 2007 had 2.17 times the odds of being in income poverty each year through to 2012 than those who were in income poverty only in 2005 (95% CI: 1.23–3.83). Multidimensional poverty measures are a useful tool for policymakers to identify target populations for policies aiming to improve equity and reduce chronic disadvantage. Copyright © 2014 John Wiley & Sons, Ltd.
    Health Economics 10/2014; · 2.23 Impact Factor
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    ABSTRACT: There has been little research on the economic status of those with multiple health conditions, particularly on the relationship between multiple health conditions and wealth. This paper will assess the difference in the value and type of wealth assets held by Australians who have multiple chronic health conditions.
    European journal of public health. 09/2014;
  • Deborah Schofield, Michelle M Cunich, Lucio Naccarella
    Australian health review: a publication of the Australian Hospital Association 08/2014; · 0.70 Impact Factor
  • Deborah J Schofield
    Pain 07/2014; · 5.64 Impact Factor
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    ABSTRACT: Studies assessing the economic burden of back problems have given little consideration to the presence of co-morbidities.
    The spine journal: official journal of the North American Spine Society 07/2014; · 2.90 Impact Factor
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    ABSTRACT: Intensity modulated radiation therapy (IMRT) is a radiation therapy technology that facilitates the delivery of an improved dose distribution with less dose to surrounding critical structures. This study estimates the longer term effectiveness and cost-effectiveness of IMRT in patients post radical prostatectomy.
    Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology. 06/2014;
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    ABSTRACT: Little is known about the effects of personal and other characteristics of care recipients on the behaviour of carers. The aim of this study is to examine the association between the main chronic (disabling) condition of care recipients and the likelihood of their (matched) primary carers aged 15-64 years being out of the labour force.
    BMC Public Health 06/2014; 14(1):561. · 2.08 Impact Factor
  • David J Hunter, Deborah Schofield, Emily Callander
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    ABSTRACT: Osteoarthritis (OA) is a highly prevalent, disabling disease, with a commensurate tremendous individual and socioeconomic burden. This Perspectives article focuses on the burden of OA for the individual, the health-care system and society, to draw attention to the magnitude of the current problem with some reference to projected figures. We have an urgent opportunity to make fundamental changes to the way we care for individuals with OA that will have an effect upon the direct and indirect costs of this disease. By focusing on the burden of this prevalent, disabling, and costly disease, we hope to highlight the opportunity for shifts in health-care policy towards prevention and chronic-disease management.
    Nature Reviews Rheumatology 03/2014; · 9.75 Impact Factor
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    ABSTRACT: Diabetes is a costly and debilitating disease. The aim of the study is to quantify the individual and national costs of diabetes resulting from people retiring early because of this disease, including lost income; lost income taxation, increased government welfare payments; and reductions in GDP. A purpose-built microsimulation model, Health&WealthMOD2030, was used to estimate the economic costs of early retirement due to diabetes. The study included all Australians aged 45-64 years in 2010 based on Australian Bureau of Statistics' Surveys of Disability, Ageing and Carers. A multiple regression model was used to identify significant differences in income, government welfare payments and taxation liabilities between people out of the labour force because of their diabetes and those employed full time with no chronic health condition. The median annual income of people who retired early because of their diabetes was significantly lower (AU$11 784) compared to those employed full time without a chronic health condition who received almost five times more income. At the national level, there was a loss of AU$384 million in individual earnings by those with diabetes, an extra AU$4 million spent in government welfare payments, a loss of AU$56 million in taxation revenue, and a loss of AU$1 324 million in GDP in 2010: all attributable to diabetes through its impact on labour force participation. Sensitivity analysis was used to assess the impact of different diabetes prevalence rates on estimates of lost income, lost income taxation, increased government welfare payments, and reduced GDP. Individuals bear the cost of lost income in addition to the burden of the disease. The Government endures the impacts of lost productivity and income taxation revenue, as well as spending more in welfare payments. These national costs are in addition to the Government's direct healthcare costs.
    BMC Public Health 03/2014; 14(1):220. · 2.08 Impact Factor
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    ABSTRACT: Few studies have assessed the impact of co-morbid conditions amongst patients with arthritis. This study will quantify the impact co-morbid health conditions have on the labour force status and economic circumstances of people with arthritis. This study uses a microsimulation model, Health&WealthMOD, to quantify the impact of co-morbidities on the labour force participation and economic circumstances of 45- to 64-year-old Australians with arthritis. The results show that the probability of being out of the labour force increases with increasing number of co-morbidities. However, there was no statistically significant difference in the amount of weekly private income received by people with arthritis and no co-morbidities, and people with arthritis and one or two co-morbidities. However, those with arthritis and three or more co-morbidities received a weekly private income 72 % lower than people with arthritis alone (95 % CI -82, -57). People with arthritis and co-morbidities paid less in tax and received more in government transfer payments. As such, it is important to consider the co-morbid conditions an individual has when assessing the impact of arthritis on labour force participation and economic circumstances. People with arthritis that have multiple co-morbid conditions are likely to have their labour force participation and economic circumstances interrupted much more than those with arthritis only.
    Rheumatology International 02/2014; · 2.21 Impact Factor
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    ABSTRACT: Background: Few studies have assessed the effect of multiple health conditions among patients with heart disease, particularly the economic implications of having multiple conditions. Methods and Results: This study used a microsimulation model, Health&WealthMOD, to assess the effect of comorbidities on the labor force participation of 45-64-year-old Australians with heart disease, and the indirect economic costs to these individuals and government. For most comorbid conditions, there is a significant increase in the chance of an individual being out of the labor force, relative to those with heart disease alone. For example, individuals with heart disease and arthritis have more than 6-fold the odds of being out of the labor force relative to those with heart disease alone (OR 6.64, 95% CI: 2.46-17.95). People with heart disease and ≥1 comorbidities also receive a significantly lower income, pay less in taxation and receive more in government transfer payments than those with heart disease alone. Conclusions: It is important to consider whether an individual with heart disease also has other health conditions, as individuals with comorbidities have inferior financial situations and are a greater burden on government finances than those with only heart disease.
    Circulation Journal 01/2014; · 3.58 Impact Factor
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    ABSTRACT: Background Intensity modulated radiation therapy (IMRT) is a radiation therapy technology that facilitates the delivery of an improved dose distribution with less dose to surrounding critical structures. This study estimates the longer term effectiveness and cost-effectiveness of IMRT in patients post radical prostatectomy. Methods A Markov decision model was developed to calculate the incremental quality adjusted life years (QALYs) and costs of IMRT compared with three dimensional conformal radiation therapy (3DCRT). Costs were estimated from the perspective of the Australian health care system. Results IMRT was both more effective and less costly than 3DCRT over 20 years, with an additional 20 QALYs gained and over $1.1 million saved per 1000 patients treated. This result was robust to plausible levels of uncertainty. Conclusions IMRT was estimated to have a modest long term advantage over 3DCRT in terms of both improved effectiveness and reduced cost. This result was reliant on clinical judgement and interpretation of the existing literature, but provides quantitative guidance on the cost effectiveness of IMRT whilst long term trial evidence is awaited.
    Radiotherapy and Oncology. 01/2014;
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    ABSTRACT: To quantify the poverty status and level of disadvantage experienced by Australians aged 45-64 years who have left the labour force due to diabetes in 2010. A purpose-built microsimulation model, Health&WealthMOD2030, was used to estimate the poverty status and level of disadvantage of those aged 45-64 years who prematurely retire from the workforce due to diabetes. A multiple regression model was used to identify significant differences in rates of income poverty and the degree of disadvantage between those out of the labour force due to diabetes and those employed full- or part-time with no diabetes. 63.9% of people aged 45-64 years who were out of the labour force due to diabetes were in poverty in 2010. The odds of being in poverty for those with no diabetes and employed full-time (OR of being in poverty 0.02 95%CI: 0.01-0.04) or part-time (OR of being in poverty 0.10 95%CI: 0.05-0.23) are significantly lower than those for persons not in the labour force due to diabetes. Amongst those with diabetes, those who were able to stay in either full- or part-time employment were as much as 97% less likely to be in poverty than those who had to retire early because of the condition. Sensitivity analysis was used to assess impacts of different poverty line thresholds and key socioeconomic predictors of poverty. This study has shown that having diabetes and not being in the labour force because of this condition significantly increases the chances of living in poverty. Intervening to prevent or delay the onset of diabetes is likely to improve their living standards.
    PLoS ONE 01/2014; 9(2):e89360. · 3.53 Impact Factor
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    ABSTRACT: Background:Due to the high prevalence of overweight and obesity there is a need to identify cost-effective approaches for weight loss in primary care and community settings.Objective:To evaluate the long-term cost-effectiveness of a commercial weight loss programme (Weight Watchers) (CP) compared with standard care (SC), as defined by national guidelines.Methods:A Markov model was developed to calculate the incremental cost-effectiveness ratio (ICER), expressed as the cost per quality adjusted life year (QALY) over the lifetime. The probabilities and quality-of-life utilities of outcomes were extrapolated from trial data using estimates from the published literature. A health sector perspective was adopted.Results:Over a patient's lifetime, the CP resulted in an incremental cost saving of AUD 70 per patient, and an incremental 0.03 QALYs gained per patient. As such, the CP was found to be the dominant treatment, being more effective and less costly than SC (95% confidence interval: dominant to 6225 per QALY). Despite the CP delaying the onset of diabetes by approximately 10 months, there was no significant difference in the incidence of type 2 diabetes, with the CP achieving less than 0.1% fewer cases than SC over the lifetime.Conclusion:The modelled results suggest that referral to community based interventions may provide a highly cost-effective approach for those at high risk of weight-related co-morbidities.International Journal of Obesity accepted article preview online, 4 December 2013. doi:10.1038/ijo.2013.227.
    International journal of obesity (2005) 12/2013; · 5.22 Impact Factor
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    ABSTRACT: Based on the clinical data, bevacizumab has been approved in Australia and globally for the treatment of advanced colorectal cancer. However, limited evidence exists for its cost-effectiveness. The purpose of this study was to evaluate the cost effectiveness of adding bevacizumab to capecitabine monotherapy in patients with metastatic colorectal cancer, using data from the prospective economic evaluation conducted alongside the MAX trial. Individual patient level data on resource use and progression free survival were prospectively collected in the phase III MAX trial. Resource use data were collected for the period between randomisation and disease progression, and unit costs were assigned from the perspective of the Australian health care funder. Effectiveness was measured in quality adjusted progression free survival years, with utility scores obtained from both the community valued EQ-5D questionnaire and the patient valued UBQ-C questionnaire. Progression free survival was used as a secondary effectiveness measure. The addition of bevacizumab to capecitabine monotherapy cost approximately $192,156 (95% confidence interval [CI], $135,619 to $326,894) per quality adjusted progression free survival year gained when using publicly listed pharmaceutical prices and utility values from the EQ-5D questionnaire. This decreased to $149,455 (95% CI, $100,356 to $245,910) when values from the UBQ-C questionnaire were applied. The incremental cost per progression free survival year was $145,059 (95% CI, $106,703 to $233,225). Bevacizumab was not found to be cost effective at its listed price, based on results from the MAX trial.
    European journal of cancer (Oxford, England: 1990) 11/2013; · 4.12 Impact Factor
  • International journal of cardiology 09/2013; · 6.18 Impact Factor
  • Australian and New Zealand Journal of Public Health 04/2013; 37(2):192-3. · 1.64 Impact Factor
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    ABSTRACT: It is known that people with depression often have other co-morbid conditions; however this is rarely acknowledged in studies that access the economic impacts of depression. This paper aims to quantify the association between co-morbid health conditions and labour force status and economic circumstances of people with depression. This study undertakes cross-sectional analysis using a dataset that is representative of the 45-64 year old Australian population with depression. The probability of being out of the labour force increases with increasing number of co-morbidities, and the amount of weekly income received by people with depression decreased with increasing numbers of co-morbidities. Those with depression and three or more co-morbidities were 4.31 times more likely to be out of the labour force (95% CI: 1.74-10.68), and received a weekly private income 88% lower (95% CI: -94%, -75%) than people with depression alone. It is important to consider the co-morbid conditions an individual has when assessing the impact of depression on labour force participation and economic circumstances.
    Journal of Psychiatric Research 03/2013; · 4.09 Impact Factor
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    ABSTRACT: BACKGROUND: The costs of arthritis to the individuals and the state are considerable. METHODS: Cross-sectional analysis of the base population of Health&WealthMOD, a microsimulation model of 45 to 64 year old Australians built on data from the Australian Bureau of Statistics' Survey of Disability, Ageing and Carers and STINMOD, an income and savings microsimulation model. RESULTS: Individuals aged 45 to 64 years who had retired early due to arthritis had a median value of AU$260 in total weekly income whereas those who were employed full time were likely to average more than five times this. The large national aggregate impact of early retirement due to arthritis includes AU$9.4 billion in lost GDP, attributable to arthritis through its impact on labour force participation.When looking at the ongoing impact of being out of the labour force those who retired from the labour force early due to arthritis were estimated to have a median value of total savings by the time they are 65 of as little as $300 (for males aged 45--54). This is far lower than the median value of savings for those males aged 45--54 who remained in the labour force full time, who would have an estimated $339 100 of savings at age 65. CONCLUSIONS: The costs of arthritis to the individuals and the state are considerable. The impacts on the state include loss of productivity from reduced workforce participation, lost income taxation revenue, and increased government support payments -- in addition to direct health care costs. Individuals bear the economic costs of lost income and the reduction of their savings over the long term.
    BMC Public Health 03/2013; 13(1):188. · 2.08 Impact Factor

Publication Stats

286 Citations
198.86 Total Impact Points

Institutions

  • 2005–2014
    • University of Sydney
      • • NHMRC Clinical Trials Centre (CTC)
      • • School of Public Health
      • • University Department of Rural Health
      Sydney, New South Wales, Australia
  • 2013
    • University of Newcastle
      • Faculty of Health and Medicine
      Newcastle, New South Wales, Australia
  • 2002–2012
    • University of Canberra
      • The National Centre for Social and Economic Modelling (NATSEM)
      Canberra, Australian Capital Territory, Australia
  • 2011
    • Charles Sturt University
      • Education for Practice Institute (EFPI)
      Melbourne, Victoria, Australia