Marjory Moodie

Deakin University · Deakin Health Economics (DHE)

Objective Aortic stenosis (AS) is one of the most common acquired cardiac valvular diseases. The success of transcatheter aortic valve implantation (TAVI) for severe AS has led to increasing interest in its use to earlier disease—moderate AS (MAS). Design Model-based study using a Markov microsimulation technique to evaluate the long-term costs an...

Purpose Sitting at work can be associated with musculoskeletal pain, but the impact of reductions in sitting is not well-understood. We examined relationships with musculoskeletal pain of changes in sitting, standing, stepping, and short and long bouts of these behaviours. Methods Analyses pooled data from 224 desk workers (68.4% women; mean ± SD...

Objectives: Underutilization and insufficient availability of dual-energy X-ray absorptiometry (DXA) in diagnosing osteoporosis in China could be changed by adopting unindicated quantitative computed tomography. We aimed to assess the cost-effectiveness of quantitative computed tomography (QCT) as a screening tool for osteoporosis in China. Metho...

Objectives: Sedentary behaviour (SB) is associated with increased incidence of chronic diseases such as type 2 diabetes (T2D), cardiovascular disease, cancers, and premature mortality. SB interventions in workplaces are effective in reducing sitting time. Previous economic evaluations have not specifically used changes in sitting time to estimate...

Multicomponent community-based obesity prevention interventions that engage multiple sectors have shown promise in preventing obesity in childhood; however, economic evaluations of such interventions are limited. This systematic review explores the methods used and summarizes current evidence of costs and cost-effectiveness of complex obesity preve...

Objective: A comprehensive understanding of the relationship between depressive symptoms and eating disorder (ED) symptoms requires consideration of additional variables that may influence this relationship. Health-related quality of life (HRQOL) has been associated with both depression and EDs; however, there is limited evidence to demonstrate ho...

Background: Despite its importance in being amongst the top ten causes of childhood death, there is limited data on the incidence of stroke in children, and whether this has changed over time. Aims: We performed a systematic review and meta-analysis to estimate the worldwide incidence rate of paediatric ischaemic stroke, identify population diff...

Whether percutaneous coronary intervention (PCI) is effective in improving long-term survival in an Australian PCI cohort remains unclear. We aimed to examine the change in the remaining life expectancy for patients who underwent PCI over the past decade. Patient data from the Melbourne Interventional Group were divided into four 3-year periods (20...

Background There is limited evidence of cost-effective primary prevention interventions for cardiovascular disease (CVD) in young women. This study aimed to assess the value for money of primary prevention of CVD in this population. Methods A Markov microsimulation model consisting of both first-ever and recurrent CVD events was developed to simul...

Introduction: We aimed to assess the long-term health outcomes and costs of endovascular thrombectomy (EVT) using clinical trials and real-world evidence in patients with large ischaemic core. Methods: Both clinical trials and the INternational Stroke Perfusion Imaging REgistry (INSPIRE) were used. Patients with acute computed tomography perfusi...

Background Whole-of-school programs have demonstrated success in improving student physical activity levels, but few have progressed beyond efficacy testing to implementation at-scale. The purpose of our study was to evaluate the scale-up of the ‘Internet-based Professional Learning to help teachers promote Activity in Youth’ (iPLAY) intervention i...

Background: This study assesses the long-term cost-effectiveness of this screening protocol from a healthcare system perspective. Methods: Australians presenting to private oral healthcare practices recruited to the iDENTify study were included as the study population. A Markov model preceded by a decision tree was developed to assess the intervent...

Objective To test the efficacy of the Transform-Us! school- and home-based intervention on children’s physical activity (PA), sedentary behaviour (SB) and cardiometabolic risk factor profiles. Methods A 30-month 2×2 factorial design cluster randomised controlled trial delivered in 20 primary schools (148 Year 3 classes) in Melbourne, Australia (20...

Rationale The evidence base for acute post-stroke rehabilitation is inadequate and global guideline recommendations vary. Aim To define optimal early mobility intervention regimens for ischaemic stroke patients of mild and moderate severity. Hypotheses Compared to a pre-specified reference arm, the optimal dose regimen(s) will result in: more parti...

Food retail strategies to improve the healthiness of food and beverage options may increase purchasing of healthier options and improve diets. Consumer demand for healthier options is an important determinant of the successful implementation and maintenance of healthy food retail interventions. A systematic review of peer-reviewed literature was un...

Background: Women with a history of preterm delivery (PTD) have significantly increased risk of experiencing cardiovascular disease (CVD) later in life. However, the risk of long-term recurrence of CVD in this population remains unknown. Methods: The study was based on a cohort of Victorian women who had a singleton birth between 1999 and 2008. The...

Background The Western Australian LiveLighter® program has implemented a series of mass media advertising campaigns that aim to encourage adults to achieve and maintain a healthy weight through healthy behaviours. This study aimed to assess the cost-effectiveness of the LiveLighter® campaign in preventing obesity-related ill health in the Western A...

Context Recommended best practice for resource allocation decisions by governments include a stepwise process guided by economic evidence. However, the use of economic evidence in preventive health decision-making, which often impacts on multiple sectors of government, is under-researched. This study aimed to explore the resource allocation decisio...

Background TransformUs was a four-arm school-based intervention to increase physical activity and reduce sedentary behaviour among primary school children. Pedagogical and environmental strategies targeted the classroom, school grounds and family setting. The aims of this study were to evaluate program fidelity, dose, appropriateness, satisfaction...

Despite frequently co-occurring, the temporal relationship between depression and eating disorder symptoms remains poorly understood. This exploratory study sought to investigate the reciprocal relationship between depressive symptoms and (1) shape and weight dissatisfaction, (2) shape and weight overvaluation, (3) preoccupation with shape or weigh...

Introduction Systems science methodologies have been used in attempts to address the complex and dynamic causes of childhood obesity with varied results. This paper presents a protocol for the Reflexive Evidence and Systems interventions to Prevention Obesity and Non-communicable Disease (RESPOND) trial. RESPOND represents a significant advance on...

Background Heterogeneity in the outcomes collected and reported in trials of interventions to prevent obesity in the first five years of life highlights the need for a core outcome set to streamline intervention evaluation and synthesis of effects. This study aimed to develop a core outcome set for use in early childhood obesity prevention interven...

Background Incentive-based programs represent a promising approach for health insurers to encourage health-promoting behaviours. However, little is known about the value for money of such programs. This study aimed to determine the cost-effectiveness of the ACHIEVE (Active CHoices IncEntiVE) program designed to incentivise increased physical activi...

Background The costs and benefits of an intervention within the intervention testing phase may differ from those experienced when that intervention is implemented and delivered at scale. Yet limited empirical work has been undertaken to explore how economic constructs related to implementation and scale-up might have an impact on intervention cost....

Objective Few countries have established national programs to maximize access and reduce operational overheads. We aimed to use patient-level data up to 12 months to model the potential long-term costs and health benefits attributable to implementing such a program for Australia.MethodsA Markov model was created for Australia with an inception popu...

Objective Stroke telemedicine improves the provision of reperfusion therapies in regional hospitals, yet evidence of its cost-effectiveness using patient-level data is lacking. The aim of this study was to estimate the cost per quality-adjusted life year (QALY) gained from stroke telemedicine.Methods As part of the Victorian Stroke Telemedicine (VS...

Background Community-based interventions have shown promise in reducing childhood overweight and obesity. However, they have been critiqued for using linear logic models. Participatory community-based systems approaches are posited as addressing the complexity of non-linear relationships in a local context. Community members are empowered to unders...

The supermarket environment impacts the healthiness of food purchased and consumed. Shelf tags that alert customers to healthier packaged products can improve the healthiness of overall purchases. This study assessed the potential value-for-money of implementing a three-year shelf tag intervention across all major supermarket chains in Australia. C...

Background and Purpose Pre-hospital severity-based triaging using the Ambulance Clinical Triage For Acute Stroke Treatment (ACT-FAST) algorithm has been demonstrated to substantially reduce time to endovascular thrombectomy in Melbourne, Australia. We aimed to model the cost-effectiveness of an ACT-FAST bypass system from the healthcare system pers...

Background The effectiveness of a nurse‐led in‐hospital monitoring protocol with mobile ECG (iECG) was investigated for detecting atrial fibrillation in patients post‐ischemic stroke or post‐transient ischemic attack. The study aimed to assess the cost‐effectiveness of using iECG during the initial hospital stay compared with standard 24‐hour Holte...

Background Strong evidence indicates that excessive time spent sitting (sedentary behaviour) is detrimentally associated with multiple chronic diseases. Sedentary behaviour is prevalent among adults in Australia and has increased during the COVID-19 pandemic. Estimating the potential health benefits and healthcare cost saving associated with reduct...

Objective: This study aimed to assess the potential financial impacts on Australian television networks of a ban on alcohol advertising during sports broadcasts. Methods: We analysed television advertising data from Nielsen, a commercial market research company. The data included details of all advertisements (ads) for the 10 highest-spending al...

Background: Given the high prevalence of early childhood overweight and obesity, more evidence is required to better understand the cost-effectiveness of community-wide interventions targeting obesity prevention in children aged 0-5 years. Objectives: To assess the cost-effectiveness of the Romp & Chomp community-wide early childhood obesity pre...

Introduction Despite being an important period for the development of movement behaviours (physical activity, sedentary behaviour and sleep), few interventions commencing prior to preschool have been trialled. The primary aim of this trial is to assess the 12-month efficacy of the Let’s Grow mHealth intervention, designed to improve the composition...

Background To estimate the short term (5 years) and long term (30 years) economic burden of stroke among younger adults (18–64 years), and to calculate the loss of health-related quality of life in these individuals, in Australia. Methods A Markov microsimulation model was built to simulate incidence of stroke among younger adults in Australia. Yo...

This scoping review was undertaken as the first stage of development of the Core Outcome Sets for Early Prevention of Obesity in CHildhood (COS‐EPOCH). The aim of this review is to identify the outcomes collected and reported in randomized controlled trials of early childhood obesity prevention interventions. A systematic scoping review was underta...

Aims •Sedentary behaviour is an established risk factor for several diseases; however, its economic impacts are less understood. This study systematically reviews the literature on the economic costs associated with excessive sedentary behaviour and the cost-effectiveness of interventions targeting sedentary time. Methods •A systematic search wa...

Background: The established link between cardiovascular disease (CVD) and dementia may provide new insights into dementia prevention. Objective: It aims to quantify the burden of dementia attributable to people with CVD. Methods: A Markov microsimulation model was developed to simulate the lifetime cost and quality-adjusted life-years (QALYs)...

Having determined the difference in cost and effect of two alternative options, this chapter brings these concepts together to determine whether an intervention is cost-effective. It discusses the concept of cost-effectiveness, describes methods for calculating an incremental cost-effectiveness ratio, and introduces the cost-effectiveness plane, a...

Background Australian governments are increasingly mandating the use of cost–benefit analysis (CBA) to inform the efficient allocation of government resources. CBA is likely to be useful when evaluating preventive health interventions that are often cross-sectoral in nature and require Cabinet approval prior to implementation. This study outlines a...

Background: To compare the cost-effectiveness of providing endovascular thrombectomy (EVT) for patients with ischemic stroke in the >4.5 h time window between patient groups who met and did not meet the perfusion imaging trial criteria. Methods: A discrete event simulation (DES) model was developed to simulate the long-term outcome post EVT in pati...

Background In Tonga, import duties were lowered on tinned fish and seafood in 2013 and raised on soft drinks, dripping and other animal fats. Additional import duties were applied to soft drinks and dripping and other fats in 2016 and duties were also applied to high fat meats, mutton flaps and turkey tails. The objective of this study was to descr...

Introduction Promoting healthy eating and active play in early life is critical, however few interventions have been delivered or sustained at scale. The evaluation of interventions at scale is a crucial, yet under-researched aspect of modifying population-level health behaviours. INFANT is an evidence-based early childhood healthy lifestyle interv...

Objective: Eating disorders (EDs) and depression are among the most debilitating and pervasive mental illnesses. Although they often co-occur, the relationship between EDs and depression remains poorly understood. This study used network analysis to explore the symptom-level relationship between EDs and depression among a sample of Australian adol...

Background In Tonga, import duties were lowered on tinned fish and seafood in 2013 and raised on soft drinks, dripping and other animal fats. Additional import duties were applied to soft drinks and dripping and other fats in 2016 and duties were also applied to high fat meats, mutton flaps and turkey tails. The objective of this study was to descr...

Background: Returning to work is an important outcome for stroke survivors. Objectives: This sub-study of a randomised controlled trial aimed to provide characteristics of working-age stroke participants and identify factors associated with return to work at 12 months. Methods: We used paid employment data collected as part of A Very Early Reh...

Introduction: Telemedicine can alleviate the problems faced in rural settings in providing access to specialist stroke care. The evidence of the cost-effectiveness of this model of care outside high-income countries is limited. This study aimed to conduct: (a) a systematic review of economic evaluations of telestroke and (b) a cost-utility analysi...

Introduction: Childhood overweight and obesity is prevalent in the first 5 years of life, and can result in significant health and economic consequences over the lifetime. The outcomes currently measured and reported in randomised controlled trials of early childhood obesity prevention interventions to reduce this burden of obesity are heterogeneo...

Objectives Non-traditional risk factors place young women at increased risk of cardiovascular disease (CVD) over their lifetime. The current study undertakes a systematic review and meta-analysis of randomised controlled trials (RCTs) that examined the effectiveness of primary prevention interventions for CVD in premenopausal women. Methods An ele...

The value of a statistical life (VSL) estimates individuals’ willingness to trade wealth for mortality risk reduction. This economic parameter is often a major component of the quantified benefits estimated in the evaluation of government policies related to health and safety. This study reviewed the literature to update the VSL recommended for Aus...

Importance Cardiorespiratory fitness is an important marker of childhood health and low fitness levels are a risk factor for disease later in life. Levels of children's fitness have declined in recent decades. Whether school-based physical activity interventions can increase fitness at the population level remains unclear. Objective To evaluate th...

Obesity prevention interventions with behavioral or lifestyle‐related components delivered via web‐based or telephone technologies have been reported as comparatively low cost as compared with other intervention delivery modes, yet to date, no synthesized evidence of cost‐effectiveness has been published. This study aimed to conduct a systematic re...

Background Successful implementation and long-term maintenance of healthy supermarkets initiatives are crucial to achieving potential population health benefits. Understanding barriers and enablers of implementation of real-world trials will enhance wide-scale implementation. This process evaluation of a healthy supermarket intervention sought to d...

Background This study aims to derive country-specific EQ-5D-5L health status utility (HSU) from the MacNew Heart Disease Health-related Quality of Life questionnaire (MacNew) using both traditional regression analyses, as well as a machine learning technique. Methods Data were drawn from the Multi-Instrument Comparison (MIC) survey. The EQ-5D-5L w...

Background: While the number of retail interventions with impacts on diet- and/or health-related outcomes is increasing, the economic evaluation literature is limited. This review investigated (i) the cost-effectiveness of health-promoting food retail interventions and (ii) key assumptions adopted in these evaluations. Methods: A systematic revi...

Introduction: Telemedicine can address limited access to medical specialists in rural hospitals. Stroke provides an important case study because: it is a major cause of disease burden; effective treatments to reduce disability (e.g., thrombolysis) can be provided within the initial hours of stroke onset; careful selection of patients is needed by s...

Background and Aims: Disability-adjusted life years (DALYs) are an important measure of the global burden of disease that informs patient outcomes and policy decision-making. Our study aimed to compare the DALYs saved by endovascular thrombectomy (EVT) in the Australasian-based EXTEND-IA trial vs. clinical registry data from EVT in Australian routi...

An amendment to this paper has been published and can be accessed via the original article.

Background and purpose: Tenecteplase improved functional outcomes and reduced the requirement for endovascular thrombectomy in ischemic stroke patients with large vessel occlusion in the EXTEND-IA TNK randomized trial. We assessed the cost-effectiveness of tenecteplase versus alteplase in this trial. Methods: Post hoc within-trial economic analy...

Background: There is increasing concern about the time people spend in sedentary behaviour, including screen time, leisure and occupational sitting. The number of both primary research studies (published trials) and reviews has been growing rapidly in this research area. A summary of the highest level of evidence that provides a broader quantitati...

Background: Community-based interventions have shown promise in addressing the childhood obesity epidemic. Such efforts rely on the knowledge of key community members and their engagement with the drivers of obesity in their community. This paper presents the protocol for the measurement and evaluation of knowledge and engagement among community l...

Background The utility-weighted modified Rankin Scale, representing patient perspectives of quality of life, is a newly proposed measure to improve the interpretability of the modified Rankin Scale. Despite obvious advantages, such weighting imperfectly reflects the multidimensional patterns of post-stroke burden. Aims To investigate multidimensio...

This study aimed to pilot the feasibility, acceptability and effectiveness of three co-developed healthy food and beverage pricing interventions in a community retail setting. Aquatic and recreation centres in Victoria, Australia were recruited to co-develop and pilot pricing interventions within their onsite cafés, for 15 weeks from January 2019....

Introduction Limited evidence exists on the cost-effectiveness of interventions to prevent obesity and promote healthy body image in adolescents. The SHINE (Supporting Healthy Image, Nutrition and Exercise) study is a cluster randomised control trial (cRCT) aiming to deliver universal education about healthy nutrition and physical activity to adole...

Introduction It is important to ascertain the cost-effectiveness of alternative services to traditional cardiac rehabilitation while the economic credentials of the Smartphone Cardiac Rehabilitation, Assisted self-Management (SCRAM) programme among people with coronary heart disease (CHD) are unknown. This economic protocol outlines the methods for...

The aim of the ACE-Obesity Policy study was to assess the economic credentials of a suite of obesity prevention policies across multiple sectors and areas of governance for the Australian setting. The study aimed to place the cost-effectiveness results within a broad decision-making context by providing an assessment of the key considerations for p...

Objectives Information about younger people of working age (≤65 years), their post stroke outcomes and rehabilitation pathways can highlight areas for further research and service change. This paper describes: (1) baseline demographics; (2) post acute rehabilitation pathways; and (3) 12-month outcomes; disability, mobility, depression, quality of l...

Restricting price promotions on unhealthy foods and beverages has been identified by governments as a promising approach for improving population diets. Using a limited societal perspective, this study assessed the potential cost-effectiveness of mandatory restrictions on price promotions for sugar-sweetened beverages (SSBs) in Australia. Australia...

Objectives: The association between preterm delivery (PTD) and maternal risk of cardiovascular disease (CVD) was demonstrated, but the economic burden of CVD in these women was unknown. Methods: A Markov microsimulation model, comprising no event, postacute coronary event (ACE, including acute myocardial infarction and unstable angina), poststroke...

Over one third of Australians’ daily energy intake is from discretionary foods and drinks. While many health promotion efforts seek to limit discretionary food intake, the population health impact of reductions in the consumption of different types of discretionary foods (e.g., sugar-sweetened beverages (SSBs), confectionery, sweet biscuits) has no...