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Objective The aim of this study was to evaluate the cost-effectiveness of the Australian Contraceptive ChOice pRoject (ACCORd) intervention. Methods An economic evaluation compared the costs and outcomes of the ACCORd intervention with usual care (UC). Data from the ACCORd trial were used to estimate costs and efficacy in terms of contraceptive uptake and quality of life. Rates of contraceptive failure and pregnancy were sourced from the literature. Using a Markov model, within-trial results were extrapolated over 10 years and subjected to univariate sensitivity analyses. Model outputs were expressed as the cost per quality-adjusted life years (QALY) gained and cost per unintended pregnancy resulting in birth (UPB) avoided. Results Over 10 years, compared with UC, initiating contraception through the ACCORd intervention resulted in 0.02 fewer UPB and higher total costs (A$2505 vs A$1179) per woman. The incremental cost-effectiveness of the ACCORd intervention versus UC was A$1172 per QALY gained and A$7385 per UPB averted. If the start-up cost of the ACCORd intervention was removed, the incremental cost-effectiveness ratio was A$81 per QALY gained and A$511 per UPB averted. The results were most sensitive to the probability of contraceptive failure, the probability of pregnancy-related healthcare service utilisation or the inclusion of the costs of implementing the ACCORd intervention. Conclusions From a health system perspective, if implemented appropriately in terms of uptake and reach, and assuming an implicit willingness to pay threshold of A$50 000 the ACCORd intervention is cost-effective. What is known about the topic? The uptake of long-active reversible contraceptives (LARC) in Australia is low. The ACCORd trial assessed the efficacy of providing structured training to general practitioners (GPs) on LARC counselling, together with access to rapid referral to insertion clinics. What does this paper add? This study is the first to assess the cost-effectiveness of a complex intervention in the general practice setting aimed at increasing the uptake of LARC in Australia. What are the implications for practitioners? The results show that implementing a complex intervention in general practice involving GP education and the availability of rapid referral to LARC insertion clinics is a cost-effective approach to increase LARC use and its attending efficacy. If the majority of Australian GPs were able to deliver effectiveness-based contraceptive counselling and either insert LARC or use a rapid referral process to a LARC insertion clinic, the additional cost associated with the purchase of LARC products and their insertion would be offset by reductions to health system costs as a result of fewer UPB and abortions. Moreover, the benefits to women’s physical and psychological health of avoiding such events is substantial.

We respond to the issues raised by Wonder and Chin1 regarding our study examining the timelines for Pharmaceutical Benefits Advisory Committee (PBAC) applications following approval by the Australian Drug Evaluation Committee (ADEC; now known as the Advisory Committee on Prescription Medicines (ACPM)).2First, it is true that not all products considered by ADEC/ ACPM are suitable for submission to the PBAC. Twenty-three products (37%) in our sample had not been submitted to the PBAC during the follow-upperiod,andsome or all may never be. However, the results presented in our paper regarding timing of submissions to the PBAC were in relation to the subsample of products that were submitted to the PBAC. This is a conservative approach, because the delays reported are conditional on having submitted a PBAC application.Second, we appreciate that the start date for the time to event analysis may have been unclear, and confirm that the ADEC recommendation date was used, as stated in the Methods.Third, we agree that collecting data for a PBAC submission alongside the data required for ADEC submission is difficult. However, this does not mean it is not a valid approach. There are many options to improve the timeline of PBS listing; this ap- proach is not about ensuring identical data for the Therapeutic Goods Administration (TGA) and Pharmaceutical Benefits Scheme (PBS) processes, but rather ensuring that all relevant data are collected early.Fourth, we concur that there are numerous stages in the PBS listingprocess where delays can occur. Weexamined thelength of time betweenADEC recommendationandPBAC submissionand approval. Byestimating this timelinewe could then put thelength of the Cabinet deferral of listings into perspective, which has not been done previously. Finally, at no point did we state that the time from TGA registration to PBS listing for new medicines is increasing on the basis of the data we collected; the assertion was referenced to a published report of PBS trends.3Since our paper was originally published there has been ongoing examination of the PBS process. A joint report from Medicines Australia and the Department of Health and Ageing found that although total PBS spending is increasing, growth is lower than forecast, due, in part, to the 2010 PBS reform legislation.4 In the lead up to the recent federal election, both the Greens and the Coalition released health policy statements that mentioned improving PBS timelines, with the Coalition specifically giving the Health Minister authority to list medicines costing less than A$20 million in any of the first 4 years of listing. …

After completing a structured evaluation of their general practitioner (GP) in terms of non-health factors, 128 people who had visited their GP in the past six months for treatment of a minor condition were administered a discrete choice experiment (DCE) designed to evaluate their preferences for non-health attributes of care within a general practice consultation. SAS and SYSTAT were used to analyse responses. Trust, legitimation, recognition of and support for emotional distress, dignity, reassurance and information (whether it is asked for or not), were the attributes respondents valued most highly. In general, participants were unwilling to change GPs.

Hospital in the home is increasingly being considered as an alternative for the provision of acute care. This article provides an overview of Hospital in the Home in Australia, discussing some of the issues that should be considered when determining whether to establish or fund hospital in the home programs such as whether efficiency is increased, care is improved and whether patients perceive more choice. These issues are discussed in the context of a transparent funding strategy that is aimed at achieving predefined goals and objectives. (author abstract)