Background and Objective During the COVID-19 pandemic, resources in intensive care units (ICUs) have the potential to be inadequate to treat all those who might benefit. Therefore, it is paramount to identify the views of the community regarding how to allocate such resources. This study aims to quantify Australian community preferences for ventilation allocation. Methods A discrete choice experiment was designed and administrated to an adult Australian online panel. Each survey respondent answered 12 choice sets from a total design of 120. Each choice set placed the respondent in the role of hypothetical decision maker, prioritising care between two patients. Conditional logit, mixed logit regression and latent class analysis were used to analyse the data. Additionally, we asked a series of attitudinal questions about different methods of making such decisions in practice, focusing on who should be responsible. Results A total of 1050 community members completed the survey and responded to each choice. Dimensions considered most important were age, likely effectiveness, smoking status, whether the person has dependents, whether they are a healthcare worker, and whether they have a disability or not. Estimating marginal rates of substitution between patient characteristics and chance of survival if ventilated yielded values of up to 30 percentage points if the patient was 70 years old relative to being 30. However, respondents typically said they would prefer such decisions to be made by medical professionals. Conclusion This study demonstrated the preferences of the community to allocation of ventilators during the COVID-19 pandemic. The use of such information should be treated with some caution as the underlying reason for such preferences are unclear, and respondents themselves preferred the decision to be made by others. Supplementary Information The online version contains supplementary material available at 10.1007/s40271-021-00498-z.

Background In 2009, mandatory folic acid fortification of bread-making flour was introduced in Australia to reduce the birth prevalence of preventable neural tube defects (NTDs) such as spina bifida. Before the introduction of the policy, modelling predicted a reduction of 14-49 NTDs each year. Objective Using real-world data, this study provides the first ex-post evaluation of the cost effectiveness of mandatory folic acid fortification of bread-making flour in Australia. Methods We developed a decision tree model to compare different fortification strategies and used registry data to quantify the change in NTD rates due to the policy. We adopted a societal perspective that included costs to industry and government as well as healthcare and broader societal costs. ResultsWe found 32 fewer NTDs per year in the post-mandatory folic acid fortification period. Mandatory folic acid fortification improved health outcomes and was highly cost effective because of the low intervention cost. The policy demonstrated improved equity in outcomes, particularly in birth prevalence of NTDs in births from teenage and indigenous mothers. Conclusions This study calculated the value of mandatory folic acid fortification using real-world registry data and demonstrated that the attained benefit was comparable to the modelled expected benefits. Mandatory folic acid fortification (in addition to policies including advice on supplementation and education) improved equity in certain populations and was effective and highly cost effective for the Australian population.

Background All countries experienced social and economic disruption and threats to health security from the COVID-19 pandemic in 2020, but the responses in terms of control measures varied considerably. While control measures, such as quarantine, lockdown and social distancing, reduce infections and infection-related deaths, they have severe negative economic and social consequences. Objectives The objective of this study was to explore the acceptability of different infectious disease control measures, and examine how respondents trade off between economic and health outcomes. Methods A discrete choice experiment was developed, with attributes covering: control restrictions, duration of restrictions, tracking, number of infections and of deaths, unemployment, government expenditure and additional personal tax. A representative sample of Australians ( n = 1046) completed the survey, which included eight choice tasks. Data were analysed using mixed logit regression to identify heterogeneity and latent class models to examine heterogeneity. Results In general, respondents had strong preferences for policies that avoided high infection-related deaths, although lower unemployment and government expenditure were also considered important. Respondents preferred a shorter duration for restrictions, but their preferences did not vary significantly for the differing levels of control measures. In terms of tracking, respondents preferred mobile phone tracking or bracelets when compared to no tracking. Significant differences in preferences was identified, with two distinct classes: Class 1 (57%) preferred the economy to remain open with some control measures, whereas Class 2 (43%), had stronger preferences for policies that reduced avoidable deaths. Conclusions This study found that the Australian population is willing to relinquish some freedom, in the short term, and trade off the negative social and economic impacts of the pandemic, to avoid the negative health consequences. Supplementary Information The online version contains supplementary material available at 10.1007/s40271-021-00503-5.

Lost productivity is one of the largest costs associated with foodborne illness (FBI); however, the methods used to estimate lost productivity are often criticised for overestimating the actual burden of illness. A discrete choice experiment (DCE) was undertaken to elicit preferences to avoid six possible FBIs and estimate whether ability to work, availability of paid sick leave and health-related quality of life affect willingness-to-pay (WTP) to avoid FBI. Respondents (N = 1918) each completed 20 DCE tasks covering two different FBIs [gastrointestinal illness, flu-like illness, irritable bowel syndrome (IBS), Guillain–Barre syndrome (GBS), reactive arthritis (ReA), or haemolytic uraemic syndrome (HUS)]. Attributes included: ability to work, availability of sick leave, treatment costs and illness duration. Choices were modelled using mixed logit regression and WTP was estimated. The WTP to avoid a severe illness was higher than a mild illness. For chronic conditions, the marginal WTP to avoid a chronic illness for one year, ranged from $531 for mild ReA ($1412 for severe ReA) to $1025 for mild HUS ($2195 for severe HUS). There was a substantial increase in the marginal WTP to avoid all the chronic conditions when the ability to work was reduced and paid sick leave was not available, ranging from $6289 for mild IBS to $11,352 for severe ReA. Including factors that reflect productivity and compensation to workers influenced the WTP to avoid a range of FBIs for both acute and chronic conditions. These results have implications for estimating the burden and cost of FBI.

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