Aim To define and quantify hospital‐acquired malnutrition, including the concept of preventable and non‐preventable malnutrition; and identify the main causes of preventable malnutrition. Furthermore, demonstrate potential cost‐savings for a quaternary hospital in Sydney (Australia) if a theoretical model of preventable malnutrition was applied to the penalties associated with hospital‐acquired malnutrition, compared to the current government framework. Methods A retrospective audit was conducted on electronic medical records reassessing cases of hospital‐acquired malnutrition previously identified by dietitians or medical coders. Costs were calculated using the Independent Hospital Pricing Authority's (IHPA) pricing principles for hospital‐acquired complications (version 3, 2018). Results Twenty‐three patients of 15 419 admissions were identified with hospital‐acquired malnutrition in the 3‐month study period. Sixteen cases (70%) were classified as preventable, two cases (9%) were classified as non‐preventable, and five cases were non‐hospital‐acquired cases of malnutrition. Under the IHPA proposed costing model, total cost of all hospital‐acquired malnutrition to the hospital is estimated to be $162 600 over 3 months. The theoretical model of preventable malnutrition resulted in a cost penalty of only $98 600, which is a hospital cost‐saving of $64 000 (or 40% of the overall penalty) when compared to the current government framework. Conclusions The majority of hospital‐acquired malnutrition cases were found to have a preventable component. It is proposed that a costing model that penalises hospitals for only preventable hospital‐acquired malnutrition be considered, which would permit hospitals to focus on addressing preventable (and thus actionable) causes of hospital‐acquired malnutrition with not only potential health benefits to patients but cost‐savings to hospitals.

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Objectives: To estimate (1) productive life years (PLYs) lost because of chronic conditions in Australians aged 45–64 years from 2010 to 2030, and (2) the impact of this loss on gross domestic product (GDP) over the same period. Design, setting and participants: A microsimulation model, Health&WealthMOD2030, was used to project lost PLYs caused by chronic conditions from 2010 to 2030. The base population consisted of respondents aged 45–64 years to the Australian Bureau of Statistics Survey of Disability, Ageing and Carers 2003 and 2009. The national impact of lost PLYs was assessed with Treasury's GDP equation. Main outcome measures: Lost PLYs due to chronic disease at 2010, 2015, 2020, 2025 and 2030 (ie, whole life years lost because of chronic disease); the national impact of lost PLYs at the same time points (GDP loss caused by PLYs); the effects of population growth, labour force trends and chronic disease trends on lost PLYs and GDP at each time point. Results: Using Health&WealthMOD2030, we estimated a loss of 347 000 PLYs in 2010; this was projected to increase to 459 000 in 2030 (32.28% increase over 20 years). The leading chronic conditions associated with premature exits from the labour force were back problems, arthritis and mental and behavioural problems. The percentage increase in the number of PLYs lost by those aged 45–64 years was greater than that of population growth for this age group (32.28% v 27.80%). The strongest driver of the increase in lost PLYs was population growth (accounting for 89.18% of the increase), followed by chronic condition trends (8.28%). Conclusion: Our study estimates an increase of 112 000 lost PLYs caused by chronic illness in older workers in Australia between 2010 and 2030, with the most rapid growth projected to occur in men aged 55–59 years and in women aged 60–64 years. The national impact of this lost labour force participation on GDP was estimated to be $37.79 billion in 2010, increasing to $63.73 billion in 2030.

BackgroundWhile several studies have examined factors that influence the use of breast screening mammography, faecal occult blood tests (FOBT) for bowel cancer screening and prostate specific antigen (PSA) tests for prostate disease in Australia, research directly comparing the use of these tests is sparse. We examined sociodemographic and health-related factors associated with the use of these tests in the previous two years either alone or in combination.MethodsCross-sectional analysis of self-reported questionnaire data from 96,711 women and 82,648 men aged 50 or over in The 45 and Up Study in NSW (2006–2010).Results5.9% of men had a FOBT alone, 44.9% had a PSA test alone, 18.7% had both tests, and 30.6% had neither test. 3.2% of women had a FOBT alone, 56.0% had a mammogram alone, 16.2% had both and 24.7% had neither test. Among men, age and socioeconomic factors were largely associated with having both FOBT and PSA tests. PSA testing alone was largely associated with age, family history of prostate cancer, health insurance status and visiting a doctor. Among women, age, use of hormone replacement therapy (HRT), health insurance status, family history of breast cancer, being retired and not having a disability were associated with both FOBT and mammograms. Mammography use alone was largely associated with age, use of HRT and family history of breast cancer. FOBT use alone among men was associated with high income, living in regional areas and being fully-retired and among women, being fully-retired or sick/disabled.ConclusionsThese results add to the literature on sociodemographic discrepancies related to cancer screening uptake and highlight the fact that many people are being screened for one cancer when they could be screened for two.

Uptake of next-generation sequencing (NGS) has increased dramatically due to significant cost reductions and broader community acceptance of NGS. To systematically review the evidence on both the clinical effectiveness and the cost-effectiveness of applying NGS to cancer care. A systematic search for full-length original research articles on the clinical effectiveness and cost-effectiveness of NGS in MEDLINE and EMBASE. Articles that focussed on cancer care and involved the application of NGS were included for the review of clinical effectiveness. For the cost-effectiveness review, we only included the articles with economic evaluations of NGS in cancer care. We report the rate of successfully detecting mutations from the clinical studies. The incremental cost-effectiveness ratio and sensitivity analysis outcomes are reported for the cost-effectiveness articles. Fifty-six articles reported that sequencing patient samples using targeted gene panels, and 83% of the successfully sequenced patients harboured at least 1 mutation. Only 6 studies reported on the cost-effectiveness of the application of NGS in cancer care. NGS is an effective tool for identifying mutation in cancer patients. However, more rigorous cost-effectiveness studies of NGS applied to cancer management are needed to determine whether NGS can improve patient outcomes cost-effectively.