Evaluating the cost-effectiveness of percutaneous closure of a patent foramen ovale versus medical management in patients with a cryptogenic stroke: from the UK payer perspective

Aims: Percutaneous closure of a patent foramen ovale (PFO) is known to lower the risk of recurrent stroke in patients with a cryptogenic stroke. However, the economic implications of transcatheter PFO closure are less well known. From a UK payer perspective, a detailed economic appraisal of PFO closure was performed for prevention of recurrent ischemic stroke in patients with a PFO who had experienced a cryptogenic stroke.

Materials and methods: A Markov cohort model was constructed using a 5-year time-horizon with a patient mean age of 45.2 years, reflecting the characteristics reported in the REDUCE trial. Transition probabilities, clinical inputs, costs, and utility values were ascertained from published and national costing sources. Total costs, incremental costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios were calculated, utilizing a discount rate of 3.5%. A range of univariate and probabilistic sensitivity analyses were also performed.

Results: When applying a willingness-to-pay (WTP) threshold of £20,000/QALY in accordance with NICE guidelines, PFO closure compared with antiplatelet therapy alone showed a beneficial cost/QALY of £18,584, attained at 4 years. Applying discount rates of 0% and 6% had a negligible effect on the base-case model findings. PFO closure demonstrated a 76.9% probability of being cost-effective at a WTP threshold of £20,000/QALY at a 5-year time-horizon.

Limitations: This model focused specifically on UK stroke patients and typically enrolled young (mean age <65 years old) patients. Hence, caution should be taken when comparing data vs non-UK populations, and it remains unclear how older patients might have affected cost-effectiveness findings, as the risk of paradoxical embolism can persist as patients age.

Conclusion: Percutaneous closure of a PFO is cost-effective compared with antiplatelet therapy alone, underlining the economic benefits potentially afforded by this treatment in selected patients.     

Community gardening and health-related benefits for a rural Victorian town

Community gardens are growing in popularity as a strategy to effectively deal with population health at a local level. There is a need to gather information about the health-related benefits of community gardens for people living in a rural locale. This paper discusses the health-related benefits of rural community gardens. We adopted a qualitative approach to examine these issues. Ten participants, eight females and two males, aged between 50 and 82, who have participated in a community garden located in South Gippsland, Victoria, for a minimum of 12 months, took part in this study. Semi-structured interviews that lasted between 30 and 60 min were conducted to explore the perspectives and lived experiences of the participants. Thematic analysis was utilised to analyse the data. We situate our discussion in this paper within the therapeutic landscape theory. Findings indicate that there is a range of health-related benefits associated with participation in rural community gardens, including physical, nutritional, social and psychological. Despite these benefits, the participants wished to see some improvements that could attract more people in rural areas to participate in community gardens. Given the paucity of research available regarding rural community gardens, future research should continue to develop an understanding of these rural sites, especially given the ever-growing popularity of community gardens Australia-wide.     

Network analysis of a new export grouping scheme: The role of economic and non-economic relations

Export grouping schemes can be viewed as an attempt to manage network development. This article examines a new Australian export grouping scheme in terms of its role and impact on the industrial network of which it is a part. The role played by non-economic exchange relations as well as economic, buyer-seller, exchange relations are emphasised, including competitive and potential interfirm relations and the way informal interpersonal relations. Spawned initially by formal grouping processes, were found to play an important part in group functioning and in outcomes from group activities.     

The role of health consciousness,food safety concern and ethical identity on attitudes and intentions towards organic food

The paper examines the roles of health consciousness, food safety concern and ethical self‐identity in predicting attitude and purchase intention within the context of organic produce. A conceptual model is derived and tested via structural equation modelling. Findings indicate food safety as the most important predictor of attitude while health consciousness appears to be the least important motive in contrast to findings from some previous research. In addition, ethical self‐identity is found to predict both attitudes and intention to purchase organic produce, emphasizing that respondents' identification with ethical issues affects their attitude and subsequent consumption choices.     

Strategic management in not-for-profit organizations

With many executives spending at least part of their management careers in not-for-profit organizations, the application of viable principles from corporate experience to the not-for-profit situation is important if these managers are to transfer their talents between organizational forms effectively. Strategy identification, evaluation, and reformulation for the not-for-profit organization are discussed in this paper, as an adaptation of the principles developed for corporate strategic management.     

Growth empirics with institutional measures for transition countries

This paper investigates the importance of institutions as a determinant of growth and foreign direct investment (FDI) in 25 transition countries for 1990–1998. It introduces some novel institutional measures, performs extensive sensitivity tests, and checks for reverse causation. Estimation results suggest that state institutions in particular are quite robustly important for growth and FDI. The relationship between institutions and growth is likely to be a causation, that between institutions and FDI less so. The significance of macroeconomic stabilization and liberalization is also confirmed, but multicollinearity problems make it impossible to properly judge their importance relative to that of institutions.