Dr Richard Norman

Norman, R., Cronin, P.A. & Viney, R.C. 2013, 'A pilot discrete choice experiment to explore preferences for EQ-5D-5L health states', Applied Health Economics and Health Policy, vol. 11, no. 3, pp. 287-298.

Norman, R., Church, J., Van den Berg, B. & Goodall, S. 2013, 'Australian health-related quality of life population norms derived from the SF-6D', Australian and New Zealand Journal of Public Health, vol. 37, no. 1, pp. 17-23.

Norman, R., Hall, J.P., Street, D. & Viney, R.C. 2013, 'Efficiency and equity: A stated preference approach', Health Economics, vol. 22, no. 5, pp. 568-581.
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Outcome measurement in the economic evaluation of health care considers outcomes independent of to whom they accrue. This article reports on a discrete choice experiment designed to elicit population preferences regarding the allocation of health gain between hypothetical groups of potential patients. A random-effects probit model is estimated, and a technique for converting these results into equity weights for use in economic evaluation is adopted. On average, the modelling predicts a relatively high social value on health gains accruing to nonsmokers, carers, those with a low income and those with an expected age of death less than 45?years. Respondents tend to favour individuals with similar characteristics to themselves. These results challenge the conventional practice of assuming constant equity weighting. For decision makers, whether a formal equity weighting system represents an improvement on more informal approaches to weighing up equity and efficiency concerns remains uncertain

Parkinson, B.T., Goodall, S. & Norman, R. 2013, 'Measuring the loss of consumer choice in mandatory health programs using discrete choice experiments', Applied Health Economics and Health Policy, vol. 11, no. 2, pp. 139-150.
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Van Gool, K., Norman, R., Hall, J.P., Massie, J. & Delatycki, M. 2013, 'Understanding the costs of care for cystic fibrosis: an analysis by age and health state', Value in Health, vol. 16, no. 2, pp. 345-355.
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Blinman, P., King, M.T., Norman, R., Viney, R.C. & Stockler, M.R. 2012, 'Preferences for cancer treatments: an overview of methods and applications in oncology', Annals Of Oncology, vol. 23, no. 5, pp. 1104-1110.
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This review provides cancer clinicians and researchers with an overview of methods for assessing preferences, with examples and recommendations for their application in oncology. Decisions about cancer treatments involve trade-offs between their relative benefits and harms. An individual+s preference for a cancer treatment reflects their evaluation of the relative benefits and harms in comparison with a given alternative or alternatives. Methods of preference assessment include the ranking or rating scale, standard gamble (SG), time trade-off (TTO), visual analogue scale, discrete choice experiment (DCE), and multi-attribute utility instrument (MAUI). The choice of method depends on the purpose of preference assessment; the ranking or rating scale, SG, TTO, and DCEs are best suited to clinical decisions, whereas MAUIs are best suited to health policy decisions. Knowledge of patients+ preferences for cancer treatments can better inform clinical decisions about patient management by enabling the tailoring of decisions to individual patients+ values, attitudes, and priorities and health policy decisions through economic evaluations of cancer treatments and their suitability for coverage by health payers.

Church, J., Goodall, S., Norman, R. & Haas, M.R. 2012, 'The cost-effectiveness of falls prevention interventions for older community-dwelling Australians', Australian and New Zealand Journal of Public Health, vol. 36, no. 3, pp. 241-248.
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Objective: To evaluate the cost-effectiveness of strategies designed to prevent falls among older people. Methods: A decision analytic Markov model of interventions designed to prevent falls was developed. Incremental cost-effectiveness ratios (ICERs) using quality adjusted life year (QALYs) as the measure, were calculated for those interventions aimed at the general population (home exercise, group exercise, tai chi, multiple and multi-factorial interventions); high-risk populations (group exercise, home hazard assessment/modification and multi-factorial interventions); and specific populations (cardiac pacing, expedited cataract surgery and psychotropic medication withdrawal). Uncertainty was explored using univariate and probabilistic sensitivity analysis. Conclusion: In the general population, compared with no intervention the ICERs were tai chi ($44,205), group-based exercise ($70,834), multiple interventions ($72,306), home exercise ($93,432), multifactorial interventions with only referral ($125,868) and multifactorial interventions with an active component ($165,841). The interventions were ranked by cost in order to exclude dominated interventions (more costly, less effective) and extendedly dominated interventions (where an intervention is more costly and less effective than a combination of two other interventions). Tai chi remained the only cost-effective intervention for the general population. Implications: Interventions designed to prevent falls in older adults living in the community can be cost-effective. However, there is uncertainty around some of the model parameters which require further investigation.

Devine, A., Spencer, A., Eldridge, S., Norman, R. & Feder, G. 2012, 'Cost-effectiveness of Identification and Referral to Improve Safety (IRIS), a domestic violence training and support programme for primary care: a modelling study based on a randomised controlled trial', BMJ Open, vol. 2, no. 3, pp. 1-8.
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Objective The Identification and Referral to Improve Safety (IRIS) cluster randomised controlled trial tested the effectiveness of a training and support intervention to improve the response of primary care to women experiencing domestic violence (DV). The aim of this study is to estimate the cost-effectiveness of this intervention. Design Markov model-based cost-effectiveness analysis. Setting General practices in two urban areas in the UK. Participants Simulated female individuals from the general UK population who were registered at general practices, aged 16 years and older. Intervention General practices received staff training, prompts to ask women about DV embedded in the electronic medical record, a care pathway including referral to a specialist DV agency and continuing contact from that agency. The trial compared the rate of referrals of women with specialist DV agencies from 24 general practices that received the IRIS programme with 24 general practices not receiving the programme. The trial did not measure outcomes for women beyond the intermediate outcome of referral to specialist agencies. The Markov model extrapolated the trial results to estimate the long-term healthcare and societal costs and benefits using data from other trials and epidemiological studies.

Norman, R., Van Gool, K., Hall, J.P., Delatycki, M. & Massie, J. 2012, 'Cost-effectiveness of carrier screening for cystic fibrosis in Australia', Journal of Cystic Fibrosis, vol. 11, no. 4, pp. 281-287.
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Carrier screening for cystic fibrosis is not widely available in Australia, partly due to concerns regarding its cost-effectiveness. The benefit of information from pregnancy to pregnancy has not been widely considered in existing cost-effectiveness analyses. Methods: A decision tree was constructed estimating costs and outcomes from screening, including both initial and subsequent pregnancies. Effectiveness was expressed in terms of CF births averted. Costs were collected using a health service perspective. All costs and outcomes were discounted at 5% per annum. Results: Screening reduced the annual incidence of CF births from 34 to 14/100,000 births (an aggregate number of CF births of 100.9 and 41.9 respectively). In initial pregnancies, costs in the screening arm (A$16.6. million/100,000 births) exceed those in the non-screening arm (A$13.4. million/100,000 births). The incremental cost per CF birth in initial pregnancies is therefore approximately A$150,000. However, this was reversed for subsequent pregnancies, in that the pre-collected information reduces the incidence of CF in subsequent pregnancies at low additional costs. When aggregated, the results suggest screening is likely to be cost-saving. Conclusions: The introduction of national carrier screening for cystic fibrosis should be considered, as it is likely to reduce CF incidence at an acceptable (potentially negative) cost.

Stein-Parbury, M.J., Chenoweth, L.L., Jeon, Y., Brodaty, H., Haas, M.R. & Norman, R. 2012, 'Implementing person-centered care in residential dementia care', Clinical Gerontology, vol. 35, no. 5, pp. 404-424.
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This article provides a detailed overview of the PCC intervention arm of the study and describes the training and procedures used to facilitate implementation of PCC. Training emphasized the impact of the social world on the person with dementia and promoted the skills of interpersonal engagement, especially in relation to feeling expression. Facilitated on-site learning involved care planning that included obtaining a life story of the person with dementia and observing social interactions.

Church, J., Goodall, S., Norman, R. & Haas, M.R. 2011, 'An economic evaluation of community and residential aged care falls prevention strategies in NSW', NSW Public Health Bulletin, vol. 22, no. 3-4, pp. 60-68.
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Aim: To evaluate the cost-effectiveness of strategies designed to prevent falls amongst people aged 65 years and over living in the community and in residential aged-care facilities. Methods: A systematic review and meta-analysis of the literature was conducted. The pooled fall rate ratio was used in a decision analytic model that combined a Markov model and decision tree to estimate the costs and outcomes of potential interventions and/or strategies. The resulting cost per quality-adjusted life year was estimated. Results: The most cost-effective falls prevention strategy in community-dwelling older people was Tai Chi. Expedited cataract surgery and psychotropic medication withdrawal were also found to be cost-effective; however, the effectiveness of these interventions is less certain due to small numbers of trials and participants. The most costeffective falls prevention strategies in residential aged-care facilities were medication review and vitamin D supplementation.

Gallego, G., Casey, R., Goodall, S. & Norman, R. 2011, 'Introduction and uptake of new medical technologies in the Australian health care system: a qualitative study', Health Policy, vol. 102, no. 2-3, pp. 152-158.
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Objective: The aim of this study was to explore the views and perceptions of stakeholders about the current national health technology assessment process conducted by the Medical Services Advisory Committee (MSAC) and its role in the uptake and diffusion of new medical technologies in Australia. Methods: Data collection occurred over a nine month period (August 2008+April 2009). Twenty in-depth, semi-structured interviews were conducted with individuals from four stakeholders groups: (i) MSAC members and evaluators, (ii) academic and health technology assessment experts, (iii) medical industry representatives and (iv) medical specialists. Interviews were digitally recorded, transcribed verbatim and coded using a constant comparative method.

Gold, L., Norman, R., Devine, A., Feder, G., Taft, A. & Hegarty, K. 2011, 'Cost-effectiveness of health care interventions to address intimate partner violence: What do we know and what else should we look for?', Violence Against Women: an international and interdisciplinary journal, vol. 17, no. 3, pp. 389-403.
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Intimate partner violence (IPV) creates a substantial burden of disease and significant costs to families, communities, and governments. Building the evidence for effective interventions to reduce violence and its sequelae requires increased use of economic evaluation to inform policy through the analysis of costs and potential savings of interventions. The authors review existing economic evaluations and present case studies of current research from the United Kingdom and Australia to illustrate the strengths and limitations of two approaches to generating economic evidence: economic evaluation alongside randomized controlled trials and economic modeling. Economic evaluation should always be considered in the design of IPV intervention research.

Viney, R.C., Norman, R., King, M.T., Cronin, P.A., Street, D., Knox, S.A. & Ratcliffe, J. 2011, 'Time trade-off derived EQ-5D weights for Australia', Value in Health, vol. 14, no. 6, pp. 928-936.
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Background: Cost-utility analyses (CUAs) are increasingly common in Australia. The EuroQol five-dimensional (EQ-5D) questionnaire is one of the most widely used generic preference-based instruments for measuring health-related quality of life for the estimation of quality-adjusted life years within a CUA. There is evidence that valuations of health states vary across countries, but Australian weights have not previously been developed. Methods: Conventionally, weights are derived by applying the time trade-off elicitation method to a subset of the EQ-5D health states. Using a larger set of directly valued health states than in previous studies, time trade-off valuations were collected from a representative sample of the Australian general population (n = 417). A range of models were estimated and compared as a basis for generating an Australian algorithm. Results: The Australia-specific EQ-5D values generated were similar to those previously produced for a range of other countries, but the number of directly valued states allowed inclusion of more interaction effects, which increased the divergence between Australia's algorithm and other algorithms in the literature. Conclusion: This new algorithm will enable the Australian community values to be reflected in future economic evaluations.

Norman, R., Spencer, A., Eldridge, S. & Feder, G. 2010, 'Cost-effectiveness of a programme to detect and provide better care for female victims of intimate partner violence', Journal of Health Services Research and Policy, vol. 15, no. 3, pp. 143-149.
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Objective: Primary care clinicians often fail to detect women who are victims of intimate partner violence (IPV). Our aim was to investigate the cost-effectiveness of a programme in primary care to detect and support such women. Methods: We developed a Markov model to estimate the cost-effectiveness of education and support for primary care clinicians to increase their identification of survivors of IPV and to refer them to a specialist advocacy agency or a psychologist with specialist skills. The programme was implemented in three general practices in the United Kingdom (with an additional practice acting as a control) and provided cost data and rates of identification and referral. Other cost data and the effectiveness of IPV advocacy came from published sources. Results: The model gave an incremental cost-effectiveness ratio (ICER) of approximately ú2,450 per quality adjusted life year (QALY). Although the ratio increased in some of the sensitivity analyses, most were under a conventional willingness to pay threshold (ú30,000/QALY). Conclusions: While there is considerable uncertainty in the underlying parameters, a training programme for primary care teams to increase identification and referral of women experiencing IPV is likely to be costeffective.

Norman, R., King, M.T., Clarke, D., Viney, R.C., Cronin, P.A. & Street, D. 2010, 'Does mode of administration matter? Comparison of online and face-to-face administration of a time trade-off task', Quality of Life Research, vol. 19, no. 4, pp. 499-508.
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Purpose Developments in electronic data collection methods have allowed researchers to generate larger datasets at lower costs, but relatively little is known about the comparative performance of the new methods. This paper considers the comparability of two modes of administration (face-to-face and remote electronic) for the time trade-off. Method Data were collected from a convenience sample of adults (n = 135) randomised to either a face-to-face time trade-off or a remote electronic tool. Patterns of responses were considered. For each sample, standard regression analysis was undertaken to generate a valuation set, which were then contrasted

Chenoweth, L.L., King, M.T., Jeon, Y., Brodaty, H., Stein-Parbury, M.J., Norman, R., Haas, M.R. & Luscombe, G. 2009, 'Caring for Aged Dementia Care Resident Study (CADRES) of person-centred care, dementia-care mapping, and usual care in dementia: A cluster-randomised trial', Lancet Neurology, vol. 8, no. 4, pp. 317-325.
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Background Evidence for improved outcomes for people with dementia through provision of person-centred care and dementia-care mapping is largely observational. We aimed to do a large, randomised comparison of person-centred care, dementia-care mapping, and usual care. Methods In a cluster randomised controlled trial, urban residential sites were randomly assigned to person-centred care, dementia-care mapping, or usual care. Carers received training and support in either intervention or continued usual care. Treatment allocation was masked to assessors. The primary outcome was agitation measured with the Cohen-Mansfield agitation inventory (CMAI). Secondary outcomes included psychiatric symptoms including hallucinations, neuropsychological status, quality of life, falls, and cost of treatment. Outcome measures were assessed before and directly after 4 months of intervention, and at 4 months of follow-up. Hierarchical linear models were used to test treatment and time effects. Analysis was by intention to treat. This trial is registered with the Australia and New Zealand Clinical Trials Registry, number ACTRN12608000084381. Findings 15 care sites with 289 residents were randomly assigned. Pairwise contrasts revealed that at follow-up, and relative to usual care, CMAI score was lower in sites providing mapping (mean difference 10À9, 95% CI 0À7+21À1; p=0À04) and person-centred care (13À6, 3À3+23À9; p=0À01). Compared with usual care, fewer falls were recorded in sites that used mapping (0À24, 0À08+0À40; p=0À02) but there were more falls with person-centred care (0À15, 0À02+0À28; p=0À03). There were no other significant effects. Interpretation Person-centred care and dementia-care mapping both seem to reduce agitation in people with dementia in residential care.

Feder, G., Ramsay, J., Dunne, D., Rose, M., Arsene, C., Norman, R., Kuntze, S., Spencer, A., Bacchus, L., Hague, G., Warburton, A. & Taket, A. 2009, 'How far does screening women for domestic (partner) violence in different health-care settings meet criterian for a screening programme? Systematic reviews of nine UK National Screening Committee criteria', Health Technology Assessment, vol. 13, no. 16, pp. 1-136.
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OBJECTIVES: The two objectives were: (1) to identify, appraise and synthesise research that is relevant to selected UK National Screening Committee (NSC) criteria for a screening programme in relation to partner violence; and (2) to judge whether current evidence fulfils selected NSC criteria for the implementation of screening for partner violence in health-care settings. DATA SOURCES: Fourteen electronic databases from their respective start dates to 31 December 2006. REVIEW METHODS: The review examined seven questions linked to key NSC criteria: QI: What is the prevalence of partner violence against women and what are its health consequences? QII: Are screening tools valid and reliable? QIII: Is screening for partner violence acceptable to women? QIV: Are interventions effective once partner violence is disclosed in a health-care setting? QV: Can mortality or morbidity be reduced following screening? QVI: Is a partner violence screening programme acceptable to health professionals and the public? QVII: Is screening for partner violence cost-effective? Data were selected using different inclusion/exclusion criteria for the seven review questions. The quality of the primary studies was assessed using published appraisal tools. We grouped the findings of the surveys, diagnostic accuracy and intervention studies, and qualitatively analysed differences between outcomes in relation to study quality, setting, populations and, where applicable, the nature of the intervention. We systematically considered each of the selected NSC criteria against the review evidence.

Norman, R., Haas, M.R., Chaplin, M., Joy, P. & Wilcken, B. 2009, 'Economic evaluation of Tandem Mass Spectrometry Newborn Screening in Australia', Pediatrics, vol. 123, no. 2, pp. 451-457.
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OBJECTIVE. The goal was to investigate the cost-effectiveness of tandem mass spectrometry screening for the detection of inborn metabolic errors in an Australian setting. METHODS. Cost-effectiveness analysis from the health service perspective was undertaken on the basis of registry data for affected individuals. The intervention group was contrasted with both a contemporaneous group in nonscreening states and a historical cohort. The registry covers all individuals identified in Australia between 1994 and 2002. Main outcome measures were the total net cost of screening, the cost of treatment, life-years saved, and deaths averted. RESULTS. The total net cost of testing was estimated to be A$218 000 per 100 000 infants. Medical costs incurred by the intervention group exceeded those for the control group by A$131 000 per 100 000 infants. The number of life-years saved per 100 000 infants screened was 32.378 life-years per 100 000 infants through an expected mortality rate reduction of 0.738 deaths per 100 000 infants. The cost per death averted was estimated to be A$472 913 and the cost per life-year saved was estimated to be A$10 779, which compare favorably with existing cost-effectiveness standards. This conclusion is particularly robust because conservative assumptions were made throughout, because of data limitations. Sensitivity analyses suggested that this result was relatively robust to adjustment of model parameters.

Norman, R., Cronin, P.A., Viney, R.C., King, M.T., Street, D. & Ratcliffe, J. 2009, 'International comparisons in valuing EQ-5D health states: A review and analysis', Value in Health, vol. 12, no. 8, pp. 1194-1200.
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Objective: To identify the key methodological issues in the construction of population-level EuroQol 5-dimensions (EQ-5D)/time trade-off (TTO) preference elicitation studies. Method: This study involved three components. The first was to identify existing population-level EQ-5D TTO studies. The second was to illustrate and discuss the key areas of divergence between studies, including the international comparison of tariffs. The third was to portray the relative merits of each of the approaches and to compare the results of studies across countries. Results: While most articles report use of the protocol developed in the original UK study, we identified three key areas of divergence in the construction and analysis of surveys. These are the number of health states valued to determine the algorithm for estimating all health states, the approach to valuing states worse than immediate death, and the choice of algorithm. The evidence on international comparisons suggests differences between countries although it is difficult to disentangle differences in cultural attitudes with random error and differences as a result of methodological divergence. Conclusions: Differences in methods may obscure true differences in values between countries. Nevertheless, population-specific valuation sets for countries engaging in economic evaluation would better reflect cultural differences and are therefore more likely to accurately represent societal attitudes.

Norman, R., Haas, M.R. & Wilcken, B. 2009, 'International perspectives on the cost-effectiveness of tandem mass spectrometry for rare metabolic conditions', Health Policy, vol. 89, no. 3, pp. 252-260.
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To examine and evaluate the economic evidence regarding the use of tandem mass spectrometry (MS/MS) for the detection of rare metabolic conditions in neonates, and then to consider the transferability of these national-level results to other decision-making contexts. Methods A systematic literature review was undertaken, identifying papers published between January 1997 and March 2008. Thirteen unique cost-effectiveness evaluations were identified and appraised for comparability and transferability of results across settings.

Norman, R., Evans, G., Easton, D.F. & Young, K.C. 2007, 'The cost-utility of Magnetic Resonance Imaging for breast cancer in BRCA1 mutation carriers aged 30-49', European Journal of Health Economics, vol. 8, no. 2, pp. 137-144.
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Recent evidence has investigated the costeffectiveness of magnetic resonance imaging (MRI) in younger women with a BRCA1 mutation. However, this evidence has not been contrasted with existing cost-effectiveness standards to determine whether screening is appropriate, given limited societal resources. We constructed a Markov model investigating surveillance tools (mammography, MRI, both in parallel) under a National Health Service (NHS) perspective. The key benefit of MRI is that increased sensitivity leads to early detection, and improved prognosis. For a 30- to 39-year-old cohort, the cost per quality-adjusted life year (QALY) of mammography relative to no screening was ú5,200. The addition of MRI to this costs ú13,486 per QALY. For a 40- to 49- year-old cohort, the corresponding values were ú2,913 and ú7,781. Probabilistic sensitivity analysis supported the cost-effectiveness of the parallel approach of mammography and MRI. It is necessary to extend this analysis beyond BRCA1 carriers within this age group, and also to other age groups.

Goodall, S., Norman, R. & Haas, M.R. 2008, 'The costs of NSW Drug Court', Crime and Justice Bulletin, NSW Bureau of Crime Statistics and Research, Sydney, Australia, pp. 1-35.
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In 2001, the Bureau of Crime Statistics and Research (BOCSAR) and the Centre for Health Economics Research and Evaluation (CHERE) undertook an analysis of the cost-effectiveness of the NSW Drug Court. In the intervening years, a number of changes have been made to the system, and the role the Drug Court undertakes has changed as the population it serves has changed. The aim of this report is to estimate the cost of these changes to the NSW Drug Court.