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Background: The quality of care for patients admitted with a primary diagnosis of gout, both before and after admission, has not been systematically examined. Aims: To understand national trends in hospital admission for a primary diagnosis of gout in Aotearoa New Zealand over the past 10 years and the quality of care for gout received by these patients before and after the admission. Methods: Data from the Aotearoa New Zealand National Collections from 1 January 2007 to 31 December 2019 were analysed to determine rates of hospital admission for a primary diagnosis of gout. Admission data include cost(weight analysis, as well as quality of care data including gout-specific medication dispensing in the year prior and year after admission. Results: There were 13 721 admissions with a primary diagnosis of gout over the analysis period, with an average cost per admission in 2019 of NZ$4301. The rate of admission per 100 000 population was highest in Pacific peoples followed by M(aori. Although dispensing of any allopurinol increased in the year after admission, rates of regular allopurinol dispensing remained low; 38.1% for admissions in 2018. Patients who were younger (especially 20–44 years), not enrolled in a primary health organisation before admission and female had lower rate of regular allopurinol after admission. Conclusion: In this nationwide study, rates of admission for gout were highest in Pacific peoples and in M(aori. Rates of regular allopurinol dispensing were low even after admission for a primary diagnosis of gout. These findings highlight the need for improvements in gout management in Aotearoa New Zealand, including in postdischarge planning from secondary care inpatient services. [ABSTRACT FROM AUTHOR]

Background: Evidence suggests index cholecystectomy (IC) in patients with acute cholecystitis is safe, has decreased hospital stay and is cheaper than delayed cholecystectomy (DC). Costs of cholecystectomy have not previously been investigated in New Zealand. The aim of this study was to compare cost of IC with DC for patients with acute cholecystitis. Methods: A retrospective analysis of adults admitted to Northland hospitals with acute cholecystitis between 1 January 2015 and 31 December 2019 who underwent subsequent cholecystectomy, was performed. Actual patient‐level costs were utilized for cost comparison between IC and DC. Factors associated with increased costs were assessed using multivariate analysis. Results: Two hundred and eleven patients were included in the study; 72 (34%) underwent IC and 139 (65%) DC. There was no significant difference in total cost for IC ($12 767) versus DC ($12 029) (p = 0.192); this persisted on multivariate analysis. Patients having IC had more severe cholecystitis, and 90‐day representation rate following DC was 35%. Costs were increased by severity of cholecystitis, age, American Society of Anesthesiology score (ASA) and travel distance. Conclusion: This study showed there is no significant difference in cost between IC and DC for patients with acute cholecystitis in Northland, New Zealand. Severity, increasing age, ASA and travel distance were drivers of costs. To recognize the cost benefits of IC, it is likely that increased rates of IC are needed. [ABSTRACT FROM AUTHOR]

Summary: Background: In the absence of rigorous evidence of cost‐effectiveness for early childhood obesity prevention interventions, the next‐best option may be for decision‐makers to consider the relevant costs of interventions when allocating resources. Objectives: This study aimed to estimate systematically the cost of five obesity prevention interventions in children aged 0‐2 years, undertaken in research settings in Australia and New Zealand. Methods: A standardised costing protocol informed the costing methodology, ensuring comparability of results across interventions. Micro‐costing was undertaken, with intervention costs defined from the funder perspective and valued in 2018 Australian dollars using unit costs from the trials or market rates. Results: Interventions varied widely in their resource use. The total cost per participant ranged from $80 for the CHAT SMS intervention arm (95% UI $77‐$82) to $1135 for the Healthy Beginnings intervention (95% UI $1059‐$1189). Time costs of personnel delivering interventions contributed >50% of total intervention costs for all included studies. Conclusions: An understanding of the costs associated with intervention delivery modes is important, alongside effectiveness. Telephone delivery may include unexpected costs associated with connection to intervention participants at convenient times. A SMS‐based intervention had the lowest delivery cost in this study. [ABSTRACT FROM AUTHOR]

Aim: A low‐carbohydrate, healthy‐fat (LCHF) dietary approach has been demonstrated as an effective strategy for improving metabolic health; however, it is often criticised for being more expensive than following a dietary approach guided by the national, Ministry of Health nutrition guidelines. This study compared the cost of these two nutritionally replete dietary approaches for one day for a family of four. Methods: In this descriptive case study, one‐day meal plans were designed for a hypothetical family of four representing the average New Zealand (NZ) male and female weight‐stable adult and two adolescent children. National documented heights, a healthy body mass index range (18.5–25.0 kg/m2), and a 1.7‐activity factor was used to estimate total energy requirements using the Schofield equation. Total daily costs were compared based on food prices from a popular Auckland supermarket. Meal plans were analysed for their nutritional adequacy using FoodWorks 8 dietary analysis software against national Australian and NZ nutrient reference value thresholds. Results: The total daily costs were $43.42 (national guidelines) and $51.67 (LCHF) representing an $8.25 difference, or $2.06 per person, with the LCHF meal plan being the costlier option. Conclusions: We consider this increased cost for an LCHF approach to be negligible. In practice, less costly food items with similar nutrition qualities can be substituted to reduce costs further should this be a goal. The LCHF approach should therefore not be disregarded as a viable dietary approach for improving health outcomes, based on its perceived expense. [ABSTRACT FROM AUTHOR]

Aim: To measure the relative change in price of healthier and less healthy foods over 10 years in New Zealand. Methods: Foods in the New Zealand food price index were classified as healthy and less healthy (WHO Europe Nutrient Profile Model) and by degree of processing (according to the NOVA classification). The change in price from February 2007 to January 2017 was analysed using a mixed model for repeated measures with healthiness (or level of processing), season and time added as covariates. Results: Eighty‐eight (of 155) relevant items had sufficient information on weight and healthiness. The trend of increasing food prices over time was similar for healthier and less healthy foods and between the three categories of processing. There was a statistically significant interaction (P = 0.014) between seasons and healthiness of foods, and seasons and degrees of processing (P < 0.001). The price of healthy foods and minimally processed foods fluctuated more by season compared to less healthy foods and processed foods. Conclusions: Food prices increased over time with no significant difference in the rate of change for healthier and less healthy foods, and between foods of different degrees of processing. This method can be used to routinely monitor relative changes in food prices according to healthiness. [ABSTRACT FROM AUTHOR]

Aim: Dietary modification is integral to the management of end stage kidney disease. However, adherence to the renal diet is poor. Few studies have explored the perspectives of renal dietitians and how they work with patients to facilitate dietary change. The objectives of this study were to explore the experiences of renal dietitians about educating patients with end stage kidney disease; and to describe the strategies perceived to help patients understand the renal diet. Methods: Semi‐structured interviews based on Sensemaking theory were conducted with renal dietitians (n = 27) working in Australia and New Zealand from a range of metropolitan, regional and remote areas. Results: Five major themes across two categories were derived from the data. The renal dietitians in this study experienced feelings of frustration, frequently worked in practice environments with limited or inadequate resources and perceived that establishing trust and demonstrating empathy were important to sense making. Renal dietitians helped patients make sense of and understand the diet by clarifying ambiguities and conflicting information; and simplifying complexity by using simple explanations, individualised advice and practical support. These strategies were considered critical to the renal diet sense making process. Conclusions: The experience of providing renal diet advice to adults with end stage kidney disease was emotionally and professionally challenging. Alternative approaches to patient education may help dietitians to empower patients to better understand the renal diet. Further research exploring the experiences of learning about the renal diet from the patient and carer perspective would also help to inform future alternative approaches. [ABSTRACT FROM AUTHOR]

The author discusses updates on issues related to the marketing of drugs to society in clinical trials. Topics mentioned include the drug acquisition component of the cost of pharmaceutical clinical trials, a concept of penetration pricing developed by economist Joel Dean, and the rising costs of anti-cancer drugs in Australia.

This observational case series in 65 premenopausal women with abnormal uterine bleeding evaluated whether transvaginal ultrasound followed by saline infusion sonohysterography ( SIS) prevented unnecessary hysteroscopy. Although SIS indicated that hysteroscopy was unnecessary in eight women, this benefit was offset by the invasive nature of the scan, the number of endometrial abnormalities falsely detected by SIS and the cost of the additional investigation. [ABSTRACT FROM AUTHOR]

Commentary is provided regarding the article "Assessing New Zealand’s cannabis legalization and control bill: prospects and challenges" by C. Wilkins and M. Rychert which appears in the same issue of the journal. New Zealand's Cannabis Legalization and Control Bill is examined, along with cannabis-related minimum pricing, taxes, and regulations. Harm reduction is also assessed.

Aims To investigate whether affordability of alcohol is an important determinant of alcohol consumption along with price. This will inform effective tax policy to influence consumption. Design Co-integration analysis was used to analyse relationship between real price, affordability and consumption. Changes in retail availability of wine in 1990 and beer in 1999 were also included in the models. The econometric approach taken allows identification of short- and long-term responses. Separate analyses were performed for wine, beer, spirits and ready-to-drinks (spirits based pre-mixed drinks). Setting New Zealand 1988-2011. Measurements Quarterly data on price and alcohol available for consumption for wine, beer, spirits and ready-to-drinks. Price data were analysed as: real price (own price of alcohol relative to the price of other goods) and affordability (average earnings relative to own price). Findings There was strong evidence for co-integration between wine and beer consumption and affordability. There was weaker evidence for co-integration between consumption and real price. Conclusions The affordability of alcohol is more important than real price in determining consumption of alcohol. This suggests that affordability needs to be considered by policy makers when determining tax and pricing policies to reduce alcohol-related harm. [ABSTRACT FROM AUTHOR]

Background: In 2010, Waitemata District Health Board piloted a new model of care for total hip and knee arthroplasties. The pilot was incentive based and clinically led. The participating surgeons and anaesthetists were responsible for increasing surgical throughput. The pilot aimed to increase productivity, reduce cost and increase quality for patients. Aim: To compare costs and outcomes for elective hip and knee arthroplasties carried out at the pilot site (Waitakere Hospital) compared with the main District Health Board hospital site (North Shore Hospital (NSH)). Methods: A retrospective matched cohort study of hip and knee replacements discharged between 1 July 2010 and 31 March 2011, comparing costs and outcomes at the pilot site compared with the NSH site. Only non-complex procedures were included, and routinely collected data were used. Results: One hundred and seventy-seven hip replacements (77 NSH, 100 pilot) and 158 knee replacements (88 NSH, 70 pilot) were analysed. Total inpatient event costs were 12% and 17% lower for hip and knee replacements, respectively, at the pilot site compared with NSH. Significant reduction in operation length (39% hip, 36% knee) and length of stay (38% hip, 39% knee) were found in the pilot groups compared with NSH. Conclusion: Implementation of an innovative new model in a public hospital setting has produced significant increases in productivity and reduced overall costs. This model could potentially be used in other public healthcare settings for non-complex elective surgery. [ABSTRACT FROM AUTHOR]

Aim: To undertake a systematic literature review to examine the effect of food cost on diet quality and risk factors for chronic disease, specifically focusing on diet-related lifestyle diseases affecting the Australian population. Methods: A search of six databases resulted in the inclusion of one systematic review, three cohort studies, 41 cross-sectional studies and four modelling studies in this review. Results: Between 2000 and 2006, the price of healthy foods has increased more than the price of less healthy foods. Healthy Food Access Basket surveys show that a healthy diet may often be unaffordable for low- and average-income households. Diets of higher energy density were associated with lower diet cost, whereas diets of higher nutrient density and nutritional quality were associated with higher diet cost. Recent studies report an inverse association between food price and food consumption. Consequently, an increase in food cost was associated with a significant reduction in weight, waist circumference, body mass index, obesity and insulin resistance. Conclusions: Manipulation of food cost may alter food consumption and therefore risk factors for chronic disease. Further longitudinal studies investigating the impact of pricing strategies on diet quality and disease risk are needed. [ABSTRACT FROM AUTHOR]