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Background: Tobacco smoking during pregnancy is the most important preventable risk factor for pregnancy complications and adverse birth outcomes and can have lifelong consequences for infants. Smoking during pregnancy is associated with higher healthcare costs related to birth complications and during childhood. Psychosocial interventions to support pregnant women to quit are effective, yet provision of smoking cessation support has been inconsistent. The Midwives and Obstetricians Helping Mothers to Quit Smoking (MOHMQuit) intervention provides systems change, and leadership and clinician elements, to support clinicians to help women stop smoking in pregnancy. There have been few long-term analyses conducted of the cost-effectiveness of smoking cessation interventions for pregnant women that target healthcare providers. This protocol describes the economic evaluation of the MOHMQuit trial, a pragmatic stepped-wedge cluster-randomised controlled implementation trial in nine public maternity services in New South Wales (NSW), Australia, to ascertain whether MOHMQuit is cost-effective in supporting clinicians to help women quit smoking in pregnancy compared to usual care. Methods: Two primary analyses will be carried out comparing MOHMQuit with usual care from an Australian health care system perspective: i) a within-trial cost-effectiveness analysis with results presented as the incremental cost per additional quitter; and ii) a lifetime cost-utility analysis using a published probabilistic decision analytic Markov model with results presented as incremental cost per quality-adjusted life-year (QALY) gained for mother and child. Patient-level data on resource use and outcomes will be used in the within-trial analysis and extrapolated and supplemented with national population statistics and published data from the literature for the lifetime analysis. Discussion: There is increasing demand for information on the cost-effectiveness of implementing healthcare interventions to provide policy makers with critical information for the best value for money within finite budgets. Economic evaluation of the MOHMQuit trial will provide essential, policy-relevant information for decision makers on the value of evidence-based implementation of support for healthcare providers delivering services for pregnant women. Trial registrations: ACTRN12622000167763, registered 2 February 2022. [ABSTRACT FROM AUTHOR]

Native flora and fauna species continue to decline in the megadiverse, wealthy, economically and politically stable nation of Australia despite current efforts in policy and management. Ongoing research is examining these declines, their causes and the adequacy of current policy, but strategies for improving the outcomes for threatened species have attracted less attention. We discuss several key aspects of Australia’s national threatened species management approach that potentially hinder the efficiency and effectiveness of management: the threatened species listing process is lengthy and biased; recovery plan development is resource intensive, restricted to a subset of species and often not effective; funding for threatened species management is not allocated efficiently or transparently; and management is not designed to incorporate uncertainties and adapt to changing future threats. Based on these issues we recommend four changes to current process: rationalize listing and assessment processes; develop approaches to prioritize species-based and threat-based responses cost-effectively; estimate funds required to recover species and secure longer term funding; and accommodate uncertainties and new threats into the current planning framework. Cost-effective prioritization for species and threats identifies which actions are likely to achieve the greatest benefits to species per unit cost, thereby managing more species and threats with available funds. These improvements can be made without legislative reform, additional funding or socio-economic shifts. If implemented, we believe more Australian threatened species will benefit from current efforts. Many of the challenges facing Australia are analogous to issues in other countries including the United States, Canada and the United Kingdom and these recommendations could assist in improving threatened species management. [ABSTRACT FROM AUTHOR]

Abstract: Surveying terrestrial invertebrates often requires lethal techniques that can also kill non-target vertebrates. Removing the desirable components of biodiversity is at odds with the philosophy of ecological restoration and biodiversity conservation more generally. Moreover, commonly used metrics generated by such survey approaches (e.g. abundance and species richness) are only indirectly related to the ecosystem services (e.g. pollination) that are often of primary interest. We examined the relationship between rates of dung removal (a direct measure of an ecosystem service) and dung beetle abundance and species richness in a temperate region of New South Wales, Australia, and examined if dung removal in revegetated riparian areas of different ages were trending monotonically toward rates in areas with mature native vegetation. Pellets of pig manure and conventional traps were left at study sites for 48h to examine the relationships between rates of dung removal and dung beetle abundance and richness. Regressions of abundance and richness with average percent dung removal were positive and significant, demonstrating the potential of the method as a non-lethal proxy. While the dung removal method cannot determine the species responsible, percentage dung removal was more time-efficient, costing 4min per sample, while abundance and richness cost 13 and 17min, respectively. Despite variability among replicates of the same habitat type, the trajectory across the restoration gradient showed an increase from sites recently revegetated toward those with mature woody vegetation. We interpreted these results as a positive response of dung beetle activity and an indication of recovery of this ecosystem service. We argue that responses that can be collected efficiently such as dung removal should be used if restorationists have limited resources for data collection and analysis; non-specialists are involved; knowledge of ecosystem function is required, and animal ethics constrain options. [Copyright &y& Elsevier]

Background: Group A streptococcus (GAS) causes an exceptionally diverse range of diseases, raising questions about the optimal product characteristics of a commercially viable vaccine. The objectives of this study were to (1) estimate the current health and economic burdens caused by 24 diseases attributable to GAS each year in Australia and (2) use these estimates to explore the value of a GAS vaccine for different clinical indications, age schedules, and population groups., Methods: For objective 1, we estimated the population heath and economic burdens by synthesising data from administrative databases, nationally representative surveys, literature reviews, public reimbursement schedules, and expert opinion. For objective 2, we modelled the prospective lifetime burden of GAS for all infants from birth, for children from 5 years of age, and for adults from 65 years of age. A vaccine was assumed to reduce each GAS disease by 70% for a period of 10 years, and the difference in outcomes between vaccinated and non-vaccinated cohorts were used to calculate the cost-effective value of vaccination., Results: The annual health and economic burdens of GAS diseases totalled 23,528 disability-adjusted life years and AU$185.1 million in healthcare costs respectively; approximately half of each measure was due to cellulitis, followed by other skin infections and throat infections. Reducing the incidence of throat infections, skin infections, and cellulitis in non-Indigenous cohorts resulted in 30%, 33%, and 28% of the total vaccine value for an infant schedule (cost-effective vaccine price AU$260 per course); 47%, 26%, and 22% of the value for a child schedule (AU$289); and 2%, 15% and 74% for an adult schedule (AU$489)., Conclusions: A vaccine that prevents GAS cellulitis and other skin infections, in addition to throat infections, would maximise its value and commercial viability, with a cost-effective price in line with other recently-licensed and funded vaccines in Australia., (Copyright © 2018 Elsevier Ltd. All rights reserved.)