Introduction: Equitable access to care is a core principle of Medicare and Australia's broader health policy frameworks, yet access to specialist care remains marked by persistent inequities. People with disability experience longer waits, face greater affordability pressures due to lower incomes and encounter greater administrative burden. These disparities undermine progress towards Australia's commitments to equitable and accessible healthcare set out in national and international policy agreements. Addressing them requires understanding the structural barriers that shape specialist access. Methods: This article synthesises evidence on inequities in specialist access and fees for people with disability and identifies policy settings that shape these outcomes. It draws on existing literature, policy documents, and emerging evidence from linked administrative data, including the Person Level Integrated Data Asset (PLIDA). Results: Key barriers include the geographic distribution of specialists, wide variation in out-of-pocket fees, fragmented referral pathways and limited care coordination, which may contribute to delayed or foregone care. These inequities are exacerbated by gaps in monitoring healthcare system performance. Australia has no system for tracking specialist wait times, limiting policymakers' ability to identify disparities. Advances in linked administrative data, particularly PLIDA, provide a foundation for improved monitoring. Conclusion: Improved wait time monitoring, greater fee transparency, targeted incentives for equitable care and strengthened navigation support are needed to improve access to specialist care for people with disability.

Gender incongruence in trans and nonbinary ("trans") populations is often associated with psychological distress and increased demand for mental healthcare. Gender-affirming hormone therapy (GAHT) is a key component of care for many trans people, yet long-term evidence around its cost implications remains limited despite increasing uptake and policy attention worldwide. We provide the first population-based evidence on the healthcare costs of GAHT initiation using longitudinal administrative data from 32,313 trans Australians who initiated testosterone-based GAHT (tGAHT) or estradiol-based GAHT (eGAHT) between 2013 and 2024. Employing a dynamic difference-in-differences design, we estimate the impacts on government expenditure and patient out-of-pocket costs in the 6 years after initiation, using future initiators as controls. We find that initiating tGAHT leads to an additional AUD$3119 (USD$2246) in government expenditure and AUD$143 (USD$103) in out-of-pocket costs over 6 years; corresponding estimates were AUD$8348 (USD$6011) and AUD$1269 (USD$914) for eGAHT recipients. For tGAHT recipients, both government and out-of-pocket costs declined after initiation, with mental healthcare reductions exceeding ongoing hormone therapy expenditure after 6 years. For eGAHT recipients, costs also fell but remained above baseline, driven by sustained prescription spending. Taken together with quality-of-life benefits, our results suggest GAHT is likely to be cost-effective.

PurposeProphylactic immunoglobulin (Ig) is used to prevent infections in patients with hypogammaglobulinaemia due to haematological malignancies (HM). Ig can be administered intravenously (IVIg) in hospital or self-administered subcutaneously (SCIg) at home, using different dosing regimens but with comparable effectiveness. In Australia, Ig product costs alone were AU$915.7 million in 2022/2023, 60% of the national blood budget. However, the total cost of IVIg and SCIg, including administration costs, remains uncertain.MethodsWe conducted a prospective, time-driven, activity-based costing study to compare the costs of providing IVIg and SCIg to patients with HM from an Australian healthcare perspective. Ig product, consumables, equipment, and in-hospital costs were included. Analyses were conducted assuming full adherence and using (1) published prices for IVIg and SCIg, which excluded plasma fractionation costs to the Australian government, and (2) equivalent average weighted price for IVIg and SCIg, including plasma fractionation costs.ResultsAnnual IVIg product cost per patient was lower than that for SCIg under both costing scenarios: (1) AU$10,012 and (2) AU$5895, driven by higher SCIg doses. The costs of treating a patient with IVIg for a year were (1) AU$9936 and (2) AU$5787 lower than with SCIg, mainly due to higher SCIg product costs. When only in-hospital administration costs were considered (excluding Ig product and SCIg home consumables), SCIg treatment was AU$1019 less costly than IVIg.ConclusionOur results indicated higher annual direct costs per patient treated with SCIg than IVIg, despite higher in-hospital costs associated with IVIg administration. Further research, including understanding costs to patients, is warranted.

Introduction Administration of antibiotics before incising the skin ('surgical antimicrobial prophylaxis') is a critical infection prevention strategy in surgery. Extending doses of prophylaxis into the postoperative period is a common practice in cardiac surgery; however, the benefit has not been clearly established and may lead to emergence of antimicrobial resistance and patient harm. We present the protocol for a large international multicentre, adaptive, pragmatic, double-blind, three-arm, placebo-controlled, randomised, non-inferiority clinical trial to compare the incidence of surgical site infection after three different durations of postoperative surgical antimicrobial prophylaxis in patients undergoing cardiac surgery.Methods and analysis This adaptive, multi-arm multistage non-inferiority trial will compare intraoperative only (Arm A), to intraoperative and 24 hours (Arm B) and, to intraoperative and 48 hours (Arm C) of intravenous cefazolin and placebo as surgical antimicrobial prophylaxis in 9180 patients undergoing cardiac surgery. The adaptive design allows for potential dropping of any of the three arms if clear inferiority is indicated at any of the scheduled interim analyses. The trial will evaluate the clinical and cost-effectiveness of the three different antibiotic prophylaxis durations.Ethics and dissemination Ethics approval will be obtained at all participating sites. Results of the study will be submitted for publication in peer-reviewed journals and the key findings presented at national and international conferences. Patients and members of the public will also be involved in the dissemination and translation of the trial results.Trial registration number NCT05447559.

People with disability experience poorer health outcomes than those without disability. These disparities were exacerbated by the onset of the COVID-19 pandemic, prompting the Australian government to implement significant changes to health and other essential services for people with disability. To reflect on these changes, the Centre of Research Excellence in Disability and Health (CRE-DH) – which consisted of investigators from five Australian universities – invited senior government officials and disability advocates to a federal-level policy forum. This study examines the recommendations arising from that forum and explores how they align with subsequent government reports and policies, offering a perspective for advancing health equity for people with disability. In September 2022, 32 senior representatives from 16 organisations participated in one of two identical half-day virtual workshops. Operating under Chatham House Rule to facilitate open discussion, each workshop included two small-group working sessions facilitated by an academic from the CRE-DH and focussed on improving health outcomes for people with disability: (1) within the health system, and (2) across disability, health, and other sectors. We used a six-phase thematic analysis approach to summarize the issues and ensuing recommendations that we grouped into strategic policy focus areas. Twelve recommendations were made to tackle health inequities across three domains: whole-of-government, health system, and cross-sectoral disability and health system reforms. Participants emphasised the unique interplay between social welfare and health systems for people with disability and highlighted the lack of coordination and accountability across government that is needed to achieve genuinely joined‑up systems. Key recommendations included: developing a National Disability and Health Strategy; implementing Disability Impact Assessments; and addressing the absence of disability identifiers in administrative systems. The researcher-led policy forum offered an opportunity to disrupt traditional government-led consultations through intersectoral and more secure open discussions. Our approach aimed to provide more equitable collaboration between different stakeholders with the policy forum resulting in actionable recommendations on persistent issues. While recent policies address some of the recommendations, others remain unfulfilled despite being echoed in two major national reports and their potential to strengthen disability-inclusive health policy and advance health equity for all people with disability.

ABSTRACT Background The economic burden of chronic lymphocytic leukemia (CLL) is high, and is projected to increase with the introduction of new targeted treatments and improved survival. These high costs are not only associated with anticancer treatment, but also with the treatment and prevention of CLL symptoms and adverse events. Infections are among the most common adverse events in CLL patients, resulting from immune dysregulation caused by both the underlying disease and treatments. Immunoglobulin replacement therapy (IgRT) is one prophylactic measure used to prevent infections, but its effectiveness in CLL is unclear and costs are substantial. The aim of this paper was to estimate the excess cost associated with serious infections in patients with CLL, and explore other factors that may increase hospitalization costs in Australia. Methods We conducted a retrospective longitudinal study of linked hospital data, including 3705 patients with CLL and hospital admissions between July 2016 and June 2022. We estimated the excess cost associated with serious infections, inhospital anticancer treatment and IgRT using generalized linear models with gamma distribution and identity link. Results Over the study period, the mean inhospital cost per patient per month was AU$1291 (US$892) and was highest in the month of CLL diagnosis, at AU$4168 (US$2880). The excess cost in the month of a serious infection was AU$22,905 (US$15,829) per patient, and costs remained higher in the subsequent 6 months. The monthly costs associated with IgRT and anticancer treatment were AU$3288 (US$2772) and AU$5223 (US$3609) per patient, respectively. Conclusion Our results highlight the high economic burden of serious infections in a large cohort of patients with CLL over a 6‐year period. Further costing studies including costs to the patient and healthcare utilization in the outpatient setting are needed to ascertain the total cost of infections and the overall cost of cancer care in patients with CLL.

Background:Transgender and gender diverse ('trans') people may be at increased risk of mortality, particularly from external causes, however, large-scale, population-based evidence remains scarce. This study aims to document all-cause and cause-specific mortality among trans people. Methods:We source administrative data on healthcare and death records (2012-2023) from all Australians aged 15 years and above. Individuals identified as trans (initiated gender-affirming hormone therapy) were matched to the general population who visited a General Practitioner during the same period. Cox proportional hazard models were used to estimate all-cause and cause-specific mortality risk for trans people, with models estimated separately for people who were assigned female sex at birth (AFAB) and people who were assigned male sex at birth (AMAB). Inverse probability weights were applied to balance comparators on month-year and age at entry. Results were additionally stratified by age (15-24, 25-39, 40-59, and ≥60 years). Findings:A total of 19,347 trans people AMAB (mean age 36.2 years; median follow-up 3.7 years) and 9713 trans people AFAB (mean age 25.4 years; median follow-up 2.8 years) were matched with 9,879,037 general population males (mean age 44.4; median follow-up 11.3 years) and 10,282,651 general population females (mean age 44.9; median follow-up 11.4 years), respectively. All-cause mortality was significantly higher for trans people AMAB [HR = 3.89 (95% CI 33.65; 4.14)] and trans people AFAB [HR = 9.03 (95% CI 6.90; 11.83)]. For trans people AFAB, cause-specific mortality was elevated for cardiovascular disease [HR = 16.39 (95% CI 8.56; 31.37)], suicide [HR = 11.73 (95% CI 6.94; 19.80)], external causes [HR = 8.95 (95% CI 5.69; 14.09)], and cancer [HR = 7.62 (95% CI 4.61; 12.61)]. For trans people AMAB, cause-specific mortality was elevated for cancer [HR = 5.12 (95% CI 4.67; 5.61)], suicide [HR = 4.02 (95% CI 3.12; 5.18)], external causes [HR = 2.78 (95% CI 2.31; 3.35)], and cardiovascular disease [HR = 2.60 (95% CI 2.22; 3.05)]. Older trans people had more pronounced excess risk from cancer and cardiovascular disease. For trans people AFAB, excess mortality from suicide and external causes increased with age, whereas for trans people AMAB relative risks were higher in young and middle adulthood. Interpretation:In this nationwide cohort study, trans Australians experienced substantially elevated mortality risk. Tailored policy responses are needed to address premature mortality in trans populations. Funding:University of Melbourne McKenzie Fellowship (2025MCK182); the National Health and Medical Research Council (2008956); Viertel Charitable Foundation; University of Melbourne Faculty Research Grant (2025FRG19).

INTRODUCTION:A Radiographer Comment and Alert (RCA) Model of Care (MoC) was piloted across five Australian hospitals for timely communication of abnormal general X-ray appearances to Emergency Department (ED) referrers. Participating stakeholders were surveyed to identify patient benefits, challenges/risks and to determine the model's continuity and sustainability. METHODS:Surveys were designed using a Qualtrics XM survey tool using binary, 4-point Likert Scales and open-ended questions. Surveys were distributed to participating radiographers, ED physicians and radiologists at pilot sites in 2023 and analysed with SPSS v29.0. RESULTS:Thirty-four survey responses were received. The radiographer response rate was 27.5 % (19/69) and ED physicians 11.2 % (13/116). Two radiologist responses were excluded due to insufficient sample size. Radiographers identified "patient advocacy" as the greatest benefit (89.5 %; 17/19) and "time constraints" as the main challenge (57.9 %; 11/19). ED physicians ranked "increased interprofessional teamwork with radiographers" the highest (78 %,7/9), followed by "case prioritization" (67 %; 6/9). Six of nine (66.6 %) ED physicians had no concerns about the model's risks. Overall, 96.2 % (25/26) of combined respondents supported the model's sustainability, and continuity was similarly endorsed; 96.2 % (24/26). DISCUSSION:Both radiographers and ED physicians supported continuity and sustainability of the RCA MoC. We believe this was driven by a paradigm shift in radiographer confidence and their desire for improved inter and intra-professional teamwork and patient advocacy. ED respondents supported the model for improved collaborative teamwork and workflow efficiencies. The key radiographer barrier of "time constraints" needs to be addressed locally by exploring intrinsic motivators such as highlighting patient benefits amongst radiographers. CONCLUSIONS:Positive results supporting the continuity and sustainability of this practice will help strengthen its ongoing implementation and potential benefits for patients. Allied health practitioners, such as radiographers, can work confidently at their full scope of practice by providing a written comment on detected general X-ray abnormalities for EDs.

ISSUES:Although alcohol consumption is linked to atrial fibrillation (AF), the relationship across different intake levels and between sexes remains unclear. This study presents the first network meta-analysis of prospective cohort studies bringing greater precision to these associations. APPROACH:A systematic review identified five meta-analyses on alcohol and AF risk. From these, 13 cohort studies totalling over 80 million person-years were included in a random-effects network meta-analysis, including sex-stratified analyses. KEY FINDINGS:Compared to low-level consumption (< 12 g/day), moderate intake (12-< 24 g/day) slightly increased AF risk (hazard ratio [HR] = 1.07; 95% confidence interval [CI] 1.04-1.10), similar at 24-< 36 g/day (HR = 1.09; 95% CI 1.00-1.20). No significant risk increase was observed for 36-< 60 g/day. Heavy consumption (≥ 60 g/day) showed the highest risk (HR = 2.84; 95% CI 1.57-5.14). Non-drinkers ('Former', 'Never' or 'Occasional') had HRs near 1, except 'None', which showed a slight increase (HR = 1.08; 95% CI 1.04-1.11). IMPLICATIONS:In males, moderate consumption increased AF risk slightly, while heavy intake had a more pronounced effect (HR = 1.49; 95% CI 1.22-1.81). In females, moderate intake had no significant effect, but heavy intake significantly increased risk (HR = 2.53; 95% CI 1.05-6.08). CONCLUSION:This network meta-analysis shows a nonlinear relationship between alcohol consumption and AF risk. Low-level or occasional intake poses the lowest risk. In males, moderate consumption slightly increases AF risk, while in females, risk rises substantially only with heavy intake. These findings support limiting alcohol consumption to reduce AF risk and highlight the need for further sex-stratified studies and consideration of sex-specific recommendations. REGISTRATION:This network meta-analysis is a split review of an overview of reviews examining alcohol-attributable health and social harms, registered under PROSPERO ID442338.

Selecting relevant items to measure individuals' wellbeing is a crucial first step in constructing a summary wellbeing index. However, this selection does not address how to aggregate (score) these items or if this aggregation should be identical across individuals. Understanding whether a tailored measure better captures subjective wellbeing is critical for policymaking—especially considering the diversity within the disability community and the cognitive burden of adding importance-rating questions. Using responses from 1,881 Australian National Disability Insurance Scheme (NDIS) participants regarding the 14 items of the Disability Wellbeing Index and their reported importance to overall wellbeing, we explored how incorporating importance ratings into a summary measure may improve correlation with established Global Life Satisfaction measures. We considered five aggregation methods, varying in whether they incorporated importance ratings, whether items marked as “not important” were included, and how importance ratings were used (individual, societal, age-cohort specific or disability-group specific). Our results show that, despite some items being reported as “not important”, correlations are consistently higher when they are included with their importance rating. Second, including individual importance ratings generally leads to a slightly higher correlation, whether using compensatory or non-compensatory approaches. Third, among the arithmetic (compensatory), geometric and harmonic means, the harmonic mean based on individual ratings performed best. While incorporating responses to 14 importance-rating questions for each individual slightly increases correlations, the additional cognitive burden must be carefully weighed against these benefits and using societal importance weighting could be considered instead.

It is well established within the public management literature that times of crisis can facilitate collaboration across government sectors and external stakeholders due to factors such as a clear task focus and the relaxation of some organisational and institutional constraints. However, what has been less explored are the mechanisms and conditions for sustaining these collaborations in a post-crisis context. In such contexts there is a need to move institutions and their processes from episodic, urgent networks to enduring governance regimes. This paper uses a case study to explore the challenges and potential solutions discussed at two policy workshops held with stakeholders from the Australian Commonwealth government, statutory agencies and Disability Representative Organisations. The policy workshops explored the experience of collaborative working over the emergency phase of the COVID-19 pandemic in terms of contributing to health outcomes of people with disability and desirable institutional changes needed for collaboration to be sustained post-crisis. We outline several practice-based recommendations that combine different governance capacities and mechanisms and seek to address the distinct challenges to collaborative government experienced during the COVID-19 context. Implementing and monitoring the collaboratively-derived solutions for the post-crisis period is likely to assist in sustaining the successes of collaborative gains in the initial phases of the COVID-19 pandemic to better support people with disability.

Despite growing recognition of the need for cross-disciplinary research collaborations to tackle complex issues, the impact of such collaborations is rarely documented. This study applied an impact framework to assess the impact of a cross-disciplinary disability research collaboration, the Centre of Research Excellence in Disability and Health (CRE-DH) (2016–2023). We report on the utility of the impact framework for this task and propose a set of actions to ensure the effectiveness of impact evaluations for other cross-disciplinary collaborations. We retrospectively applied the Framework to Assess the Impact from Translational health research (FAIT) to the CRE-DH, which included a modified payback framework, an economic analysis and a narrative account of the impact generated by the collaboration. The impact assessment covered the period 2016–2024. Data were gathered from project records, reports and publications and secondary analysis of interviews conducted with external and internal stakeholders. Data were mapped to five impact domains: knowledge advancement, capacity strengthening, policy contribution, economic impact and community benefit. The 5.4 million (2024 AUD) initially invested in the CRE-DH delivered an additional investment of39.9 million (2024 AUD) (sensitivity analysis 26.5–53.2 million) in leveraged grants, consultancies and fellowships. Collectively, CRE-DH members produced 148 publications, 4 books, 15 book chapters, 48 reports, 17 fact sheets and 132 media articles. Publications were mentioned in the media more than 3400 times and cited in 45 policy documents. The CRE-DH funded and developed 9 early career disability researchers, and held 11 external events to strengthen capacity in disability research with policymakers and disability organizations. A total of 29 policy submissions were made, with those focussing on coronavirus disease 2019 (COVID-19) and its disproportionate impact on people with disability having particular influence on government policy. Applying FAIT retrospectively to assess a cross-disciplinary research collaboration’s impact allowed us to examine multiple benefit domains. The CRE-DH demonstrated impact in advancing knowledge, strengthening capacity, influencing policy and generating economic benefits; evidence on quantifiable community benefit is not yet available. However, our assessment was limited by insufficient data collection on some critical issues, such as disability representation. As a result, we propose several recommendations for applying FAIT in future research collaborations.

This paper presents the first empirical evidence linking tobacco tax policies to unintended social consequences in the form of increased energy poverty. We focus on Australia, where smokers face some of the world’s highest cigarette prices. We analyse an unanticipated aggressive tax regime implemented in 2010 using a difference-in-differences approach with a nationally representative panel dataset covering 14 years. Our findings indicate significant increases in the incidence of energy poverty among smoking households. Relative to the smoking cohort’s pre-policy mean, subjective reports of heating difficulties rose by 24%, while objective measures increased by 38% (10% energy-burden threshold), 15% (twice-median burden), and 26% under the Low-Income High Costs (LIHC) measure. Mechanism analyses indicate that reduced energy expenditures and compromised financial stability exacerbate the observed energy poverty. The impacts were particularly pronounced among lower-income families, heavy smokers, and individuals who find quitting hard. This research highlights the complex trade-offs involved in aggressive tobacco taxation and emphasises the need for targeted measures to mitigate the negative consequences on the energy well-being of vulnerable smokers and their families.

The 2010 abuse-deterrent reformulation of OxyContin is widely credited with triggering substitution to heroin, yet two puzzles remain: pharmaceutical opioid mortality continued to rise despite falling OxyContin use, and heroin mortality increased only gradually. We resolve both by identifying Opana ER — a near-identical licit substitute left on the market for 18 months after the OxyContin reformulation — as a critical missing link. Using brand-specific opioid shipment microdata linked to mortality records in continuous-treatment event study models, we show that substitution from OxyContin to Opana ER explains approximately 75% of continued pharmaceutical opioid mortality growth after 2010. When Opana ER was itself reformulated in 2012, states with greater Opana ER exposure experienced an additional wave of heroin substitution. Counterfactual simulations imply that closing the Opana ER pathway in 2010 would have yielded 19% lower heroin mortality growth, 18% lower synthetic opioid mortality, and 26% lower overall opioid mortality by 2016. Supply-side interventions targeting a single product are substantially undermined by close substitutes; effective policy must address substitution pathways simultaneously.

Poor mental health is a major global health issue, with many countries documenting high levels of unmet need and regional disparities in mental healthcare utilization. To determine how best to address these disparities, it is important to understand what drives regional variation. Using Census-linked microdata from Australia, we exploit cross-region migration to identify the extent to which patient and place factors drive regional variation in utilization of mental healthcare services and mental health prescriptions (antidepressants, anxiolytics, antipsychotics). We find that place factors account for approximately 72 % and 19 % of the regional variation in utilization of mental healthcare services and mental health prescriptions, respectively, with the rest reflecting patient-related demand. We also find suggestive evidence that larger place effects predict fewer mental health related Emergency Department presentations, self-harm hospitalizations, and suicides. Altogether, our findings suggest there is inadequate and inequitable supply in regions with low utilization, rather than inefficiently high utilization in high utilization regions.

Background Australia faces a critical challenge with access to opioid dependence treatment, particularly in regional areas where treatment shortages are amplified. Objective (s): To assess outcomes of a collaborative care model for opioid dependence treatment where community pharmacists work to their full scope of practice, in partnership with prescribers. Methods Community pharmacists and prescribers were recruited from the south-eastern suburbs of Melbourne, Victoria, Australia, to take part in a prospective, multisite, Type 2 hybrid implementation-effectiveness trial. Patients received collaborative prescriber/pharmacist care over a 6-month period, with outcomes compared to a non-randomised comparison group receiving usual care. Data was collected using a mixed methods approach with outcomes mapped to the RE-AIM framework. A health economics evaluation established time and costs associated with collaborative care. Results Collaborative care provided comparable outcomes on retention in treatment (97.2%, 35/36) compared to the control cohort (89.8 %, 44/49) with no significant differences between groups on substance use or mental or physical health outcomes. Collaborative care was associated with significant increases in treatment satisfaction and quality adjusted life years (QALYs) and was cost-effective when compared to treatment as usual. The model was implemented with relatively high fidelity, with high levels of satisfaction among pharmacists, prescribers, and patients. Considerations for broader implementation included pharmacist workload, the need for secure communication software, and a mechanism to remunerate pharmacists for their time providing clinical care. Conclusion Pharmacist-led collaborative care for opioid dependence is feasible and acceptable and can provide an at least equivalent standard of care to usual care. Further research is required to establish how collaborative care can maximise prescriber capacity at scale. Clinical Trial registration ACTRN12621000871842

BACKGROUND:Sickle cell disease (SCD) is an inherited condition that impairs red blood cell function, posing a substantial health burden on patients. As the prevalence of SCD in Australia rises due to migration, discussions surrounding treatment and management strategies are becoming more prominent. AIMS:Australia lacks a dedicated study on the prevalence and economic implications of SCD. In this study, we estimate the economic burden of SCD in Australia from the perspective of the Australian healthcare system. METHODS:We performed a cost-of-illness study by using a bottom-up approach to estimate resource use per patient from a national registry with unit costs from national sources, and a top-down estimate of the prevalence of SCD in Australia using stratification by ancestry. RESULTS:We estimated the prevalence of SCD in Australia in 2021 to be 8485 patients, the cost per patient per year to be AU$13 975 and the total cost to the Australian healthcare system to be approximately AU$119 million per year. Factors influencing costs were age, interventions and frequency of hospital visits for vaso-occlusive crises. Prevalence had the greatest influence on results in the sensitivity analysis. CONCLUSIONS:While the estimated prevalence of SCD in Australia resulted in a relatively small total cost, the per patient annual cost of SCD remains high. This cost of SCD is anticipated to increase alongside migration and improved treatment. There are policies that could enhance patients' quality of life, thereby mitigating both economic and health burdens.

This study investigates the relative importance for people with disability of key life domains and whether this differs between young people (15–24) and adults (25 and over). A cross-sectional survey was conducted from 20 October to 31 December 2022 with National Disability Insurance Scheme (NDIS) participants asked to rank eight domains: Choice control, Daily living, Relationships, Home, Health wellbeing, Lifelong learning, Work, Social, Community and Civic participation. Based on a random utility framework, the data were analysed based on a ranked-ordered logit model to estimate preference shares for the order of preferences across domains. Analyses were conducted separately for the young and adult cohorts. Sensitivity analyses were conducted by relaxing the equal importance of NDIS domains in the ranking exercise based on related life domain importance rating information, which was also collected in the survey. Our sample consisted of 1140 NDIS participants. While the majority ranked the domains as equally important, answers from the rating module suggested otherwise. Adjustments for these differences lead to similar results with both age cohorts ranking Health Wellbeing, Home and Daily living as the most important domains. These were followed by Relationships, Choice control, Social, Community Civic participation, Lifelong learning, and Work for younger people. For older people the importance order between the Choice control and Relationships was switched. Our results revealed similarity between what younger and older people perceive as important and despite often receiving a fair share of policy attention, work was seen, on average, as the least important life domain.

BACKGROUND:Vaporized nicotine products (VNPs) are more effective than nicotine replacement therapy (NRT) for smoking cessation in general populations, but their effectiveness among low socioeconomic groups is largely unknown. OBJECTIVE:To examine whether VNPs are more effective than NRT for smoking cessation among people experiencing social disadvantage. DESIGN:Two-group, open-label, randomized trial with blinded outcome ascertainment. (Australian New Zealand Clinical Trials Registry ACTRN12621000076875). SETTING:Australia, between March 2021 and December 2022. PARTICIPANTS:1045 adults who smoked daily, were willing to quit smoking, and were receiving a government pension/allowance (proxy for social disadvantage). INTERVENTION:Participants were randomly assigned (1:1) to either a free 8-week supply of NRT or VNPs, and all participants received text-message support. MEASUREMENTS:The primary outcome was 6-month continuous smoking abstinence verified using a carbon monoxide breath test at 7-month follow-up. Analysis included randomly assigned participants in accordance with Russell Standard criteria and the intention-to-treat principle. RESULTS:Among 1045 randomly assigned participants, 866 (82.9%) completed final follow-up. The verified 6-month continuous abstinence rate was 9.6% (50 of 523) in the NRT group and 28.4% (148 of 522) in the VNP group (posterior risk difference estimate, 18.7% [95% credible interval, 14.1% to 23.3%]; >99% posterior probability that VNP is superior). Self-reported adverse events occurred less frequently in the VNP group (355 events among 237 participants) compared with the NRT group (442 events among 278 participants; incident rate ratio, 0.75 [95% CI, 0.65 to 0.88]; P < 0.001). LIMITATIONS:Biochemical verification method tested short-term exposure to cigarette smoke. CONCLUSION:Findings indicate that VNPs were more effective than NRT for smoking cessation in this population. Given the challenges for cessation among these socially disadvantaged populations, VNPs present a promising treatment option for this priority group. PRIMARY FUNDING SOURCE:Australian National Health and Medical Research Council.