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AIM: To describe insomnia treatment in New Zealand and estimate the annual societal costs of insomnia among New Zealanders aged 20-59 years. METHOD: Twenty-one interviews were conducted with insomnia treatment providers in New Zealand using a snowballing recruitment method. Information from the interviews and the international literature was used to estimate treatment profiles, availability, uptake and costs, as the basis for a decision analytic model with micro costing of each potential outcome. Sensitivity analyses were conducted with 10,000 Monte Carlo simulations randomly varying between each model parameter between minimum and maximum estimates. RESULTS: The treatment provider interviews highlighted the unstructured nature of insomnia treatment in New Zealand. The net cost of treating a person with insomnia was estimated to be -$482. The net annual benefit (saving) for treating insomniacs aged between 20-59 yrs was estimated at $21.8 million. CONCLUSION: The estimated total societal costs per QALY gained by treating insomnia is substantially lower than the average QALY cost-effectiveness threshold ($6,865) of PHARMAC funding decisions for new pharmaceuticals. Thus, these analyses strongly support the cost-effectiveness of insomnia treatment.

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Treatment of deep venous thrombosis (DVT)--a primary cause of potentially fatal pulmonary embolism (PE)--depends on the age of the thrombus. The existing clinical imaging methods are capable of visualizing a thrombus but cannot determine the age of the blood clot. Therefore, there is a need for an imaging technique to reliably diagnose and adequately stage DVT. To stage DVT (i.e., to determine the age of the thrombus, and therefore, to differentiate acute from chronic DVT), we explored photoacoustic imaging, a technique capable of noninvasive measurements of the optical absorption in tissue. Indeed, optical absorption of the blood clot changes with age, since maturation of DVT is associated with significant cellular and molecular reorganization. The ultrasound and photoacoustic imaging studies were performed using DVT-mimicking phantoms and phantoms with embedded acute and chronic thrombi obtained from an animal model of DVT. The location and structure of the clots were visualized using ultrasound imaging, while the composition, and therefore age, of thrombi were related to the magnitude and spatiotemporal characteristics of the photoacoustic signal. Overall, the results of our study suggest that combined ultrasound and photoacoustic imaging of thrombi may be capable of simultaneous detection and staging of DVT.

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OBJECTIVE: The objective of this study was to compare the potential economic efficiency of third-line treatment of chronic lymphocytic leukaemia (CLL) with alemtuzumab versus fludarabine, cyclophosphamide and rituximab (FCR). METHODS: The target population for this study were patients with CLL who were able to tolerate third-line treatment with either FCR or alemtuzumab. The perspective used was that of the New Zealand Pharmaceutical Management Agency (PHARMAC)/District Health Board. Health outcomes considered were survival time from commencement of treatment and quality-adjusted life-years (QALYs) gained. Average costs and outcomes and incremental cost per patient treated, per survival month and per QALY gained, were calculated. All costs were presented in 2006 New Zealand dollars. RESULTS: Base-case direct medical costs for alemtuzumab per treatment regimen per patient were $NZ15 303 lower than those for FCR. The average direct medical cost per survival month gained for alemtuzumab was $NZ3144 and for FCR was $NZ4101, and the average direct medical cost per QALY gained was $NZ46,016 and for FCR was $NZ60,012. CONCLUSION: Third-line treatment of eligible patients with alemtuzumab was found to be $NZ15,303 less costly than FCR per patient.

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In elasticity imaging, the ultrasound frames acquired during tissue deformation are analyzed to estimate the internal displacements and strains. If the deformation rate is high, high-frame-rate imaging techniques are required to avoid the severe decorrelation between the neighboring ultrasound images. In these high-frame-rate techniques, however, the broader and less focused ultrasound beam is transmitted and, hence, the image quality is degraded. We quantitatively compared strain images obtained using conventional and ultrafast ultrasound imaging methods. The performance of the elasticity imaging was evaluated using custom-designed, numerical simulations. Our results demonstrate that signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) and spatial resolutions in displacement and strain images acquired using conventional and ultrafast ultrasound imaging are comparable. This study suggests that the high-frame-rate ultrasound imaging can be reliably used in elasticity imaging if frame rate is critical.

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BACKGROUND: Providers of health care usually have much better information about health and health care interventions than do consumers. The internet is an important and rapidly evolving source of global health-related information and could provide a means of correcting for asymmetric information. However, little is known about who accesses this information and how it is used in New Zealand. The aims of this research were to: determine the nature of the health information sought, how respondents use the information, how helpful they perceive the information to be, and the self-assessed value of such information. METHODS: The researchers conducted an anonymous five minute telephone and mall intercept survey of randomly selected Wellington residents who had searched for health-related information on the internet. Investigators entered the data into an Excel spreadsheet and transferred it to SPSS for data cleaning, data exploration and statistical analysis. Search time costs were based on the opportunity cost of income foregone and respondents were asked to provide a money value for the information found. RESULTS: Eighty-three percent of respondents accessed the internet from home, and 87% conducted the search for themselves. Forty-five percent of people were looking for general health and nutrition information, 42% for data about a specific illness and 40% for a medicine. After finding the information, 58% discussed it with a family member/friend/workmate, 36% consulted a general practitioner, 33% changed their eating or drinking habits, and 13% did nothing. Respondents found the information very quick to find and useful. It took them on average 0.47 hours and cost $12 (opportunity cost of time) to find the information. The average value of the data found was $60 and the net benefit to the consumer was $48 ($60 - $12). CONCLUSION: The results of this research could assist providers of health information via the internet to tailor their websites to better suit users' needs. Given the high perceived value of internet health information (greater than the average general practitioner fee) and the fact that some of the information found may be unreliable or even unsafe a valuable public health policy initiative would be to provide an improved New Zealand health information website containing information on how to evaluate data sourced from the world-wide-web and links to a range of useful and trustworthy health information sites.