Evaluation of the Victorian Healthy Homes Program: protocol for a randomised controlled trial.

INTRODUCTION: The evaluation of the Victorian Healthy Homes Program (VHHP) will generate evidence about the efficacy and cost-effectiveness of home upgrades to improve thermal comfort, reduce energy use and produce health and economic benefits to vulnerable households in Victoria, Australia. METHODS AND ANALYSIS: The VHHP evaluation will use a staggered, parallel group clustered randomised controlled trial to test the home energy intervention in 1000 households. All households will receive the intervention either before (intervention group) or after (control group) winter (defined as 22 June to 21 September). The trial spans three winters with differing numbers of households in each cohort. The primary outcome is the mean difference in indoor average daily temperature between intervention and control households during the winter period. Secondary outcomes include household energy consumption and residential energy efficiency, self-reported respiratory symptoms, health-related quality of life, healthcare utilisation, absences from school/work and self-reported conditions within the home. Linear and logistic regression will be used to analyse the primary and secondary outcomes, controlling for clustering of households by area and the possible confounders of year and timing of intervention, to compare the treatment and control groups over the winter period. Economic evaluation will include a cost-effectiveness and cost-benefit analysis. ETHICS AND DISSEMINATION: Ethical approval was received from Victorian Department of Human Services Human Research Ethics Committee (reference number: 04/17), University of Technology Sydney Human Research Ethics Committee (reference number: ETH18-2273) and Australian Government Department of Veterans Affairs. Study results will be disseminated in a final report and peer-reviewed journals. TRIAL REGISTRATION NUMBER: ACTRN12618000160235.

Exploring the Trade-Off Between Economic and Health Outcomes During a Pandemic: A Discrete Choice Experiment of Lockdown Policies in Australia.

BACKGROUND: All countries experienced social and economic disruption and threats to health security from the COVID-19 pandemic in 2020, but the responses in terms of control measures varied considerably. While control measures, such as quarantine, lockdown and social distancing, reduce infections and infection-related deaths, they have severe negative economic and social consequences. OBJECTIVES: The objective of this study was to explore the acceptability of different infectious disease control measures, and examine how respondents trade off between economic and health outcomes. METHODS: A discrete choice experiment was developed, with attributes covering: control restrictions, duration of restrictions, tracking, number of infections and of deaths, unemployment, government expenditure and additional personal tax. A representative sample of Australians (n = 1046) completed the survey, which included eight choice tasks. Data were analysed using mixed logit regression to identify heterogeneity and latent class models to examine heterogeneity. RESULTS: In general, respondents had strong preferences for policies that avoided high infection-related deaths, although lower unemployment and government expenditure were also considered important. Respondents preferred a shorter duration for restrictions, but their preferences did not vary significantly for the differing levels of control measures. In terms of tracking, respondents preferred mobile phone tracking or bracelets when compared to no tracking. Significant differences in preferences was identified, with two distinct classes: Class 1 (57%) preferred the economy to remain open with some control measures, whereas Class 2 (43%), had stronger preferences for policies that reduced avoidable deaths. CONCLUSIONS: This study found that the Australian population is willing to relinquish some freedom, in the short term, and trade off the negative social and economic impacts of the pandemic, to avoid the negative health consequences.

Quality adjusted life years in the time of COVID-19.

The quality adjusted life year (QALY) as a basis of valuing additional expenditure on health is widely accepted. Although early in the COVID-19 pandemic, several commentators called for a similar approach in resolving trade-offs between economic activity and reducing the burden of COVID-19, this has not occurred. The value of a QALY has not been used to deny all intervention, as the rule of rescue attests. Further, while there was no other way of managing the pandemic, there were other means available to mitigate the economic losses. Now that vaccine programs have commenced in several countries, it is interesting to consider whether economic evaluation should now be applied. However, the recognised complexities of the evaluation of vaccines, plus the challenge of measuring opportunity costs in the face of an economic recession and the severity of the consequences of an outbreak even though the probability of transmission is exceedingly low, mean its use will be restricted. COVID-19 has changed everything, even the way we should think about economic evaluation.