ORCID Profile
0000-0002-6464-744X
Current Organisations
Peking University School of Stomatology
,
University of Queensland
,
Mahidol University
,
Deakin University - Melbourne Burwood Campus
,
Deakin University
,
Chiangmai University
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Publications
Quantifying the Economic Structure of the Australian Mental Health Sector Since 1992-93
Publisher: Informa UK Limited
Date: 07-2011
Minimally Invasive Dentistry Based on Atraumatic Restorative Treatment to Manage Early Childhood Caries in Rural and Remote Aboriginal Communities: Protocol for a Randomized Controlled Trial (Preprint
Publisher: JMIR Publications Inc.
Date: 08-03-2018
Abstract: he caries experience of Aboriginal children in Western Australia (WA) and elsewhere in Australia is more than twice that of non-Aboriginal children. Early childhood caries (caries among children years) has a significant impact on the quality of life of children and their caregivers, and its management is demanding and commonly undertaken under general anesthesia. A randomized controlled trial using a minimally invasive dentistry approach based on Atraumatic Restorative Treatment (ART) in metropolitan Perth, WA, has demonstrated a significant reduction in the rate of referral to a dental specialist for dental care among children with early childhood caries, potentially reducing the need for treatment under general anesthesia. The tested approach was clinically successful and was without adverse effects on child dental anxiety. The model of ART-based primary care requires further testing and development if similar outcomes for Aboriginal children in remote and rural settings are to be achieved. he study aims to develop, implement, and evaluate a remote primary care model to deliver effective primary dental services, encompassing treatment and preventive services, to Aboriginal preschool children (based on minimally invasive approaches including ART). his is a two-arm parallel cluster randomized controlled study in which a test group will be provided with the intervention treatment at the start of the study and a control group will be provided with the intervention treatment 12 months after study commencement (delayed intervention). Participating communities, stratified by size of community (ie, number of children in the s le frame) and baseline caries experience, will be randomly assigned using a computer-generated block randomized list into immediate (test group) or delayed intervention (control group provided with standard care). Informed consent will be obtained from all participants. Aboriginal research assistants will explain the study to the parents and assist the parents in completing the questionnaires. Participants in the randomized study will be examined at baseline and at 12 months follow-up by a calibrated examiner. Test group participants will subsequently be contacted and appropriate appointments coordinated for treatment. Control group participants will be provided with standard preventive care by the Aboriginal Health Workers and managed for treatment as per standard procedures. ommunity consultations have been undertaken and 26 communities have agreed to participate. Fieldwork is in progress to recruit study participants. he significance of the study lies in its holistic approach to testing the model of care. Clinical evaluations as well as oral health‒related quality of life evaluations will be undertaken. Cost-effectiveness and cost-utility evaluations will assist in the development of policy options for oral health services for rural and remote communities. The elicitation of caregiver perspectives through focus group interviews will supplement the clinical, psychosocial, and cost-utility evaluations and provide a richer evaluation of the intervention. ustralian New Zealand Clinical Trials Registry ACTRN12616001537448 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371735 (Archived by WebCite at 0UMxndFZ) R1-10.2196/10322
Developing an early childhood oral health impact–specific health‐state classification system for a new preference‐based instrument, the ECOHIS‐4D
Publisher: Wiley
Date: 18-04-2022
DOI: 10.1111/CDOE.12650
Abstract: Most of the paediatric quality‐of‐life instruments in oral health research are not preference‐based measures, thus cannot be used in economic evaluations. The Early Childhood Oral Health Impact Scale (ECOHIS) is one such instrument which assesses oral health impact on children's quality of life among three‐ to five‐year‐olds. With increasing demands for more resource allocation in oral health care, there is a need for an outcome metric which can be used as the outcome in economic evaluations. The aim of this study was to develop a preference‐based, health‐state classification system from the existing ECOHIS instrument. The 13‐item ECOHIS instrument was applied to the carers of 280 preschoolers who participated in a clinical trial in metropolitan Perth, Western Australia. Exploratory factor analysis was conducted to assess the dimensionality of the ECOHIS. Rasch analysis was used to eliminate and select items per determined dimensions and to reduce the number of response options for each item, because six levels were not amenable to valuation. The final classification system was determined through a combination of psychometric and expert advice. Items loaded on to four dimensions with the factor analysis. Using Rasch analysis, three items were selected from the first dimension (child functional and psychological impact) and one item from the second dimension (child social interaction impact). None were selected from the third dimension (parental distress and family function impact) as it is not an appropriate proxy method of measuring the level of impact on a child. The final classification system has four dimensions with three levels in each, and so it has been named the ECOHIS‐4D. The ECOHIS‐4D classification system is a new preference‐based instrument derived from the existing ECOHIS instrument. Future valuation studies will develop a utility value set for the health states defined by this classification system, and this will guide economic evaluations related to oral health interventions.
Lessons drawn from research utilization in the maternal iodine supplementation policy development in Thailand
Publisher: Springer Science and Business Media LLC
Date: 30-05-2012
Abstract: In this paper, the authors share their experience on evidence utilization in the development of Thailand’s maternal iodine supplementation policy in 2009–2010. Observations and reflections on their experience of engaging with research for policymaking are illustrated. The case study indicates that rapid approaches in conducting research, namely a targeted literature review and cross-sectional survey of professionals’ opinions and current practices were efficient in achieving the timeliness of evidence provision. In addition pro-activity, trust and interaction between researchers and policymakers enhanced the research–policy integration. The Thai experience may be useful for other developing countries which pursue evidence-informed policymaking, despite differences in the health system context.
Evaluation of an intervention to promote minimally invasive dentistry (MID) in an Australian community dental agency-A pilot study.
Publisher: Wiley
Date: 02-06-2022
DOI: 10.1111/IDH.12523
Abstract: To evaluate the impact of an intervention consisting of a 1-day continuing professional development (CPD) education programme on the International Caries Classification and Management System (ICCMS A quasi non-randomized controlled trial with convenience s ling method was adopted. Fourteen dental practitioners received the intervention. The prevalence of dental caries and gingivitis in Australian children was used to determine the treatment demand and used as the performance benchmark. Ten types of preventive and non-preventive dental services were examined. A Difference-in-Differences (DiD) of 12-month pre- (baseline) and post-intervention analysis was performed. The intervention group demonstrated increases in topical fluoride application and dietary analysis and advice services. The standard care group had increases in oral prophylaxis or scale and clean, topical fluoride application and oral hygiene instructions (p-value <0.05). The DiD analysis confirmed the above findings in the intervention group, while other preventive services declined. In the intervention group, the performance benchmark for oral prophylaxis or scale and clean and oral hygiene instructions was met at baseline and post-intervention. Only a few preventive services had already met the performance benchmark. The intervention was associated with varied changes to preventive and non-preventive dental services. More robust study design addressing the study limitations and validating the performance benchmark is required.
Multi-objective carbon neutrality optimization and G1-EW-TOPSIS assessment for renewable energy transition
Publisher: Elsevier BV
Date: 08-2023
Cost‐effectiveness analysis of atraumatic restorative treatment to manage early childhood caries: microsimulation modelling
Publisher: Wiley
Date: 03-2021
DOI: 10.1111/ADJ.12857
Abstract: This study assessed the cost‐effectiveness of atraumatic restorative treatment and the Hall Technique approach (ART/HT) in managing dental caries in young children under the health provider perspective in order to explore a best‐buy alternative to dental general anaesthesia (DGA). Sixty‐five observations from a randomized controlled trial were used to construct 20 000 microsimulations representing in idual‐level clinical outcome and costs of the DGA and ART/HT. Outcome was percentage of successfully managed cases. Costs were reported in 2020 price. Three different scenarios with different assumptions of clinical success of the DGA and the ART/HT were analysed. Probabilistic sensitivity analysis was carried out. The ART/HT successfully managed more cases at lower cost ($557) than the DGA when the system failure of the DGA was considered. Under per protocol analysis, participants in both arms were successfully managed, but the ART/HT costed $580 less than the DGA. Probabilistic sensitivity analysis confirmed the ART/HT was a dominant intervention. The ART/HT approach was non‐inferior in managing dental caries in young children but at lower costs than the DGA. The ART/HT could be a viable option in the provision of comprehensive dental care in locations with limited access to DGA and reduce hospital admission.
Protocol for the Hall Technique study: A trial to measure clinical effectiveness and cost-effectiveness of stainless steel crowns for dental caries restoration in primary molars in young children
Publisher: Elsevier BV
Date: 09-2015
DOI: 10.1016/J.CCT.2015.07.005
Abstract: The Hall Technique (HT) is a carious primary molar treatment that does not require local analgesia, carious tissue removal or tooth preparation. The carious lesions in carefully selected teeth are sealed with a stainless steel crown (preformed metal crown). The study aims are to determine the clinical effectiveness, acceptability and cost-effectiveness of the HT for management of carious lesions in young dental patients. Children, aged 3-7years, with a primary molar tooth with a carious lesion extending no further than the middle third of dentine, with no signs or symptoms of pulp inflammation or infection, and attending one of three community agencies are recruited. Target s le size is 220. A control tooth with an intra-coronal restoration is sourced from the same mouth. The primary outcome is the period of time free from further treatment. The assessments are scheduled at 6, 12 and 24months. In addition to the clinical assessment, acceptability of the HT will be assessed via questionnaires among patients and their primary carers at baseline, 6, 12 and 24months. Cost-outcome description and cost-effectiveness analysis from healthcare provider and societal perspective will be conducted. The clinical effectiveness, acceptability and cost-effectiveness of the HT in the community dental setting will be evaluated. The results of this study will determine the implementation of HT in the management of dental caries in young children.
Cost-effectiveness analysis of silver diamine fluoride to divert dental general anaesthesia compared to standard care.
Publisher: Wiley
Date: 29-09-2022
DOI: 10.1111/ADJ.12936
Abstract: The aim is to perform a model-based cost-effectiveness analysis of a silver diamine fluoride (SDF) protocol intervention to ert dental general anaesthesia (DGA) among Victorian children aged 2-10 years. Data inputs were based on an Australian single-cohort 2017/18 study. Intervention costs for standard care were derived from two subgroups of children: (1) children who received standard care without DGA, and (2) children who received standard care with DGA. Two scenarios were modelled due to limited post-follow-up data: (1) children receiving SDF had standard care without DGA (base-case scenario), and (2) children receiving SDF did not receive standard care without DGA (alternative scenario). A simple decision-tree model with probabilistic sensitivity analysis (PSA) estimated the incremental costs per erted DGA. The probability of children requiring specialist referral and offered SDF, but the primary carer opted for DGA is 0.124 (SD 0.034), and the probability of children requiring DGA in standard care is 0.346 (SD 0.036). For both the base-case and alternative scenario, the incremental cost-effectiveness ratio outcome is dominant and their cost-effectiveness being either 74.8% or 100% respectively. The SDF protocol intervention is cost-effective dental caries management option for young children where referral for DGA is considered. © 2022 Australian Dental Association.
A Capacity Building Program to Improve the Self-Efficacy of Key Workers to Support the Well-Being of Parents of a Child with a Disability Accessing an Early Childhood Intervention Service: Protocol for a Stepped-Wedge Design Trial
Publisher: JMIR Publications Inc.
Date: 03-04-2019
DOI: 10.2196/12531
Cost-analysis of teledentistry in residential aged care facilities
Publisher: SAGE Publications
Date: 08-07-2016
Abstract: The purpose of this research was to conduct a cost-analysis, from a public healthcare perspective, comparing the cost and benefits of face-to-face patient examination assessments conducted by a dentist at a residential aged care facility (RACF) situated in rural areas of the Australian state of Victoria, with two teledentistry approaches utilizing virtual oral examination. The costs associated with implementing and operating the teledentistry approach were identified and measured using 2014 prices in Australian dollars. Costs were measured as direct intervention costs and programme costs. A population of 100 RACF residents was used as a basis to estimate the cost of oral examination and treatment plan development for the traditional face-to-face model vs. two teledentistry models: an asynchronous review and treatment plan preparation and real-time communication with a remotely located oral health professional. It was estimated that if 100 residents received an asynchronous oral health assessment and treatment plan, the net cost from a healthcare perspective would be AU$32.35 (AU$27.19–AU$38.49) per resident. The total cost of the conventional face-to-face examinations by a dentist would be AU$36.59 ($30.67–AU$42.98) per resident using realistic assumptions. Meanwhile, the total cost of real-time remote oral examination would be AU$41.28 (AU$34.30–AU$48.87) per resident. Teledental asynchronous patient assessments were the lowest cost service model. Access to oral health professionals is generally low in RACFs however, the real-time consultation could potentially achieve better outcomes due to two-way communication between the nurse and a remote oral health professional via health promotion/disease prevention delivered in conjunction with the oral examination.
Economic Evaluations of Preventive Interventions for Dental Caries and Periodontitis: A Systematic Review.
Publisher: Springer Science and Business Media LLC
Date: 12-09-2022
DOI: 10.1007/S40258-022-00758-5
Abstract: To critically examine the methods used for full economic evaluations of preventive interventions for dental caries and periodontitis. Published literature post-2000 was searched to April 2021. Based on a developed intervention classification framework for dental caries and periodontitis, only universal, selective or indicated interventions were included in this review. The Drummond 10-point checklist was used for quality appraisal. Of 3,007 unique records screened for relevance, 73 studies were reviewed. Most model-based studies (61/73) used cost-effectiveness analysis (49%) or cost-benefit analysis (28%). Trial-based studies (16/73) commonly used cost-effectiveness analysis (59%). Four studies used both economic evaluation methods. Sixty-four papers (88%) were on dental caries, eight papers (11%) focused on periodontitis, and one paper (1%) included both oral diseases 72% of model-based and 82% of trial-based studies were of good quality. The most frequently investigated dental caries preventive interventions were water fluoridation (universal intervention cost-saving or cost-effective), fissure sealant and fluoride varnish (selective and indicated interventions cost-effectiveness outcomes were inconsistent). Supportive periodontal therapy with oral health education (indicated intervention cost-effective) was the most frequently evaluated preventive intervention for periodontitis. Thirty percent of studies with a time horizon > 1 year did not apply an appropriate discount rate and 26% did not comprehensively discuss other important considerations beyond the technical analysis. Generic health outcome measures should be incorporated for economic evaluations on preventive interventions for dental caries and periodontitis, and an increased focus to prevent periodontitis using economic evaluation methods is needed to inform resource allocation and policy decision-making.
An intervention to improve the self-efficacy of key workers to support parental wellbeing at an early childhood intervention service in Australia: a stepped wedged randomized cluster trial
Publisher: Informa UK Limited
Date: 02-09-2023
Atraumatic restorative treatments and oral health-related quality of life and dental anxiety in Australian Aboriginal children
Publisher: Wiley
Date: 23-11-2022
DOI: 10.1111/CDOE.12704
Abstract: The management of early childhood caries is challenging and the impacts of its treatment on child oral health‐related quality of life (COHRQoL) and dental anxiety among Australian Aboriginal children is relatively unknown. The aim of the study was to compare the impact on COHRQoL and dental anxiety after approximately 12 months among Aboriginal children treated for early childhood caries (ECC) using the Atraumatic Restorative Treatment and the Hall Technique (ART/HT: test) or standard care (control). Consenting Aboriginal communities in the North‐West of Western Australia were randomized into early (test) or delayed (control) intervention for the management of ECC. Children and parents/carers completed a questionnaire at baseline and at follow‐up. The questionnaire sought information on COHRQoL using the proxy‐reported Early Childhood Oral Health Impact Scale (ECOHIS) and the self‐reported Caries Impacts and Experiences Questionnaire for Children (CARIES‐QC). The test group was provided with the ART/HT care at baseline while the control group was advised to seek care through the usual care options available within the community. At follow‐up, both groups were offered care using the ART/HT approach. Changes in the mean scores from baseline to follow‐up within groups were evaluated using appropriate paired ( t ‐test, Wilcoxon paired test), and between groups with unpaired tests ( t ‐test). Multivariate regression analysis after multiple imputations of missing data used generalized estimating equation (GEE) controlling for clustering within communities. Twenty‐five communities and 338 children (mean age = 3.6 years, sd 1.7) participated in the study (test = 177). One child was excluded from the analysis because of a missing questionnaire and clinical data at baseline and follow‐up. At baseline, test group children were older (test = 3.8 years, 95% CI 3.6–4.1 control = 3.3 years, 95% CI 3.1–3.6) and had higher caries experience (test dmft = 4.4, 95% CI 3.8–5.0 control dmft = 3.1, 95% CI 2.5–3.7), but there was no significant difference in COHRQoL or anxiety levels between the groups. At follow‐up, parents in the delayed intervention reported worsening of COHRQoL (70% worsening of the family impact section of the ECOHIS and 37% worsening of the total ECOHIS scale), and there was an 8% reduction in child dental anxiety among the early treatment group. The application of the ART/HT approaches was feasible, effective, and impacted positively on child oral health‐related quality of life and child dental anxiety among Aboriginal children in remote communities. The model of care as tested in this study should be further developed for inclusion in main‐stream service delivery programmes.
EFFECTIVENESS OF DIAPERS AMONG PEOPLE WITH CHRONIC INCONTINENCE IN THAILAND
Publisher: Cambridge University Press (CUP)
Date: 2015
DOI: 10.1017/S0266462315000343
Abstract: Objectives: The aim of this study was to assess effect of adult diapers on health-related quality of life (HRQOL) and the independent level of performing activities of daily living (ADLs) in people with urinary or fecal incontinence. Psychological consequences of patients’ caregivers were also measured. Methods: This quasi-experimental study was conducted at two rehabilitation centers in Thailand. People aged 15 years or greater with chronic urinary or fecal incontinence were eligible. Study participants received adult diapers for 10 weeks after recruitment. Thai EuroQol Five Dimensions (EQ-5D) and the Barthel Index were measured at baseline and weeks 2, 6, and 10 to evaluate HRQOL and the independent level of performing ADLs, respectively. The Braden Scale was used to assess the risk of having pressure ulcers. Mean differences in the Thai EQ-5D, the Barthel Index, and the Braden Scale, before and after receiving adult diapers, were estimated using a multilevel linear regression model. Results: There were ninety patients and forty-eight caregivers who took part in this study. HRQOL and independent level of performing ADLs had improved significantly by week 10 after receiving adult diapers with mean differences of 0.102 (95% confidence interval [CI], 0.046–0.158) and 4.40 (95% CI, 1.74–7.07), respectively. The risk of having pressure ulcers had significantly decreased by 67 percent (95% CI, 16 percent–78 percent) by week 10 after receiving adult diapers. Conclusions: The results indicate a significant improvement of HRQOL and the independent level of performing ADLs among incontinent patients after receiving adult diapers. These results were used to inform the development of the health benefits package under the Universal Health Coverage Scheme in Thailand.
Measuring Adherence to Evidence-Based Clinical Practice Guidelines.
Publisher: Elsevier BV
Date: 12-2017
DOI: 10.1016/J.JEBDP.2017.05.001
Abstract: Dental Health Services Victoria publishes evidence-based clinical practice guidelines (CPGs) to assist public oral health practitioners to provide high-quality dental care. How well these CPGs are implemented into practice is unknown. The aim of this study was to assess adherence to selected CPGs. An electronic auditing tool was developed using clinical indicators derived for "stainless steel crown (SSC)," "restorative care for children under general anesthetic (GA)," and "direct restorative materials" CPG. Six trained dentists audited a random s le of 204 dental records of children aged 3-12 years from 2 major public dental agencies. In total, 319 material-based treatments were audited, comprising 170 resin composite, 81 glass ionomer cement, 64 SSC, and 4 amalgam restorations. Adherence to the current guidelines varied from 94% of the SSC to none of the amalgam treatments audited. Almost half (47%) of the resin composite restorations and 5% of glass ionomer cement restorations were nonadherent to the relevant guideline. Average adherence was up to 72% of cases. Clinicians need to consider recording the rationale upon which their professional judgment is based when they decide not to follow an appropriate CPG.
Alkaline shear-thinning micro-nanocomposite hydrogels initiate endogenous TGFβ signaling for in situ bone regeneration
Publisher: Springer Science and Business Media LLC
Date: 13-10-2023
Health‐related quality of life and upper‐limb impairment in children with cerebral palsy: developing a mapping algorithm
Publisher: Wiley
Date: 16-02-2020
DOI: 10.1111/DMCN.14488
Cost‐effectiveness analysis of the atraumatic restorative treatment‐based approach to managing early childhood caries
Publisher: Wiley
Date: 14-11-2017
DOI: 10.1111/CDOE.12265
Abstract: Paediatric dental care under general anaesthesia among preschool children in Western Australia is increasing and costly. This study assessed cost‐effectiveness of the atraumatic restorative treatment‐based ( ART ‐based) approach against the standard care ( SC ) approach to managing early childhood caries in a primary care setting based on a 1‐year pragmatic randomized controlled trial. Cost‐effectiveness analysis, from the service provider perspective, was conducted. Outcomes include number of referral to specialists and dental treatments. One‐way and probabilistic sensitivity analyses were undertaken to test the robustness of the cost‐effectiveness estimates. Six children in the ART ‐based group and 62 children in the SC group ( n = 127 each group) were referred for paediatric dental specialist care. Children in the ART ‐based group received more dental services than those allocated to the SC group (mean = 3.8, SD 2.0 and mean = 1.8, SD 1.8, respectively, Wilcoxon rank‐sum test, P 0.01). Total costs of the ART ‐based approach and the SC group were $137 860 and $178 217, respectively. Based on probabilistic sensitivity analysis, $654 was saved per referral to specialist avoided and $36 was saved per additional dental treatment. The probability that the ART ‐based approach is cost‐saving was 63%. Specialist dental treatment fees had a big impact on the cost‐effectiveness estimates. The ART ‐based approach appears to be a worthwhile intervention because it resulted in fewer referred cases and enabled more treatments to be provided with cost‐savings.
A systematic review of utility values in children with cerebral palsy
Publisher: Springer Science and Business Media LLC
Date: 02-08-2019
DOI: 10.1007/S11136-018-1955-8
Abstract: Project aims include the following: (i) to identify reported utility values associated with CP in children aged ≤ 18 years (ii) to explore utility value elicitation techniques in published studies and (iii) to examine performance of the measures and/or elicitation approaches. Peer-reviewed studies published prior to March 2017 were identified from six electronic databases. Construct validity, convergent validity, responsiveness, and reliability of instruments were assessed. Five studies met the inclusion criteria. Utility values of hypothetical general CP states obtained from a general population of parents ranged from 0.55 to 0.88 using time trade off (TTO) and 0.60-0.87 using standard gamble (SG) techniques. Utility values reported by clinicians of three hypothetical spastic quadriplegic CP states, using the Health Utility Index Mark 2 (HUI-2), ranged from 0.40 to 0.13. Other sources of utilities identified were based on both proxy and child ratings using Health Utility Index Mark 3 (HUI-3) (values ranged from - 0.013 to 0.84 depending on the valuation source) and the Assessment of Quality of Life 4 Dimension instrument, with values ranging from 0.01 to 0.58. Construct validity of the HUI-3 varied from moderate to strong, whereas mixed results were found for convergent validity. Responsiveness and reliability were not reported. There was substantial variation in reported utilities. Indirect techniques (i.e. via multi-attribute utility instruments) were more frequently used than direct techniques (e.g. TTO, SG). Further research is required to improve the robustness of utility valuation of health-related quality of life in children with CP for use in economic evaluation.
Systematic review of the economic impact of cerebral palsy
Publisher: Elsevier BV
Date: 09-2018
DOI: 10.1016/J.RIDD.2018.06.012
Abstract: Cerebral palsy (CP) and its associated conditions can pose a significant economic burden on families, the health care system and the general economy. The boundary for inclusion of costs in research can vary substantially across studies. To summarize the evidence for burden of disease for CP including the impacts on the health system, the community and carers. Literature was identified from Ovid Medline, Embase, CINHAL, PsyInfo, Econlit, Health Economic Evaluation Database (HEED) and NHS Economic Evaluation Database (NHS EED) in the Cochrane Library. The search was restricted to articles published in English between 1970 and April 2016. All costs were converted to $USD 2016 price. Twenty-two articles were included. Studies varied from snapshot cost descriptions to more complex lifetime estimates, from prevalence-based to incidence-based studies, and from inclusion to exclusion of non-medical costs. There was a strong positive relationship between CP severity and expenditure. Significant costs were incurred by families and the welfare system to facilitate school and community engagement. Facilitating participation for people with CP involves substantial expense. The size, nature and distribution of the economic burden emphasises the importance of finding effective strategies to reduce the risk and severity of CP, together with how it is financed.
Roles of Parents in Preventing Dental Caries in the Primary Dentition Among Preschool Children in Thailand
Publisher: SAGE Publications
Date: 02-07-2011
Abstract: This study aimed to identify important roles of parents in preventing caries in primary dentition among preschool children in Thailand. A total of 664 preschool children aged 3 to 4 years and their parents were s led from representative provinces of the 5 regions of Thailand. Dental examination to assess dental caries in preschool children was conducted. Questionnaires investigating roles of parents in caring for their children’s teeth were used to interview parents. Preschool children were more likely to have at least 1 carious tooth if parents did not always clean their teeth every time they bathed them, did not always examine the cleanliness of children’s teeth regularly, and always allowed children to consume snacks more than 3 times a day. Thai parents must be motivated to consistently spend the time required to take care of the primary dentition of their children by regular cleaning and controlling the snacking behavior of children.
Developing an Australian utility value set for the Early Childhood Oral Health Impact Scale-4D (ECOHIS-4D) using a discrete choice experiment
Publisher: Springer Science and Business Media LLC
Date: 17-11-2023
DOI: 10.1007/S10198-022-01542-X
Abstract: Preference-based quality of life measures (PBMs) are used to generate quality-adjusted life years (QALYs) in economic evaluations. A PBM consists of (1) a health state classification system and (2) a utility value set that allows the instrument responses to be converted to QALYs. A new, oral health-specific classification system, the Early Childhood Oral Health Impact Scale-4D (ECOHIS-4D) has recently been developed. The aim of this study was to generate an Australian utility value set for the ECOHIS-4D. A discrete choice experiment with duration (DCE TTO ) was used as the preference elicitation technique. An online survey was administered to a representative s le of Australian adults over 18 years. Respondents were given 14 choice tasks (10 tasks from the DCE design of 50 choice sets blocked into five blocks, 2 practice tasks, a repeated and a dominant task). Data were analyzed using the conditional logit model. A total of 1201 respondents from the Australian general population completed the survey. Of them, 69% ( n = 829) perceived their oral health status to be good, very good, or excellent. The estimated coefficients from the conditional logit models were in the expected directions and were statistically significant ( p 0.001). The utility values for health states defined by the ECOHIS-4D ranged from 0.0376 to 1.0000. This newly developed utility value set will enable the calculation of utility values for economic evaluations of interventions related to oral diseases such as dental caries among young children. This will facilitate more effective resource allocation for oral health services.
Systematic review and quality appraisal of economic evaluation publications in dentistry
Publisher: SAGE Publications
Date: 16-06-2015
Abstract: Economic evaluation (EE) studies have been undertaken in dentistry since the late 20th century because economic data provide additional information to policy makers to develop guidelines and set future direction for oral health services. The objectives of this study were to assess the methodological quality of EEs in oral health. Electronic searching of Ovid MEDLINE, the Cochrane Library, and the NHS Economic Evaluation Database from 1975 to 2013 were undertaken to identify publications that include costs and outcomes in dentistry. Relevant reference lists were also searched for additional studies. Studies were retrieved and reviewed independently for inclusion by 3 authors. Furthermore, to appraise the EE methods, 1 author applied the Drummond 10-item (13-criteria) checklist tool to each study. Of the 114 publications identified, 79 studies were considered full EE and 35 partial. Twenty-eight studies (30%) were published between the years 2011 and 2013. Sixty-four (53%) studies focused on dental caries prevention or treatment. Median appraisal scores calculated for full and partial EE studies were 11 and 9 out of 13, respectively. Quality assessment scores showed that the quality of partial EE studies published after 2000 significantly improved ( P = 0.02) compared to those published before 2000. Significant quality improvement was not found in full EE studies. Common methodological limitations were identified: absence of sensitivity analysis, discounting, and insufficient information on how costs and outcomes were measured and valued. EE studies in dentistry increased over the last 40 y in both quantity and quality, but a number of publications failed to satisfy some components of standard EE research methods, such as sensitivity analysis and discounting.
Minimally Invasive Dentistry Based on Atraumatic Restorative Treatment to Manage Early Childhood Caries in Rural and Remote Aboriginal Communities: Protocol for a Randomized Controlled Trial
Publisher: JMIR Publications Inc.
Date: 25-07-2018
DOI: 10.2196/10322
Economic evaluation and cost of interventions for cerebral palsy: a systematic review
Publisher: Wiley
Date: 10-01-2018
DOI: 10.1111/DMCN.13653
Abstract: Economic appraisal can help guide policy-making for purchasing decisions, and treatment and management algorithms for health interventions. We conducted a systematic review of economic studies in cerebral palsy (CP) to inform future research. Economic studies published since 1970 were identified from seven databases. Two reviewers independently screened abstracts and extracted data following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Any discrepancies were resolved by discussion. Of 980 identified references, 115 were included for full-text assessment. Thirteen articles met standard criteria for a full economic evaluation, two as partial economic evaluations, and 18 as cost studies. Six were full economic evaluations alongside clinical studies or randomized controlled trials, whereas seven involved modelling simulations. The economic case for administration of magnesium sulfate for imminent preterm birth is compelling, achieving both health gain and cost savings. Current literature suggests intrathecal baclofen therapy and botulinum toxin injection are cost-effective, but stronger evidence for long-term effects is needed. Lifestyle and web-based interventions are inexpensive, but broader measurement of outcomes is required. Prevention of CP would avoid significant economic burden. Some treatments and interventions have been shown to be cost-effective, although stronger evidence of clinical effectiveness is needed. What this paper adds Cost-effectiveness evidence shows prevention is the most significant strategy. Some treatments are cost-effective, but stronger evidence for long-term effectiveness is required. Comparison of treatment costs is challenging owing to variations in methodologies and varying clinical indications.
Dental enamel defects and dental caries of primary teeth among Indigenous children in Western Australia
Publisher: Wiley
Date: 21-12-2023
DOI: 10.1111/ADJ.12948
Abstract: Teeth affected with enamel defects (EDs) are at an increased risk of dental caries. In spite of improving oral health status overall in Australia, Indigenous Australians still experience higher rates of dental caries than non‐Indigenous Australians. This study reports on the prevalence of EDs and dental caries experience among Indigenous children in the Kimberley region of Western Australia. Health status of all the primary teeth (ICDAS II criteria) and the presence of EDs on index teeth (modified Dental Defects of Enamel index DDE) of young Indigenous children who participated in a 2‐arm intervention trial was recorded. Generalized estimating equations were used to estimate the association between EDs and dental caries and effect estimates were presented as odds ratios and associated 95% confidence intervals. Person‐level prevalence, from 237 children (mean age 3.6 years, standard deviation 1.7) assessed for EDs, was 58% and tooth‐level prevalence was 24%. Teeth affected with demarcated or diffuse defects were associated with a twofold higher odds of having caries experience, odds ratio (OR) 2.5, 95% confidence interval (CI) 1.7–3.7 and OR 2.7, 95% CI 1.7–4.0 respectively. The presence of EDs among young Indigenous children was associated with a higher odds of caries experience among affected teeth.
A dental workforce strategy to make Australian public dental services more efficient
Publisher: Springer Science and Business Media LLC
Date: 30-05-2019
A Rights-Based Approach for Service Providers to Measure the Quality of Life of Children with a Disability
Publisher: Elsevier BV
Date: 12-2018
DOI: 10.1016/J.JVAL.2018.05.009
Abstract: This paper identifies the best instruments for service providers to measure the quality of life (QoL) of children with a disability, with a focus on their alignment with the Convention on the Rights of Persons with a Disability (CRPD). This study reviewed systematic reviews to identify generic QoL instruments for children and adolescents, followed by an appraisal process using newly developed criteria. QoL instruments with a health status, functioning, and condition-specific focus were excluded. Twenty generic QoL instruments for children were identified from existing systematic reviews to undergo further review. Only 2 of the 20 instruments were recommended for service providers to measure the QoL of children with a disability (KIDSCREEN and KINDL). Many pediatric QoL instruments (N = 9) focus on functioning and are not consistent with the CRPD, confounding a child's functioning with their feelings about their life. KIDSCREEN and KINDL have self-report and parent report versions, are applicable for childhood and adolescence, demonstrate adequate reliability and validity, involved children in their development, focus on wellbeing, are likely to be able to be completed by a child with a disability, and are low in cost. Many instruments focus on functioning rather than wellbeing and thus may not capture the QoL of children with a disability. A child's functional limitations may not be consistent with their feelings about life. Two instruments that assess wellbeing and meet the criteria important for service providers now require further testing to explore their usefulness and validity for children with varying abilities.
Comparison of the Early Childhood Oral Health Impact Scale (ECOHIS‐4D) and Child Health Utility Index (CHU‐9D) in children with oral diseases
Publisher: Wiley
Date: 09-10-2023
DOI: 10.1111/CDOE.12917
Modeled health economic and equity impact on dental caries and health outcomes from a 20% sugar sweetened beverages tax in Australia
Publisher: Wiley
Date: 21-07-2023
DOI: 10.1002/HEC.4739
Abstract: Dental caries is the most prevalent oral disease across the life course. This study modeled the population health and economic impact of a 20% sugar sweetened beverages tax (SSB) for preventing dental caries compared to no intervention (societal and healthcare perspective). A cost‐effectiveness analysis according to quintiles of area‐level socioeconomic disadvantage was performed for the 2020 Australian population (0–100 years old) using a closed cohort Markov model. A qualitative assessment of implementation considerations (e.g., acceptability, equity, sustainability) was undertaken. Health outcomes were modeled as decayed teeth prevented and disability‐adjusted life years (DALYs) averted. The 10‐year and lifetime scenarios were modeled with probabilistic sensitivity analysis (Monte Carlo simulation, 2000 cycles). The 10‐year scenario from a societal perspective yielded cost‐savings of AUD$63.5M, healthcare cost‐savings of AUD$42.2M, 510,977 decayed teeth averted and 98.1 DALYs averted. The lifetime scenario resulted in societal cost savings of AUD$176.6M, healthcare cost‐savings of AUD$122.5M, 1,309,211 decayed teeth averted and 254.9 DALYs averted. Modeling indicated 71.5% and 74.5% cost‐effectiveness for the 10‐year and lifetime scenarios, respectively. A three‐fold health benefit for the least advantaged was found compared to the most advantaged. A 20% SSB tax in Australia is cost‐effective and promotes health equity.
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