ORCID Profile
0000-0003-3501-2645
Current Organisation
University of St Andrews
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Publisher: BMJ
Date: 10-2020
DOI: 10.1136/BMJOPEN-2020-038626
Abstract: A new health state classification system has been developed for dental caries - Dental Caries Utility Index (DCUI) to facilitate the assessment of oral health interventions in the cost-utility analysis (CUA). This paper reports the protocol for a valuation study, which aims to generate a preference-based algorithm for the classification system for the DCUI. Discrete choice experiments (DCEs) will be conducted to value health states generated by the DCUI classification system and preferences for these health states will be modelled to develop a utility algorithm. DCEs produce utility values on a latent scale and these values will be anchored into the full health-dead scale to calculate the quality-adjusted life years in CUA. There is no previous evidence for the most suitable anchoring method for dental caries health state valuation. Hence, we will first conduct pilot studies with two anchoring approaches DCE including duration attribute and DCE anchoring to worst heath state in Visual Analogue Scale. Based on the pilot studies, the most suitable anchoring method among two approaches will be used in the main valuation survey, which will be conducted as an online survey among a representative s le of 2000 adults from the Australian general population. Participants will be asked to complete a set of DCE choice tasks along with anchoring tasks, basic social-demographic questions, DCUI, a generic preference-based measure and oral health quality of life instrument. Ethical approval for this study was obtained from the Human Research Ethics Committee, Griffith University (reference number HREC/2019/550). The generated algorithm will facilitate the use of the new dental caries preference-based measure in economic evaluations of oral health interventions. The results will be disseminated through journal articles and professional conferences.
Publisher: Springer Science and Business Media LLC
Date: 22-04-2022
DOI: 10.1186/S12913-022-07939-X
Abstract: Mental health disorders among children and youth are causing significant burden on health care systems. Hence, identifying cost-effective interventions is important for effective mental health care allocation. Although model-based economic evaluations are an essential component of assessing cost-effectiveness, evidence are limited in the context of child and youth mental health care. The objective was to systematically review the model-based economic evaluations of mental health interventions for children and youth. Methods Four databases (MEDLINE, EMBASE, PsycINFO and Web of Science) were searched using appropriate search terms to retrieve model-based economic evaluations of mental health interventions for children and youth. The reporting quality of the included studies were appraised using the Consolidated health economic evaluation reporting standards (CHEERS) checklist. Results The database search yielded 1921 records. Of the 12 selected for review, 66% were published after year 2015. Most of the studies were related to anxiety and post-traumatic stress disorder. There were eight cost-utility studies, three cost-effectiveness studies, and one study using both forms of analysis. Six studies used Markov models, three used decision trees, and three studies used both types of models. However, the model structure, health states, time horizon, and economic perspective showed wide variation. The reporting quality of the included studies varied from 91 to 96%. Conclusion Model based mental health economic evaluations among children and youth are increasingly being reported in recent research. The included studies used Markov models and decision trees, either alone or in combination, and the majority of the articles were of good reporting quality.
Publisher: Wiley
Date: 16-06-2020
DOI: 10.1111/CDOE.12553
Publisher: Wiley
Date: 19-09-2018
DOI: 10.1111/CDOE.12336
Abstract: To assess the usage of cost-utility analysis (CUA) in oral health interventions and to evaluate the methods used and the reporting quality of CUA in publications on oral health interventions. A systematic review was performed on literature published between 2000 and 2016 where cost-utility analyses of oral health interventions were included. The reporting quality of these oral health CUAs was assessed against the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. Of the 6637 publications identified initially, 23 met the inclusion criteria. Of these, 14 (61%) had been published in the last 6 years. Included studies were on oral cancer (n = 6), provision of dental prosthesis (n = 6), dental caries (n = 4), periodontal diseases (n = 3), antibiotic prophylaxis (n = 2), dento-facial anomalies (n = 1) and dental service provision (n = 1). Twenty-one studies were able to identify the most cost-effective intervention among the different options compared. Of the 23 studies identified, 15 (65%) used quality-adjusted life years (QALY) as the outcome measure, and 18 (78%) reported an incremental cost-effectiveness ratio. The economic perspective was clearly stated in 13 articles (57%). Twenty studies (87%) reported the discount rate, and 22 (96%) undertook sensitivity analysis. The reporting quality of studies, appraised by the CHEERS checklist, varied from 75% to 100% (median 92%). The use of CUAs in evaluation of oral health interventions has been increasing recently, especially from 2011 to 2016. The majority of CUA articles were of good reporting quality as assessed by the CHEERS checklist and were able to provide conclusions regarding the most cost-effective intervention among the different options compared: this will assist in healthcare decision-making and resource allocation. These positive outcomes of our study encourage wider use of CUAs within the dental and oral health professions.
Publisher: Elsevier BV
Date: 2018
DOI: 10.1016/J.JVAL.2018.06.019
Abstract: To identify the generic or disease-specific pediatric quality of life (QoL) instruments used in oral health research among children and adolescents and to provide an overview of these QoL instruments. A systematic literature search was performed with multiple databases to identify the pediatric QoL instruments used in oral health research. The literature search yielded 872 records from these, 16 pediatric QoL instruments were identified that had been used among children and adolescents in oral health research. Of these, 11 were oral health-specific QoL instruments and five were generic instruments. Of the 11 oral health-specific QoL instruments, none were multiattribute utility instruments (MAUI), whereas of the five generic instruments, two (Child Health Utility 9D index and EuroQoL-5D youth) were classified as an MAUI. Except for one, all pediatric QoL instruments were published after the year 2000 and the majority originated from the USA (n = 8). Of the 11 oral health-specific QoL instruments, five instruments are designed for the respondent to be a child (i.e., self-report), one uses proxy responses from a parent or guardian, and five instruments have both self and proxy versions. Of the five generic QoL instruments, one uses proxy responses and the other four instruments have both self and proxy versions. This review identified a wide variety of pediatric oral health-specific and generic QoL instruments used in oral health research among children and adolescents. The availability of these QoL instruments provides researchers with the opportunity to select the instrument most suited to address their research question.
Publisher: Springer Science and Business Media LLC
Date: 05-09-2023
Publisher: Queensland University of Technology
Date: 2022
DOI: 10.5204/REP.EPRINTS.227473
Abstract: Demand for public hospital emergency departments’ services and care is increasing, placing considerable restraint on their performance and threatens patient safety. Many factors influence such demand including in idual characteristics (e.g. perceptions, knowledge, values and norms), healthcare availability, affordability and accessibility, population aging, and internal health system factors (e.g patient flow, discharge process). To alleviate demand, many initiatives have been trialled or suggested, including early identification of at-risk patients, better management of chronic disease to reduce avoidable ED presentation, expanded capacity of front-line clinician to manage sub-acute and non-urgent care, improved hospital flow to reduce access block, and ersion to alternate site for care. However, none have had any major or sustained impact on the growth in ED demand. A major focus of the public discourse on ED demand has been the use and integration of primary healthcare and ED, based on the assumption that between 10%–25% of ED presentations are potentially avoidable if patients’ access to appropriate primary healthcare (PHC) services were enhanced. However, this requires not only improved access but also appropriateness in terms of the patients’ preference and PHC providers’ capacity to address the needs. What is not known at the moment is the extent of the potential for ersion of non-urgent ED patients to PHC and the cost-benefits of such policy and funding changes required, particularly in the Australian context. There is a need to better understand ED patients’ needs and capacity constraint so as to effect delivery of accessible, affordable, efficient and responsive services. Jennie Money Doug Morel
Publisher: Springer Science and Business Media LLC
Date: 21-12-2023
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.
Publisher: Sri Lanka Journals Online (JOL)
Date: 16-07-2016
DOI: 10.4038/SLJM.V24I2.8
Publisher: Wiley
Date: 19-06-2019
Publisher: BirdLife Australia, Ltd.
Date: 2023
DOI: 10.20938/AFO40225230
Publisher: Oxford University Press (OUP)
Date: 2017
DOI: 10.1002/BJS.10428
Abstract: Surgical-site infection (SSI) occurs in 1–10 per cent of all patients undergoing surgery rates can be higher depending on the type of surgery. The aim of this review was to establish whether (or not) surgical hand asepsis, intraoperative skin antisepsis and selected surgical dressings are cost-effective in SSI prevention, and to examine the quality of reporting. The authors searched MEDLINE via Ovid, CINAHL via EBSCO, Cochrane Central and Scopus databases systematically from 1990 to 2016. Included were RCTs and quasi-experimental studies published in English, evaluating the economic impact of interventions to prevent SSI relative to surgical hand and skin antisepsis, and wound dressings. Characteristics and results of included studies were extracted using a standard data collection tool. Study and reporting quality were assessed using SIGN and CHEERS checklists. Across the three areas of SSI prevention, the combined searches identified 1214 articles. Of these, five health economic studies evaluating the cost-effectiveness of selected surgical dressings were eligible. Study authors concluded that the interventions being assessed were cost-effective, or were potentially cost-saving. Still, there is high uncertainty around the decision to adopt these dressings/devices in practice. The studies' reporting quality was reasonable three reported at least 15 of the 24 CHEERS items appropriately. Assessment of methodological quality found that two studies were considered to be of high quality. With few economic studies undertaken in this area, the cost-effectiveness of these strategies is unclear. Incorporating economic evaluations alongside RCTs will help towards evidence-informed decisions.
Publisher: Quintessence Publishing
Date: 20-09-2023
DOI: 10.11607/IJP.8278
Publisher: Elsevier BV
Date: 2022
Publisher: Wiley
Date: 15-09-2016
DOI: 10.1111/JICD.12237
Abstract: Oral lichen planus (OLP) is a common, chronic inflammatory disease of the oral mucosa. Although several studies have shown the efficacy of different treatment modalities, a definitive cure has not yet been established. The present trial compares the effectiveness of topically-applied clobetasol and tacrolimus in the symptomatic management of OLP. A randomized, comparative, double-blind study with 68 patients (43 females, 25 males mean age: 46.76 years) was undertaken. Patients were randomly ided into two groups of 34 patients each to receive topical tacrolimus 0.1% cream or clobetasol propionate 0.05% cream for 3 weeks. After 3 weeks of treatment, the mean pain score dropped by 1.59 (right) and 1.53 (left) in the tacrolimus group, while in clobetasol group these values were 0.94 and 0.85, respectively. The mean scores for clinical appearance reduced by 1.18 (right) and 1.0 (left) in the tacrolimus group compared with a reduction of 0.5 and 0.26, respectively, in the clobetasol group. These reductions were statistically significant (P < .05). The results suggest that tacrolimus 0.1% cream is an effective alternative to topical steroid and can be considered a first-line therapy in OLP. However, further studies are needed to confirm the effectiveness of this treatment before it is recommended for use in clinical practice.
Publisher: SAGE Publications
Date: 19-09-2023
Publisher: Wiley
Date: 02-12-2022
DOI: 10.1111/JPHD.12490
Abstract: Preference‐based quality‐of‐life measures (PBMs) have been developed in many clinical areas to aid estimation of more accurate utility values for economic evaluations. Existing oral health‐related quality‐of‐life (OHRQoL) instruments are non‐PBM and hence, cannot be used to generate utility values. The objective of this study was to develop a classification system for a new PBM (dental caries utility index‐DCUI) for the most prevalent childhood oral health condition: dental caries. Possible domains and items to be included in the classification system were identified based on the reviewing available pediatric non‐PBM OHRQoL instruments, studies eliciting utility values for oral health outcomes and clinical dentistry textbooks and based on the findings, a draft classification system was developed. To refine the draft classification system, semi‐structured interviews were conducted among a convenience s le of 15 12–17‐year‐old adolescents who had experience with dental caries. The classification system was further refined and validated by a group of dental experts, using a modified Delphi technique. The classification system comprised five items (pain/discomfort, difficulty in eating food/drinking, worried, ability to participate in activities, and appearance) and each item had a four‐level response scale. The classification system developed herein is considered an amenable tool for the subsequent development of a new PBM for dental caries. Once the scoring algorithm is completed, the classification system can be used to incorporate economic evaluations of dental caries health interventions.
Publisher: Wiley
Date: 09-10-2023
DOI: 10.1111/CDOE.12917
Location: United Kingdom of Great Britain and Northern Ireland
Location: Sri Lanka
No related grants have been discovered for Ruvini Manjula Hettiarachchi.