A comparison of health state utility values associated with oral potentially malignant disorders and oral cancer in Sri Lanka assessed using the EQ-5D-3 L and the EORTC-8D

Background: It has been suggested that the EQ-5D-3 L preference-based measure of health outcome lacks sensitivity to discriminate between health states in cancer patients. An alternative approach is to use a disease (cancer) specific preference-based measure, such as the EORTC-8D. A limited number of comparisons have been made between generic and disease specific preference-based measures. The aim of this study was to compare the utility scores from the EQ-5D-3 L and the EORTC-8D in a group of patients with oral cancer or with oral potentially malignant disorders (OPMD). Methods: Patients (n = 151) with OPMD or oral cancer were recruited consecutively from six hospitals in Sri Lanka. All participants completed both the EQ-5D-3 L and the EORTC's QLQC-30 instrument. The Sri Lankan EQ-5D-3 L and EORTC-8D scoring algorithms were employed to estimate utility scores. The utility scores from the two instruments were compared for discrimination, responsiveness and correlation. Results: There were significant differences across the two utility scores. The EQ-5D-3 L showed better discrimination than EORTC-8D with higher effect sizes. There were higher ceiling effects observed in the EQ-5D-3 L. There was poor correlation between the dimensions of the two instruments except for the mobility and physical functions. Conclusion: The two instruments captured different aspects of quality of life. The EQ-5D-3 L demonstrated better discrimination than the EORTC-8D. In mild conditions EORTC-8D was more responsive and we recommend further validation of this instrument in diverse cancer conditions

A comparison of health state utility values associated with oral potentially malignant disorders and oral cancer in Sri Lanka assessed using the EQ-5D-3 L and the EORTC-8D

Background: It has been suggested that the EQ-5D-3 L preference-based measure of health outcome lacks sensitivity to discriminate between health states in cancer patients. An alternative approach is to use a disease (cancer) specific preference-based measure, such as the EORTC-8D. A limited number of comparisons have been made between generic and disease specific preference-based measures. The aim of this study was to compare the utility scores from the EQ-5D-3 L and the EORTC-8D in a group of patients with oral cancer or with oral potentially malignant disorders (OPMD). Methods: Patients (n = 151) with OPMD or oral cancer were recruited consecutively from six hospitals in Sri Lanka. All participants completed both the EQ-5D-3 L and the EORTC's QLQC-30 instrument. The Sri Lankan EQ-5D-3 L and EORTC-8D scoring algorithms were employed to estimate utility scores. The utility scores from the two instruments were compared for discrimination, responsiveness and correlation. Results: There were significant differences across the two utility scores. The EQ-5D-3 L showed better discrimination than EORTC-8D with higher effect sizes. There were higher ceiling effects observed in the EQ-5D-3 L. There was poor correlation between the dimensions of the two instruments except for the mobility and physical functions. Conclusion: The two instruments captured different aspects of quality of life. The EQ-5D-3 L demonstrated better discrimination than the EORTC-8D. In mild conditions EORTC-8D was more responsive and we recommend further validation of this instrument in diverse cancer conditions

The prevalence of Early Childhood Caries in 1-2 yrs olds in a semi-urban area of Sri Lanka

<p>Abstract</p> <p>Background</p> <p>ECC remains a problem in both developed and developing countries and ECC has been considered to be present in epidemic proportions in the developing countries. The aetiology and associated factors of ECC should be studied adequately to overcome this health hazard. The objective of this study is to determine the prevalence of ECC in 1 to 2 years old children in some selected MOH areas (semi-urban) in the district of Colombo, Sri Lanka.</p> <p>Methods</p> <p>This study was conducted as a cross sectional study. A total of 422 children aged 1-2 years were selected using systematic sampling technique in Maharagama, Piliyandala, Nugegoda and Boralesgamuwa MOH areas in Colombo district, Western province, Sri Lanka. The pre-test was done initially with 10 children aged 1 1/2 year olds.</p> <p>Prior to the clinical examination of each child, a questionnaire consisting questions regarding tooth brushing, dietary habits, breast and bottle feeding, long term medications(Sweetened medications taken more than 3 months), attending a dental clinic during pregnancy of mother and socio-economical status of the family was administered to mothers of those children. Sterile dental mouth mirrors were used to detect ECC in children.</p> <p>Results</p> <p>The prevalence of ECC of the whole sample of 410 children aged 1-2 years was 32.19% and the mean dmft was 2.01 and the mean dmfs was 3.83. From the children who had ECC 95% were untreated. There were significant relationships between dmft and long term use of medications (p < 0.000), intake of sugar with milk (p = 0.013), sweet consumption (p = 0.013), employment of mothers (p < 0.000) and visiting a dental clinic during pregnancy (p < 0.000).</p> <p>Conclusions</p> <p>This study documents high prevalence and severity of ECC among 1-2 years old children in four selected MOH areas of Colombo district and caries in most of the children with ECC (95%) were untreated. Results reveal an urgent need to increase awareness among the public about ECC and institute preventive strategies.</p

Cost-effectiveness analysis of paediatric mental health interventions: a systematic review of model-based economic evaluations

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

EQ-5D-3L Derived Population Norms for Health Related Quality of Life in Sri Lanka

Background Health Related Quality of Life (HRQoL) is an important outcome measure in health economic evaluation that guides health resource allocations. Population norms for HRQoL are an essential ingredient in health economics and in the evaluation of population health. The aim of this study was to produce EQ-5D-3L-derived population norms for Sri Lanka. Method A population sample (n =  780) was selected from four districts of Sri Lanka. A stratified cluster sampling approach with probability proportionate to size was employed. Twenty six clusters of 30 participants each were selected; each participant completed the EQ-5D-3L in a face-to-face interview. Utility weights for their EQ-5D-3L health states were assigned using the Sri Lankan EQ-5D-3L algorithm. The population norms are reported by age and socio-economic variables. Results The EQ-5D-3L was completed by 736 people, representing a 94% response rate. Sixty per cent of the sample reported being in full health. The percentage of people responding to any problems in the five EQ-5D-3L dimensions increased with age. The mean EQ-5D-3L weight was 0.85 (SD 0.008; 95%CI 0.84-0.87). The mean EQ-5D-3L weight was significantly associated with age, housing type, disease experience and religiosity. People above 70 years of age were 7.5 times more likely to report mobility problems and 3.7 times more likely to report pain/discomfort than those aged 18-29 years. Those with a tertiary education were five times less likely to report any HRQoL problems than those without a tertiary education. A person living in a shanty was 4.3 more likely to have problems in usual activities than a person living in a single house. Conclusion The population norms in Sri Lanka vary with socio-demographic characteristics. The socioeconomically disadvantaged have a lower HRQoL. The trends of population norms observed in this lower middle income country were generally similar to those previously reported in high income countries

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

BACKGROUND: The 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 &lt;6 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. OBJECTIVE: The 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). METHODS: This 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 sample 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. RESULTS: Community consultations have been undertaken and 26 communities have agreed to participate. Fieldwork is in progress to recruit study participants. CONCLUSIONS: The 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.<br /

Effectiveness, cost-effectiveness and cost-benefit of a single annual professional intervention for the prevention of childhood dental caries in a remote rural Indigenous community

Background The aim of the study is to reduce the high prevalence of tooth decay in children in a remote, rural Indigenous community in Australia, by application of a single annual dental preventive intervention. The study seeks to (1) assess the effectiveness of an annual oral health preventive intervention in slowing the incidence of dental caries in children in this community, (2) identify the mediating role of known risk factors for dental caries and (3) assess the cost-effectiveness and cost-benefit of the intervention. Methods/design The intervention is novel in that most dental preventive interventions require regular re-application, which is not possible in resource constrained communities. While tooth decay is preventable, self-care and healthy habits are lacking in these communities, placing more emphasis on health services to deliver an effective dental preventive intervention. Importantly, the study will assess cost-benefit and cost-effectiveness for broader implementation across similar communities in Australia and internationally. Discussion There is an urgent need to reduce the burden of dental decay in these communities, by implementing effective, cost-effective, feasible and sustainable dental prevention programs. Expected outcomes of this study include improved oral and general health of children within the community; an understanding of the costs associated with the intervention provided, and its comparison with the costs of allowing new lesions to develop, with associated treatment costs. Findings should be generalisable to similar communities around the world. The research is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR), registration number ACTRN12615000693527; date of registration: 3rd July 2015

Study protocol: Comparison of inconsistency between time trade off and discrete choice experiments in EQ-5D-3L health state valuations

Abstract Background: The EQ-5D-3L is the most widely used multi-attribute utility instrument for describing health states. A popular method for valuing the EuroQOL five dimension (EQ-5D)-3L health states is the time trade-off approach (TTO) where quality of life is traded against length of life. However, TTO valuations can provide logically inconsistent values. That is, where a respondent provides a utility value for one health state that is lower than the score they give for a logically worse health state. More recently there has been a tendency by researchers to use discrete choice experiments (DCE) as opposed to TTO in health state valuation exercises; however, DCEs often exclude dominant choices by design. The aim of this paper is to explore the differences in the rate of logically inconsistency health state valuations between TTO and DCE methodologies. Methods: A representative sample of the Australian general population will be recruited from an online cohort. Of the 243 EQ-5D-3L health states, a number of health state sets, comprising of potentially logically inconsistent health state pairs, will be used for the valuation. Participants will be asked to value given health state sets using both TTO and DCE methods. Consequently, the proposed study is not a health state valuation exercise, but rather an evaluation of competing methods under controlled circumstances. Logical inconsistency will be assessed based on comparing quantitative health state valuations within the TTO and stated preferences from discrete choices within the DCE. The count of logical inconsistencies will be estimated at an individual level for both approaches and compared. The comparison of the two approaches will identify if there are significant differences between the number of logical inconsistencies produced from DCE and TTO methods. Discussion: A difference in logical inconsistency is only one of many criterions for selecting the best approach for conducting health state valuations. It is recommended to examine the strengths and limitations of each methodological approach both theoretically and empirically. This is novel research into important methodological concerns often overlooked up until no

Methodology to derive preference for health screening programmes using discrete choice experiments : a scoping review

Background: While involving users in healthcare decision-making has become increasingly common and important, there is a lack of knowledge about how to best design community-based health screening programs. Reviews of methods that incorporate discrete choice experiments (DCEs) are scarce, particularly for non-cancer illnesses like cardiovascular disease, diabetes and liver disease. We provide an overview of currently available applications and methods available by using DCEs in health screening programs, for chronic conditions. Methods: A scoping review was undertaken, where four electronic databases were searched for key terms to identify eligible DCE studies related to community health screening. We included studies that met a pre-determined criteria, including being published between 2011 and 2021, in English and reported findings on human participants. Data were systematically extracted, tabulated, and summarised in a narrative review. Results: A total of 27 studies that used a DCE to elicit preferences for cancer (n = 26) and cardiovascular disease screening (n = 1) programmes were included in the final analysis. All studies were assessed for quality, against a list of 13 criteria, with the median score being 9/13 (range 5–12). Across the 27 studies, the majority (80%) had the same overall scores. Two-thirds of included studies reported a sample size calculation, approximately half (13/27) administered the survey completely online and over 75% used the general public as the participating population. Conclusion: Our review has led to highlighting several areas of current practice that can be improved, particularly greater use of sample size calculations, increased use of qualitative methods, better explanation of the chosen experimental design including how choice sets are generated, and methods for analysis.</p