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Papers by Sanjeewa Kularatna

Community dentistry and oral epidemiology, Jan 25, 2015

To evaluate the cost-effectiveness of a home-visit intervention conducted by oral health therapis... more To evaluate the cost-effectiveness of a home-visit intervention conducted by oral health therapists relative to a telephone-based alternative and no intervention. A Markov model was built to combine data on dental caries incidence, dental treatments, quality of life and costs for a cohort of children from age 6 months to 6 years. The probabilities of developing caries and subsequent treatments were derived primarily from the key intervention study. The outcome measures were costs (US dollars), quality-adjusted life years (QALYs) and the number of carious teeth prevented. One-way and probabilistic sensitivity analyses were used to test the stability of the model. For every group of 100 children, the model predicted that having the home-visit intervention would save 167032andtelephonecontacts167 032 and telephone contacts 167032andtelephonecontacts144 709 over 5½ years relative to no intervention (usual care). The home visits and telephone intervention would prevent 113 and 100 carious teeth (per 100 children) relative to no interven...

Medical decision making : an international journal of the Society for Medical Decision Making, Jan 17, 2014

Currently there are no reported cancer-specific health state valuations in low- and middle-income... more Currently there are no reported cancer-specific health state valuations in low- and middle-income countries using a validated preference-based measure. The EORTC-8D, a cancer-specific preference-based measure, has 81,920 health states and is useful for economic evaluations in cancer care. The aim of this study was to develop a utility algorithm to value EORTC-8D health states using preferences derived from a representative population sample in Sri Lanka. The time-tradeoff method was used to elicit preferences from a general population sample of 780 in Sri Lanka. A block design of 85 health states, with a time horizon of 10 years, was used for the direct valuation. Data were analyzed using generalized least squares with random effects. All respondents with at least one logical inconsistency were excluded from the analysis. After logical inconsistencies were excluded, 4520 observations were available from 717 respondents for the analysis. The preferred model specified main effects wit...

PLoS ONE, 2014

Background: Health Related Quality of Life (HRQoL) is an important outcome measure in health econ... more 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.

Quality of Life Research, 2014

Purpose The aim of this study was to derive an algorithm to estimate utility values for the EQ-5D... more Purpose The aim of this study was to derive an algorithm to estimate utility values for the EQ-5D-3L health states based on the preferences of a population sample from Sri Lanka. Methods The time trade-off method was used to directly value 198 EQ-5D-3L health states in a general population sample (n = 780) from Sri Lanka. Stratified cluster sampling with random selection within clusters was used to select the sample from four districts. Each participant valued 15 health states via face-to-face interviews. The best fit model was selected using consistency, parsimony, and goodness of fit. Based on logical inconsistency, numerous sub-samples were also used for model specification. For each model, the numbers of illogical orderings in the resulting value set were also examined. Results Generalised least squares with random effects were found to be the best specification. The sub-sample consisting of participants with less than seven logical inconsistent observations produced no illogical ordering in the final value set and is considered the preferred model. Compared to value sets in other countries, a high disutility is associated with level 3 deficits in the mobility dimension. More than 50 % of health states in the Sri Lankan value set are deemed worse than death health states. Conclusions Sri Lankan utility values for EQ-5D-3L states deviate markedly from existing values for upper middle and high-income countries. It is important to have country-specific utility values to conduct cost-utility analysis.

Objectives: Early childhood caries is a highly destructive dental disease which is compounded by ... more Objectives: Early childhood caries is a highly destructive dental disease which is compounded by the need for young children to be treated under general anaesthesia. In Australia, there are long waiting periods for treatment at public hospitals. In this paper, we examined the costs and patient outcomes of a prevention programme for early childhood caries to assess its value for government services.

Value in Health, 2013

Cost-utility analysis is widely used in high-income countries to inform decisions on efficient he... more Cost-utility analysis is widely used in high-income countries to inform decisions on efficient health care resource allocation. Cost-utility analysis uses the quality-adjusted life-year as the outcome measure of health. High-income countries have undertaken health state valuation (HSV) studies to determine country-specific utility weights to facilitate valuation of health-related quality of life. Despite an evident need, however, the extent of HSVs in low- and middle-income countries (LMICs) is unclear. The literature was searched systematically by using four databases and additional Web searches to identify HSV studies carried out in LMICs. The Preferred Reporting System for Systematic Reviews and Meta-Analysis (PRISMA) strategy was followed to ensure systematic selection of the articles. The review identified 17 HSV studies from LMICs. Twelve studies were undertaken in upper middle-income countries, while lower middle- and low-income countries contributed three and two studies, respectively. There were 7 generic HSV and 10 disease-specific HSV studies. The seven generic HSVs included five EuroQol five-dimensional questionnaire, one six-dimensional health state short form (derived from short-form 36 health survey), and one Assessment of Quality of Life valuations. Time trade-off was the predominant valuation method used across all studies. This review found that health state valuations from LMICs are uncommon and utility weights are generally unavailable for these countries to carry out health economic evaluation. More HSV studies need to be undertaken in LMICs to facilitate efficient resource allocation in their respective health systems.

Health and Quality of Life Outcomes, 2013

Background: Economic evaluations to inform decisions about allocation of health resources are sca... more Background: Economic evaluations to inform decisions about allocation of health resources are scarce in Low and Middle Income Countries, including in Sri Lanka. This is in part due to a lack of country-specific utility weights, which are necessary to derive appropriate Quality Adjusted Life Years. The EQ-5D-3L, a generic multi-attribute instrument (MAUI), is most widely used to measure and value health states in high income countries; nevertheless, the sensitivity of generic MAUIs has been criticised in some conditions such as cancer. This article describes a protocol to produce both a generic EQ-5D-3L and cancer specific EORTC-8D utility index in Sri Lanka. Method: EQ-5D-3L and EORTC-8D health states will be valued using the Time Trade-Off technique, by a representative population sample (n = 780 invited) identified using stratified multi-stage cluster sampling with probability proportionate to size method. Households will be randomly selected within 30 clusters across four districts; one adult (≥18 years) within each household will be selected using the Kish grid method. Data will be collected via face-to-face interview, with a Time Trade-Off board employed as a visual aid. Of the 243 EQ-5D-3L and 81,290 EORTC-8D health states, 196 and 84 respectively will be directly valued. In EQ-5D-3L, all health states that combine level 3 on mobility with either level 1 on usual activities or self-care were excluded. Each participant will first complete the EQ-5D-3L, rank and value 14 EQ-5D-3L states (plus the worst health state and "immediate death"), and then rank and value seven EORTC-8D states (plus "immediate death"). Participant demographic and health characteristics will be also collected. Regression models will be fitted to estimate utility indices for EQ-5D-3L and EORTC-8D health states for Sri Lanka. The dependent variable will be the utility value. Different specifications of independent variables will be derived from the ordinal EQ-5D-3L to test for the best-fitting model.

Caries Research, 2007

The aim of the present study was to assess the prevalence and factors associated with root surfac... more The aim of the present study was to assess the prevalence and factors associated with root surface caries in older individuals from Sri Lanka. A total of 600 urban subjects aged 60 years and above was selected using a two-stage cluster sampling combined with probability-proportionate-to-size technique. The data were collected by means of an interviewer-administered questionnaire and an oral examination. The mean number of teeth present was 13.4 8 8.7. The prevalence of root surface caries was 89.7%. The mean number of root surfaces with decay or fillings and the mean root caries index (RCI) per subject were 3.8 and 25.0%, respectively. In both arches, the molars were the most affected by root caries. A multiple logistic regression analysis showed that betel chewing (OR = 0.36; 95% CI 0.20, 0.65), being 1 80 years of age (OR = 0.24; CI 0.09, 0.57), number of retained teeth (OR = 0.88; CI 0.83, 0.93) and number of root surfaces with recession (OR = 1.03; CI 1.01, 1.07) were significantly associated with the presence of root surface caries. In conclusion, it was evident from the study that the prevalence of root surface caries was high in this group of older individuals. Chewing betel, age, number of retained teeth and the number of root surfaces with recession emerged as significant predictors of root caries.

BMC Oral Health, 2015

The aim of the study is to reduce the high prevalence of tooth decay in children in a remote, rur... more 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. 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. 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.