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Spetz J, Rose J, Kahn JG, Lin T, Levy D, Pugach O, Hyde S, Borrelli B, Henshaw M, Martin M, Nelson S, Ramos-Gomez F, Gansky SA. Cost-effectiveness analysis design for interventions to prevent children's oral disease. FRONTIERS IN ORAL HEALTH 2024; 5:1428638. [PMID: 39092198 PMCID: PMC11292419 DOI: 10.3389/froh.2024.1428638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 06/12/2024] [Indexed: 08/04/2024] Open
Abstract
Introduction In 2015, the National Institute of Dental and Craniofacial Research (NIDCR) launched the Multidisciplinary Collaborative Research Consortium to Reduce Oral Health Disparities in Children, supporting four randomized trials testing strategies to improve preventive care. A Coordinating Center provides scientific expertise, data acquisition and quality assurance services, safety monitoring, and final analysis-ready datasets. This paper describes the trials' economic analysis strategies, placing these strategies within the broader context of contemporary economic analysis methods. Methods The Coordinating Center established a Cost Collaborative Working Group to share information from the four trials about the components of their economic analyses. Study teams indicated data sources for their economic analysis using a set of structured tables. The Group meets regularly to share progress, discuss challenges, and coordinate analytic approaches. Results All four trials will calculate incremental cost-effectiveness ratios; two will also conduct cost-utility analyses using proxy diseases to estimate health state utilities. Each trial will consider at least two perspectives. Key process measures include dental services provided to child participants. The non-preference-weighted Early Childhood Oral Health Impact Scale (ECOHIS) will measure oral health-related quality of life. All trials are measuring training, implementation, personnel and supervision, service, supplies, and equipment costs. Conclusions Consistent with best practices, all four trials have integrated economic analysis during their planning stages. This effort is critical since poor quality or absence of essential data can limit retrospective analysis. Integrating economic analysis into oral health preventive intervention research can provide guidance to clinicians and practices, payers, and policymakers.
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Affiliation(s)
- Joanne Spetz
- Philip R. Lee Institute for Health Policy Studies and Healthforce Center, University of California, San Francisco, CA, United States
| | - Johnie Rose
- Center for Community Health Integration, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - James G. Kahn
- Philip R. Lee Institute for Health Policy Studies and Healthforce Center, University of California, San Francisco, CA, United States
| | - Tracy Lin
- Institute for Health and Aging, School of Nursing, University of California, San Francisco, CA, United States
| | - Douglas Levy
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Oksana Pugach
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL, United States
| | - Susan Hyde
- Center to Address Disparities in Children's Oral Health, School of Dentistry, University of California, San Francisco, CA, United States
| | - Belinda Borrelli
- Goldman School of Dental Medicine, Boston University, Boston, MA, United States
| | - Michelle Henshaw
- Goldman School of Dental Medicine, Boston University, Boston, MA, United States
| | - Molly Martin
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL, United States
- College of Medicine, University of Illinois, Chicago, IL, United States
| | - Suchitra Nelson
- School of Dental Medicine, Case Western Reserve University, Cleveland, OH, United States
| | - Francisco Ramos-Gomez
- Section on Pediatric Dentistry, Center for Children's Oral Health, School of Dentistry, University of California, Los Angeles, CA, United States
| | - Stuart A. Gansky
- Philip R. Lee Institute for Health Policy Studies and Healthforce Center, University of California, San Francisco, CA, United States
- Center to Address Disparities in Children's Oral Health, School of Dentistry, University of California, San Francisco, CA, United States
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Dhanapriyanka M, Kosgallana S, Kanthi RDFC, Jayasekara P, Dao TMA, Ha DH, Do L. Professionally applied fluorides for preventing and arresting dental caries in low- and middle-income countries: Systematic review. J Public Health Dent 2024; 84:213-227. [PMID: 38623701 DOI: 10.1111/jphd.12617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 03/24/2024] [Accepted: 04/03/2024] [Indexed: 04/17/2024]
Abstract
OBJECTIVES This systematic review aimed to review the safety and effectiveness of professionally applied fluorides for preventing and arresting dental caries in low- and middle-income countries (LMICs). METHODS Randomized controlled trials conducted in LMICs, in which professionally applied fluorides were compared with placebo/no treatment/health education only or usual care with a minimum one-year follow-up period, were included. Any topically applied fluoride agents such as sodium fluoride (NaF), acidulated phosphate fluoride, silver diamine fluoride (SDF), and nano silver fluoride (NSF) were included. Five databases (PubMed, Embase, Scopus, Web of Science, and Cochrane Library) were searched in May 2022. Meta-analysis was conducted using a random effect model. RESULTS This review included 33 studies for qualitative synthesis, encompassing 16,375 children aged between 1.5 and 14 years. Nevertheless, the meta-analysis focused on only 17 studies, involving 4067 children. Fourteen papers assessed potential adverse events, none of which was reported as major adverse events. SDF and NSF were identified as effective in arresting caries on primary teeth (p < 0.05) compared with a placebo or no treatment. Fluoride varnish and gel were identified as effective in reducing new caries development on primary teeth (p < 0.05) but not on permanent teeth (p > 0.05). The certainty of the generated evidence obtained is low. CONCLUSION The review provides valuable insights into the use of professionally applied fluorides in LMICs and contributes to recommendations for their use. However, the limited rigorous evidence suggests the need for further research to strengthen these findings and draw more robust conclusions.
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Affiliation(s)
- Manori Dhanapriyanka
- Ministry of Health, Colombo 10, Sri Lanka
- School of Dentistry, Faculty of Health and Behavioural Sciences, University of Queensland, Herston, Queensland, Australia
| | - Shamini Kosgallana
- Ministry of Health, Colombo 10, Sri Lanka
- School of Dentistry, Faculty of Health and Behavioural Sciences, University of Queensland, Herston, Queensland, Australia
| | | | | | - Thi Minh An Dao
- School of Dentistry, Faculty of Health and Behavioural Sciences, University of Queensland, Herston, Queensland, Australia
| | - Diep Hong Ha
- School of Dentistry, Faculty of Health and Behavioural Sciences, University of Queensland, Herston, Queensland, Australia
| | - Loc Do
- School of Dentistry, Faculty of Health and Behavioural Sciences, University of Queensland, Herston, Queensland, Australia
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Han C, Lin C, Raichur A, Hall M, Nguyen TM. Leadership, regulatory approaches and policy to re-orientate health services towards health promotion. Health Promot Int 2024; 39:daae050. [PMID: 38809234 PMCID: PMC11135209 DOI: 10.1093/heapro/daae050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2024] Open
Abstract
Globally, oral conditions remain the most prevalent of all non-communicable diseases. Among the broad range of target goals and recommendations for action by the World Health Organization's Global Oral Health Strategy, we call out three specific actions that provide an enabling environment to improve population oral health including: (i) enabling population oral health reform through leadership, (ii) enabling innovative oral health workforce models, (iii) enabling universal health coverage that includes oral health. The aim of the article is to outline how leadership, regulatory approaches and policy in Australia can strengthen health promotion practice and can inform global efforts to tackle the complex wicked problems associated with population oral health. Examples in Australia show that effective leadership, regulatory approaches and well-designed policies can address the growing burden of non-communicable diseases, and are made possible through public health advocacy, collaboration and research.
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Affiliation(s)
- Chun Han
- Dental Health Services Victoria, Level 1, 720 Swanston Street, Carlton, Victoria, 3053, Australia
| | - Clare Lin
- Dental Health Services Victoria, Level 1, 720 Swanston Street, Carlton, Victoria, 3053, Australia
- Melbourne Dental School, University of Melbourne, Level 1, 720 Swanston Street, Carlton, Victoria, 3053, Australia
| | - Anil Raichur
- Victorian Department of Health, 50 Lonsdale Street, Melbourne, Victoria, 3000, Australia
| | - Martin Hall
- Dental Health Services Victoria, Level 1, 720 Swanston Street, Carlton, Victoria, 3053, Australia
- Melbourne School of Population & Global Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, 207 Bouverie Street, Carlton, Victoria, 3053, Australia
| | - Tan Minh Nguyen
- Dental Health Services Victoria, Level 1, 720 Swanston Street, Carlton, Victoria, 3053, Australia
- Institute for Health Transformation, Deakin Health Economics, Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125, Australia
- Health Economics Group, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences. Monash University, Level 4, 553 St Kilda Road, Melbourne, Victoria, 3004, Australia
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Sharda S, Gupta A, Jyani G, Prinja S, Goyal A. Modeling the cost-effectiveness of school-based supervised toothbrushing program in reducing the dental caries burden in India. Int J Paediatr Dent 2024. [PMID: 38807269 DOI: 10.1111/ipd.13214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 04/22/2024] [Accepted: 05/13/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND Supervised toothbrushing (STB) significantly reduces the incidence and progression of dental caries. School years present a favorable age for introducing such healthy habits for a lifetime. AIM To estimate the cost-effectiveness of implementing a STB program in India in preventing dental caries incidence. DESIGN An operational framework of a national STB program was devised. A mathematical model was then developed to evaluate this program's clinical effectiveness and economic impact in the Indian scenario. This study considered a hypothetical cohort of the Indian population aged from 6 to 75 years. Two groups were compared: no intervention and STB in government schools. The health outcomes assessed were a number of tooth caries incidences averted and quality-adjusted life years gained. RESULTS The STB program in the government schools of India would prevent at least one tooth from developing caries in an individual's lifetime. Considering the current treatment-seeking behavior, the STB program saves INR 153 (US$ 1.95) per carious tooth incidence averted and INR 22 202 (US$ 283) per QALY gained. CONCLUSION In India, the school-based STB program is expected to be a cost-effective strategy for reducing the dental caries burden and its associated treatment costs.
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Affiliation(s)
- Shweta Sharda
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Arpit Gupta
- Unit of Public Health & Preventive Dentistry, Oral Health Sciences CentreI National Resource Centre for Oral Healthcare of Children & Elderly, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Gaurav Jyani
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Ashima Goyal
- Head, Oral Health Sciences Centre, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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Boachie MK, Molete M, Hofman K, Thsehla E. Cost-effectiveness of dental caries prevention strategies in South African schools. BMC Oral Health 2023; 23:814. [PMID: 37898738 PMCID: PMC10613394 DOI: 10.1186/s12903-023-03474-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/29/2023] [Indexed: 10/30/2023] Open
Abstract
BACKGROUND In South Africa, an estimated 85% of the population relies on the public sector for oral health services. With poor infrastructure and inadequate personnel, over 80% of children with dental caries remain untreated. To reduce this burden of disease, one key goal is to promote good oral health and address oral diseases through prevention, screening, and treatment among children. While all policies have been proven to be effective in the control and prevention of dental caries, it is unclear which of those strategies provide value for money. This study evaluated five caries preventative strategies in terms of the cost and benefits among South African school children. METHODS The study uses a hypothetical South African population of school aged learners aged 5-15. The context and insights of the strategies utilized at the schools were informed by data from both grey and published literature. Using Markov modeling techniques, we conducted a cost-effectiveness analysis of Acidulated Phosphate Fluoride (APF) application, atraumatic restorative treatment (ART), sugar-reduction and fissure sealants. Markov model was used to depict the movement of a hypothetical patient cohort between different health states over time. We assessed both health outcomes and costs of various interventions. The health outcome metric was measured as the number of Decayed, Missing, Filled Tooth (DMFT). The net monetary benefit was then used to determine which intervention was most cost-effective. RESULTS The results showed that school-based caries prevention strategies are cost-effective compared to the status quo of doing nothing. The average cost per learner over the 10-year period ranged from ZAR4380 to approx. ZAR7300 for the interventions considered. The total costs (including screening) associated with the interventions and health outcome (DMFT averted) were: sugar reduction (ZAR91,380, DFMT: 63,762), APF-Gel (ZAR54 million, DMFT: 42,010), tooth brushing (ZAR72.8 million, DMFT: 74,018), fissure sealant (ZAR44.63 million, DMFT: 100,024), and ART (ZAR45 million, DMFT: 144,035). The net monetary benefits achieved for APF-Gel, sugar reduction, tooth brushing, fissure sealant and ART programs were ZAR1.56, ZAR2.45, ZAR2.78, ZAR3.81, and ZAR5.55 billion, respectively. CONCLUSION Based on the net monetary benefit, ART, fissure sealant and sugar-reduction appear to be the most cost-effective strategies for preventing caries in South Africa. In a resource-scarce setting such as South Africa, where there is no fluoridation of drinking water, this analysis can inform decisions about service packages for oral health.
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Affiliation(s)
- Micheal Kofi Boachie
- Discipline of Public Health Medicine, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, 4041, Durban, South Africa.
- SAMRC/Centre for Health Economics and Decision Science - PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 2193, Parktown, Johannesburg, South Africa.
| | - Mpho Molete
- Department of Oral Biological Sciences, School of Oral Health Sciences, Faculty of Health Sciences, University of the Witwatersrand, 2193, Parktown, Johannesburg, South Africa
| | - Karen Hofman
- SAMRC/Centre for Health Economics and Decision Science - PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 2193, Parktown, Johannesburg, South Africa
| | - Evelyn Thsehla
- SAMRC/Centre for Health Economics and Decision Science - PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 2193, Parktown, Johannesburg, South Africa
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Sanghvi R, Cant A, de Almeida Neves A, Hosey MT, Banerjee A, Pennington M. Should compromised first permanent molar teeth in children be routinely removed? A health economics analysis. Community Dent Oral Epidemiol 2023; 51:755-766. [PMID: 35638700 DOI: 10.1111/cdoe.12751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 02/14/2022] [Accepted: 04/24/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the cost-effectiveness of retaining one or more compromised first permanent molars (cFPMs) affected by dental caries or enamel hypomineralization, compared to timely extraction, in children aged 8 years. METHODS A Markov model was developed to simulate the lifetime of a cFPM. Two management strategies were compared: extraction facilitating spontaneous space closure or maintenance of teeth with restorations. Ten health states were utilized to capture long-term outcomes including various tooth restorations, prostheses or a retained gap at the cFPM site. Outcomes were expressed as Quality Adjusted Tooth-Years (QATYs). The model was informed by survey data on patient preferences for treatment outcomes and UK data on costs. Discounted costs and QATYs were calculated over 62 years. RESULTS Regardless of the number of cFPMs, retaining cFPMs was more effective than early removal, generating an additional 2.3 QATYs per cFPM. Early removal of one or two cFPM under general anaesthetic (GA) was more expensive than retention and hence never cost-effective. Retaining a cFPM was more expensive than early removal under local anaesthesia or where four cFPMs were extracted under GA. In these cases, retaining cFPMs was cost-effective if a QATY was valued at £100 or £35, respectively. Results were robust to sensitivity analysis. CONCLUSION Preserving a cFPM was more cost-effective than the early loss of one, or two cFPMs under GA. Preservation of four cFPMs was cost-effective if sufficient value was placed on a QATY. These findings can guide clinical practice on management of cFPMs alongside patient/payer values on maintaining teeth.
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Affiliation(s)
- Risha Sanghvi
- Centre of Oral, Clinical and Translational Science, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Aisling Cant
- Centre of Oral, Clinical and Translational Science, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Aline de Almeida Neves
- Centre of Oral, Clinical and Translational Science, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marie Therese Hosey
- Centre of Oral, Clinical and Translational Science, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Avijit Banerjee
- Centre of Oral, Clinical and Translational Science, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Mark Pennington
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Nguyen TM, Lin C, Raichur A, Patterson A, Hall M, Aldrich R, Robinson S. Prioritizing population oral health through public policy in Australia: the Victorian experience. Health Promot Int 2023; 38:daad086. [PMID: 37555701 PMCID: PMC10411047 DOI: 10.1093/heapro/daad086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023] Open
Abstract
Dental caries, a non-communicable disease, is one of the most prevalent diseases globally and share common modifiable risk factors with obesity such as excess sugar intake. However, prioritization by governments to improve population oral health has been limited and is typically excluded from the discourse of public health policy development. Therefore, interventions that target dental caries can have other co-benefits including obesity prevention. In Victoria, Australia, local government authorities have a regulatory requirement to develop their Municipal Health and Wellbeing Plans. The aim of this paper is to identify whether prioritization for oral health by local government authorities in Victoria has changed through the subsequent renewal of the Victorian Public Health and Wellbeing Plans 2011-2015 and 2019-2023. Three desktop audits for all publicly available Municipal Health and Wellbeing Plans by local government authorities in Victoria were conducted between 2014 and 2022. Key terms related to oral health was searched within these policy documents and categorized into six indicators: (i) included oral health as a priority, (ii) linked healthy eating and oral health, (iii) supported the Achievement Program, (iv) included the Smiles 4 Miles program, (v) advocated for fluoridated drinking water, and (vi) included other strategies related to oral health. Overall, there was statistically significant reduction in five of the six indicators, with the exception for prioritization of other strategies related to oral health such as targeting excess sugar intake and smoking. A multi-sectoral approach, that includes oral health would be advantageous to address the growing burden of non-communicable diseases.
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Affiliation(s)
- Tan Minh Nguyen
- Oral Health Economics Research Stream, Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Melbourne, Victoria, Australia
| | - Clare Lin
- Dental Health Services Victoria, Carlton, Victoria, Australia
| | - Anil Raichur
- Community Based Health Services Policy & Improvement, Commisioning and System Improvement, Victorian Department of Health, State Government of Victoria, Melbourne, Victoria, Australia
| | - Amy Patterson
- Dental Health Services Victoria, Carlton, Victoria, Australia
| | - Martin Hall
- Dental Health Services Victoria, Carlton, Victoria, Australia
| | | | - Suzanne Robinson
- Oral Health Economics Research Stream, Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Melbourne, Victoria, Australia
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Nguyen TM, Bridge G, Hall M, Theodore K, Lin C, Scully B, Heredia R, Le LKD, Mihalopoulos C, Calache H. Is value-based healthcare a strategy to achieve universal health coverage that includes oral health? An Australian case study. J Public Health Policy 2023; 44:310-324. [PMID: 37142745 PMCID: PMC10232653 DOI: 10.1057/s41271-023-00414-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2023] [Indexed: 05/06/2023]
Abstract
The 2021 Resolution on Oral Health by the 74th World Health Assembly supports an important health policy direction: inclusion of oral health in universal health coverage. Many healthcare systems worldwide have not yet addressed oral diseases effectively. The adoption of value-based healthcare (VBHC) reorients health services towards outcomes. Evidence indicates that VBHC initiatives are improving health outcomes, client experiences of healthcare, and reducing costs to healthcare systems. No comprehensive VBHC approach has been applied to the oral health context. Dental Health Services Victoria (DHSV), an Australian state government entity, commenced a VBHC agenda in 2016 and is continuing its efforts in oral healthcare reform. This paper explores a VBHC case study showing promise for achieving universal health coverage that includes oral health. DHSV applied the VBHC due to its flexibility in scope, consideration of a health workforce with a mix of skills, and alternative funding models other than fee-for-service.
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Affiliation(s)
- Tan M Nguyen
- Deakin Health Economics, Deakin University, Level 3, Building BC, 221 Burwood Highway, Burwood, Melbourne, VIC, 3125, Australia.
- Dental Health Services Victoria, Level 1, Corporate Services, 720 Swanston Street, Carlton, Melbourne, VIC, 3053, Australia.
- Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
| | - Gemma Bridge
- Queen Mary University of London, Mile End Road, London, E1 4NS, UK
| | - Martin Hall
- Dental Health Services Victoria, Level 1, Corporate Services, 720 Swanston Street, Carlton, Melbourne, VIC, 3053, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Katy Theodore
- Deakin Health Economics, Deakin University, Level 3, Building BC, 221 Burwood Highway, Burwood, Melbourne, VIC, 3125, Australia
| | - Clare Lin
- Dental Health Services Victoria, Level 1, Corporate Services, 720 Swanston Street, Carlton, Melbourne, VIC, 3053, Australia
- Melbourne Dental School, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Ben Scully
- Dental Health Services Victoria, Level 1, Corporate Services, 720 Swanston Street, Carlton, Melbourne, VIC, 3053, Australia
| | - Ruth Heredia
- Dental Health Services Victoria, Level 1, Corporate Services, 720 Swanston Street, Carlton, Melbourne, VIC, 3053, Australia
| | - Long K-D Le
- Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Cathrine Mihalopoulos
- Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Hanny Calache
- Deakin Health Economics, Deakin University, Level 3, Building BC, 221 Burwood Highway, Burwood, Melbourne, VIC, 3125, Australia
- La Trobe University, Bendigo, VIC, 3552, Australia
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Nguyen TM, Tonmukayakul U, Le LKD, Calache H, Mihalopoulos C. Economic Evaluations of Preventive Interventions for Dental Caries and Periodontitis: A Systematic Review. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2023; 21:53-70. [PMID: 36089630 PMCID: PMC9834378 DOI: 10.1007/s40258-022-00758-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/16/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To critically examine the methods used for full economic evaluations of preventive interventions for dental caries and periodontitis. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Tan Minh Nguyen
- Deakin Health Economics, Institute of Health Transformation, Deakin University, Level 3, Building BC, 221 Burwood Highway, Burwood, Melbourne, VIC, 2125, Australia.
- Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Utsana Tonmukayakul
- Deakin Health Economics, Institute of Health Transformation, Deakin University, Level 3, Building BC, 221 Burwood Highway, Burwood, Melbourne, VIC, 2125, Australia
| | - Long Khanh-Dao Le
- Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Hanny Calache
- Deakin Health Economics, Institute of Health Transformation, Deakin University, Level 3, Building BC, 221 Burwood Highway, Burwood, Melbourne, VIC, 2125, Australia
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Victory E, Rhiannon ET, Girvan B, Pauline A, Cynthia PM. Cost-effectiveness Analysis of the Dental RECUR Pragmatic Randomized Controlled Trial: Evaluating a Goal-oriented Talking Intervention to Prevent Reoccurrence of Dental Caries in Children. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2022; 20:431-445. [PMID: 35298778 PMCID: PMC9021113 DOI: 10.1007/s40258-022-00720-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/31/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND The formation of dental caries is the most common chronic disease in children, and is preventable. The oral health-related quality of life has an immense impact on an individual's daily functioning, well-being or overall quality of life. OBJECTIVES This study aims to investigate the cost effectiveness of the Dental RECUR Brief Negotiated Interview for Oral Health (DR-BNI). This 30-minute therapeutic "talk" by a dental nurse with a parent/guardian was compared with a placebo-controlled intervention in preventing reoccurrence of dental caries in children who have had a primary tooth extracted. METHODS An economic model was developed to simulate the clinical progression of dental caries among children who have previously had a primary tooth extracted. The analysis was conducted using the UK NHS perspective. The main outcome was the incremental cost-effectiveness ratio (ICER) based on the quality-adjusted life years (QALYs). Estimates of costs and probabilities were obtained from the DR-BNI multicentre randomised controlled trial (RCT), while QALY values were obtained from published literature. Univariate and probabilistic sensitivity analyses were conducted to assess the uncertainty of the result and robustness of the model. Affordability and risk-aversion of the intervention were investigated to help decision makers make the best possible choices. RESULTS With an intervention cost of £6.47, the results from the RCT showed the healthcare cost for the DR-BNI intervention was £115.90 per child while the control had a healthcare cost of £119.46 per child. The QALYs gained for the prevention of reoccurrence of dental caries was higher in the DR-BNI intervention arm by 0.023 QALYs; thus, the DR-BNI was the dominant intervention. At willingness to pay threshold of £3500/QALY gained, a maximum probability of being cost effectiveness is achieved at 86%. The secondary analysis showed a cost-savings of £20.94 per participant for the prevention of at least one filling or extraction. Affordability results showed that the DR-BNI programme is affordable to the UK health system at a moderately low budget. CONCLUSIONS This study shows the proactive talking intervention to have a very moderate cost and to be effective in providing better health related quality-of-life gains. The intervention is cost savings with a dominant ICER even with a 200% increase in the cost of intervention. The NHS will be providing better oral health for children at a better net monetary benefit-to-risk ratio by adopting the DR-BNI intervention in preventing the reoccurrence of dental fillings and extractions for each participant. TRIAL REGISTRATION This trial was registered prospectively on 27th September 2013 with the trial registration number ISRCTN 24958829.
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Affiliation(s)
- Ezeofor Victory
- Centre for Health Economics and Medicines Evaluations, Bangor University, Bangor, UK.
| | - Edwards T Rhiannon
- Centre for Health Economics and Medicines Evaluations, Bangor University, Bangor, UK
| | - Burnside Girvan
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Adair Pauline
- School of Psychology, Queen's University, Belfast, UK
| | - Pine M Cynthia
- School of Psychology, Queen's University, Belfast, UK
- Salford Royal NHS Foundation Trust, Salford, England
- Kippax Design Ltd, Colchester, Essex, UK
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Skinner J, Dimitropoulos Y, Sohn W, Holden A, Rambaldini B, Spallek H, Ummer-Christian R, Marshall S, Raymond K, AO TC, Gwynne K. Child Fluoride Varnish Programs Implementation: A Consensus Workshop and Actions to Increase Scale-Up in Australia. Healthcare (Basel) 2021; 9:healthcare9081029. [PMID: 34442166 PMCID: PMC8392282 DOI: 10.3390/healthcare9081029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/20/2021] [Accepted: 07/22/2021] [Indexed: 11/16/2022] Open
Abstract
This paper presents the findings of the National Fluoride Varnish Workshop in 2018 along with subsequent actions to scale-up the use of fluoride varnish nationally in Australia. The use of fluoride varnish programs to prevent dental caries in high-risk child populations is an evidence-based population health approach used internationally. Such programs have not been implemented at scale nationally in Australia. A National Fluoride Varnish Consensus Workshop was held in Sydney in November 2018 with an aim of sharing the current work in this area being undertaken by various Australian jurisdictions and seeking consensus on key actions to improve the scale-up nationally. Forty-four people attended the Workshop with oral health representatives from all Australian state and territory health departments, as well as the Australian Dental Association (ADA) at both NSW branch and Federal levels. There was strong support for further scale-up of fluoride varnish programs nationally and to see the wider use of having non-dental professionals apply the varnish. This case study identifies key actions required to ensure scale-up of systematic fluoride varnish programs as part of a strategic population oral health approach to preventing dental caries among high-risk children who may not routinely access dental care.
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Affiliation(s)
- John Skinner
- Poche Centre for Indigenous Health, The University of Sydney, Room 224 Edward Ford Building, Sydney 2006, Australia; (Y.D.); (B.R.); (T.C.A.); (K.G.)
- Correspondence: ; Tel.: +61-4889-27557
| | - Yvonne Dimitropoulos
- Poche Centre for Indigenous Health, The University of Sydney, Room 224 Edward Ford Building, Sydney 2006, Australia; (Y.D.); (B.R.); (T.C.A.); (K.G.)
| | - Woosung Sohn
- The University of Sydney School of Dentistry, 2 Chalmers St, Surry Hills 2010, Australia; (W.S.); (A.H.); (H.S.)
| | - Alexander Holden
- The University of Sydney School of Dentistry, 2 Chalmers St, Surry Hills 2010, Australia; (W.S.); (A.H.); (H.S.)
| | - Boe Rambaldini
- Poche Centre for Indigenous Health, The University of Sydney, Room 224 Edward Ford Building, Sydney 2006, Australia; (Y.D.); (B.R.); (T.C.A.); (K.G.)
| | - Heiko Spallek
- The University of Sydney School of Dentistry, 2 Chalmers St, Surry Hills 2010, Australia; (W.S.); (A.H.); (H.S.)
| | - Rahila Ummer-Christian
- Fluoride Varnish Initiative, Loddon Mallee Aboriginal Reference Group, Bendigo 3550, Australia;
| | - Stuart Marshall
- Statewide Dental Services, SA Dental, Level 5 Roma Mitchell House, 136 North Tce, Adelaide 5000, Australia;
| | - Kate Raymond
- Department of Health, Northern Territory Government, Level 7 Manunda Place, 38 Cavenagh Street, Darwin 0800, Australia;
| | - Tom Calma AO
- Poche Centre for Indigenous Health, The University of Sydney, Room 224 Edward Ford Building, Sydney 2006, Australia; (Y.D.); (B.R.); (T.C.A.); (K.G.)
| | - Kylie Gwynne
- Poche Centre for Indigenous Health, The University of Sydney, Room 224 Edward Ford Building, Sydney 2006, Australia; (Y.D.); (B.R.); (T.C.A.); (K.G.)
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney 2113, Australia
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Davidson T, Blomma C, Bågesund M, Krevers B, Vall M, Wärnberg Gerdin E, Tranæus S. Cost-effectiveness of caries preventive interventions - a systematic review. Acta Odontol Scand 2021; 79:309-320. [PMID: 33370544 DOI: 10.1080/00016357.2020.1862293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The primary purpose of this study was to assess the cost-effectiveness of caries preventive interventions. MATERIAL AND METHODS A systematic review was conducted, following the PRISMA Statement. Four electronic databases were searched (final search 16 March 2020). Studies fulfilling the inclusion criteria were independently critically appraised, by two reviewers in parallel. Data from each included study were extracted and tabulated: the analysis used a narrative approach to present the results of the estimated cost-effectiveness. RESULTS AND CONCLUSIONS Twenty-six publications fulfilled the inclusion criteria and were of low or moderate risk of bias. Ten publications were economic evaluations, directly based on empirical studies, and the other 16 were modelling studies. Most of the studies concerned interventions for children and the most common were analyses of fluoride varnish and risk-based programs. Some of the studies showed both reduced cost and improved outcomes, but most studies reported that the improved outcome came with an additional cost. The results disclosed several cost-effectiveness evaluations of caries preventive interventions in the literature, but these target primarily children at high risk. There is a scarcity of studies specifically targeting adults and especially the elderly.
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Affiliation(s)
- Thomas Davidson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Health Technology Assessment - Odontology (HTA-O), Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Caroline Blomma
- Public Dental Service Östergötland, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Mats Bågesund
- Center for Orthodontics and Pediatric Dentistry, Norrköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Barbro Krevers
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Martina Vall
- Malmö University Library, Malmö University, Malmö, Sweden
| | - Elisabeth Wärnberg Gerdin
- Odontological Research Unit, Public Dental Service, Region Örebro County, Örebro, Sweden
- School of Health and Medical Sciences, Örebro University, Örebro, Sweden
| | - Sofia Tranæus
- Health Technology Assessment - Odontology (HTA-O), Faculty of Odontology, Malmö University, Malmö, Sweden
- Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
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Nguyen TM, Christian B, Koshy S, Morgan MV. A Validation and Cost-Analysis Study of a Targeted School-Based Dental Check-Up Intervention: Children's Dental Program. CHILDREN-BASEL 2020; 7:children7120257. [PMID: 33256020 PMCID: PMC7760058 DOI: 10.3390/children7120257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/16/2020] [Accepted: 11/23/2020] [Indexed: 12/14/2022]
Abstract
Background: Limited evidence exists to inform best practice approaches to implement school-based dental screening to address child retention via referral for dental services. This research tested the null hypothesis that a targeted school-based dental check-up program (intervention) has a 75% child retention rate for public dental care (H0 = 0.75). Methods: A prospective non-randomised controlled trial was conducted with a convenience sampling approach in metropolitan Melbourne, Australia. Children in the intervention group were recruited from two preschools and two primary schools from a low socioeconomic area. Children in the standard care group were recruited from the local public dental service. Statistical analysis was performed using Stata IC Version 12. Results: Children in the intervention (45%) were significantly less likely to have never had a dental check-up compared to standard care (20%) (p < 0.001). There was no significant difference for the child retention rate for the intervention group when compared against the null hypothesis (p = 0.954). The total society costs were AU$754.7 and AU$612.2 for the intervention and standard care groups, respectively (p = 0.049). Conclusions: This validation study provides evidence that a targeted school-based dental check-up program can achieve a 75% child retention rate and should be considered for program expansion.
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Affiliation(s)
- Tan Minh Nguyen
- Deakin Health Economics, Institute of Health Transformation, Faculty of Health, Deakin University, Waurn Ponds, VIC 3216, Australia
- Community Dental Program, Peninsula Health, Frankston, VIC 3199, Australia
- Coburg Hill Oral Care, Coburg North, VIC 3058, Australia
- Correspondence: ; Tel.: +61-432-715-420
| | - Bradley Christian
- Dentistry and Oral Health, La Trobe Rural Health School, La Trobe University, Bundoora, VIC 3552, Australia;
- Centre for Oral Health Outcomes & Research Translation (COHORT), School of Nursing & Midwifery, Western Sydney University, Sydney, NSW 2751, Australia
| | - Sajeev Koshy
- Dental Health Services Victoria, Carlton, VIC 3053, Australia;
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Maslak EE, Onishchenko LF, Soboleva SY, Dmitrienko DS, Fursik DI. Clinical and economic analysis of caries prevention programs by mathematic modeling. Pediatr Dent 2020. [DOI: 10.33925/1683-3031-2020-20-3-205-209] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Relevance. Underestimating the importance of economic analysis is the barrier to the implementation of cariesprevention programs.The aim is to study with use of mathematic modeling method the clinical and economic effectiveness of dental caries prevention programs provided for schoolchildren.Materials and methods. The method of mathematic modeling was used to evaluate the clinical and economic efficiency of the caries prevention programs (educational, fissure sealing, fluoride varnish). The cost of prevention program implementation and the expenses for caries treatment without prevention were calculated according to the rate of Volgograd territorial mandatory medical insurance Fund for 2018 year. The differences between the caries prevention program’s cost and the expenses needed for the treatment of “prevented caries” were considered as saving.Results. It was revealed that the Educational Dental Program for the first grade schoolchildren has short duration (2 years) of clinical-economic efficiency. The Continuous Educational Dental Program applied for 6 years by dental hygienists or dentists led to saving (per 100 children) of 99.5-115.0 or 84.0-99.6 thousand roubles respectively. The economic effect of The First Permanent Molar Fissure Sealing Program was revealed after 2 years only when The Program was implemented by dental hygienists. After 6 years of working with this Program the saving were 181.3 or 146.2 thousand roubles per 100 children depending on who implemented the Program, dental hygienists or dentists. The cost of Fluoride Varnish Program implementation was higher than the treatment of “prevented caries”. However, the number of “prevented caries” after fluoride varnish application is higher than after the implementation of the Educational Dental Programs. Moreover, fluoride varnish, in contrast to fissure sealing, prevents caries of smooth surfaces of permanent teeth. Conclusions. The method of mathematic modeling can be used for the development of the caries prevention programs in various regions considering the availability of personnel and financial resources, and for evaluation of the clinical and economic effectiveness of preventive programs implementation.
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Affiliation(s)
- E. E. Maslak
- Federal State Budgetary Educational Institution of Higher Education «Volgograd State Medical University» of the Ministry of Health of the Russian Federation
| | - L. F. Onishchenko
- Federal State Budgetary Educational Institution of Higher Education «Volgograd State Medical University» of the Ministry of Health of the Russian Federation
| | - S. Yu. Soboleva
- Federal State Budgetary Educational Institution of Higher Education «Volgograd State Medical University» of the Ministry of Health of the Russian Federation
| | - D. S. Dmitrienko
- Federal State Budgetary Educational Institution of Higher Education «Volgograd State Medical University» of the Ministry of Health of the Russian Federation
| | - D. I. Fursik
- Federal State Budgetary Educational Institution of Higher Education «Volgograd State Medical University» of the Ministry of Health of the Russian Federation
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Nguyen TM, Tonmukayakul U, Warren E, Cartwright S, Liew D. A Markov cost-effective analysis of biannual fluoride varnish for preventing dental caries in permanent teeth over a 70-year time horizon. Health Promot J Austr 2019; 31:177-183. [PMID: 31373066 PMCID: PMC7187475 DOI: 10.1002/hpja.283] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 05/27/2019] [Accepted: 07/28/2019] [Indexed: 11/08/2022] Open
Abstract
ISSUE ADDRESSED Biannual application of fluoride varnish is effective for dental caries prevention, but its cost-effectiveness using quality-adjusted life years (QALY) is unknown. This study performed a cost-effectiveness analysis, from the Australian health care system perspective of biannual application of fluoride varnish versus current practice (non-routine application) for an individual aged 15 years and older over a 70-year time horizon. METHODS Health outcomes measured were the number of prevented decayed, missing, and filled teeth (prevented-DMFT) and QALY gained. The calculated incremental cost-effectiveness ratio (ICER) was compared against the reference cost-effectiveness ICER threshold of AUD$28 033 per QALY gained. A published Markov model capturing dental caries progression of eight permanent molars was used. This 6-monthly cycle model represented ten possible health states for an individual tooth. A 5% discount rate was applied with relevant sensitivity analysis. RESULTS In the base-case scenario, the net cost for the intervention was $3600 compared to $2303 in the current practice arm. The intervention arm yielded 13.99 DMFT and 15.44 QALY gained, whereas the current practice arm yielded 15.52 DMFT and 14.74 QALY gained. The estimated ICER was $849 per prevented-DMFT and $1851 per QALY gained. Sensitivity analysis shows the ICER ranged from $424-$1807 per prevented-DMFT and $1851-$3941 per QALY gained. CONCLUSION Biannual professional application of fluoride varnish appears to be a highly cost-effective strategy and should be considered for universal funding in Australia's health care system.
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Affiliation(s)
- Tan Minh Nguyen
- Deakin Health Economics, Institute of Health Transformation, Faculty of Health, Deakin University, Waurn Ponds, Vic., Australia.,Melbourne Dental School, The University of Melbourne, Melbourne, Vic., Australia
| | - Utsana Tonmukayakul
- Deakin Health Economics, Institute of Health Transformation, Faculty of Health, Deakin University, Waurn Ponds, Vic., Australia
| | | | | | - Danny Liew
- Nursing and Health Sciences, School of Public Health & Preventive Medicine, Faculty of Medicine, Monash University, Clayton, Vic., Australia
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