Evaluating societal outcomes of orthognathic surgery: an innovative application of the Social Return on Investment methodology to patients after orthognathic treatment

Evaluation of orthodontists' experience with the surgery first protocol in orthodontic-surgical management

AIM OF THE STUDY

The aim of this study was to analyze the popularity of surgery first among orthodontists as well as the protocols used for its implementation and to collect the opinions (favorable or unfavorable) of practitioners and patients regarding it.

MATERIALS AND METHODS

A questionnaire was sent to a population of dental surgeons qualified in Dentofacial Orthopedics or in the process of specialization (residents) practicing in France. The questionnaire consisted of a total of 27 questions. There were 10 open-ended questions and 17 closed-ended questions (8 binary and 9 multiple choices). The conditional pathway allows the respondent's path through the form to be modified based on their answers. This survey was conducted using Google Forms online survey software.

RESULTS

On average, the responding practitioners had 15.9 years of experience, and most of them (78.2%) work in private practice. Most treated between 200 and 400 cases per year, of which 7% were surgical cases. Orthodontists who are familiar with and practice the surgery first protocol use it on average for 7 cases per year. The most frequent indication for the surgery first protocol was: transverse maxillary defects.

CONCLUSIONS

Surgery first protocol is a preferred option in cases of high severity since it prevents respiratory worsening during the pre-surgical orthodontic phase. The lack of a standardized protocol for this approach, at the pre-surgical and post-surgical levels, requires an increase in the number of high-level evidence publications to clarify the methods of application of this protocol.

Measurement of quality of life in orthognathic surgery using an original questionnaire: About a series of 123 cases

INTRODUCTION

The aim of this study was to measure changes in the quality of life of patients who had orthognathic surgery using an original questionnaire, designed for this purpose.

MATERIAL AND METHOD

This single-center retrospective study included all patients who had orthognathic surgery in our center between 2014 and 2019. An original questionnaire comprising 13 items in 4 domains was sent to patients postoperatively by email after telephone contact and obtaining their consent. Items were scored on a 5-point scale ranging from (-1), worse than before surgery, to (+3), better than before surgery.

RESULTS

All data were collected in a standardized way. In total, 123 patients responded. The mean score for all surgeries combined was +1.14, indicating an improvement in QOL considered to be "low to moderate". A total of 118 patients (95.9%) reported an improvement following surgery, including 18 patients (14.6%) who reported a marked improvement. The greatest improvement was observed for psychosocial aspects and morphology.

CONCLUSION

This study shows a positive effect of orthognathic surgery on patients' QOL, including self-perception, relationships with others, or functional aspects as mastication and breathing. We propose an original tool that is easy to use by patients to measure quality of life following orthognathic surgery.

The impact of improving haemophilia A management within the Spanish National Healthcare System: a social return on investment analysis

BACKGROUND

Haemophilia A (HA) has been associated with poor health-related quality of life and a large economic burden, accentuated by severity, arthropathy, and inhibitors. To meet global standards of care, the management of HA should align with the principles of care outlined by the World Federation of Haemophilia. The aims of the present study were to establish a set of proposals to improve HA management within the Spanish National Health System (SNHS) and to estimate the impact its hypothetical implementation would generate from a clinical, healthcare, economic, and social perspective.

METHODS

A multidisciplinary group of experts agreed on a set of 15 proposals to improve HA management within the SNHS. Thereafter, a forecast-type Social Return on Investment analysis was carried out to estimate the impact of implementing this set of proposals within the SNHS over a one-year timeframe, in relation to the required investment.

RESULTS

This study estimated that the implementation of the complete set of 15 proposals would require a total investment of 2.34 M€ and have a total impact of 14.60 M€. Accordingly, every euro invested in the complete set of 15 proposals would yield a social return of €6.23 (€3.37 in the worst-case scenario and €9.69 in the best-case scenario) of both tangible and intangible nature in similar proportions (45.71 and 54.29%, respectively).

CONCLUSIONS

These results can be used to inform policy and practice such that interventions that may potentially improve current public health challenges associated with the management of HA may be implemented.