An introduction to economic evaluation of health care

Cost-effectiveness analysis: nonsurgical root canal treatment versus single-tooth implant

BACKGROUND

Economic evaluation of nonsurgical root canal treatment (NSRCT) and single-tooth implant (STI) provides useful information for medical decision. This retrospective study aimed to evaluate the cost-effectiveness of NSRCT versus single-tooth implant (STI) after 5-year treatment in a university affiliated hospital in Beijing, China.

METHODS

211 patients who underwent NSRCT and 142 patients who had STI were included and recalled after 5-year treatment. The propensity scores were used to match the cases of two treatment modalities. At recall, outcomes were determined based on clinical and radiographical examinations. For endodontically treated cases, absence or reduction of radiolucency were defined as success. Marginal bone loss (MBL) ≤ 4 mm were determined as success for implant cases. Direct and indirect costs were calculated in China Yuan (CNY). Patients' willingness to pay (WTP) for each treatment modality was evaluated by questionnaires. A cost-effectiveness analysis was performed from the societal perspective.

RESULTS

170 patients with 120 NSRCT teeth and 96 STI were available at recall. Based on propensity score matching, 76 endodontically treated teeth were matched to 76 implants. Absence of the radiolucency was observed in 58 of 76 endodontically treated teeth (76%) and reduction of the radiolucency in 9 of 76 teeth (12%) and altogether the success rate was 88%. 100% implants were detected with marginal bone loss (MBL) ≤ 4 mm. The cost advantage of NSRCT (4,751 CNY) over STI (20,298 CNY) was more pronounced. Incremental cost effectiveness ratio (ICER) was 129,563 CNY (STI-NSRCT) per success rate gained. It exceeded the patients' willingness to pay value 7,533 CNY.

CONCLUSIONS

Clinical outcomes of NSRCT and STI could be predictable after 5-year treatment. NSRCT may be more cost-effective than STI for managing endodontically diseased teeth.

A cost minimisation analysis of two dental sealing methods in an outreach dental program

OBJECTIVE

To conduct economic evaluation of two sealing methods (placement of resin sealant or glass ionomer ART sealant) in preventing pit and fissure caries in permanent first molars (PFMs) in schoolchildren.

MATERIALS AND METHODS

An outreach dental program was conducted in two randomly selected primary schools, one was covered by the national government-funded dental sealing service (group 1) and the other was not (group 2). Resin or ART sealant (sealant using glass ionomer material with the aid of the finger-press technique) was applied to all of the eligible PFMs in group 1 and group 2 students (grade 1 or 2), respectively. All the applications was provided at school. The cost for sealant application was recorded for each method. After 18 months, a cost minimisation analysis was performed based on the efficacy results of the two methods.

RESULTS AND CONCLUSION

In total, 445 sealants were applied to 126 children in group 1, and 668 sealants were applied to 203 children in group 2. Dental caries incidence was 29.4 % in group 1 and 28.6 % in group 2 after 18 months. Logistic regression analysis showed no statistically significant difference (p = 0.552) between the two groups. Cost minimisation analysis was used to evaluate the economic performance. The analytical model showed that the ART sealant was economically better than resin sealant. Sensitivity analysis showed that the life expectancy of the equipment/instrument used in sealant applications was the major parameter affecting the cost. The cost of using ART sealant over the study period was lower than that of using resin sealant. Overall, ART sealant is a less costly alternative for pit and fissure caries prevention in outreach dental services.

CLINICAL SIGNIFICANCE

While pit and fissure sealing using ART sealant was as effective as using resin sealant in dental caries prevention, the cost of using ART sealant was lower than that of using resin sealant. Therefore, ART sealant could be a good alternative to resin sealant for pit and fissure caries prevention in outreach dental services for rural populations who have the greatest need.

The potential of the Child Health Utility 9D Index as an outcome measure for child dental health

BACKGROUND

The Child Health Utility 9D (CHU9D) is a relatively new generic child health-related quality of life measure (HRQoL)-designed to be completed by children-which enables the calculation of utility values.The aim is to investigate the use of the CHU9D Index as an outcome measure for child dental health in New Zealand.

METHOD

A survey was conducted of children aged between 6 and 9 years attending for routine dental examinations in community clinics in Dunedin (New Zealand) in 2012. The CHU9D, a HRQoL, was used, along with the Child Perceptions Questionnaire (CPQ), a validated oral health-related quality of life (OHRQoL) measure. Socio-demographic characteristics (sex, age, ethnicity and household deprivation) were recorded. Dental therapists undertook routine clinical examinations, with charting recorded for each child for decayed, missing and filled deciduous teeth (dmft) at the d3 level.

RESULTS

One hundred and forty 6-to-9-year-olds (50.7% female) took part in the study (93.3% participation rate). The mean d3mft was 2.4 (SD = 2.6; range 0 to 9). Both CHU9D and CPQ detected differences in the impact of dental caries, with scores in the expected direction: children who presented with caries had higher scores (indicating poorer OHRQoL) than those who were free of apparent caries. Children with no apparent caries had a higher mean CHU9D score than those with caries (indicating better HRQoL). The difference for the CPQ was statistically significant, but for CHU9D the difference was not significant. When the two indices were compared, there was a significant difference in mean CHU9D scores by the prevalence of CPQ and subscale impacts with children experiencing no impacts having mean CHU9D scores closer to 1.0 (representing perfect health).

CONCLUSION

The CHU9D may be useful in dental research. Further exploration in samples with different caries experience is required. The use of the CHU9D in child oral health studies will enable the calculation of quality-adjusted life years (QALYs) for use in economic evaluation.

A comparison of the EQ-5D-3L and ICECAP-O in an older post-acute patient population relative to the general population

BACKGROUND

The measurement and valuation of quality of life forms a major component of economic evaluation in health care and is a major issue in health services research. However, differing approaches exist in the measurement and valuation of quality of life from a health economics perspective. While some instruments such as the EQ-5D-3L focus on health-related quality of life alone, others assess quality of life in broader terms, for example, the newly developed ICECAP-O.

OBJECTIVE

The aim of this study was to utilize two generic preference-based instruments, the EQ-5D-3L and the ICECAP-O, to measure and value the quality of life of older adult patients receiving post-acute care. An additional objective was to compare the values obtained by each instrument with those generated from two community-based general population samples.

METHOD

Data were collected from a clinical patient population of older adults receiving post-acute outpatient rehabilitation or residential transition care and two Australian general population samples of individuals residing in the general community. The individual responses to the ICECAP-O and EQ-5D-3L instruments were scored using recently developed Australian general population algorithms. Empirical comparisons were made of the resulting patient and general population sample values for the total population and dis-aggregated according to age (65-79 and 80+ years) and gender.

RESULTS

A total of 1,260 participants aged 65-99 years (n = 86 clinical patient sample, n = 385 EQ-5D-3L general population sample, n = 789 ICECAP-O general population sample) completed one or both of the EQ-5D-3L and ICECAP-O instruments. As expected, the patient group demonstrated lower quality of life than the general population sample as measured by both quality-of-life instruments. The difference in values between the patient and general population groups was found to be far more pronounced for the EQ-5D-3L than for the ICECAP-O. The ICECAP-O was associated with a mean difference in values of 0.04 (patient group mean 0.753, SD 0.18; general population group mean 0.795, SD 0.17, respectively, p = 0.033). In contrast, the EQ-5D-3L was associated with a mean difference in values of 0.19 (patient group mean 0.595, SD 0.20; general population group mean 0.789, SD 0.02, respectively, p ≤ 0.001).

CONCLUSIONS

The study findings illustrate the magnitude of the difference in patient and general population values according to the instrument utilized, and highlight the differences in both the theoretical underpinnings and valuation algorithms for the EQ-5D-3L and ICECAP-O instruments. Further empirical work is required in larger samples and alternative patient groups to investigate the generalizability of the findings presented here.