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Dhyppolito IM, Nadanovsky P, Cruz LR, de Oliveira BH, Dos Santos APP. Economic evaluation of fluoride varnish application in preschoolers: A systematic review. Int J Paediatr Dent 2023; 33:431-449. [PMID: 36695007 DOI: 10.1111/ipd.13049] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 10/20/2022] [Accepted: 01/12/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND Fluoride varnish (FV) is a convenient way of professionally applying fluoride in preschoolers. However, its modest anticaries effect highlights the need for economic evaluations. AIM To assess economic evaluations reporting applications of FV to reduce caries incidence in preschoolers. DESIGN We included full economic evaluations with preschool participants, in which the intervention was FV and the outcome was related to dentin caries. We searched in CENTRAL; MEDLINE via PubMed; WEB OF SCIENCE; EMBASE; SCOPUS; LILACS; BBO; and BVS Economia em saúde, OpenGrey, and EconoLit. Clinical trial registers, thesis and dissertations, and meeting abstracts were hand searched, as well as 11 dental journals. Risk of bias in the included studies was assessed using the Philips' and Drummond's (full and simplified) tools. RESULTS Titles and abstracts of 2871 articles were evaluated, and 200 were read in full. Eight cost-effectiveness studies were included: five modeling and three within-trial evaluations. None of the studies gave sufficient information to allow a thorough assessment using the bias tools. We did not combine the results of the studies due to the great heterogeneity among them. Four studies reported that FV in preschool children was a cost-effective measure, but in one of these studies, sealants and fluoride toothpaste were more cost-effective measures than the varnish, and three studies used limited data that compromised the generalizability of their results. The other four studies showed a large increase in costs due to the application of varnish and/or low cost-effectiveness. CONCLUSION We did not find convincing overall evidence that applying FV in preschoolers is an anticaries cost-effective measure. The protocol of this systematic review is available at Open Science Framework (https://osf.io/xw5va/).
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Affiliation(s)
- Izabel Monteiro Dhyppolito
- Department of Epidemiology, Institute of Social Medicine, Rio de Janeiro State University, Rio de Janeiro, Brazil
- Department of Community and Preventive Dentistry, Faculty of Dentistry, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Paulo Nadanovsky
- Department of Epidemiology, Institute of Social Medicine, Rio de Janeiro State University, Rio de Janeiro, Brazil
- Department of Epidemiology, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Laís Rueda Cruz
- Department of Community and Preventive Dentistry, Faculty of Dentistry, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Branca Heloisa de Oliveira
- Department of Community and Preventive Dentistry, Faculty of Dentistry, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Ana Paula Pires Dos Santos
- Department of Community and Preventive Dentistry, Faculty of Dentistry, Rio de Janeiro State University, Rio de Janeiro, Brazil
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Nantanee R, Sriratanaban J. Cost‐effectiveness and estimated net monetary benefits of a fluoride varnish application program during well‐child visits by 9‐ to 30‐month‐old children in three areas of Thailand. Community Dent Oral Epidemiol 2022; 51:512-518. [DOI: 10.1111/cdoe.12769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 04/10/2022] [Accepted: 06/15/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Ratichanok Nantanee
- Department of Preventive and Social Medicine, Faculty of Medicine Chulalongkorn University Bangkok Thailand
- Department of Pediatric Dentistry, Faculty of Dentistry Chulalongkorn University Bangkok Thailand
| | - Jiruth Sriratanaban
- Department of Preventive and Social Medicine, Faculty of Medicine Chulalongkorn University Bangkok Thailand
- Thailand Research Center for Health Services System, Faculty of Medicine Chulalongkorn University Bangkok Thailand
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Huter K, Dubas-Jakóbczyk K, Kocot E, Kissimova-Skarbek K, Rothgang H. Economic evaluation of health promotion interventions for older people: do applied economic studies meet the methodological challenges? COST EFFECTIVENESS AND RESOURCE ALLOCATION 2018; 16:14. [PMID: 29686540 PMCID: PMC5902889 DOI: 10.1186/s12962-018-0100-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 04/10/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the light of demographic developments health promotion interventions for older people are gaining importance. In addition to methodological challenges arising from the economic evaluation of health promotion interventions in general, there are specific methodological problems for the particular target group of older people. There are especially four main methodological challenges that are discussed in the literature. They concern measurement and valuation of informal caregiving, accounting for productivity costs, effects of unrelated cost in added life years and the inclusion of 'beyond-health' benefits. This paper focuses on the question whether and to what extent specific methodological requirements are actually met in applied health economic evaluations. METHODS Following a systematic review of pertinent health economic evaluations, the included studies are analysed on the basis of four assessment criteria that are derived from methodological debates on the economic evaluation of health promotion interventions in general and economic evaluations targeting older people in particular. RESULTS Of the 37 studies included in the systematic review, only very few include cost and outcome categories discussed as being of specific relevance to the assessment of health promotion interventions for older people. The few studies that consider these aspects use very heterogeneous methods, thus there is no common methodological standard. CONCLUSION There is a strong need for the development of guidelines to achieve better comparability and to include cost categories and outcomes that are relevant for older people. Disregarding these methodological obstacles could implicitly lead to discrimination against the elderly in terms of health promotion and disease prevention and, hence, an age-based rationing of public health care.
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Affiliation(s)
- Kai Huter
- 1SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Mary-Somerville-Straße 5, 28359 Bremen, Germany
- 2High-profile Area of Health Sciences, University of Bremen, Bremen, Germany
| | - Katarzyna Dubas-Jakóbczyk
- 3Health Economics and Social Security Department, Institute of Public Health, Jagiellonian University Medical College, Krakow, Poland
| | - Ewa Kocot
- 3Health Economics and Social Security Department, Institute of Public Health, Jagiellonian University Medical College, Krakow, Poland
| | - Katarzyna Kissimova-Skarbek
- 3Health Economics and Social Security Department, Institute of Public Health, Jagiellonian University Medical College, Krakow, Poland
| | - Heinz Rothgang
- 1SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Mary-Somerville-Straße 5, 28359 Bremen, Germany
- 2High-profile Area of Health Sciences, University of Bremen, Bremen, Germany
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Huter K, Kocot E, Kissimova-Skarbek K, Dubas-Jakóbczyk K, Rothgang H. Economic evaluation of health promotion for older people-methodological problems and challenges. BMC Health Serv Res 2016; 16 Suppl 5:328. [PMID: 27609155 PMCID: PMC5016726 DOI: 10.1186/s12913-016-1519-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The support of health promotion activities for older people gains societal relevance in terms of enhancing the health and well-being of older people with a view to the efficient use of financial resources in the healthcare sector. Health economic evaluations have become an important instrument to support decision-making processes in many countries. Sound evidence on the cost-effectiveness of health promotion activities would encourage support for the implementation of health promotion activities for older people. This debate article discusses to what extent economic evaluation techniques are appropriate to support decision makers in the allocation of resources regarding health promotion activities for older people. We address the problem that the economic evaluation of these interventions is hampered by methodological obstacles that limit comparability, e.g. with economic evaluations of curative measures. Our central objective is to describe and discuss the specific problems and challenges entailed in the economic evaluation of health promotion activities especially for older people with regard to their usefulness for informing decision making processes. DISCUSSION Beyond general problems concerning the economic evaluation of health promotion, our discussion focusses on problems that pertain to the analysis of cost and outcomes of health promotion interventions for older people. With regard to costs these are general problems of economic evaluations, namely the actual implementation of a societal perspective, the appropriate measurement and valuation of informal caregiver time, the measurement and valuation of productivity costs and costs incurred in added years of life. The main problems concerning the identification and measurement of outcomes are related to the identification of outcome parameters that, firstly, adequately reflect the broad effects of health promotion interventions, especially social benefits that gain importance for older people, and secondly, ensure a comparability of effects across different age groups. In particular, the limitations of the widely used QALY for older people are discussed and recently developed alternatives are presented. CONCLUSIONS The key conclusion of the article is that a comparison of the effects of different health promotion initiatives between different age groups by means of economic evaluation is not recommendable. Taking into account the complex outcomes of health promotion interventions it has to be accepted that the outcomes of these interventions will often not be comparable with clinical interventions and have to be assessed differently.
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Affiliation(s)
- Kai Huter
- SOCIUM - Research Center on Inequality and Social Policy, University of Bremen, Mary-Somerville-Straße 5, 28359 Bremen, Germany
- High-profile area Health Sciences, University of Bremen, Bremen, Germany
| | - Ewa Kocot
- Health Economics and Social Security Department, Institute of Public Health, Jagiellonian University Medical College, Grzegórzecka 20 St., 30-351 Crakow, Poland
| | - Katarzyna Kissimova-Skarbek
- Health Economics and Social Security Department, Institute of Public Health, Jagiellonian University Medical College, Grzegórzecka 20 St., 30-351 Crakow, Poland
| | - Katarzyna Dubas-Jakóbczyk
- Health Economics and Social Security Department, Institute of Public Health, Jagiellonian University Medical College, Grzegórzecka 20 St., 30-351 Crakow, Poland
| | - Heinz Rothgang
- SOCIUM - Research Center on Inequality and Social Policy, University of Bremen, Mary-Somerville-Straße 5, 28359 Bremen, Germany
- High-profile area Health Sciences, University of Bremen, Bremen, Germany
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Ananthapavan J, Sacks G, Moodie M, Carter R. Economics of obesity--learning from the past to contribute to a better future. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:4007-25. [PMID: 24736685 PMCID: PMC4025046 DOI: 10.3390/ijerph110404007] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Revised: 03/28/2014] [Accepted: 03/28/2014] [Indexed: 11/16/2022]
Abstract
The discipline of economics plays a varied role in informing the understanding of the problem of obesity and the impact of different interventions aimed at addressing it. This paper discusses the causes of the obesity epidemic from an economics perspective, and outlines various justifications for government intervention in this area. The paper then focuses on the potential contribution of health economics in supporting resource allocation decision making for obesity prevention/treatment. Although economic evaluations of single interventions provide useful information, evaluations undertaken as part of a priority setting exercise provide the greatest scope for influencing decision making. A review of several priority setting examples in obesity prevention/treatment indicates that policy (as compared with program-based) interventions, targeted at prevention (as compared with treatment) and focused “upstream” on the food environment, are likely to be the most cost-effective options for change. However, in order to further support decision makers, several methodological advances are required. These include the incorporation of intervention costs/benefits outside the health sector, the addressing of equity impacts, and the increased engagement of decision makers in the priority setting process.
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Affiliation(s)
- Jaithri Ananthapavan
- Deakin Health Economics, Faculty of Health, Deakin University, 221 Burwood Highway, Burwood, Victoria 3125, Australia.
| | - Gary Sacks
- WHO Collaborating Centre for Obesity Prevention, Faculty of Health, Deakin University, 221 Burwood Highway, Burwood, Victoria 3125, Australia.
| | - Marj Moodie
- Deakin Health Economics, Faculty of Health, Deakin University, 221 Burwood Highway, Burwood, Victoria 3125, Australia.
| | - Rob Carter
- Deakin Health Economics, Faculty of Health, Deakin University, 221 Burwood Highway, Burwood, Victoria 3125, Australia.
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Sancho LG, Dain S. [Health assessment and economic assessment in health: introduction to the debate on the points of intersection]. CIENCIA & SAUDE COLETIVA 2012; 17:765-74. [PMID: 22450419 DOI: 10.1590/s1413-81232012000300024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Accepted: 12/11/2010] [Indexed: 11/21/2022] Open
Abstract
The study aims to infer the existence of a continuum between Health Assessment and Economic Assessment in Health, by highlighting points of intersection of these forms of appraisal. To achieve this, a review of the theoretical foundations, methods and approaches of both forms of assessment was conducted. It was based on the theoretical model of health evaluation as reported by Hartz et al and economic assessment in health approaches reported by Brouwer et al. It was seen that there is a continuum between the theoretical model of evaluative research and the extrawelfarist approach for economic assessment in health, and between the normative theoretical model for health assessment and the welfarist approaches for economic assessment in health. However, in practice the assessment is still conducted using the normative theoretical model and with a welfarist approach.
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Affiliation(s)
- Leyla Gomes Sancho
- Instituto de Estudos em Saúde Coletiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ.
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Abstract
Health promotion of school faculty and staff is an important part of a coordinated school health program. The lack of evaluation of health promotion programs and inconsistent results highlighting the efficacy and benefits of programs adds to employers’ perceptions of inconsistent benefits. More studies evaluating effectiveness and development of standards for health promotion programs must be conducted. The steps essential to a successful health promotion program are assessment of the target population’s needs, planning, implementation, and evaluation of the health promotion program. School nurses are one of many groups who must be involved in the development of health promotion programs for school faculty and staff. Collaboration with other school personnel, administration, and community resources is essential to the success of a health promotion program.
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Affiliation(s)
- Kelly M. Ryan
- Kelly M. Ryan, RN, MSN, is a school nurse in Mount Carmel Area Elementary School, Mount Carmel, PA
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Abstract
As the clinical implications of the genetic components of disease come to be better understood, there is likely to be a significant increase in the volume of genetic information held within clinical records. As patient health care records, in turn, come on-line as part of broader health information networks, there is likely to be considerable pressure in favour of special laws protecting genetic privacy. This paper reviews some of the privacy challenges posed by electronic health records, some government initiatives in this area, and notes the impact that developments in genetic testing will have upon the 'genetic content' of e-health records. Despite the sensitivity of genetic information, the paper argues against a policy of 'genetic exceptionalism', and its implications for genetic privacy laws.
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