1
|
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.
Collapse
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
| |
Collapse
|
2
|
Nguyen T, Rogers H, Taylor G, Tonmukayakul U, Lin C, Hall M, Calache H, Vernazza C. Fit for Purpose? The Suitability of Oral Health Outcome Measures to Inform Policy. JDR Clin Trans Res 2024; 9:190-192. [PMID: 37554046 PMCID: PMC10943604 DOI: 10.1177/23800844231189997] [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] [Indexed: 08/10/2023] Open
Abstract
KNOWLEDGE TRANSFER STATEMENT Oral health research and program evaluation should consider alternative outcome measures for population oral health other than the DMFT index.
Collapse
Affiliation(s)
- T.M. Nguyen
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Melbourne, VIC, Australia
- Public Health & Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- Dental Health Services Victoria, Carlton, VIC, Australia
| | - H. Rogers
- Dental Health Services Victoria, Carlton, VIC, Australia
| | - G.D. Taylor
- Dental Health Services Victoria, Carlton, VIC, Australia
| | - U. Tonmukayakul
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Melbourne, VIC, Australia
| | - C. Lin
- Public Health & Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - M. Hall
- Public Health & Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - H. Calache
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Melbourne, VIC, Australia
| | - C. Vernazza
- Dental Health Services Victoria, Carlton, VIC, Australia
| |
Collapse
|
3
|
Tobias G, Sgan-Cohen H, Spanier AB, Mann J. Perceptions and Attitudes Toward the Use of a Mobile Health App for Remote Monitoring of Gingivitis and Willingness to Pay for Mobile Health Apps (Part 3): Mixed Methods Study. JMIR Form Res 2021; 5:e26125. [PMID: 34609320 PMCID: PMC8527382 DOI: 10.2196/26125] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 12/13/2020] [Accepted: 08/07/2021] [Indexed: 01/19/2023] Open
Abstract
Background Gum infection, known as gingivitis, is a global issue. Gingivitis does not cause pain; however, if left untreated, it can worsen, leading to bad breath, bleeding gums, and even tooth loss, as the problem spreads to the underlying structures anchoring the teeth in the jaws. The asymptomatic nature of gingivitis leads people to postpone dental appointments until clinical signs are obvious or pain is evident. The COVID-19 pandemic has necessitated social distancing, which has caused many people to postpone dental visits and neglect gingival health. iGAM is a dental mobile health (mHealth) app that remotely monitors gum health, and an observational study demonstrated the ability of iGAM to reduce gingivitis. We found that a weekly dental selfie using the iGAM app reduced the signs of gingivitis and promoted oral health in a home-based setting. Objective The aim of this mixed methods study is to assess perceptions, attitudes, willingness to pay, and willingness to use an mHealth app. Methods The first qualitative phase of the study included eight semistructured interviews, and the second quantitative phase included data collected from responses to 121 questionnaires. Results There was a consensus among all interviewees that apps dealing with health-related issues (mHealth apps) can improve health. Three themes emerged from the interviews: the iGAM app is capable of improving health, the lack of use of medical apps, and a contradiction between the objective state of health and the self-definition of being healthy. Participants were grouped according to how they responded to the question about whether they believed that mHealth apps could improve their health. Participants who believed that mHealth apps can enhance health (mean 1.96, SD 1.01) had a higher willingness to pay for the service (depending on price) than those who did not believe in app efficacy (mean 1.31, SD 0.87; t119=−2417; P=.02). A significant positive correlation was found between the amount a participant was willing to pay and the benefits offered by the app (rs=0.185; P=.04). Conclusions Potential mHealth users will be willing to pay for app use depending on their perception of the app’s ability to help them personally, provided they define themselves as currently unhealthy.
Collapse
Affiliation(s)
- Guy Tobias
- Department of Community Dentistry, Faculty of Dental Medicine, The Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Harold Sgan-Cohen
- Department of Community Dentistry, Faculty of Dental Medicine, The Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Assaf B Spanier
- Department of Software Engineering, Azrieli College of Engineering, Jerusalem, Israel
| | - Jonathan Mann
- Department of Community Dentistry, Faculty of Dental Medicine, The Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
| |
Collapse
|
4
|
Boyers D, van der Pol M, Watson V, Lamont T, Goulao B, Ramsay C, Duncan A, Macpherson L, Clarkson J. The Value of Preventative Dental Care: A Discrete-Choice Experiment. J Dent Res 2021; 100:723-730. [PMID: 33541186 PMCID: PMC8217903 DOI: 10.1177/0022034521989943] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Scale and polish (SP) and oral hygiene advice (OHA) are commonly provided in primary care dental practice to help prevent periodontal disease. These services are widely consumed by service users, incurring substantial cost, without any clear evidence of clinical benefit. This article aims to elicit general population preferences and willingness to pay (WTP) for preventative dental care services and outcomes. An online discrete-choice experiment (DCE) was completed by a nationally representative sample of the UK general population. Respondents each answered 10 choice tasks that varied in terms of service attributes (SP, OHA, and provider of care), outcomes (bleeding gums and aesthetics), and cost. Choice tasks were selected using a pivoted segmented experimental design to improve task realism. An error components panel logit model was used to analyze the data. Marginal WTP (mWTP) for each attribute and level was calculated. In total, 667 respondents completed the DCE. Respondents valued more frequent SP, care provided by a dentist, and personalized OHA. Respondents were willing to pay for dental packages that generated less frequent ("never" or "hardly ever") bleeding on brushing and teeth that look and feel at least "moderately clean." Respondents were willing to pay more (+£145/y) for improvements in an aesthetic outcome from "very unclean" (-£85/y) to "very clean" (+£60/y) than they were for reduced bleeding frequency (+£100/y) from "very often" (-£54/y) to "never" (+£36/y). The general population value routinely provided SP, even in the absence of reductions in bleeding on brushing. Dental care service providers must consider service user preferences, including preferences for both health and nonhealth outcomes, as a key factor in any service redesign. Furthermore, the results provide mWTP estimates that can be used in cost-benefit analysis of these dental care services.
Collapse
Affiliation(s)
- D Boyers
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - M van der Pol
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - V Watson
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - T Lamont
- School of Dentistry, University of Dundee, Dundee, UK
| | - B Goulao
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - C Ramsay
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - A Duncan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - L Macpherson
- School of Dentistry, University of Dundee, Dundee, UK
| | - J Clarkson
- School of Dentistry, University of Dundee, Dundee, UK
| |
Collapse
|
5
|
Rogers HJ, Freitas RD, Beeson MJ, Vernazza CR. Economic evaluations in paediatric dentistry clinical trials. Int J Paediatr Dent 2020; 31 Suppl 1:56-65. [PMID: 33469952 DOI: 10.1111/ipd.12772] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 12/04/2020] [Accepted: 12/09/2020] [Indexed: 12/22/2022]
Abstract
Economic evaluations play an important role in identifying the cost-effectiveness of alternative healthcare programmes, informing decisions surrounding funding and the allocation of resources. This paper outlines the basic principles of economic evaluation and how it can be conducted alongside a clinical trial. Furthermore, it considers the ways in which evidence from these studies can be used, and the challenges researchers are faced with when conducting economic evaluations in the field of children's oral health.
Collapse
Affiliation(s)
| | - Raiza Dias Freitas
- Department of Paediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | | | | |
Collapse
|
6
|
Barber S, Bekker H, Marti J, Pavitt S, Khambay B, Meads D. Development of a Discrete-Choice Experiment (DCE) to Elicit Adolescent and Parent Preferences for Hypodontia Treatment. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2019; 12:137-148. [PMID: 30367434 PMCID: PMC6335368 DOI: 10.1007/s40271-018-0338-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objective Our objective was to develop and test a discrete-choice experiment (DCE) survey to elicit adolescent and parent preferences for dental care for hypodontia (a developmental condition where one or more teeth fail to develop). Methods This was a mixed-methods study. Participants were adolescents (aged 12–16 years) with hypodontia and their parents and the dentists providing hypodontia care. Stage one entailed attribute development, as follows. (1) Attribute identification: systematic review of hypodontia literature; interviews with adolescents with hypodontia (n = 8) and parents (n = 8); observation of hypodontia clinical consultations (n = 5); environmental scan of hypodontia patient information resources (n = 30); and systematic analysis of social media posts (n = 176). (2) Attribute selection: stakeholder consultation to develop items for a questionnaire; rating and ranking questionnaire for adolescents with hypodontia and parents (n = 18); further stakeholder consultation. Stage two involved the development of the DCE survey, and stage three included the pre-testing using cognitive interviews with adolescents (n = 12) and parents (n = 8) to assess face and content validity. Results The attribute long list included 27 attributes focusing on service delivery and treatment outcome, from which seven ‘important’ attributes were selected for pre-testing. Cognitive interviewing suggested adolescents found the DCE choice tasks challenging to understand; the survey was modified to enhance its acceptability. One attribute was excluded as it showed poor validity with adolescents. Pre-testing suggested DCE choice tasks encouraged thinking and discussion about preferences for treatment. Conclusions Including the target respondent group in all stages of DCE development ensured the final DCE survey was valid and acceptable. DCE methods appear to be a useful tool for exploring joint decision making alongside conventional preference elicitation. Electronic supplementary material The online version of this article (10.1007/s40271-018-0338-0) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Sophy Barber
- Orthodontic Department, Leeds Dental Institute, Clarendon Way, Leeds, LS2 9LU UK
| | - Hilary Bekker
- Leeds Institute of Health Sciences, Level 10 Worsley Building, Clarendon Way, Leeds, LS2 9TJ UK
| | - Joachim Marti
- Institute of Social and Preventive Medicine (IUMSP), Université de Lausanne-CHUV, Route de la Corniche 10, 1010 Lausanne, Switzerland
| | - Sue Pavitt
- School of Dentistry, Level 6 Worsley Building, Clarendon Way, Leeds, LS2 9LU UK
| | - Balvinder Khambay
- School of Dentistry, University of Birmingham, 5 Mill Pool Way, Birmingham, B5 7EG UK
| | - David Meads
- Leeds Institute of Health Sciences, Level 11 Worsley Building, Clarendon Way, Leeds, LS2 9TJ UK
| |
Collapse
|