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Health economic evaluation methods for decision-making in preventive dentistry
Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
2006 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aims of this thesis were to evaluate caries-preventive measures from a societal perspective, to demonstrate the use of resources in preventive dentistry, to develop and discuss techniques suitable for evaluating dental care costs and outcomes, and to test costs and consequences within a health economic decision model adapted to preventive dental care.

The thesis is based on three separate studies with three separate cohorts. In the first study, performed at a single dental clinic, analysis was made of data on dental caries progression over four years in 92 adolescents, along with the use of resources for preventive treatment. In the second study, data from the intervention study “Evaluation of caries-preventive measures” (performed between 1995 and 1999 at 26 dental health clinics throughout Sweden) were used for economic evaluation. Three different approaches to calculating unit cost were discussed, each of which reflect the differences in treatment costs as influenced by the practitioner’s level of skill and competence (salary) and by methods of handling overhead cost allocation. These methods seem useful for evaluating costs in cost-effectiveness analysis (CEA) and cost-benefit analysis (CBA). The CEA showed an incremental cost-effectiveness over four years of SEK 2 043* per averted decayed (D) enamel (e) and dentine caries, missing (M) and filled (F) surface (S) (DeMFS). In the third study, 82 19-year-old individuals agreed to participate in a pilot exploratory case-control study. Individuals with high caries experience formed the test group while the control group consisted of individuals with no caries experience. To explore whether any differences existed between these two groups in perceived oral health-related quality of life (OHRQOL), two OHRQOL measures were used. Additionally, the willingness of these individuals to pay (WTP) for a preventive strategy was elicited using the contingent valuation method (CVM) within a cost-benefit approach. Using these WTP values, the cost-benefit analyses showed positive net social benefit (NSB) values for both study groups, meaning that the benefits of prevention exceeded the costs. A new outcome measure, Value of Statistical Oral Health (VOSOH), was also presented.

Consideration was also made, within the economic framework fundamental to this thesis, of the trend away from a strictly bio-medical paradigm towards a biopsychosocial perspective. The health economic decision model encompasses a number of different techniques for comparing costs with consequences, each with its own advantages and disadvantages and each with its own field of application. These techniques should be seen as complementary rather than competing. Preventive dentistry plays a central role in Swedish dental health care, and it is important that resources are used properly. Accurate evaluation methods are necessary in order to improve the basis for public decision-making; the methods proposed in this thesis seem to be of potential use in this endeavour.

*SEK8.54 = US$1 (December 1999).

Place, publisher, year, edition, pages
Umeå: Folkhälsa och klinisk medicin , 2006. , 106 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1004
Keyword [en]
costs and cost analysis; cost-effectiveness analysis (CEA); cost-benefit analysis (CBA); contingent valuation method; willingness to pay; dental caries, prevention, preventive dentistry; oral health; health outcome; quality of life.
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:umu:diva-687ISBN: 91-7264-020-0 (print)OAI: oai:DiVA.org:umu-687DiVA: diva2:144232
Public defence
2006-03-01, sal B, Tandläkarhuset, Norrlands Universitetssjukhus, 901 85 Umeå, 09:00 (English)
Opponent
Supervisors
Available from: 2006-02-02 Created: 2006-02-02 Last updated: 2009-10-20Bibliographically approved
List of papers
1. Costs for prevention of dental caries in a group of Swedish teenagers
Open this publication in new window or tab >>Costs for prevention of dental caries in a group of Swedish teenagers
1997 (English)In: Swedish Dental Journal, ISSN 0347-9994, Vol. 21, no 5, 193-197 p.Article in journal (Refereed) Published
Identifiers
urn:nbn:se:umu:diva-4932 (URN)9472148 (PubMedID)
Available from: 2006-02-02 Created: 2006-02-02Bibliographically approved
2. Methods of evaluating dental care costs in the Swedish public dental health care sector
Open this publication in new window or tab >>Methods of evaluating dental care costs in the Swedish public dental health care sector
1998 (English)In: Community Dentistry and Oral Epidemiology, ISSN 0301-5661, Vol. 26, no 3, 160-165 p.Article in journal (Refereed) Published
Abstract [en]

Twenty-six Swedish dental health care clinics participating in the intervention study "Evaluation of caries preventive measures" have been analysed with focus on costs, with the aim of demonstrating techniques suitable for evaluating direct dental care costs and also finding out whether charges are acceptable as a proxy for real costs. Three different approaches to calculating unit costs are discussed: average treatment time cost and two methods of different allocation of overhead cost. Average treatment time cost shows treatment time cost regardless of who (dentist, dental hygienist or nurse) provides the dental care. The other two methods reflect both the differences of treatment costs depending on practitioners' skill level and competence (salary) and the methods of handling overhead cost allocation. Our conclusions are that the proposed methods seem useful for evaluating costs in cost-effectiveness and cost-benefit analysis. The alternative to average treatment time cost or unit time cost depends on what data is available and the perspective of the analysis. This study also concludes that charges are not sufficient as an alternative to a more detailed cost evaluation, at least not in Swedish public dental health care, since charges do not cover costs.

Identifiers
urn:nbn:se:umu:diva-4933 (URN)10.1111/j.1600-0528.1998.tb01944.x (DOI)9669593 (PubMedID)
Available from: 2006-02-02 Created: 2006-02-02Bibliographically approved
3. Cost-effectiveness of different caries preventive measures in a high-risk population of Swedish adolescents
Open this publication in new window or tab >>Cost-effectiveness of different caries preventive measures in a high-risk population of Swedish adolescents
2003 (English)In: Community Dentistry and Oral Epidemiology, ISSN 0301-5661, Vol. 31, no 3, 169-178 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: A total of 3373 12-year-olds agreed to participate in an intervention study evaluating different caries preventive measures. The study, titled 'Evaluation of caries preventive measures', was performed between 1995 and 1999 at 26 dental health clinics throughout Sweden. At the start of the study, the subjects were classified as individuals at high or low risk of developing caries. The high-risk group consisted of 1165 subjects. The children in the high-risk group were randomly assigned to one of four preventive programs. The programs represent a step-wise increase in fluoride content, contact with dental personnel and cost. The aim of the present cost-effectiveness analysis (CEA) study performed from a societal perspective is to compare costs and consequences of caries preventive programs in a caries high-risk population. By 'costs' is meant both treatment costs and costs contributed by the patient and the patient's family. Costs contributed by patients and their families consist of out-of-pocket expenses, transportation costs, and time. Conclusions are that it is important to consider the perspective from which a study is carried out. Costs contributed by the patient and the patient's family have a high impact on total costs for children and younger adolescents but decrease with time as the adolescents get older. The present study shows an incremental cost-effectiveness of 2043 SEK (8.54 SEK = 1 US dollar, December 1999) per averted decayed enamel and dentine missing and filled surface (DeMFS), of which treatment costs represent 1337 SEK using the unit cost for a nurse. This means a yearly cost of approximately 334 SEK.

Identifiers
urn:nbn:se:umu:diva-4934 (URN)10.1034/j.1600-0528.2003.00033.x (DOI)12752542 (PubMedID)
Available from: 2006-02-02 Created: 2006-02-02Bibliographically approved
4. Using Oral Health-relalted Quality of Life Measures as an Outcome for Analysing the Impact of Caries Disease among Swedish 19-year-Olds
Open this publication in new window or tab >>Using Oral Health-relalted Quality of Life Measures as an Outcome for Analysing the Impact of Caries Disease among Swedish 19-year-Olds
Manuscript (Other academic)
Identifiers
urn:nbn:se:umu:diva-4935 (URN)
Available from: 2006-02-02 Created: 2006-02-02 Last updated: 2010-01-13Bibliographically approved
5. Valuation of Caries Preventive Care among 19-year-Olds Using the Contingent Valuation Method within a Cost-Benefit Approach
Open this publication in new window or tab >>Valuation of Caries Preventive Care among 19-year-Olds Using the Contingent Valuation Method within a Cost-Benefit Approach
Manuscript (Other academic)
Identifiers
urn:nbn:se:umu:diva-4936 (URN)
Available from: 2006-02-02 Created: 2006-02-02 Last updated: 2010-01-13Bibliographically approved

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