Cost-effectiveness of the Hall Technique in a Randomized Trial

Clinical and patient-reported outcomes were reported for carious primary molars treated with the Hall technique (HT) as compared with conventional carious tissue removal and restorations (i.e., conventional restoration [CR]) in a 5-y randomized controlled practice-based trial in Scotland. We interrogated this data set further to investigate the cost-effectiveness of HT versus CR. A total of 132 children who had 2 matched occlusal/occlusal-proximal carious lesions in primary molars ( n = 264 teeth) were randomly allocated to HT or CR, provided by 17 general dental practitioners. Molars were followed up for a mean 5 y. A societal perspective was taken for the economic analysis. Direct dental treatment costs were estimated from a Scottish NHS perspective (an NHS England perspective was taken for a sensitivity analysis). Initial, maintenance, and retreatment costs, including rerestorations, endodontic treatments, and extractions, were estimated with fee items. Indirect/opportunity costs were estimated with time and travel costs from a UK perspective. The primary outcome was tooth survival. Secondary outcomes included 1) not having pain or needing endodontic treatments/extractions and 2) not needing rerestorations. Cost-effectiveness and acceptability were estimated from bootstrapped samples. Significantly more molars in HT survived (99%, 95% CI: 98% to 100%) than in CR (92%; 87% to 97%). Also, the proportion of molars retained without pain or requiring endodontic treatment/extraction was significantly higher in HT than CR. In the base case analysis (NHS Scotland perspective), cumulative direct dental treatment costs (Great British pound [GBP]) of HT were 24 GBP (95% CI: 23 to 25); costs for CR were 29 (17 to 46). From an NHS England perspective, the cost advantage of HT (29 GBP; 95% CI: 25 to 34) over CR (107; 86 to 127) was more pronounced. Indirect/opportunity costs were significantly lower for HT (8 GBP; 95% CI: 7 to 9) than CR (19; 16 to 23). Total cumulative costs were significantly lower for HT (32 GBP; 95% CI: 31 to 34) than CR (49; 34 to 69). Based on a long-term practice-based trial, HT was more cost-effective than CR with HT retained for longer and experiencing less complications at lower costs.

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Parents' Time Is Worth Money

PEDIATRICS ◽

10.1542/peds.71.3.466a ◽

1983 ◽

Vol 71 (3) ◽

pp. 466-466

Author(s):

DOUGLAS RICHARDSON

Keyword(s):

Intensive Care ◽

Cost Effectiveness ◽

Economic Analysis ◽

Bronchopulmonary Dysplasia ◽

Neonatal Intensive Care ◽

Waiting Times ◽

Opportunity Costs ◽

Home Management ◽

Tacit Assumption ◽

The Cost

To the Editor.— I was delighted to see Donn's letter about the cost effectiveness of home management of bronchopulmonary dysplasia.1 Such contributions are vital in helping to curb the rapidly rising costs of neonatal intensive care. However, his economic analysis is flawed. By tacit assumption, he omits any consideration of the opportunity costs to the parents. To omit this presumes that the parents' time is worth little or nothing, as we often seem to indicate by the long patient waiting times in our offices.

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Dental Home Visits for Caries Prevention Among Preschool Children: Protocol for a Cost-Effectiveness Analysis on a Randomized Control Trial (Preprint)

10.2196/preprints.10053 ◽

2018 ◽

Author(s):

Niekla Survia Andiesta ◽

Maimunah A Hamid ◽

KKC Lee ◽

Allan Pau

Keyword(s):

Cost Effectiveness ◽

Oral Health ◽

Young Children ◽

Dental Treatment ◽

Home Visits ◽

Cost Effectiveness Analysis ◽

Caries Prevention ◽

Effectiveness Analysis ◽

Dental Home ◽

The Cost

BACKGROUND In 2012, nearly 4000 children in Malaysia were referred to hospital pediatric dental services due to dental caries. Recent research has reported the effectiveness of dental home visits in preventing caries development in young children. Dental home visits (DHVs) are described as an ongoing relationship between the dentist and their patients, providing all aspects of a preventive oral health care program in the presence of the parents at home. OBJECTIVE The objective of this study is to evaluate the cost-effectiveness of dental home visits and oral health information, in the form of educational leaflets, in preventing new caries development in young children, compared to those receiving only educational leaflets over a period of two years. Cost-effectiveness analysis will be used to evaluate the cost-effectiveness of dental home visits. METHODS This is a collaborative project with the Oral Health Division of the Ministry of Health Malaysia. The Oral Health Division will provide access to a subsample from the National Oral Health of Preschoolers Survey which was carried out in 2015. The population of interest is children aged 5 and 6 years from kindergartens in the Selangor state of Malaysia. The study adopted a societal perspective for cost-effectiveness analysis and all types of resources that are of value to society will be included in analyzing the costs; such as cost to the patient, cost to the provider or institution, and indirect costs because of loss of productivity. RESULTS The trial has been approved by the International Medical University Malaysia’s Joint Research and Ethics Committee (Project ID: IMU R157-2014 [File III – 2016]). This trial is currently recruiting participants. CONCLUSIONS The number of young children in Malaysia who have been referred to the hospital children’s dentistry service for severe caries is disturbing. The cost of dental treatment in young children is high due to the severity of the caries which require an aggressive treatment, and the need for general anesthesia or sedation. This study will provide information on the cost and effectiveness of DHVs in caries prevention of young children in Malaysia. REGISTERED REPORT IDENTIFIER RR1-10.2196/10053

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Methods for the estimation of the National Institute for Health and Care Excellence cost-effectiveness threshold

Health Technology Assessment ◽

10.3310/hta19140 ◽

2015 ◽

Vol 19 (14) ◽

pp. 1-504 ◽

Cited By ~ 311

Author(s):

Karl Claxton ◽

Steve Martin ◽

Marta Soares ◽

Nigel Rice ◽

Eldon Spackman ◽

...

Keyword(s):

Cost Effectiveness ◽

Health Effects ◽

The Other ◽

Opportunity Costs ◽

Best Estimate ◽

The Cost ◽

The Impact ◽

The Relationship ◽

Cost Effectiveness Threshold ◽

Effectiveness Threshold

BackgroundCost-effectiveness analysis involves the comparison of the incremental cost-effectiveness ratio of a new technology, which is more costly than existing alternatives, with the cost-effectiveness threshold. This indicates whether or not the health expected to be gained from its use exceeds the health expected to be lost elsewhere as other health-care activities are displaced. The threshold therefore represents the additional cost that has to be imposed on the system to forgo 1 quality-adjusted life-year (QALY) of health through displacement. There are no empirical estimates of the cost-effectiveness threshold used by the National Institute for Health and Care Excellence.Objectives(1) To provide a conceptual framework to define the cost-effectiveness threshold and to provide the basis for its empirical estimation. (2) Using programme budgeting data for the English NHS, to estimate the relationship between changes in overall NHS expenditure and changes in mortality. (3) To extend this mortality measure of the health effects of a change in expenditure to life-years and to QALYs by estimating the quality-of-life (QoL) associated with effects on years of life and the additional direct impact on QoL itself. (4) To present the best estimate of the cost-effectiveness threshold for policy purposes.MethodsEarlier econometric analysis estimated the relationship between differences in primary care trust (PCT) spending, across programme budget categories (PBCs), and associated disease-specific mortality. This research is extended in several ways including estimating the impact of marginal increases or decreases in overall NHS expenditure on spending in each of the 23 PBCs. Further stages of work link the econometrics to broader health effects in terms of QALYs.ResultsThe most relevant ‘central’ threshold is estimated to be £12,936 per QALY (2008 expenditure, 2008–10 mortality). Uncertainty analysis indicates that the probability that the threshold is < £20,000 per QALY is 0.89 and the probability that it is < £30,000 per QALY is 0.97. Additional ‘structural’ uncertainty suggests, on balance, that the central or best estimate is, if anything, likely to be an overestimate. The health effects of changes in expenditure are greater when PCTs are under more financial pressure and are more likely to be disinvesting than investing. This indicates that the central estimate of the threshold is likely to be an overestimate for all technologies which impose net costs on the NHS and the appropriate threshold to apply should be lower for technologies which have a greater impact on NHS costs.LimitationsThe central estimate is based on identifying a preferred analysis at each stage based on the analysis that made the best use of available information, whether or not the assumptions required appeared more reasonable than the other alternatives available, and which provided a more complete picture of the likely health effects of a change in expenditure. However, the limitation of currently available data means that there is substantial uncertainty associated with the estimate of the overall threshold.ConclusionsThe methods go some way to providing an empirical estimate of the scale of opportunity costs the NHS faces when considering whether or not the health benefits associated with new technologies are greater than the health that is likely to be lost elsewhere in the NHS. Priorities for future research include estimating the threshold for subsequent waves of expenditure and outcome data, for example by utilising expenditure and outcomes available at the level of Clinical Commissioning Groups as well as additional data collected on QoL and updated estimates of incidence (by age and gender) and duration of disease. Nonetheless, the study also starts to make the other NHS patients, who ultimately bear the opportunity costs of such decisions, less abstract and more ‘known’ in social decisions.FundingThe National Institute for Health Research-Medical Research Council Methodology Research Programme.

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Cost-Effectiveness of Adult Spinal Deformity Surgery

Global Spine Journal ◽

10.1177/2192568220964098 ◽

2020 ◽

pp. 219256822096409

Author(s):

Anthony M. Alvarado ◽

Bryan A. Schatmeyer ◽

Paul M. Arnold

Keyword(s):

Cost Effectiveness ◽

Resource Utilization ◽

Spinal Deformity ◽

Adult Spinal Deformity ◽

Operative Management ◽

Patient Reported ◽

Spinal Deformity Surgery ◽

Reducing Costs ◽

The Cost

Study Design: Review article. Objective: A review of the literature evaluating the cost-effectiveness of undergoing adult spinal deformity surgery and potential avenues for reducing costs. Methods: A review of the current literature and synthesis of data to provide an update on the cost effectiveness of undergoing adult spinal deformity surgery. Results: Compared with nonoperative management, operative management for adult spinal deformity is associated with improved patient-reported outcomes and quality of life; however, it is associated with significant financial and resource use. Conclusion: Operative management for adult spinal deformity has been shown to be effective but is associated with significant cost and resource utilization. The optimal operative treatment is highly dependent on the patients’ symptomatology and is surgeon dependent. Maximizing preoperative surgical health and minimizing postoperative complications are key measures in reducing the cost and resource utilization of adult spinal deformity surgery. Future studies are needed to evaluate how to optimize the cost-effectiveness.

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Cost-Effectiveness of a Multifaceted Podiatry Intervention for the Prevention of Falls in Older People: The REducing Falls with Orthoses and a Multifaceted Podiatry Intervention Trial Findings

Gerontology ◽

10.1159/000489171 ◽

2018 ◽

Vol 64 (5) ◽

pp. 503-512 ◽

Cited By ~ 4

Author(s):

Belen Corbacho ◽

Sarah Cockayne ◽

Caroline Fairhurst ◽

Catherine E. Hewitt ◽

Kate Hicks ◽

...

Keyword(s):

Cost Effectiveness ◽

Older People ◽

Usual Care ◽

Incidence Rate ◽

Intervention Group ◽

Cost Effective ◽

Falls Prevention ◽

Data Set ◽

Life Years ◽

The Cost

Background: Falls are a major cause of morbidity among older people. Multifaceted interventions may be effective in preventing falls and related fractures. Objective: To evaluate the cost-effectiveness alongside the REducing Falls with Orthoses and a Multifaceted podiatry intervention (REFORM) trial. Methods: REFORM was a pragmatic multicentre cohort randomised controlled trial in England and Ireland; 1,010 participants (> 65 years) were randomised to receive either a podiatry intervention (n = 493), including foot and ankle strengthening exercises, foot orthoses, new footwear if required, and a falls prevention leaflet, or usual podiatry treatment plus a falls prevention leaflet (n = 517). Primary outcome: incidence of falls per participant in the 12 months following randomisation. Secondary outcomes: proportion of fallers and quality of life (EQ-5D-3L) which was converted into quality-adjusted life years (QALYs) for each participant. Differences in mean costs and QALYs at 12 months were used to assess the cost-effectiveness of the intervention relative to usual care. Cost-effectiveness analyses were conducted in accordance with National Institute for Health and Clinical Excellence reference case standards, using a regression-based approach with costs expressed in GBP (2015 price). The base case analysis used an intention-to-treat approach on the imputed data set using multiple imputation. Results: There was a small, non-statistically significant reduction in the incidence rate of falls in the intervention group (adjusted incidence rate ratio 0.88, 95% CI 0.73–1.05, p = 0.16). Participants allocated to the intervention group accumulated on average marginally higher QALYs than the usual care participants (mean difference 0.0129, 95% CI –0.0050 to 0.0314). The intervention costs were on average GBP 252 more per participant compared to the usual care participants (95% CI GBP –69 to GBP 589). Incremental cost-effectiveness ratios ranged between GBP 19,494 and GBP 20,593 per QALY gained, below the conventional National Health Service cost-effectiveness thresholds of GBP 20,000 to GBP 30,000 per additional QALY. The probability that the podiatry intervention is cost-effective at a threshold of GBP 30,000 per QALY gained was 0.65. The results were robust to sensitivity analyses. Conclusion: The benefits of the intervention justified the moderate cost. The intervention could be a cost-effective option for falls prevention when compared with usual care in the UK.

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Sealing Caries in Primary Molars

Journal of Dental Research ◽

10.1177/0022034511422064 ◽

2011 ◽

Vol 90 (12) ◽

pp. 1405-1410 ◽

Cited By ~ 109

Author(s):

N.P.T. Innes ◽

D.J.P. Evans ◽

D.R. Stirrups

Keyword(s):

Primary Molars ◽

Dental Practitioners ◽

Term Trial ◽

Caries Removal ◽

Tooth Preparation ◽

Initial Lesions ◽

Irreversible Pulpitis ◽

Hall Technique

The Hall Technique (HT) is a method for managing carious primary molars. Decay is sealed under pre-formed metal crowns without any caries removal, tooth preparation, or local anesthesia. The aim of this study was to compare HT clinical/radiographic failure rates with General Dental Practitioners’ (GDPs) standard (control) restorations. We conducted a split-mouth, randomized control trial (132 children, aged 3-10 yrs, GDPs n = 17) in Scotland. There were 264 study teeth with initial lesions, 42% of which were radiographically > half-way into dentin, and 67% of which had Class II restorations. Teeth were randomized to HT (intervention) or GDPs’ usual treatment (control). Annual clinical/radiographic follow-up data were recorded. Ninety-one patients (69%) had 48 months’ minimum follow-up. At 60 months, ‘Major’ failures (irreversible pulpitis, loss of vitality, abscess, or unrestorable tooth) were recorded: HT, 3 (3%); control restorations, 15 (16.5%) (p = 0.000488; NNT 8); and ‘Minor’ failures (reversible pulpitis, restoration loss/wear/fracture; or secondary caries): HT, 4 (5%); control restorations, 38 (42%) (p < 0.000001; NNT 3). Overall, there were follow-up data for 130 patients (2-60 mos): ‘Major’ failures: HT, 3 (2%); control restorations, 22 (17%) (p = 0.000004; NNT 7); and ‘Minor’ failures, HT, 7 (5%); control restorations, 60 (46%) (p < 0.000001; NNT 3). Sealing in caries by the Hall Technique statistically, and clinically, significantly outperformed GDPs’ standard restorations in the long term (Trial registration no. ISRCTN 47267892).

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The cost-effectiveness of testing strategies for type 2 diabetes: a modelling study

Health Technology Assessment ◽

10.3310/hta19330 ◽

2015 ◽

Vol 19 (33) ◽

pp. 1-80 ◽

Cited By ~ 15

Author(s):

Mike Gillett ◽

Alan Brennan ◽

Penny Watson ◽

Kamlesh Khunti ◽

Melanie Davies ◽

...

Keyword(s):

Type 2 Diabetes ◽

Cost Effectiveness ◽

High Risk ◽

Risk Score ◽

Cost Effective ◽

Data Set ◽

Uptake Rates ◽

Multiethnic Population ◽

The Cost

BackgroundAn estimated 850,000 people have diabetes without knowing it and as many as 7 million more are at high risk of developing it. Within the NHS Health Checks programme, blood glucose testing can be undertaken using a fasting plasma glucose (FPG) or a glycated haemoglobin (HbA1c) test but the relative cost-effectiveness of these is unknown.ObjectivesTo estimate and compare the cost-effectiveness of screening for type 2 diabetes using a HbA1ctest versus a FPG test. In addition, to compare the use of a random capillary glucose (RCG) test versus a non-invasive risk score to prioritise individuals who should undertake a HbA1cor FPG test.DesignCost-effectiveness analysis using the Sheffield Type 2 Diabetes Model to model lifetime incidence of complications, costs and health benefits of screening.SettingEngland; population in the 40–74-years age range eligible for a NHS health check.Data sourcesThe Leicester Ethnic Atherosclerosis and Diabetes Risk (LEADER) data set was used to analyse prevalence and screening outcomes for a multiethnic population. Alternative prevalence rates were obtained from the literature or through personal communication.Methods(1) Modelling of screening pathways to determine the cost per case detected followed by long-term modelling of glucose progression and complications associated with hyperglycaemia; and (2) calculation of the costs and health-related quality of life arising from complications and calculation of overall cost per quality-adjusted life-year (QALY), net monetary benefit and the likelihood of cost-effectiveness.ResultsBased on the LEADER data set from a multiethnic population, the results indicate that screening using a HbA1ctest is more cost-effective than using a FPG. For National Institute for Health and Care Excellence (NICE)-recommended screening strategies, HbA1cleads to a cost saving of £12 and a QALY gain of 0.0220 per person when a risk score is used as a prescreen. With no prescreen, the cost saving is £30 with a QALY gain of 0.0224. Probabilistic sensitivity analysis indicates that the likelihood of HbA1cbeing more cost-effective than FPG is 98% and 95% with and without a risk score, respectively. One-way sensitivity analyses indicate that the results based on prevalence in the LEADER data set are insensitive to a variety of alternative assumptions. However, where a region of the country has a very different joint HbA1cand FPG distribution from the LEADER data set such that a FPG test yields a much higher prevalence of high-risk cases relative to HbA1c, FPG may be more cost-effective. The degree to which the FPG-based prevalence would have to be higher depends very much on the uncertain relative uptake rates of the two tests. Using a risk score such as the Leicester Practice Database Score (LPDS) appears to be more cost-effective than using a RCG test to identify individuals with the highest risk of diabetes who should undergo blood testing.LimitationsWe did not include rescreening because there was an absence of required relevant evidence.ConclusionsBased on the multiethnic LEADER population, among individuals currently attending NHS Health Checks, it is more cost-effective to screen for diabetes using a HbA1ctest than using a FPG test. However, in some localities, the prevalence of diabetes and high risk of diabetes may be higher for FPG relative to HbA1cthan in the LEADER cohort. In such cases, whether or not it still holds that HbA1cis likely to be more cost-effective than FPG depends on the relative uptake rates for HbA1cand FPG. Use of the LPDS appears to be more cost-effective than a RCG test for prescreening.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Understanding the Cost-Effectiveness of Hearing Aids and Surgery for the Treatment of Otosclerosis

Current Otorhinolaryngology Reports ◽

10.1007/s40136-021-00378-y ◽

2022 ◽

Author(s):

Danielle M. Gillard ◽

Jeffrey D. Sharon

Keyword(s):

Quality Of Life ◽

Cost Effectiveness ◽

Hearing Aids ◽

Cost Effective ◽

Stapes Surgery ◽

Cost Effective Method ◽

Patient Reported ◽

Complications Of Surgery ◽

The Cost

Abstract Purpose of Review To summarize and critically review recent literature on the relative cost-effectiveness of hearing augmentation versus stapes surgery for the treatment of otosclerosis. Recent Findings Otosclerosis leads to reduced patient quality of life, which can be ameliorated by either stapes surgery, or hearing aid usage. The success of stapes surgery is high, and the risks of serious postoperative complications are low. Hearing aids don’t have the complications of surgery but are associated with long-term costs. Cost-effectiveness models have shown that stapes surgery is a cost-effective method for treating otosclerosis. Summary Both stapes surgery and hearing aids can improve patient-reported quality of life in otosclerosis. Stapes surgery has larger upfront costs and surgical risks, but hearing aids are associated with longer lifetime costs. Stapes surgery is cost-effective for the treatment of otosclerosis.

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Assessing the Health Economic Agreement of Different Data Sources

The Stata Journal Promoting communications on statistics and Stata ◽

10.1177/1536867x1801800114 ◽

2018 ◽

Vol 18 (1) ◽

pp. 223-233 ◽

Cited By ~ 4

Author(s):

Daniel Gallacher ◽

Felix Achana

Keyword(s):

Cost Effectiveness ◽

Rapid Assessment ◽

Routine Data ◽

Rapid Identification ◽

Effectiveness Analysis ◽

Patient Reported ◽

Economic Analyses ◽

Reported Data ◽

The Cost ◽

Different Sources

In this article, we present a simple-to-use framework for assessing the agreement of cost-effectiveness endpoints generated from different sources of data. The aim of this package is to enable the rapid assessment of routine data for use in cost-effectiveness analyses. By quantifying the comparability of routine data with “gold-standard” trial data, we inform decisions on the suitability of routine data for cost-effectiveness analysis. The rapid identification of informative routine data will increase the opportunity for economic analyses and potentially reduce the cost and burden of collecting patient-reported data in clinical trials.

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