The economic impact of two diagnostic strategies in the management of restorations in primary teeth: a health economic analysis plan for a trial-based economic evaluation

Abstract Background Different approaches have been used in the clinical routine to assess restorations and determine the need for further reinterventions. In general, dentists based their decision in different parameters, including aesthetical ones, leading to a more interventionist approach. Indeed, using a more interventionist strategy (the World Dental Federation - FDI), more replacements tend to be indicated than using a minimally invasive one (based on the Caries Around Restorations and Sealants -CARS). Since the resources related to the long-term health effects of these strategies have not been explored, the economic impact of using the less invasive strategy is still uncertain. Thus, this health economic analysis plan aims to describe methodologic strategies for conducting a trial-based economic evaluation that aims to assess whether a minimally invasive strategy is more efficient in allocating resources than the conventional strategy for managing restorations in primary teeth. Methods A trial-based economic evaluation will be conducted, including three cost-effectiveness analysis (CEA) and one cost-utility analysis (CUA). These analyses will be based on the main trial (CARDEC-03/NCT03520309), in which children aged 3 to 10 were included and randomized to one of the diagnostic strategies (based on FDI or CARS). An examiner will assess children's restorations using the randomized strategy, and treatment will be recommended according to the same criteria. The time horizon for this study is two years, and we will adopt the societal perspective. The average costs per child for 24 months will be calculated. Three different cost-effectiveness analysis (CEA) will be performed. For CEAs, the effects will be the number of operative interventions, the percentage of patients who did not need new interventions in the follow-up, and the scores obtained with a questionnaire to assess children’s oral health-related quality of life. For CUA, the effect will be quality-adjusted life-years (QALYs). Intention-to-treat analyses will be conducted. Finally, we will assess the difference when using the minimally invasive strategy for each health effect (∆effect) compared to the conventional strategy (based on FDI) as the reference strategy. The same will be calculated for related costs (∆cost). The discount rate of 5% will be applied for costs and effects. We will perform deterministic one-way and probabilistic sensitivity analyses to handle uncertainties. The net benefit will be calculated, and acceptability curves plotted using different willingness-to-pay thresholds. A longer-term economic evaluation will be carried out with trial results extrapolated over a primary tooth lifetime horizon using Markov modelling methods. Discussion The main trial is ongoing, and data collection is still not finished. Therefore, economic evaluation has not commenced. We hypothesize that conventional strategy will be associated with more need for replacements of restorations in primary molars. These replacements may lead to more reinterventions, leading to higher costs after two years. The health effects will be a crucial aspect to take into account when deciding whether the minimally invasive strategy will be more efficient in allocating resources than the conventional strategy when considering the management of restorations in primary teeth. Finally, patients/parents preferences and consequent utility values may also influence this final conclusion about the economic aspects of implementing the minimally invasive approach for managing restorations in clinical practice. Therefore, this trial-based economic evaluations may bring actual evidence of the economic impact of such these interventions. Trial registration: NCT03520309. Registered May 9th, 2018. Economic evaluations (the focus of this plan) are not initiated at the moment.

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The economic impact of two diagnostic strategies in the management of restorations in primary teeth: a health economic analysis plan for a trial-based economic evaluation

Trials ◽

10.1186/s13063-021-05722-7 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Raíza Dias Freitas ◽

Bruna Lorena Pereira Moro ◽

Laura Regina Antunes Pontes ◽

Haline Cunha Medeiros Maia ◽

Ana Laura Passaro ◽

...

Keyword(s):

Economic Evaluation ◽

Minimally Invasive ◽

Economic Impact ◽

Primary Teeth ◽

Economic Evaluations ◽

Health Economic Analysis ◽

Main Trial ◽

Invasive Strategy ◽

Diagnostic Strategies ◽

Related Quality

Abstract Background Different approaches have been used by dentists to base their decision. Among them, there are the aesthetical issues that may lead to more interventionist approaches. Indeed, using a more interventionist strategy (the World Dental Federation - FDI), more replacements tend to be indicated than using a minimally invasive one (based on the Caries Around Restorations and Sealants—CARS). Since the resources related to the long-term health effects of these strategies have not been explored, the economic impact of using the less-invasive strategy is still uncertain. Thus, this health economic analysis plan aims to describe methodologic approaches for conducting a trial-based economic evaluation that aims to assess whether a minimally invasive strategy is more efficient in allocating resources than the conventional strategy for managing restorations in primary teeth and extrapolating these findings to a longer time horizon. Methods A trial-based economic evaluation will be conducted, including three cost-effectiveness analyses (CEA) and one cost-utility analysis (CUA). These analyses will be based on the main trial (CARDEC-03/NCT03520309), in which children aged 3 to 10 were included and randomized to one of the diagnostic strategies (based on FDI or CARS). An examiner will assess children’s restorations using the randomized strategy, and treatment will be recommended according to the same criteria. The time horizon for this study is 2 years, and we will adopt the societal perspective. The average costs per child for 24 months will be calculated. Three different cost-effectiveness analyses (CEA) will be performed. For CEAs, the effects will be the number of operative interventions (primary CEA analysis), the time to these new interventions, the percentage of patients who did not need new interventions in the follow-up, and changes in children’s oral health-related quality of life (secondary analyses). For CUA, the effect will be tooth-related quality-adjusted life years (QALYs). Intention-to-treat analyses will be conducted. Finally, we will assess the difference when using the minimally invasive strategy for each health effect (∆effect) compared to the conventional strategy (based on FDI) as the reference strategy. The same will be calculated for related costs (∆cost). The discount rate of 5% will be applied for costs and effects. We will perform deterministic and probabilistic sensitivity analyses to handle uncertainties. The net benefit will be calculated, and acceptability curves plotted using different willingness-to-pay thresholds. Using Markov models, a longer-term economic evaluation will be carried out with trial results extrapolated over a primary tooth lifetime horizon. Discussion The main trial is ongoing, and data collection is still not finished. Therefore, economic evaluation has not commenced. We hypothesize that conventional strategy will be associated with more need for replacements of restorations in primary molars. These replacements may lead to more reinterventions, leading to higher costs after 2 years. The health effects will be a crucial aspect to take into account when deciding whether the minimally invasive strategy will be more efficient in allocating resources than the conventional strategy when considering the management of restorations in primary teeth. Finally, patients/parents preferences and consequent utility values may also influence this final conclusion about the economic aspects of implementing the minimally invasive approach for managing restorations in clinical practice. Therefore, these trial-based economic evaluations may bring actual evidence of the economic impact of such interventions. Trial registration NCT03520309. Registered May 9, 2018. Economic evaluations (the focus of this plan) are not initiated at the moment.

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Health economic measures in schizophrenia research

The British Journal of Psychiatry ◽

10.1192/bjp.191.50.s42 ◽

2007 ◽

Vol 191 (S50) ◽

pp. s42-s45 ◽

Cited By ~ 10

Author(s):

Paul McCrone

Keyword(s):

Health Economic ◽

Economic Evaluation ◽

Cost Utility ◽

Outcome Data ◽

Cost Utility Analysis ◽

Economic Evaluations ◽

Utility Analysis ◽

Short Term ◽

Effectiveness Analysis

BackgroundIt is essential in economic evaluations of schizophrenia interventions that all relevant costs are identified and measured appropriately Also of importance is the way in which cost data are combined with information on outcomesAimsTo examine the use of health economicsin evaluations of interventions for schizophreniaMethodsAreview of the key methods used to estimate costs and to link costs and outcomes was conductedResultsCosts fall on a number of different agencies and can be short term or long term. Cost-effectiveness analysis and cost-utility analysis are the most appropriate methods for combing cost and outcome dataConclusionsSchizophrenia poses a number of challenges for economic evaluation

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Resource allocation and economic evaluation in Australia's healthcare system

Australian Health Review ◽

10.1071/ah10890 ◽

2011 ◽

Vol 35 (3) ◽

pp. 278 ◽

Cited By ~ 11

Author(s):

Abdolvahab Baghbanian ◽

Ian Hughes ◽

Freidoon A. Khavarpour

Keyword(s):

Decision Making ◽

Resource Allocation ◽

Economic Evaluation ◽

Cost Effectiveness ◽

Decision Makers ◽

Economic Evaluations ◽

Healthcare Decision ◽

Effectiveness Analysis ◽

Allocation Decisions ◽

Resource Allocation Decisions

Objective. To explore dimensions and varieties of economic evaluations that healthcare decision-makers do or do not use. Design. Web-based survey. Setting and participants. A purposive sample of Australian healthcare decision-makers was recruited by direct invitation through email. All were invited to complete an online questionnaire derived from the EUROMET 2004 survey. Results. A total of 91 questionnaires were analysed. Almost all participants were involved in financial resource allocations. Most commonly, participants based their decisions on patient needs, effectiveness of interventions, cost of interventions or overall budgetary effect, and policy directives. Evidence from cost-effectiveness analysis was used by half of the participants. Timing, ethical issues and lack of knowledge about economic evaluation were the most significant barriers to the use of economic evaluations in resource allocation decisions. Most participants reported being moderately to very familiar with the cost-effectiveness analysis. There was a general impression that evidence from economic evaluations should play a larger role in the future. Conclusions. Evidence from health economic evaluations may provide valuable information in some decisions; however, at present, it is not central to many decisions. The study suggests that, for economic evaluation to be helpful in real-life policy decisions, it has to be placed into context – a context which is complex, political and often resistant to voluntary change. What is known about the topic? There are increasing calls for the use of evidence from formal economic evaluations to improve the quality of healthcare decision making; however, it is widely acknowledged that such evidence, as presently constituted, is underused in its influence on allocation decisions. What does this paper add? This study highlights that resource allocation decisions cannot be purely based on the use of technical, economic data or systematic evidence-based reviews. In order to exploit the full potential value of economic evaluations, researchers need to make better sense of decision contexts at specific times and places. What are the implications for practitioners? The study has the potential to expand researchers and policy-makers’ understanding of the limited use of economic evaluation in decision-making. It produces evidence that decision-making in Australia’s healthcare system is not or cannot be a fully rational bounded process. Economic evaluation is used in some contexts, where information is accurate, complete and available.

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Economic Evaluation in Neurological Physiotherapy: A Systematic Review

Brain Sciences ◽

10.3390/brainsci11020265 ◽

2021 ◽

Vol 11 (2) ◽

pp. 265

Author(s):

David García-Álvarez ◽

Núria Sempere-Rubio ◽

Raquel Faubel

Keyword(s):

Systematic Review ◽

Economic Evaluation ◽

Cost Utility ◽

Economic Evaluations ◽

Evidence Based ◽

Stroke Patients ◽

Upward Trend ◽

Effectiveness Analysis ◽

The Usa ◽

The Uk

This systematic review was carried out to compile and assess original studies that included economic evaluations of neurological physiotherapy interventions. A thorough search of PubMED, Cochrane and Embase was developed using keywords such as health economics, neurological physiotherapy and cost analysis, and studies published during the last six-year term were selected. A total of 3124 studies were analyzed, and 43 were eligible for inclusion. Among the studies analyzed, 48.8% were interventions for stroke patients, and 13.9% were focused on Parkinson’s disease. In terms of the countries involved, 46.5% of the studies included were developed in the UK, and 13.9% were from the USA. The economic analysis most frequently used was cost-utility, implemented in 22 of the studies. A cost-effectiveness analysis was also developed in nine of those studies. The distribution of studies including an economic evaluation in this discipline showed a clear geographic dominance in terms of the pathology. A clear upward trend was noted in the economic evaluation of interventions developed in neurological physiotherapy. However, these studies should be promoted for their use in evidence-based clinical practice and decision-making.

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Efficiency of Diagnostic Testing for Helicobacter pylori Infections—A Systematic Review

Antibiotics ◽

10.3390/antibiotics10010055 ◽

2021 ◽

Vol 10 (1) ◽

pp. 55

Author(s):

Paula Rojas García ◽

Simon van der Pol ◽

Antoinette D. I. van Asselt ◽

Maarten Postma ◽

Roberto Rodríguez-Ibeas ◽

...

Keyword(s):

Systematic Review ◽

Helicobacter Pylori ◽

Economic Evaluation ◽

Evaluation Studies ◽

Diagnostic Testing ◽

Health Economic Evaluation ◽

Cost Effective ◽

Economic Evaluations ◽

Diagnostic Strategies ◽

H Pylori

Background: The most recommended treatment for a Helicobacter pylori infection is high doses of combined antibiotics. The objective of this article is to perform a systematic review of the economic evaluation studies applied to assess the efficiency of diagnostic testing for H. pylori infections, so that their main characteristics can be identified and to learn from the literature how the antimicrobial resistance (AMR) issue is incorporated into these economic evaluations. Methods: We conducted a systematic review to compare the costs and clinical effectiveness of diagnostic strategies for H. pylori infections. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and extracted the items from the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. Results: We found thirteen articles that were of good quality according to CHEERS: six studies focused on diagnostics of Helicobacter pylori infections associated with dyspepsia and four on duodenal ulcers. Testing was found to be the most cost-effective strategy in eight articles. Four studies considered AMR. Conclusions: Testing was more cost-effective than empirical treatment, except in cases of high prevalence (as with developing countries) or when patients could be stratified according to their comorbidities. The introduction of AMR into the model may change the efficiency of the testing strategy.

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In search of the evidentiary foundation of published Canadian economic evaluations (2001–06)

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462309090278 ◽

2009 ◽

Vol 25 (02) ◽

pp. 214-221

Author(s):

Jean-Eric Tarride ◽

Morgan E. Lim ◽

James M. Bowen ◽

Catherine Elizabeth McCarron ◽

Gord Blackhouse ◽

...

Keyword(s):

Economic Evaluation ◽

Statistical Methods ◽

Resource Utilization ◽

Sensitivity Analyses ◽

Economic Evaluations ◽

Design Data ◽

Effectiveness Analysis ◽

Modeling Techniques ◽

Canadian Perspective ◽

Utilization Data

Objectives:The aim of this study was to present a review of economic evaluations conducted from a Canadian perspective and to characterize sources of evidence and statistical methods to analyze effectiveness measures, resource utilization, and uncertainty.Methods:A search strategy was developed to identify Canadian economic evaluations published between January 2001 and June 2006. A standardized abstraction form was used to extract key data (e.g., study design, data sources, statistical methods).Results:A total of 153 unique studies were included for review, of which 75 were evaluations of drug therapies and less than half were funded by industry. Cost-effectiveness analysis was the most common type of economic evaluation and 80 percent of the studies used modeling techniques. A single source of evidence for effectiveness measures was used in half of the studies. Statistical methods were commonly reported to compare effectiveness measures when the economic evaluation was conducted alongside a clinical trial but less commonly when determining effectiveness input parameters in model-based economic evaluations, or to analyze resource utilization data. Authors relied mostly on univariate sensitivity analyses to explore uncertainty.Conclusions:This review identifies the need to improve the conduct and reporting of statistical methods for economic evaluations to improve confidence in the results.

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Looking forward and looking backward: Economic evaluations and regime support in China

Politics ◽

10.1177/0263395721989545 ◽

2021 ◽

pp. 026339572198954

Author(s):

Yida Zhai

Keyword(s):

Economic Evaluation ◽

National Economy ◽

Authoritarian Regimes ◽

Economic Situation ◽

Economic Conditions ◽

Economic Evaluations ◽

Age Cohorts ◽

Psychological Mechanism ◽

The Stability ◽

Regime Support

It is widely acknowledged that the economic situation is of vital importance for the stability of an authoritarian regime, but it is rarely known how the public’s economic evaluation contributes to such outcomes. This study examines the effects of citizens’ retrospective and prospective evaluations of their household economic situation and the national economy on the level of regime support in China. The findings show that the national economy outweighs household economic conditions in its effects on the public’s support of the regime. However, the gap between evaluations of the national economy and individual economic situations debilitates regime support. The population in different age cohorts has distinct patterns of relationships between retrospective and prospective economic evaluations and regime support. This study elucidates the political-psychological mechanism of the public’s economic evaluation affecting regime support, and the ruling strategy in authoritarian regimes of manipulating this evaluation.

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Cost-effectiveness of new MDR-TB regimens: study protocol for the TB-PRACTECAL economic evaluation substudy

BMJ Open ◽

10.1136/bmjopen-2019-036599 ◽

2020 ◽

Vol 10 (10) ◽

pp. e036599

Author(s):

Sedona Sweeney ◽

Gabriela Gomez ◽

Nichola Kitson ◽

Animesh Sinha ◽

Natalia Yatskevich ◽

...

Keyword(s):

Economic Evaluation ◽

Cost Effectiveness ◽

Best Practice ◽

Current Treatment ◽

Outcome Data ◽

London School ◽

Main Trial ◽

Ethical Approval ◽

Mdr Tb ◽

The Impact

IntroductionCurrent treatment regimens for multidrug-resistant tuberculosis (MDR-TB) are long, poorly tolerated and have poor outcomes. Furthermore, the costs of treating MDR-TB are much greater than those for treating drug-susceptible TB, both for health service and patient-incurred costs. Urgent action is needed to identify short, effective, tolerable and cheaper treatments for people with both quinolone-susceptible and quinolone-resistant MDR-TB. We present the protocol for an economic evaluation (PRACTECAL-EE substudy) alongside an ongoing clinical trial (TB-PRACTECAL) aiming to assess the costs to patients and providers of new regimens, as well as their cost-effectiveness and impact on participant poverty levels. This substudy is based on data from the three countries participating in the main trial.Methods and analysisPrimary cost data will be collected from the provider and patient perspectives, following economic best practice. We will estimate the probability that new MDR-TB regimens containing bedaquiline, pretomanid and linezolid are cost-effective from a societal perspective as compared with the standard of care for MDR-TB patients in Uzbekistan, South Africa and Belarus. Analysis uses a Markov model populated with primary cost and outcome data collected at each study site. We will also estimate the impact of new regimens on prevalence of catastrophic patient costs due to TB.Ethics and disseminationEthical approval has been obtained from the London School of Hygiene & Tropical Medicine and Médecins Sans Frontières. Local ethical approval will be sought in each study site. The results of the economic evaluation will be shared with the country health authorities and published in a peer-reviewed journal.Trial registration numberClinicalTrials.gov Registry (NCT04207112); Pre-results.

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Economic impact of the use of the National Surgical Quality Improvement Program

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462320000616 ◽

2021 ◽

Vol 37 (1) ◽

Author(s):

Alvine Fansi ◽

Angela Ly ◽

Julie Mayrand ◽

Maggy Wassef ◽

Aldanie Rho ◽

...

Keyword(s):

Quality Improvement ◽

Cost Analysis ◽

Economic Impact ◽

Quality Improvement Program ◽

Economic Evaluations ◽

Complication Rates ◽

Improvement Program ◽

Surgical Quality ◽

Acs Nsqip ◽

The Cost

Objectives The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP®) is a validated, risk-adjusted database for improving the quality and security of surgical care. ACS NSQIP can help participating hospitals target areas that need improvement. The aim of this study was to systematically review the literature analyzing the economic impact of using NSQIP. This paper also provides an estimation of annual cost savings following the implementation of NSQIP and quality improvement (QI) activities in two hospitals in Quebec. Methods In June 2018, we searched in seven databases, including PubMed, Embase, and NHSEED for economic evaluations based on NSQIP data. Contextual NSQIP databases from two hospitals were collected and analyzed. A cost analysis was conducted from the hospital care perspective, comparing complication costs before and after 1 year of the implementation of NSQIP and QI activities. The number and the cost of complications are measured. Costs are presented in 2018 Canadian dollars. Results Out of 1,612 studies, 11 were selected. The level of overall evidence was judged to be of moderate to high quality. In general, data showed that, following the implementation of NSQIP and QI activities, a significant decrease in complications and associated costs was observed, which improved with time. In the cost analysis of contextual data, the reduction in complication costs outweighed the cost of implementing NSQIP. However, this cost analysis did not take into account the costs of QI activities. Conclusions NSQIP improves complication rates and associated costs when QI activities are implemented.

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