| 1. |
- Fransson, Helena, et al.
(författare)
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There is a paucity of economic evaluations of prediction methods of caries and periodontitis : A systematic review
- 2021
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Ingår i: Clinical and Experimental Dental Research. - : John Wiley & Sons. - 2057-4347. ; 7:3, s. 385-398
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Direct cost for methods of prediction also named risk assessment in dentistry may be negligible compared with the cost of extensive constructions. On the other hand, as risk assessment is performed daily and for several patients in general dental practice, the costs may be considerable. The objective was to summarize evidence in studies of economic evaluation of prognostic prediction multivariable models and methods of caries and periodontitis and to identify knowledge gaps (PROSPERO registration number: CRD42020149763). Material and methods: Four electronic databases (PubMed, Web of Science, The Cochrane Library, NHS Economic Evaluation Database) and reference lists of included studies were searched. Titles and abstracts were screened by two reviewers in parallel. Full-text studies reporting resources used, costs and cost-effectiveness of prediction models and methods were selected and critically appraised using a protocol based on items from the CHEERS checklist for economic evaluations and the CHARMS checklist for evaluation of prediction studies. Results: From 38 selected studies, six studies on prediction fulfilled the eligibility criteria, four on caries and two on periodontitis. As the economic evaluations differed in method and perspective among the studies, the results could not be generalized. Our systematic review revealed methodological shortcomings regarding the description of predictive models and methods, and particularly of the economic evaluation. Conclusions: The systematic review highlighted a paucity of economic evaluations regarding methods or multivariable models for prediction of caries and periodontitis. Our results indicate that what we currently practice using models and methods to predict caries and periodontitis lacks evidence regarding cost-effectiveness.
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| 2. |
- Christell, Helena, et al.
(författare)
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A framework for costing diagnostic methods in oral health care : an application comparing a new imaging technology with the conventional approach for maxillary canines with eruption disturbances
- 2012
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Ingår i: Community Dentistry and Oral Epidemiology. - : John Wiley & Sons. - 0301-5661 .- 1600-0528. ; 40:4, s. 351-361
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The aims were (i) to propose a framework for costing diagnostic methods in oral health care and (ii) to illustrate the application of the framework to the radiographic examination of maxillary canines with eruption disturbances. Methods: The framework for costing, following Drummond et al.(2005), includes three elements: (i) identification of different resources used in producing and delivering the service, (ii) measurement of the amount of each resource required and (iii) valuation of the resources in monetary terms. Four data collection instruments were designed – a protocol for apportioning the cost of capital equipment to each diagnostic procedure, separate forms for recording consumable items, for the time of different health care providers used for a diagnostic examination and a patient survey for calculation of the total cost to the patient associated with the examination. The framework was applied to the radiographic examination of maxillary canines with eruption disturbances comparing two imaging methods: (i) a new method with cone beam computed tomography and panoramic radiography and (ii) a conventional method using intraoral and panoramic radiography. The primary analysis was performed from the perspective of the health care system. A separate analysis included patient costs with health care system costs to provide a societal perspective. Comparison of the two perspectives allows consideration of whether any costs savings to the health care system are generated at the expense of greater costs for patients and their families. Data for the cost-analysis were retrieved from 47 patients (mean age 14 years) referred to a department of radiology for examination of maxillary canines. Results:Application of the framework for costing allowed us to compare the resources used to perform examinations of the two methods. The mean total cost per examination for the new method was 128.38€ and 81.80€ for the conventional method, resulting in an incremental cost per examination of the new method of 46.58€. Conclusions: The application of the framework demonstrates the feasibility of measuring and comparing the total costs as well as the distribution of total costs between providers and patients for different approaches to this common examination.
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| 3. |
- Christell, Helena
(författare)
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Cost and benefits of cone beam computed tomography : for maxillary canines with eruption disturbance
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- I tandvården finns allt fler metoder för prevention, diagnostik och behandling. Eftersom resurserna är begränsade bör den metod väljas där nyttan uppväger kostnaden. Idag saknas dock vetenskapliga belägg gällande kostnadseffektivitet för undersökning med Cone Beam Computed Tomography (CBCT). En systematisk översikt i Studie I identifierade 160 hälsoekonomiska utvärderingar inom tandvård varav 12 gällande diagnostiska metoder. Översikten kunde inte identifiera någon kostnadsanalys på patientnivå för diagnostiska metoder. Därför konstruerades i Studie II ett ramverk för analys av kostnader förknippade med diagnostiska metoder i tandvården. Applicering av ramverket visade att CBCT och panoramaröntgen hade en signifikant högre kostnad (128,80€) jämfört med intraoral och panoramaröntgen (81,80€). I Studie III jämfördes kostnader för CBCT undersökning av patienter med olika kliniska tillstånd på kliniker i Cluj -Rumänien, Leuven -Belgien, Malmö -Sverige och Vilnius -Litauen. Klinikrelaterade kostnader varierade mellan sjukvårdssystemen vilket främst berodde på olika höga inköpskostnader för CBCT-apparaterna. I enkätundersökning i Studie IV ombads specialister i tandreglering att ta beslut om behandling gällande patienter med misstanke om eruptionsstörning av överkäkshörntanden. Majoriteten av behandlingsvalen var samma oavsett om de hade tillgång till CBCT och panorama eller till intraoral röntgen och panorama.Sammanfattningsvis kan sägas att det finns ett stort behov av hälsoekonomiska studier med god kvalitet gällande diagnostiska metoder inom tandvård. Undersökning med CBCT medför en högre kostnad än konventionella röntgenmetoder och för majoriteten av patienter med misstanke om eruptionsstörning av överkäkshörntänderna medför den ingen extra nytta avseende behandlingsbeslut.
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| 4. |
- Christell, Helena, et al.
(författare)
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Economic evaluation in oral health care
- 2009
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Ingår i: Programme and abstract book. ; , s. 70-70
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Introduction Economic evaluation attempts to weigh costs and effects of alternative interventions with the goal that available resources are used to achieve maximum benefits for patients in terms of health and quality of life. In emerging technologies this is particularly important to avoid inappropriate and excessive use. Objectives To analyse evidence on economic evaluation in oral health care, particularly on diagnostic imaging methods, by systematic review. Material and methods A search for literature was made starting with a hand made search according to the pearl growing model. This search strategy means that articles and relevant literature are retrieved by talking to renowned specialists in the subject area and by finding indexing and MeSH terms by looking at those articles and their reference lists. From seven articles indexing terms and MeSH terms were chosen and searches were made from PubMed, the Cochrane Library and Science Citations Index. The retrieved primary studies that according to the abstract contained a cost-effectiveness analysis were interpreted by two reviewers using a check-list for assessing economic evaluations (Drummond et al. 2005). Results The literature search yielded 258 titles and abstracts. Out of these, 93 studies were selected and read in full text. There was a vast heterogeneity in study design. No clear evidence was found. Methodology regarding the odontological part was acceptable in a few studies but the methodology for the economic evaluation was insufficient. Conclusions and discussion This review reveals a need for studies with improved quality in economic evaluation in oral health care. We will propose and discuss a model for economic evaluation of diagnostic methods that will contain information of how to (i) identify costs (ii) categorise costs and (iii) value costs. This model will be applied in the SEDENTEXCT project on Cone Beam Computed Tomography. Reference: Drummond MF, Sculpher MJ, Torrance GW, O´Brian BJ, Stoddart GL. Methods for the economic evaluation of health care programmes, Oxford, 2005, Oxford Medical Publications, 3rd ed. The research leading to these results has received funding from the European Atomic Energy Community’s Seventh Framework Programme FP7/2007-2011 under grant agreement no 212246 (SEDENTEXCT: Safety and Efficacy of a New and Emerging Dental X-ray Modality).
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| 5. |
- Christell, Helena, et al.
(författare)
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Economic evaluation of diagnostic methods used in dentistry : a systematic review
- 2014
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Ingår i: Journal of Dentistry. - : Elsevier. - 0300-5712 .- 1879-176X. ; 42:11, s. 1361-1371
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Forskningsöversikt (refereegranskat)abstract
- OBJECTIVES: To review the literature of economic evaluations regarding diagnostic methods used in dentistry. DATA SOURCES: Four databases (MEDLINE, Web of Science, The Cochrane library, the NHS Economic Evaluation Database) were searched for studies, complemented by hand search, until February 2013. STUDY SELECTION: Two authors independently screened all titles or abstracts and then applied inclusion and exclusion criteria to select full-text publications published in English, which reported an economic evaluation comparing at least two alternative methods. Studies of diagnostic methods were assessed by four reviewers using a protocol based on the QUADAS tool regarding diagnostic methods and a check-list for economic evaluations. The results of the data extraction were summarized in a structured table and as a narrative description. RESULTS: From 476 identified full-text publications, 160 were considered to be economic evaluations. Only 12 studies (7%) were on diagnostic methods, whilst 78 studies (49%) were on prevention and 70 (40%) on treatment. Among studies on diagnostic methods, there was between-study heterogeneity methodologically, regarding the diagnostic method analysed and type of economic evaluation addressed. Generally, the choice of economic evaluation method was not justified and the perspective of the study not stated. Costing of diagnostic methods varied. CONCLUSIONS: A small body of literature addresses economic evaluation of diagnostic methods in dentistry. Thus, there is a need for studies from various perspectives with well defined research questions and measures of the cost and effectiveness. CLINICAL SIGNIFICANCE: Economic resources in healthcare are finite. For diagnostic methods, an understanding of efficacy provides only part of the information needed for evidence-based practice. This study highlighted a paucity of economic evaluations of diagnostic methods used in dentistry, indicating that much of what we practise lacks sufficient evidence.
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| 6. |
- Christell, Helena, et al.
(författare)
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The impact of Cone Beam CT on financial costs and orthodontists' treatment decisions in the management of maxillary canines with eruption disturbance
- 2018
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Ingår i: European Journal of Orthodontics. - : Oxford University Press. - 0141-5387 .- 1460-2210. ; :1, s. 65-73
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Tidskriftsartikel (refereegranskat)abstract
- Background: Examination with Cone Beam CT (CBCT) is common for localizing maxillary canines with eruption disturbance. The benefits and costs of these examinations are unclear. Objectives: To measure: 1. the proportion of orthodontists' treatment decisions that were different based on intraoral and panoramic radiography (M1) compared with CBCT and panoramic radiography (M2); and 2. the costs of producing different treatment plans, regarding patients with maxillary canines with eruption disturbance. Subjects and methods: Orthodontists participated in a web-based survey and were randomly assigned to denote treatment decisions and the level of confidence in this decision for four patient cases presented with M1 or M2 at two occasions for the same patient case. Results: One hundred and twelve orthodontists made 445 assessments based on M1 and M2, respectively. Twenty-four per cent of the treatment decisions were different depending on which method the raters had access to, whereof one case differed significantly from all other cases. The mean total cost per examination was €99.84 using M1 and €134.37 using M2, resulting in an incremental cost per examination of €34.53 for M2. Limitations: Benefits in terms of number of different treatment decisions must be considered as an intermediate outcome for the effectiveness of a diagnostic method and should be interpreted with caution. Conclusions: For the patient cases presented in this study, most treatment decisions were the same irrespective of radiological method. Accordingly, this study does not support routine use of CBCT regarding patients with maxillary canine with eruption disturbance.
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| 7. |
- Christell, Helena, et al.
(författare)
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Variation in costs of cone beam CT examinations among health care systems
- 2012
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Ingår i: Dento-Maxillo-Facial Radiology. - : British Institute of Radiology. - 0250-832X .- 1476-542X. ; 41:7, s. 571-577
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To analyse the costs of cone beam CT (CBCT) in different healthcare systems for patients with different clinical conditions. Methods: Costs were calculated for CBCT performed in Cluj (Romania), Leuven (Belgium), Malmö (Sweden) and Vilnius (Lithuania) on patients with (i) a maxillary canine with eruption disturbance, (ii) an area with tooth loss prior to implant treatment or (iii) a lower wisdom tooth planned for removal. The costs were calculated using an approach based on the identification, measurement and valuation of all resources used in the delivery of the service that combined direct costs (capital equipment, accommodation, labour) with indirect costs (patients’ and accompanying persons’ time, ‘‘out of pocket’’ costs for examination fee and visits). Results: The estimates for direct and indirect costs varied among the healthcare systems, being highest in Malmö and lowest in Leuven. Variation in direct costs was mainly owing to different capital costs for the CBCT equipment arising from differences in purchase prices (range J148 000–227 000). Variation in indirect costs were mainly owing to examination fees (range J0–102.02). Conclusions: Cost analysis provides an important input for economic evaluations of diagnostic methods in different healthcare systems and for planning of service delivery. Additionally, it enables decision-makers to separate variations in costs between systems into those due to external influences and those due to policy decisions. A cost evaluation of a dental radiographic method cannot be generalized from one healthcare system to another, but must take into account these specific circumstances.
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| 8. |
- Christell, Helena, et al.
(författare)
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Willingness to pay for osteoporosis risk assessment in primary dental care
- 2019
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Ingår i: Health Economics Review. - : BioMed Central (BMC). - 2191-1991. ; 9:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Fragility fracture related to osteoporosis among postmenopausal women is a significant cause of morbidity. The care and aftercare of these fractures are associated with substantial costs to society. A main problem is that many individuals suffer from osteoporosis without knowing it before a fracture happens. Dentists may have an important role in early identification of individuals with osteoporosis by assessment of dental radiographs already included in the dental examination. The aim of this study was therefore to investigate postmenopausal women's preferences for an osteoporosis risk assessment in primary dental care. Results: Most respondents (129 of 144 (90%)) were willing to pay for an osteoporosis risk assessment in primary dental care. The overall mean willingness to pay (WTP) including respondents that denoted none or zero WTP was 44.60 Euro (CI 95% 38.46-50.74 Euro) (median 34.75 Euro). A majority (80.6%) of the respondents that denoted WTP also gave a motivation for their answer. The two most common reasons denoted for being willing to pay for osteoporosis risk assessment were the importance of early diagnosis and preventive care to avoid fractures (41.0%) and the importance of knowledge of a risk of osteoporosis (26.4%). A majority of respondents (67.8%) considered it valuable if dental clinics would offer osteoporosis risk assessment. Conclusions: Postmenopausal women seem to find it valuable to be offered osteoporosis risk assessment in primary dental care and are willing to pay for such a risk assessment. From a societal perspective early diagnosis of osteoporosis by risk assessment in primary dental care could prevent osteoporotic related fractures and benefit women's health and quality of life, as well as have a major impact on the health-care budget in terms of cost-savings.
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| 9. |
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Vetenskap och beprövad erfarenhet. Tandvård
- 2019
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Samlingsverk (redaktörskap) (övrigt vetenskapligt/konstnärligt)abstract
- Detta är den nionde skriften i forskningsprogrammet Vetenskap och beprövad erfarenhets (VBE:s) skriftserie om begreppet vetenskap och beprövad erfarenhet. Denna gång är skriften resultatet av ett pågående samarbete med forskningsprogrammet Foresight vid Malmö universitet. Foresights forskning är inriktad på att hitta nya verktyg för att identifiera patienter som löper ökad risk för karies och tandlossning. Kunskaper om munhålans bakterieflora, biomarkörer och avancerad teknik skall gemensamt leda till effektiva prediktionsmodeller och ett bättre förebyggande arbete. Klinikern skall få användbara redskap. Det är inte alltid vetenskap och beprövad erfarenhet går hand i hand. Ibland finns vetenskapen men inte erfarenheten. De prediktionsmodeller Foresight skall forska fram kommer, när de blir verklighet, att behöva kompletteras med beprövad erfarenhet. Instrumenten och modellerna måste testas ute på klinikerna. Ibland finns erfarenheten men inte vetenskapen. I viss mån har tandvården kanske vuxit fram på det sättet. Och ibland står den praktiska erfarenheten i strid med samtida forskningsrön. Oavsett hur situationen ser ut påverkar kunskapsläget (vetenskap och beprövad erfarenhet) tandläkarens beslutsfattande, gör det enkelt eller komplicerat. Men det påverkar också på ett avgörande sätt utbildningen av framtidens tandvårdspersonal.Vetenskap och beprövad erfarenhet är ett viktigt begrepp, och att det är av stor betydelse framgår tydligt om man tittar närmare på tandvården.
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