scholarly journals Effectiveness, Costs and Patient Acceptance of a Conventional and a Biological Treatment Approach for Carious Primary Teeth in Children

2018 ◽  
Vol 53 (1) ◽  
pp. 65-75 ◽  
Author(s):  
Alaa BaniHani ◽  
Chris Deery ◽  
Jack Toumba ◽  
Monty Duggal
Keyword(s):  
Cost Effectiveness ◽  
Primary Teeth ◽  
Treatment Costs ◽  
Selective Removal ◽  
Patient Acceptance ◽  
Treatment Approaches ◽  
Biological Approach ◽  
Significant Difference ◽  
Prospective Study Design ◽  
Hall Technique

Background: Over the last years, conventional restorations for the treatment of active carious lesions (CL) in primary teeth have been challenged and a more biological approach has been suggested. This approach involves less invasive techniques that alter the environment of the CL isolating it from the cariogenic biofilm and substrate. Aim: To investigate the cost-effectiveness and patient acceptance of 2 treatment approaches for the treatment of deep CLs in primary teeth in children. Methods: This was a retrospective/prospective cohort study carried out in 2 UK specialist hospital settings. Data on cost-effectiveness was extracted retrospectively from clinical dental records of 246 patients aged 4–9 years. A prospective study design was used to explore patient acceptance of the 2 treatment approaches. One hundred and ten patients aged 4–9 years and their carers completed 2 questionnaires on treatment acceptance. Results: In total, 836 primary teeth that had received treatment with either approach were included. More than 2 thirds (75.7%) of the restorations in the conventional approach were of non-selective removal to hard dentine followed by pulpotomy (24.3%). In the biological approach, most of the restorations were stainless steel crowns placed with the Hall Technique (95%) followed by selective removal to firm dentine (5%). The majority of the primary teeth remained asymptomatic after a follow-up period of up to 77 months; 95.3% in the conventional and 95.8% in the biological arm. When the treatment costs were analysed, a statistically significant difference was found between the mean costs of the 2 approaches with a mean difference of GBP 45.20 (Pound Sterling; p < 0.001), in favour of the biological approach. The majority of the children and carers were happy with the conventional or biological restorations. Conclusion: Although both approaches had similar successful outcomes, the biological approach consisting mainly of Hall Technique was associated with reduced treatment costs. Both approaches were accepted favourably by the children and carers.

scholarly journals Cost-effectiveness of the Hall Technique in a Randomized Trial

2018 ◽  
Vol 98 (1) ◽  
pp. 61-67 ◽  
Author(s):  
F. Schwendicke ◽  
J. Krois ◽  
M. Robertson ◽  
C. Splieth ◽  
R. Santamaria ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Dental Treatment ◽  
Treatment Costs ◽  
Primary Molars ◽  
Opportunity Costs ◽  
Data Set ◽  
Dental Practitioners ◽  
Patient Reported ◽  
The Cost ◽  
Hall Technique

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.

Long-term treatment costs and cost-effectiveness of restoration repair versus replacement

2021 ◽  
Author(s):  
Philipp Kanzow ◽  
Joachim Krois ◽  
Annette Wiegand ◽  
Falk Schwendicke
Keyword(s):  
Cost Effectiveness ◽  
Term Treatment ◽  
Treatment Costs ◽  
Long Term Treatment

scholarly journals Cost-Effectiveness of Initial Revision Digit Amputation Performed in the Emergency Department Versus the Operating Room

Hand ◽  
2018 ◽  
Vol 15 (2) ◽  
pp. 208-214 ◽  
Author(s):  
Joseph A. Gil ◽  
Avi D. Goodman ◽  
Andrew P. Harris ◽  
Neill Y. Li ◽  
Arnold-Peter C. Weiss
Keyword(s):  
Emergency Department ◽  
Cost Effectiveness ◽  
Operating Room ◽  
Cost Effective ◽  
Initial Management ◽  
Fingertip Amputation ◽  
Significant Difference ◽  
Initial Procedure ◽  
The Cost ◽  
Cost Effectiveness Threshold

Background: The objective of this study was to determine the comparative cost-effectiveness of performing initial revision finger amputation in the emergency department (ED) versus in the operating room (OR) accounting for need for unplanned secondary revision in the OR. Methods: We retrospectively examined patients presenting to the ED with traumatic finger and thumb amputations from January 2010 to December 2015. Only those treated with primarily revision amputation were included. Following initial management, the need for unplanned reoperation was assessed and associated with setting of initial management. A sensitivity analysis was used to determine the cost-effectiveness threshold for initial management in the ED versus the OR. Results: Five hundred thirty-seven patients had 677 fingertip amputations, of whom 91 digits were initially primarily revised in the OR, and 586 digits were primarily revised in the ED. Following initial revision, 91 digits required unplanned secondary revision. The unplanned secondary revision rates were similar between settings: 13.7% digits from the ED and 12.1% of digits from the OR ( P = .57). When accounting for direct costs, an incidence of unplanned revision above 77.0% after initial revision fingertip amputation in the ED would make initial revision fingertip amputation in the OR cost-effective. Therefore, based on the unplanned secondary revision rate, initial management in the ED is more cost-effective than in the OR. Conclusions: There is no significant difference in the incidence of unplanned/secondary revision of fingertip amputation rate after the initial procedure was performed in the ED versus the OR.

An in Vivo Comparison of Antimicrobial Efficacy of Sodium Hypochlorite and Biopure MTAD™ against Enterococcus Faecalis in Primary Teeth: A qPCR Study

2014 ◽  
Vol 39 (1) ◽  
pp. 30-34 ◽  
Author(s):  
SG Tulsani ◽  
N Chikkanarasaiah ◽  
S Bethur
Keyword(s):  
Root Canal ◽  
Primary Teeth ◽  
Antimicrobial Efficacy ◽  
Permanent Teeth ◽  
Control Group ◽  
Statistical Significant Difference ◽  
Anterior Teeth ◽  
Significant Difference ◽  
Root Canal Irrigant

Objectives: Biopure MTAD™, a new root canal irrigant has shown promising results against the most common resistant microorganism, E. faecalis, in permanent teeth. However, there is lack of studies comparing its antimicrobial effectiveness with NaOCl in primary teeth. The purpose of this study was to compare the in vivo antimicrobial efficacy of NaOCl 2.5% and Biopure MTAD™ against E. faecalis in primary teeth. Study design: Forty non vital single rooted primary maxillary anterior teeth of children aged 4-8 years, were irrigated either with NaOCl 2.5% (n=15), Biopure MTAD™ (n=15) and 0.9% Saline (n=10, control group). Paper point samples were collected at baseline (S1) and after chemomechanical preparation (S2) during the pulpectomy procedure. The presence of E. faecalis in S1 & S2 was evaluated using Real time Polymerase Chain Reaction. Results: Statistical significant difference was found in the antimicrobial efficacy of NaOCl 2.5 % and BioPure MTAD™ when compared to saline (p&gt;0.05). However, no statistical significant difference was found between the efficacies of both the irrigants. Conclusions: NaOCl 2.5% and BioPure MTAD™, both irrigants are equally efficient against E. faecalis in necrotic primary anterior teeth. MTAD is a promising irrigant, however clinical studies are required to establish it as ideal root canal irrigant in clinical practice.

COST-EFFECTIVENESS IMPACTS CANCER CARE FUNDING DECISIONS IN BRITISH COLUMBIA, CANADA, EVIDENCE FROM 1998 TO 2008

2017 ◽  
Vol 33 (4) ◽  
pp. 481-486
Author(s):  
Zahra Ismail ◽  
Stuart J. Peacock ◽  
Laurel Kovacic ◽  
Jeffrey S. Hoch
Keyword(s):  
British Columbia ◽  
Cost Effectiveness ◽  
Outcome Measures ◽  
Nonparametric Tests ◽  
Lower Probability ◽  
Economic Evidence ◽  
Cancer Drugs ◽  
Life Years ◽  
Significant Difference ◽  
The Mean

Objectives: The Priorities and Evaluation Committee (PEC) funding recommendations for new cancer drugs in British Columbia, Canada have been based on both clinical and economic evidence. The British Columbia Ministry of Health makes funding decisions. We assessed the association between cost-effectiveness of cancer drugs considered from 1998 to 2008 and the subsequent funding decisions.Methods: All proposals submitted to the PEC between 1998 and 2008 were reviewed, and the association between cost-effectiveness and funding decisions was examined by (i) using logistic regression to test the hypothesis that interventions with higher incremental cost-effectiveness ratios (ICERs) have a lower probability of receiving a positive funding decision and (ii) using parametric and nonparametric tests to determine if a statistically significant difference exists between the mean cost-effectiveness of funded versus not funded proposals. A sub-analysis was conducted to determine if the findings varied across different outcome measures.Results: Of the 149 proposals reviewed, 78 reported cost-effectiveness using various outcome measures. In the proposals that used life-years gained as the outcome (n = 22), a statistically significant difference of nearly $115,000 was observed between the mean ICERs for funded proposals ($42,006) and for unfunded proposals ($156,967). An odds ratio indicating higher ICERs have a lower probability of being funded was also found to be statistically significant (p < .05).Conclusions: Economic evidence appears to play a role in British Columbia cancer funding decisions from 1998 to 2008; other decision-making criteria may also have an important role in recommendations and subsequent funding decisions.

scholarly journals Bond Strength of Self-Adhesive Flowable Composites and Glass Ionomer Cements to Primary Teeth: A Systematic Review and Meta-Analysis of In Vitro Studies

Materials ◽  
2021 ◽  
Vol 14 (21) ◽  
pp. 6694
Author(s):  
Flavia Iaculli ◽  
Alessandro Salucci ◽  
Gianni Di Giorgio ◽  
Valeria Luzzi ◽  
Gaetano Ierardo ◽  
...  
Keyword(s):  
Systematic Review ◽  
Bond Strength ◽  
Primary Teeth ◽  
Meta Analysis ◽  
Deciduous Teeth ◽  
Glass Ionomer Cements ◽  
Glass Ionomer ◽  
Significant Difference ◽  
Flowable Composites

Background: Conventional composites are largely used in pediatric restorative dentistry and demonstrate successful clinical outcomes. However, the need for simplification of operative steps in young or uncooperative children demands reliable alternatives. Therefore, the aim of the present systematic review and meta-analysis was to evaluate the in vitro bond strength of glass ionomer cements (GICs) and self-adhesive flowable composites (SFCs) on deciduous teeth. Methods: A comprehensive literature search according to the PRISMA checklist was manually and electronically performed by two independent reviewers through the following databases: MEDLINE/PubMed, Google Scholar, Scopus, and Embase, to include in vitro studies comparing GICs and SFCs bond strength values of restorations on primary teeth. In addition, three groups of meta-analyses were conducted using random-effects models. Results: Three articles meeting the inclusion criteria were selected and subjected to both qualitative and quantitative assessment. No statistically significant difference was found between SFC versus GIC; however, both groups significantly differed with conventional flowable composites (CFs). Conclusions: Despite the absence of significant difference in bond strength values, SFCs may be considered a valid alternative to GICs in the restoration of deciduous teeth, although CFs proved better in vitro performances.

scholarly journals Cost-utility Analysis of Extensile Lateral Approach Versus Sinus Tarsi Approach in Sanders type II/III Calcaneus Fractures

2020 ◽  
Author(s):  
Zihua Li ◽  
Xinbo Wu ◽  
Haichao Zhou ◽  
Shaochen Xu ◽  
Fajiao Xiao ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Internal Fixation ◽  
Incremental Cost ◽  
Lateral Approach ◽  
Type Ii ◽  
Calcaneus Fracture ◽  
Sinus Tarsi Approach ◽  
Significant Difference ◽  
Extensile Lateral Approach ◽  
Calcaneus Fractures

Abstract Background Extensile lateral approach had been recognized as the gold standard technique for displaced intra-articular calcaneus fractures (DIACFs) while sinus tarsi approach had been increasingly valued by surgeons. And comparative clinical outcome was shown in both techniques. Appropriate decisions could be made by the clinicians with the help of CUA about optimal healthcare for type II/III calcaneus fracture. Method A single-center, retrospective study was conducted in which basic characteristics, clinical outcomes and health care costs of 109 patients had been obtained and analyzed. Changes in health-related quality of life (HRQoL) scores, validated by EuroQol five-dimensional-three levels (EQ-5D-3L), were used to enumerate quality-adjusted life-years (QALYs). Cost-effectiveness was determined by the incremental cost per QALY. Results 109 patients were enrolled in our study including 62 in the ELA group and 47 in the STA group. There were no significant differences between these two groups in mean total cost, laboratory and radiographic evaluation expense, surgery, anesthesia and antibiotic expense. The expense of internal fixation materials ($3289.0 ± 543.9) versus ($2630.6 ± 763.7) and analgesia ($145.8 ± 85.6) versus ($102.9 ± 62.7) in ELA group were significantly higher than in the STA group ( P <.001, P =.008, respectively). Visual Analogue Scale (VAS) scores showed significant difference at postoperative 3 and 5 days ( P <.001). American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores and the Bohlers’ and Gissane angle showed no significant differences between the two groups before and after the operation. The cost-effectiveness ratios of ELA and STA were $8766.8±2835.2/QALY and $7914.9 ± 1822.0/QALY respectively and incremental cost-effectiveness ratio (ICERs) of ELA over STA was $32110.00/QALY, but both showed no significant difference. Conclusion Both ELA and STA techniques are effective operative procedures for the patients with calcaneus fracture. Moreover, STA seems to be more reasonable for its merits including less postoperative pain, and less expense of analgesia as well as internal fixation materials.

scholarly journals Comparison of Polishing Methods Used in Extrinsic Discolouration of Primary Teeth in Terms of Surface Roughiness 

2021 ◽  
Author(s):  
Burcu Duman ◽  
Salih Doğan
Keyword(s):  
Surface Roughness ◽  
Primary Teeth ◽  
Plaque Formation ◽  
Tooth Surface ◽  
Primary Tooth ◽  
Average Roughness ◽  
Primary Molar ◽  
Biofilm Growth ◽  
Tooth Discoloration ◽  
Significant Difference

Abstract BackgroundSurface roughness is one of the main factors affecting bacterial adhesion, biofilm growth, plaque formation and coloration on the tooth surface. Improper polishing may increase roughness or not contribute to a reduction in roughness while removing biofilms on tooth surfaces. The aim of this study is to examine the effects of different polishing pastes applied to the enamel of primary teeth on the surface roughness through AFM, which enables a more detailed examination of the measurements, and to evaluate the roughness changes created by the paste on the surface. MethodsIn the present study, in order to compare polishing made using Septodent Détartrine, Kerr Cleanic, Shofu Mersaage Regular under the recommendations of the companies in addition to the application of pumice with a rubber brush, a total of 88 samples with 22 samples in each group were created using 88 primary molar teeth. Before and after polishing, roughness measurements and visualizations were performed with atomic force microscopy (AFM). After polishing, Ra (average roughness) values, which express the surface roughness of the re-scanned samples, were calculated so that the samples were the same as the first scanning. For statistical analysis, Shapiro-Wilk normality test and generalized linear models tests were applied and p <0.05 was considered as statistically significantResultsIn the groups; while there was no significant difference in terms of roughness values ​​(Ra) within the group (p> 0.05), a statistically significant reduction in roughness (Ra) was observed on the sample surfaces after polishing in all groups compared to the baseline (p <0.05). According to the data obtained; all polishing methods used in the treatment of primary tooth discoloration can reduce the plaque formation and thus the amount of recoloring by reducing the surface roughness at a similar level.ConclusionAccordingly, it has been observed that the current polishing pastes do not provide a significant advantage over the traditional polishing method (polishing brush with pumice) in terms of surface roughness in removing discoloration in primary teeth.

scholarly journals Effectiveness and cost-effectiveness of cognitive behavior therapy-enhanced compared with treatment-as-usual for anorexia nervosa in an inpatient and outpatient routine setting: a consecutive cohort study

2022 ◽  
Vol 10 (1) ◽  
Author(s):  
Elske van den Berg ◽  
Daniela Schlochtermeier ◽  
Jitske Koenders ◽  
Liselotte de Mooij ◽  
Margo de Jonge ◽  
...  
Keyword(s):  
Anorexia Nervosa ◽  
Cohort Study ◽  
Eating Disorder ◽  
Cost Effectiveness ◽  
Weight Regain ◽  
Psychological Treatment ◽  
Health Gain ◽  
Treatment Costs ◽  
Treatment As Usual ◽  
Psychological Treatments

Abstract Background For anorexia nervosa, firm evidence of the superiority of specialized psychological treatments is limited and economic evaluations of such treatments in real world settings are scarce. This consecutive cohort study examined differential (cost-)effectiveness for adult inpatients and outpatients with anorexia nervosa, after implementing cognitive behavioral therapy-enhanced (CBT-E) throughout a routine setting. Methods Differences in remission, weight regain and direct eating disorder treatment costs were examined between one cohort (N = 75) receiving treatment-as-usual (TAU) between 2012–2014, and the other (N = 88) CBT-E between 2015–2017. The economic evaluation was performed from a health care perspective with a one-year time horizon, using EDE global score < 2.77, the absence of eating disorder behaviors combined with a BMI ≥ 18.5, as effect measure. Incremental cost-effectiveness ratios were calculated and cost-effectiveness planes and cost-effectiveness acceptability curves were displayed to assess the probability that CBT-E is cost effective compared to TAU. Results Using direct eating disorder treatment costs in the cost-effectiveness analysis, the cost-effectiveness plane of the base case scenario for all patients indicated a 84% likelihood of CBT-E generating better health gain at additional costs. The median ICER is €51,081, indicating a probable preference for CBT-E (> 50% probability of cost-effectiveness) assuming a WTP of €51,081 or more for each additional remission, On remission, no difference was found with 9.3% remission during TAU and 14.6% during CBT-E (p = .304). Weight regain was higher during CBT-E (EMD = 1.33 kg/m2, SE = .29, 95% CI [0.76–1.9], p < .001). Conclusions In this mixed inpatient and outpatient cohort study, findings indicate a probability of CBT-Ebeing more effective at higher costs. These findings may contribute to the knowledge of effectiveness and cost-effectiveness of specialized psychological treatments. Plain English Summary In this study, the effectiveness and treatment costs of a specialized psychological treatment for adult clients with anorexia nervosa were compared with a regular, non-specialist treatment. One group of inpatients and outpatients did receive non-specialist treatment, the next group of inpatients and outpatients received CBT-E, a specialized treatment, later on. CBT-E is recommended for clients with bulimia and with binge eating disorder, for clients with anorexia nervosa it is less clear which specialized psychological treatment should be recommended. Results indicate that at end-of-treatment, CBT-E was not superior on remission. When looking at weight regain, CBT-E seemed superior than the treatment offered earlier. Economic evaluation suggests that CBT-E generates better health gain, but at additional costs. This study contributes to the knowledge on the effectiveness and treatment costs of psychological treatments, as they are offered in routine practice, to adults with anorexia nervosa.

scholarly journals Comparison of the Clauss and Prothrombin Time-Derived Fibrinogen Methods in Patients with Dysfibrinogenemia, and Verification of their Reference Interval

2021 ◽  
Vol 2 (1) ◽  
pp. 44-57
Author(s):  
Emmanuel Oluwabori Bajo
Keyword(s):  
Cost Effectiveness ◽  
Reference Interval ◽  
Reference Intervals ◽  
Coagulation Disorder ◽  
Clinical Group ◽  
Fibrinogen Concentration ◽  
Main Study ◽  
Medical Field ◽  
Significant Difference ◽  
Missed Diagnosis

Introduction: Dysfibrinogenemia is a coagulation disorder caused by abnormal fibrinogen functions, with ever-growing concern in medical field. Therefore, it is critical to establish and optimise effective methods, both in terms of efficient and accurate clinical diagnosis and cost effectiveness. Methods: Fibrinogen assays; PT-derived and Clauss quantification are such method. This study, compared fibrinogen concentrations determined by the Clauss and PT-derived methods in 80 patients (diseased clinical group) and in 20 and 120 healthy patients (pilot and main study respectively). Reference interval verification was done following the Clinical and Laboratory Standards Institute guidelines. Results: There was a significant difference between Clauss fibrinogen and PT-derived fibrinogen irrespective of sample clinical groups, although, the discrepancy between these two assays appeared to correlate. Normal patients (mean PT-Fib 4.50 vs Clauss 3.07g/l, p <0.0001), r = 0.7567. Liver/renal dysfunction (mean PT-Fib 2.20 vs Clauss 1.75g/l, p = 0.0003), r = 0.8622. Critically-ill (mean PT-Fib 2.7 vs Clauss 2.17g/l, p <0.0001), r = 0.9553 and OAC (mean PT-Fib 3.49 vs Clauss 2.49g/l, p = 0.0004), r = 0.8158. 70% of PT-derived and 95% of Clauss fibrinogen results were within the reference interval 1.5 – 4.5 g/L. Verification of the published reference interval failed as >10% of the PT-derived results were outside the reference interval. Conclusion: Performing both PT-derived and Clauss methods on all clotting screen requests will prevent missed diagnosis, although, it will provide extra cost of £10,825. Thus, it is necessary to determine fibrinogen reference intervals for both the PT-derived and Clauss methods. Until further studies verify a reference interval for PT-Fib at the IH, the Clauss assay is a preferable diagnostic tool when treating patients with low fibrinogen concentrations. The PT-derived may erroneously report patients’ plasma fibrinogen concentration as normal.

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