Is non-invasive management of dental caries in private practice cost-effective? A randomized controlled trial

私人诊所的无创龋齿管理是否具有成本效益？

• 批准号: nhmrc : 402466
• 负责人: A/Pr Wendell Evans
• 金额: $ 21.68万
• 依托单位: The University of Sydney
• 依托单位国家: 澳大利亚
• 项目类别: NHMRC Project Grants
• 财政年份: 2006
• 资助国家: 澳大利亚
• 起止时间: 2006-01-01 至 2008-12-31
• 项目状态: 已结题
• 来源: https://researchdata.edu.au/non-invasive-management-controlled-trial/81321
• 关键词: non; invasive; management; dental; caries

Despite evidence to the contrary, dentists routinely fill decayed teeth that, managed preventively, would be likely to repair (arrest). The probable cost to society of this approach is enormous. Modeling indicates that each new dental filling is likely to cost an average of $1811 (US) over the life-cycle of a tooth. This figure includes re-treatment costs, and the increased likelihood of more expensive re-treatment in future, such as root canal treatment and tooth crowning. An examination of the societal costs involved is likely to reveal this amount to be an under-estimate; consider the costs borne by sectors outside health: days lost to work, lost productivity. Further, we should consider costs to families: travel time and costs, childcare, the opportunity cost of items forgone in order to pay for the dental treatment. Despite this, a recent systematic review of dental caries prevention concluded 'there is presently no proof, in published economic evaluations of the cost-effectiveness of caries-preventive measures'. The authors highlighted a lack of methodologically sound studies. This research will compare a targeted preventive program to standard care within private dental practices. Prior to an alternative approach being introduced, an assessment of effectiveness and cost-effectiveness is needed. It is through such assessment that the value of the comparator can be assessed and our precious health dollars saved. The radical surgical approach (filling) that evolved to deal with the caries problem is entrenched in both public and private institutions that teach and deliver dental care. The strategic element is to reorient the services provided by general practices towards to goal of delivering a substantial reduction in the need to drill teeth, while maximizing the opportunity for a non-invasive remineralization approach that has been successfully demonstrated in in-vitro, in-vivo, and in small scale clinical trials.

尽管有相反的证据，牙医通常会填充腐烂的牙齿，如果进行预防管理，很可能会修复(卡住)。这种方法可能会给社会带来巨大的成本。模型表明，在一颗牙齿的生命周期内，每颗新的补牙可能平均花费1811美元(美国)。这一数字包括再治疗费用，以及未来更昂贵的再治疗的可能性增加，如根管治疗和牙冠。对所涉及的社会成本的审查可能会发现，这一数字可能被低估了；考虑一下医疗以外部门承担的成本：失去工作的天数，生产力的损失。此外，我们应该考虑家庭的成本：旅行时间和成本，育儿，为支付牙科治疗而放弃的物品的机会成本。尽管如此，最近一项关于龋齿预防的系统回顾得出结论：“在已发表的预防龋齿措施的成本效益经济评估中，目前还没有证据”。这两位作者强调了缺乏方法论上合理的研究。这项研究将比较有针对性的预防计划和私人牙科实践中的标准护理。在采用替代办法之前，需要对效力和成本效益进行评估。正是通过这种评估，才能评估比较器的价值，并节省我们宝贵的健康资金。为处理龋齿问题而发展起来的激进外科方法(填充物)在教授和提供牙齿护理的公共和私人机构中根深蒂固。战略要素是调整一般做法提供的服务方向，以实现大幅减少钻牙需求的目标，同时最大限度地增加非侵入性再矿化方法的机会，这种方法已在体外、体内和小规模临床试验中成功证明。