COST UTILITY ANALYSIS OF REPLACING POSTERIOR TEETH

在美国，35-60岁的人中有近30%经历过牙齿问题。 拔牙导致剩余牙齿之间的空间。治疗这种 条件下，有界缺牙空间，成本超过27亿美元 每年。有五种替代治疗策略， 但其总体成本和后果尚不清楚。的 描述替代方案临床结局的稀疏信息 治疗，再加上没有任何关于病人的信息， 对这些治疗的偏好导致了这样一种情况， 每年有数百万项实质性治疗决定是基于 不过是牙医对效果的主观印象 本提案介绍了以下方面的成本效益和成本效用分析： 有界缺牙间隙的五种替代治疗策略。 分析将基于马尔可夫模型，以适应复杂的 一系列反复出现的并发症，伴随着大多数替代品， 治疗。因为这些替代疗法的临床效果 定义不明确，所有健康状态的过渡概率， 马尔可夫模型将通过回顾性分析确定， 四个大型供应商组织的治疗记录和数据表 纵向流行病学研究，并辅以来自Meta的信息， 文献分析。成本效用中使用的患者效用 还将收集分析结果， 接受和未接受替代治疗的患者 将被审查。在成本效益分析中，效益是 以“治疗存活年”衡量。“成本效用分析 将使用经过“质量调整”的同一度量标准的版本 患者的偏好。 分析的结果将有助于共同决策， 患者和牙医关于更换后牙。 同样重要的是，这些结果将代表着 发展补牙实务指引， 最复杂和昂贵的治疗常规进行的一般 牙医.更广泛地说，这些信息对 由公营及私营机构厘定适当的牙科健康福利 无论任何医疗保健改革的确切结果如何， 最后，由于牙齿脱落是任何牙科治疗的终点事件， 这些分析的结果对几乎所有其他 牙科治疗的成本、效果和效用分析。

Nearly 30% of 35-60 years-olds in the U.S. have experienced tooth extraction resulting in spaces between remaining teeth. Treatment of this condition, the bounded edentulous space, costs in excess of $2.7 billion annually. There are five alternative treatment strategies for the condition, but their overall costs and consequences are not known. The sparse information describing clinical outcomes of the alternative treatments, coupled with the absence of any information about patient preferences for these treatments has resulted in a situation where several million substantive treatment decisions are based each year on little more than dentists' subjective impressions of effectiveness. This proposal describes cost-effectiveness and cost-utility analyses of the five alternative treatment strategies for a bounded edentulous space. The analyses will be based on Markov models to accommodate the complex set of recurring complications that accompanies most of the alternative treatments. Because the clinical outcomes of these alternative treatments are poorly defined, transitional probabilities for all health states in the Markov model will be determined through retrospective analyses of treatment records in four large provider organizations and data form a longitudinal epidemiology study, supplemented by information from a meta- analysis of the literature. Patient utilities for use in the cost-utility analyses will also be collected, and differences in utilities among patients experienced and not experienced with the alternative treatments will be examined. For the cost-effectiveness analysis, effectiveness is measured in terms of "treatment survival year." The cost-utility analysis will use a version of the same measure that has been "quality adjusted" for patient preferences. The results of the analyses will be useful in shared-decision making by patients and dentists concerning the replacement of a posterior tooth. Just as importantly, the results will represent the first step in the development of practice guidelines for replacement of a lost tooth, the most complex and expensive treatment routinely performed by general dentists. More broadly, the information will be important to the determination of appropriate dental health benefits by public and private purchases regardless of the exact outcome of any health care reform. Finally, because tooth loss is a terminal event in any dental treatment sequence, the results of these analyses are vital to virtually all other analyses of cost, effectiveness, and utility of dental treatment.