COST UTILITY ANALYSIS OF REPLACING POSTERIOR TEETH

在美国，近30%的35-60岁的人经历过牙齿 拔牙造成剩余牙齿之间的间隙。对此的处理 条件，有界的无牙空间，花费超过27亿美元 每年一次。有五种可供选择的治疗策略 但它们的总成本和后果尚不清楚。这个 描述替代方案的临床结果的稀疏信息 治疗，再加上没有任何关于患者的信息 对这些治疗的偏好导致了一种情况 每年有数百万项实质性的治疗决定是基于 只不过是牙医对疗效的主观印象。 本提案描述了以下项目的成本效益和成本效用分析 五种可供选择的治疗策略，适用于有限无牙合空间。 分析将基于马尔可夫模型，以适应复杂的情况 大多数替代方案都伴随着一系列反复出现的并发症 治疗。因为这些替代疗法的临床结果 中所有健康状态的定义不明确、过渡概率 马尔可夫模型将通过回顾分析确定 四个大型医疗服务提供者组织的治疗记录和数据表格 纵向流行病学研究，辅以来自Meta-Mate的信息 文献分析。在成本效用中使用的患者实用程序 还将收集分析，并在公用事业之间的差异 经历过和没有经历过替代治疗的患者 将会被检查。对于成本效益分析，有效性是 以“治疗存活年”来衡量。成本效用分析 将使用经过“质量调整”的相同衡量标准的版本 病人的喜好。 分析的结果将有助于通过以下方式进行共享决策 关于后牙替换的病人和牙医。 同样重要的是，这些结果将是 制定修复牙齿缺失的实践指南 最复杂和最昂贵的治疗通常由普通医生进行 牙医。更广泛地说，这些信息将对 由公营和私营机构厘定适当的牙齿健康福利 购买，而不考虑任何医疗改革的确切结果。 最后，因为牙齿脱落在任何牙科治疗中都是一种终极事件 序列，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.