How can we associate an economic evaluation with a clinical trial?

Braga, Mariana Minatel; Machado, Gabriela Manco; Rocha, Elizabeth Souza; Viganó, Maria Eduarda F; Pontes, Laura Regina Antunes; Raggio, Daniela Prócida

doi:10.1590/1807-3107bor-2020.vol34.0076

Cited by 5 publications

(3 citation statements)

References 19 publications

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“…Finally, the main finding of this study was that the reciprocating instrumentation technique in endodontic treatments proved to be more cost-effective, since it showed treatment in a shorter clinical time and, therefore, a decrease in the costs associated [28,29]. The costs of incorporation of this technology (reciprocal) could be paid by the municipalities through transfers of federal incentives from the Ministry of Health.…”

Section: Discussionmentioning

confidence: 85%

Economic analysis of the different endodontic instrumentation techniques used in the Unified Health System

et al. 2022

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Background To assess the financial impact of incorporating a new (reciprocal) technology into endodontic treatments in the public health system (SUS). Methods This was a economic evaluation study (comparing the 3 different endodontic instrumentation techniques—manual, rotary and reciprocating), allocative efficiency analysis to optimize existing resources in the SUS, and financial contribution impact analysis of incorporation of a new technology. Thirty-one (31) 12 years-old volunteers were evaluated. Results The incremental cost-effectiveness ratio (ICER) was calculated at R$1.34/min, − R$0.60/min and BRL 0.10/min for the single-rooted, bi-rooted and tri-rooted teeth, respectively, when the rotary technique was compared with the manual type. In turn, the ICER was R$ 21.04/min, − R$ 0.73/min and − R$ 2.81/min for the 3 types of teeth, respectively, when the reciprocating technique was compared with the manual type. The incremental financial impact of replacing manual endodontic with rotary endodontic treatments would be − R$ 2060963.66 in the case of single-rooted teeth, but the number of treatments would also be reduced (− 19,379). In the case of two-rooted teeth, the incremental financial impact would be BRL 34921540.62 with the possibility of performing an additional 204,110 treatments. In turn, BRL 11523561.50 represented the incremental financial impact for teeth with 3 or more roots and with an increase of 72,545 procedures. When we analyzed the incremental financial impact of replacing manual endodontic with reciprocating endodontic treatments, it would be − R$ 730227.80 in the case of single-rooted teeth, allowing for an additional 2538 treatments. In turn, R$ 21674853.00 represented the incremental financial impact for bi-radicular teeth, with an increase of 121,700 procedures. In the case of two-rooted teeth, the incremental financial impact would be BRL 13591742.90 with the possibility of performing an additional 40,670 treatments. Conclusions The reciprocating technique could improve access to endodontic treatment in the SUS as it allowed a simultaneous reduction in clinical time and associated costs. However, the higher number of endodontic treatments performed would have a financial impact.

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Section: Discussionmentioning

confidence: 85%

Economic analysis of the different endodontic instrumentation techniques used in the Unified Health System

et al. 2022

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“…Deterministic one-way sensitivity analysis will be conducted for CEAs and CUA to assess the quantitative relationship among estimates in parameters that could perform differently in a distinct scenario, such as costs, discount rate, and effects. In these analyses, we will also test the influence of different baseline conditions as covariates associated with the effects and costs [30], checking the possibility of extrapolating data from this single trial to a broader population. The results will be demonstrated in a tornado diagram.…”

Section: Methodsmentioning

confidence: 99%

The economic impact of two diagnostic strategies in the management of restorations in primary teeth: a health economic analysis plan for a trial-based economic evaluation

Freitas

Moro

Pontes

et al. 2021

Trials

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Background Different approaches have been used by dentists to base their decision. Among them, there are the aesthetical issues that may lead to more interventionist approaches. Indeed, using a more interventionist strategy (the World Dental Federation - FDI), more replacements tend to be indicated than using a minimally invasive one (based on the Caries Around Restorations and Sealants—CARS). Since the resources related to the long-term health effects of these strategies have not been explored, the economic impact of using the less-invasive strategy is still uncertain. Thus, this health economic analysis plan aims to describe methodologic approaches for conducting a trial-based economic evaluation that aims to assess whether a minimally invasive strategy is more efficient in allocating resources than the conventional strategy for managing restorations in primary teeth and extrapolating these findings to a longer time horizon. Methods A trial-based economic evaluation will be conducted, including three cost-effectiveness analyses (CEA) and one cost-utility analysis (CUA). These analyses will be based on the main trial (CARDEC-03/NCT03520309), in which children aged 3 to 10 were included and randomized to one of the diagnostic strategies (based on FDI or CARS). An examiner will assess children’s restorations using the randomized strategy, and treatment will be recommended according to the same criteria. The time horizon for this study is 2 years, and we will adopt the societal perspective. The average costs per child for 24 months will be calculated. Three different cost-effectiveness analyses (CEA) will be performed. For CEAs, the effects will be the number of operative interventions (primary CEA analysis), the time to these new interventions, the percentage of patients who did not need new interventions in the follow-up, and changes in children’s oral health-related quality of life (secondary analyses). For CUA, the effect will be tooth-related quality-adjusted life years (QALYs). Intention-to-treat analyses will be conducted. Finally, we will assess the difference when using the minimally invasive strategy for each health effect (∆effect) compared to the conventional strategy (based on FDI) as the reference strategy. The same will be calculated for related costs (∆cost). The discount rate of 5% will be applied for costs and effects. We will perform deterministic and probabilistic sensitivity analyses to handle uncertainties. The net benefit will be calculated, and acceptability curves plotted using different willingness-to-pay thresholds. Using Markov models, a longer-term economic evaluation will be carried out with trial results extrapolated over a primary tooth lifetime horizon. Discussion The main trial is ongoing, and data collection is still not finished. Therefore, economic evaluation has not commenced. We hypothesize that conventional strategy will be associated with more need for replacements of restorations in primary molars. These replacements may lead to more reinterventions, leading to higher costs after 2 years. The health effects will be a crucial aspect to take into account when deciding whether the minimally invasive strategy will be more efficient in allocating resources than the conventional strategy when considering the management of restorations in primary teeth. Finally, patients/parents preferences and consequent utility values may also influence this final conclusion about the economic aspects of implementing the minimally invasive approach for managing restorations in clinical practice. Therefore, these trial-based economic evaluations may bring actual evidence of the economic impact of such interventions. Trial registration NCT03520309. Registered May 9, 2018. Economic evaluations (the focus of this plan) are not initiated at the moment.

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“…The cost of professional labor took i nto consideration the amount of US$ 27.02 per hour of work, according to the dental office cost spreadsheet. The clinical hour value was calculated by the average cost of the operators, according to Braga et al 21 which was based on the time taken to perform the endodontic treatment.…”

Section: Cost Analysismentioning

confidence: 99%

Cost analysis of endodontic treatment in primary teeth: results from a randomized clinical trial

et al. 2021

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This study compared the cost of endodontic treatment in primary teeth involving a technique that does not require root canal instrumentation using antibiotic paste (CTZ) with that of the instrumented technique using iodoform paste (GP). This study is part of a randomized, controlled, parallel arm, noninferiority, 1:1 allocation, blinded (patient) multioperator study of 52 primary incisors of children aged 3 to 6 years with caries lesion and pulp involvement. Each technique was performed according to the creators' descriptions. The cost was assessed by analyzing the costs of capital, dental supplies, and professional labor according to the time taken to perform the procedure and the CHEERS guidelines were used to report the cost assessment. Endodontic treatment with CTZ had a 58.33% lower execution cost than GP (US$6.73 and US$16.15, respectively). The t-test showed significant differences between groups regarding treatment time and total cost (p < 0.0001). The CTZ technique seems to be more economically viable than GP for endodontic treatment of primary teeth, requiring a shorter treatment time and lower costs.

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How can we associate an economic evaluation with a clinical trial?

Cited by 5 publications

References 19 publications

Economic analysis of the different endodontic instrumentation techniques used in the Unified Health System

Economic analysis of the different endodontic instrumentation techniques used in the Unified Health System

The economic impact of two diagnostic strategies in the management of restorations in primary teeth: a health economic analysis plan for a trial-based economic evaluation

Cost analysis of endodontic treatment in primary teeth: results from a randomized clinical trial

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