Reducing an already low dental diagnostic X-ray dose: does it make sense? Comparison of three cost-utility analysis methods used to assess two dental dose-reduction measures

Abstract

Objectives: To find a method that is suitable for providing an objective assessment of the cost effectiveness of a dose-reducing measure used for diagnostic dental X-ray exposures. Methods: Three cost-utility analysis (CUA) methods were evaluated by comparing their assessments of two dose-reduction measures, a rectangular collimator and the combination of two devices that reduce the radiation dose received during orthodontic lateral cephalography. The following CUA methods were used: (1) the alpha value (AV), a monetary valuation of dose reduction used in the nuclear industry; (2) the value of a statistical life for valuation of the reduction in stochastic adverse effects; and (3) the time-for-time method, based on the postulate that risk reduction is effective when the number of years of life gained is more than the years that an average worker must work to earn the costs of the risk-reducing measure. The CUA methods were used to determine the minimum number of uses that was required for the dose-reducing device to be cost effective. The methods were assessed for coherence (are comparable results achieved for comparable countries?) and adaptability (can the method be adjusted for age and gender of specific patient groups?). Results: The performance of the time-for-time method was superior to the other methods. Both types of dose-reduction devices tested were assessed as cost effective after a realistic number of uses with all three methods except low AVs. Conclusions: CUA for the methods of X-ray dose reduction can be performed to determine if investment in low dose reduction is cost effective. The time-for-time method proved to be a coherent and versatile method for performing CUA.

Dosis de radiación permitida en pacientes odontológicos. Una revisión

“…La magnitud para medir la radiación es la energía recopilada por unidad de masa, que se denomina dosis absorbida. Esta se refiere a la cantidad de energía que se absorbe en una exposición a las radiaciones ionizantes por unidad de masa irradiada, según la cantidad de energía absorbida por la materia sin que repercutan la clase de radiación y el medio que la absorbe 2 , 3 , 29 . La forma en que un tejido es dañado es distinta de acuerdo con las diferentes clases de radiaciones ionizantes.…”

“…Uno de los factores que se ha puesto siempre en discusión es la cantidad de dosis utilizada en pacientes, en diferentes etapas de su vida, por la evidencia científica de los efectos nocivos de las radiaciones ionizantes 2 .…”

“…Las magnitudes de estas exposiciones dependen principalmente de los parámetros utilizados en radiología 7 , 8 . Los niveles de dosis y sus efectos nocivos, la “cantidad de energía absorbida por una unidad de masa en una región de interés” 2 , 9 , han sido modificados y regulados a través del tiempo, con el respaldo de una continua investigación científica en el mundo 3 , 4 , 10 .…”

The value of thyroid shielding in intraoral radiography

“…15 Using a thyroid shield reduces the dose at a certain cost. To assess if this investment is effective, a cost-utility analysis can be performed as proposed by Hoogeveen et al 18 When we assume the cost of the thyroid shield at €100 and the effective dose reduction of 50% or 1 mSv per exposure, then according to the referenced article, the thyroid shield would become cost effective in a high-income economy after circa 500 times of use. In offices with a younger patient population, this number would be substantially lower, as the radiation risks for younger people are two to three folds higher.…”

Protección Radiológica en Radiología Dental

“…Por lo expuesto en el capítulo anterior, leyes y regulaciones de protección radiológica son requeridas para cada exposición del paciente (51). En esa dirección, varios países han dispuesto guías para el uso seguro de los rayos X en la práctica odontológica (3,15).…”