Cost-effectiveness of silicone and alginate impressions for complete dentures
Identifieur interne : 001B75 ( Main/Exploration ); précédent : 001B74; suivant : 001B76Cost-effectiveness of silicone and alginate impressions for complete dentures
Auteurs : C. Hulme [Royaume-Uni] ; G. Yu [Royaume-Uni] ; C. Browne [Royaume-Uni] ; J. O Wyer [Royaume-Uni] ; H. Craddock [Royaume-Uni] ; S. Brown [Royaume-Uni] ; J. Gray [Royaume-Uni] ; S. Pavitt [Royaume-Uni] ; C. Fernandez [Royaume-Uni] ; M. Godfrey [Royaume-Uni] ; G. Dukanovic [Royaume-Uni] ; P. Brunton [Royaume-Uni, Nouvelle-Zélande] ; T. P. Hyde [Royaume-Uni]Source :
- Journal of Dentistry [ 0300-5712 ] ; 2014.
Abstract
The aim of this study was to assess the cost effectiveness of silicone and alginate impressions for complete dentures.
Cost effectiveness analyses were undertaken alongside a UK single centre, double blind, controlled, crossover clinical trial. Taking the perspective of the healthcare sector, effectiveness is measured using the EuroQol (EQ-5D-3L) which provides a single index value for health status that may be combined with time to produce quality adjusted life years (QALYs); and Oral Health Impact Profile (OHIP-EDENT). Incremental cost effectiveness ratios are presented representing the additional cost per one unit gained.
Mean cost was higher in the silicone impression group (£388.57 vs. £363.18). Negligible between-group differences were observed in QALY gains; the silicone group had greater mean OHIP-EDENT gains. The additional cost using silicone was £3.41 per change of one point in the OHIP-EDENT.
The silicone group was more costly, driven by the cost of materials. Changes in the EQ-5D and QALY gains over time and between arms were not statistically significant. Change in OHIP-EDENT score showed greater improvement in the silicone group and the difference between arms was statistically significant. Given negligible QALY gains and low level of resource use, results must be treated with caution. It is difficult to make robust claims about the comparative cost-effectiveness.
Silicone impressions for complete dentures improve patients’ quality of life (OHIP-EDENT score). The extra cost of silicone impressions is £30 per patient. Dentists, patients and health care funders need to consider the clinical and financial value of silicone impressions. Different patients, different dentists, different health funders will have individual perceptions and judgements.
ISRCTN01528038.
NIHR-RfPB grant PB-PG-0408-16300.
This article forms part of a project for which the author (TPH) won the Senior Clinical Unilever Hatton Award of the International Assocation for Dental Research, Capetown, South Africa, June 2014.
Url:
DOI: 10.1016/j.jdent.2014.03.001
PubMed: 24995472
PubMed Central: 4119300
Affiliations:
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Yu</name><affiliation wicri:level="4"><nlm:aff id="aff0005">Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9LJ, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9LJ</wicri:regionArea><orgName type="university">Université de Leeds</orgName><placeName><settlement type="city">Leeds</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Yorkshire-et-Humber</region></placeName></affiliation></author><author><name sortKey="Browne, C" sort="Browne, C" uniqKey="Browne C" first="C." last="Browne">C. 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Dukanovic</name><affiliation wicri:level="4"><nlm:aff id="aff0040">Dental Translational Clinical Research Unit (DenTCRU), Leeds Dental Institute, University of Leeds, Leeds LS2 9LU, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Dental Translational Clinical Research Unit (DenTCRU), Leeds Dental Institute, University of Leeds, Leeds LS2 9LU</wicri:regionArea><orgName type="university">Université de Leeds</orgName><placeName><settlement type="city">Leeds</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Yorkshire-et-Humber</region></placeName></affiliation></author><author><name sortKey="Brunton, P" sort="Brunton, P" uniqKey="Brunton P" first="P." last="Brunton">P. 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Hulme</name><affiliation wicri:level="4"><nlm:aff id="aff0005">Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9LJ, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9LJ</wicri:regionArea><orgName type="university">Université de Leeds</orgName><placeName><settlement type="city">Leeds</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Yorkshire-et-Humber</region></placeName></affiliation></author><author><name sortKey="Yu, G" sort="Yu, G" uniqKey="Yu G" first="G." last="Yu">G. Yu</name><affiliation wicri:level="4"><nlm:aff id="aff0005">Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9LJ, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9LJ</wicri:regionArea><orgName type="university">Université de Leeds</orgName><placeName><settlement type="city">Leeds</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Yorkshire-et-Humber</region></placeName></affiliation></author><author><name sortKey="Browne, C" sort="Browne, C" uniqKey="Browne C" first="C." last="Browne">C. Browne</name><affiliation wicri:level="4"><nlm:aff id="aff0005">Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9LJ, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9LJ</wicri:regionArea><orgName type="university">Université de Leeds</orgName><placeName><settlement type="city">Leeds</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Yorkshire-et-Humber</region></placeName></affiliation></author><author><name sortKey="O Wyer, J" sort="O Wyer, J" uniqKey="O Wyer J" first="J." last="O Wyer">J. O Wyer</name><affiliation wicri:level="4"><nlm:aff id="aff0005">Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9LJ, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9LJ</wicri:regionArea><orgName type="university">Université de Leeds</orgName><placeName><settlement type="city">Leeds</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Yorkshire-et-Humber</region></placeName></affiliation></author><author><name sortKey="Craddock, H" sort="Craddock, H" uniqKey="Craddock H" first="H." last="Craddock">H. Craddock</name><affiliation wicri:level="1"><nlm:aff id="aff0010">University of Aberdeen Dental School, Cornhill Road, Aberdeen AB25 2ZR, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>University of Aberdeen Dental School, Cornhill Road, Aberdeen AB25 2ZR</wicri:regionArea><wicri:noRegion>Aberdeen AB25 2ZR</wicri:noRegion></affiliation></author><author><name sortKey="Brown, S" sort="Brown, S" uniqKey="Brown S" first="S." last="Brown">S. Brown</name><affiliation wicri:level="4"><nlm:aff id="aff0015">Leeds Institute of Clinical Trials Research, University of Leeds, Leeds LS29JT, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Leeds Institute of Clinical Trials Research, University of Leeds, Leeds LS29JT</wicri:regionArea><orgName type="university">Université de Leeds</orgName><placeName><settlement type="city">Leeds</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Yorkshire-et-Humber</region></placeName></affiliation></author><author><name sortKey="Gray, J" sort="Gray, J" uniqKey="Gray J" first="J." last="Gray">J. Gray</name><affiliation wicri:level="4"><nlm:aff id="aff0015">Leeds Institute of Clinical Trials Research, University of Leeds, Leeds LS29JT, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Leeds Institute of Clinical Trials Research, University of Leeds, Leeds LS29JT</wicri:regionArea><orgName type="university">Université de Leeds</orgName><placeName><settlement type="city">Leeds</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Yorkshire-et-Humber</region></placeName></affiliation></author><author><name sortKey="Pavitt, S" sort="Pavitt, S" uniqKey="Pavitt S" first="S." last="Pavitt">S. Pavitt</name><affiliation wicri:level="4"><nlm:aff id="aff0025">Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9LJ, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9LJ</wicri:regionArea><orgName type="university">Université de Leeds</orgName><placeName><settlement type="city">Leeds</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Yorkshire-et-Humber</region></placeName></affiliation></author><author><name sortKey="Fernandez, C" sort="Fernandez, C" uniqKey="Fernandez C" first="C." last="Fernandez">C. Fernandez</name><affiliation wicri:level="4"><nlm:aff id="aff0015">Leeds Institute of Clinical Trials Research, University of Leeds, Leeds LS29JT, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Leeds Institute of Clinical Trials Research, University of Leeds, Leeds LS29JT</wicri:regionArea><orgName type="university">Université de Leeds</orgName><placeName><settlement type="city">Leeds</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Yorkshire-et-Humber</region></placeName></affiliation></author><author><name sortKey="Godfrey, M" sort="Godfrey, M" uniqKey="Godfrey M" first="M." last="Godfrey">M. Godfrey</name><affiliation wicri:level="4"><nlm:aff id="aff0025">Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9LJ, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9LJ</wicri:regionArea><orgName type="university">Université de Leeds</orgName><placeName><settlement type="city">Leeds</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Yorkshire-et-Humber</region></placeName></affiliation></author><author><name sortKey="Dukanovic, G" sort="Dukanovic, G" uniqKey="Dukanovic G" first="G." last="Dukanovic">G. Dukanovic</name><affiliation wicri:level="4"><nlm:aff id="aff0040">Dental Translational Clinical Research Unit (DenTCRU), Leeds Dental Institute, University of Leeds, Leeds LS2 9LU, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Dental Translational Clinical Research Unit (DenTCRU), Leeds Dental Institute, University of Leeds, Leeds LS2 9LU</wicri:regionArea><orgName type="university">Université de Leeds</orgName><placeName><settlement type="city">Leeds</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Yorkshire-et-Humber</region></placeName></affiliation></author><author><name sortKey="Brunton, P" sort="Brunton, P" uniqKey="Brunton P" first="P." last="Brunton">P. Brunton</name><affiliation wicri:level="4"><nlm:aff id="aff0045">Leeds Dental Institute, University of Leeds, Leeds LS2 9LU, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Leeds Dental Institute, University of Leeds, Leeds LS2 9LU</wicri:regionArea><orgName type="university">Université de Leeds</orgName><placeName><settlement type="city">Leeds</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Yorkshire-et-Humber</region></placeName></affiliation><affiliation wicri:level="1"><nlm:aff id="aff0050">Faculty of Dentistry, University of Otago, Dunedin, New Zealand</nlm:aff><country xml:lang="fr">Nouvelle-Zélande</country><wicri:regionArea>Faculty of Dentistry, University of Otago, Dunedin</wicri:regionArea><wicri:noRegion>Dunedin</wicri:noRegion></affiliation></author><author><name sortKey="Hyde, T P" sort="Hyde, T P" uniqKey="Hyde T" first="T. P." last="Hyde">T. P. Hyde</name><affiliation wicri:level="4"><nlm:aff id="aff0045">Leeds Dental Institute, University of Leeds, Leeds LS2 9LU, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Leeds Dental Institute, University of Leeds, Leeds LS2 9LU</wicri:regionArea><orgName type="university">Université de Leeds</orgName><placeName><settlement type="city">Leeds</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Yorkshire-et-Humber</region></placeName></affiliation></author></analytic><series><title level="j">Journal of Dentistry</title><idno type="ISSN">0300-5712</idno><idno type="eISSN">1879-176X</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Objective</title><p>The aim of this study was to assess the cost effectiveness of silicone and alginate impressions for complete dentures.</p></sec><sec><title>Methods</title><p>Cost effectiveness analyses were undertaken alongside a UK single centre, double blind, controlled, crossover clinical trial. Taking the perspective of the healthcare sector, effectiveness is measured using the EuroQol (EQ-5D-3L) which provides a single index value for health status that may be combined with time to produce quality adjusted life years (QALYs); and Oral Health Impact Profile (OHIP-EDENT). Incremental cost effectiveness ratios are presented representing the additional cost per one unit gained.</p></sec><sec><title>Results</title><p>Mean cost was higher in the silicone impression group (£388.57 vs. £363.18). Negligible between-group differences were observed in QALY gains; the silicone group had greater mean OHIP-EDENT gains. The additional cost using silicone was £3.41 per change of one point in the OHIP-EDENT.</p></sec><sec><title>Conclusions</title><p>The silicone group was more costly, driven by the cost of materials. Changes in the EQ-5D and QALY gains over time and between arms were not statistically significant. Change in OHIP-EDENT score showed greater improvement in the silicone group and the difference between arms was statistically significant. Given negligible QALY gains and low level of resource use, results must be treated with caution. It is difficult to make robust claims about the comparative cost-effectiveness.</p></sec><sec><title>Clinical significance</title><p>Silicone impressions for complete dentures improve patients’ quality of life (OHIP-EDENT score). The extra cost of silicone impressions is £30 per patient. Dentists, patients and health care funders need to consider the clinical and financial value of silicone impressions. Different patients, different dentists, different health funders will have individual perceptions and judgements.</p><p>ISRCTN01528038.</p><p>NIHR-RfPB grant PB-PG-0408-16300.
</p><p>This article forms part of a project for which the author (TPH) won the Senior Clinical Unilever Hatton Award of the International Assocation for Dental Research, Capetown, South Africa, June 2014.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Fuller, E" uniqKey="Fuller E">E. Fuller</name></author><author><name sortKey="Steele, J" uniqKey="Steele J">J. Steele</name></author><author><name sortKey="Watt, R" uniqKey="Watt R">R. Watt</name></author><author><name sortKey="Nuttall, N" uniqKey="Nuttall N">N. Nuttall</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Petropoulos, V C" uniqKey="Petropoulos V">V.C. Petropoulos</name></author><author><name sortKey="Rashedi, B" uniqKey="Rashedi B">B. Rashedi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hyde, T P" uniqKey="Hyde T">T.P. 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