Hulme C, Yu G, Browne C, O'Dwyer J, Craddock H, Brown S, Gray J, Pavitt S, Fernandez C, Godfrey M, Dukanovic G, Brunton P, Hyde T P
Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9LJ, UK.
University of Aberdeen Dental School, Cornhill Road, Aberdeen AB25 2ZR, UK.
J Dent. 2014 Aug;42(8):902-7. doi: 10.1016/j.jdent.2014.03.001. Epub 2014 Jul 1.
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.
本研究旨在评估硅橡胶印模和藻酸盐印模用于全口义齿的成本效益。
成本效益分析与一项英国单中心、双盲、对照、交叉临床试验同步进行。从医疗保健部门的角度来看，使用欧洲五维度健康量表（EQ-5D-3L）来衡量有效性，该量表可提供一个健康状况的单一指标值，该值可与时间相结合以产生质量调整生命年（QALYs）；以及口腔健康影响程度量表（OHIP-EDENT）。给出了增量成本效益比，代表每获得一个单位所增加的成本。
硅橡胶印模组的平均成本更高（388.57英镑对363.18英镑）。在质量调整生命年的增加方面，组间差异可忽略不计；硅橡胶组在口腔健康影响程度量表上的平均增加幅度更大。使用硅橡胶时，口腔健康影响程度量表每变化一分的额外成本为3.41英镑。
硅橡胶组成本更高，这是由材料成本驱动的。欧洲五维度健康量表和质量调整生命年随时间和组间的变化在统计学上无显著差异。口腔健康影响程度量表得分的变化在硅橡胶组显示出更大的改善，且组间差异具有统计学意义。鉴于质量调整生命年增加可忽略不计且资源使用水平较低，结果必须谨慎对待。很难就比较成本效益做出有力的断言。
全口义齿使用硅橡胶印模可改善患者的生活质量（口腔健康影响程度量表得分）。硅橡胶印模的额外成本为每位患者30英镑。牙医、患者和医疗保健资助者需要考虑硅橡胶印模的临床和财务价值。不同的患者、不同的牙医、不同的医疗保健资助者会有各自的看法和判断。国际标准随机对照试验编号：ISRCTN01528038。英国国家卫生研究院（NIHR）基于项目的研究资助PB-PG-0408-16300。本文是作者（TPH）于2014年6月在南非开普敦获得国际牙科研究协会联合利华高级临床哈顿奖的一个项目的一部分。
