Institute for Health & Aging, Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, San Francisco, CA, USA.
Center to Address Disparities in Children's Oral Health, Department of Preventive Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA.
JDR Clin Trans Res. 2024 Jan;9(1):85-94. doi: 10.1177/23800844221149337. Epub 2023 Feb 15.
Cost-utility analysis (CUA)-a method to evaluate intervention cost-effectiveness-transforms benefits of alternatives into a measure of quantity and quality of life, such as quality-adjusted life year (QALY), to enable comparison across heterogeneous programs. Measurement challenges prevent directly estimating utilities and calculating QALYs for caries in primary dentition. Proxy disease QALYs are often used as a substitute; however, there lacks quantitative evidence that these proxy diseases are comparable to caries.
To employ a discrete choice experiment (DCE) to quantitatively determine the most comparable proxy disease for different levels of caries in primary dentition.
A cross-sectional DCE survey was administered to respondents ( = 461) who resided in California, were aged ≥18 y, and were primary caretakers for ≥1 child aged 3 to 12 y. Four attributes were included: pain level, disease duration, treatment cost, and family life impacts. Mixed effects logistic regression and conditional logistic regression were used to analyze the survey data.
Respondents from the overall sample preferred no pain over mild (odds ratio [OR] = 0.50, < 0.05), moderate (OR = 0.57, < 0.05), and severe pain (OR = 0.48, < 0.05). Acute gastritis (OR = 0.44, < 0.05), chronic gastritis (OR = 0.31, < 0.01), and cold sore (OR = 0.38, < 0.05) were less preferred than stage 1 caries. Acute tonsilitis (OR = 0.43, < 0.05), acute gastritis (OR = 0.38, < 0.05), chronic gastritis (OR = 0.26, < 0.01), and cold sore (OR = 0.33, < 0.01) were less preferred than stage 2 caries. Chronic gastritis (OR = 0.42, < 0.05) was less preferred than stage 4 caries.
Parents viewed the characteristics of many diseases with similar QALYs differently. Findings suggest that otitis media and its QALY-as commonly used in CUAs-may be a suitable proxy disease and substitute. However, other disease states with slightly different QALYs may be suitable. As such, the recommendation is to consider a range of proxy diseases and their QALYs when conducting a CUA for child caries interventions.
This study reviews and systematically compares pediatric diseases that are comparable to caries in primary dentition. The findings may inform future research using cost-utility analysis to examine the incremental cost-effectiveness ratio of interventions to prevent and treat caries as compared with an alternative.
成本效用分析（CUA）——一种评估干预措施成本效益的方法——将替代方案的效益转化为衡量生命数量和质量的指标，例如质量调整生命年（QALY），从而能够在异质方案之间进行比较。测量挑战阻止了对效用的直接估计，并计算了乳牙龋齿的 QALY。代理疾病 QALY 通常被用作替代品；然而，缺乏定量证据表明这些代理疾病与龋齿具有可比性。
采用离散选择实验（DCE）来定量确定乳牙龋齿不同程度的最可比代理疾病。
对居住在加利福尼亚州、年龄≥18 岁且是 3 至 12 岁儿童主要照顾者的 461 名受访者进行了横断面 DCE 调查。包括四个属性：疼痛程度、疾病持续时间、治疗成本和家庭生活影响。使用混合效应逻辑回归和条件逻辑回归分析调查数据。
来自总体样本的受访者更喜欢没有疼痛而不是轻度（比值比 [OR] = 0.50，<0.05）、中度（OR = 0.57，<0.05）和重度疼痛（OR = 0.48，<0.05）。急性胃炎（OR = 0.44，<0.05）、慢性胃炎（OR = 0.31，<0.01）和唇疱疹（OR = 0.38，<0.05）比第 1 阶段龋齿的选择度低。急性扁桃体炎（OR = 0.43，<0.05）、急性胃炎（OR = 0.38，<0.05）、慢性胃炎（OR = 0.26，<0.01）和唇疱疹（OR = 0.33，<0.01）比第 2 阶段龋齿的选择度低。慢性胃炎（OR = 0.42，<0.05）比第 4 阶段龋齿的选择度低。
父母对具有相似 QALY 的许多疾病的特征有不同的看法。研究结果表明，中耳炎及其 QALY——通常在 CUA 中使用——可能是一种合适的代理疾病和替代品。然而，其他 QALY 略有不同的疾病状态也可能是合适的。因此，建议在进行儿童龋齿干预措施的成本效用分析时，考虑一系列代理疾病及其 QALY。
本研究回顾并系统比较了与乳牙龋齿具有可比性的儿科疾病。研究结果可能为未来使用成本效用分析来检验预防和治疗龋齿的干预措施的增量成本效益比提供信息，而不是替代方案。
