背景:单侧后牙合是一种常见的错牙合,建议早期治疗以实现正常生长。关于选择用于纠正这种错牙合的矫治器有几种可能性;但是,当治疗由公共资金资助时,决策不仅需要基于效果,还需要基于与成本相关的效果。
目的:目的是进行成本效益分析,比较儿童早期混合牙列中的四螺旋(QH)和快速上颌扩张器(RME;hyrax型)。
方法:72例患者随机接受QH或RME治疗,在两个不同的中心。从患者的医疗记录中收集有关成功率的数据,访问次数,总治疗时间,紧急访问,等等,以及有关失学和使用镇痛药的患者问卷调查的答案。使用意向治疗(ITT)和按方案方法进行了成本效益分析,以及确定性敏感性分析。
结果:成功率,扩建完成一年后,根据ITT方法,组间相等。从医疗保健的角度来看,RME和QH之间的平均成本差异为32.05欧元,有利于QH(P=0.583;NS)。从社会的角度来看,平均成本差异为32.61欧元,有利于QH(P=0.742;NS)。仅RME组的总家电成本就更高202.67欧元。QH组€155.58(P=0.001)。从医疗保健角度来看,RME成本较高的可能性为71%,从社会角度来看为62.7%。QH组总治疗时间延长97天。在确定性敏感性分析中,当使用较高的儿童教育损失估值时,QH比RME贵58欧元。各中心之间的主持时间和就诊时间差异有统计学意义(P<0.001)。
结论:RME和QH之间的成本差异无统计学意义,然而,从医疗保健的角度来看,RME比QH贵的可能性略高,平均每位患者的额外费用为32欧元.不同中心的不同工作程序表明,与用于减少就诊次数和节省主持时间以及成本的设备相比,围绕患者治疗的后勤是更重要的方面。
BACKGROUND: Unilateral posterior crossbite is a common malocclusion, and early treatment is recommended to enable normal growth. There are several possibilities regarding choice of appliances used for correcting this malocclusion; however, when treatment is financed by public funds the decision needs to be based not only on the effects but also on the effect in relation to the costs.
OBJECTIVE: The aim was to perform a cost-effectiveness analysis comparing quad helix (QH) and rapid maxillary expanders (RME; hyrax-type) in children in the early mixed dentition.
METHODS: Seventy-two patients were randomized to treatment with either QH or RME, at two different centres. Data were collected from the patient\'s medical records regarding success rate, number of visits, total treatment time, emergency visits, and so forth, together with answers from patient questionnaires concerning absence from school and use of analgesics. A cost-effectiveness analysis with both an intention-to-treat (ITT) and a per-protocol approach was performed, as well as a deterministic sensitivity analysis.
RESULTS: The success rate, one year after the completion of the expansion, was equal between groups according to the ITT approach. From a healthcare perspective, the mean cost difference between RME and QH was €32.05 in favour of QH (P = 0.583; NS). From a societal perspective, the mean cost difference was €32.61 in favour of QH (P = 0.742; NS). The total appliance cost alone was higher in the RME group €202.67 resp. €155.58 in the QH group (P = 0.001). The probability of RME having a higher cost was 71% from a healthcare perspective and 62.7% from a societal perspective. The total treatment time was 97 days longer in the QH group. In the deterministic sensitivity analysis, when using a higher valuation of the children\'s educational loss, the QH becomes €58 more costly than the RME. There was a statistically significant difference in chair time and visits between centres (P < 0.001).
CONCLUSIONS: The difference in costs between RME and QH is not statistically significant, however, there is a slightly higher probability that RME is more expensive than QH with a mean cost of an additional €32 per patient from a healthcare perspective. Different work procedures at different centres indicate that logistics around the patient\'s treatment is a more important aspect than appliance used to decrease the number of visits and save chair time and thereby also costs.