Methods and preliminary findings of a cost-effectiveness study of glass-ionomer-based and composite resin sealant materials after 2 yr.

The cost-effectiveness of glass-carbomer, conventional high-viscosity glass-ionomer cement (HVGIC) [without or with heat (light-emitting diode (LED) thermocuring) application], and composite resin sealants were compared after 2 yr in function. Estimated net costs per sealant were obtained from data on personnel time (measured with activity sampling), transportation, materials, instruments and equipment, and restoration costs for replacing failed sealants from a community trial involving 7- to 9-yr-old Chinese children. Cost data were standardized to reflect the placement of 1,000 sealants per group. Outcomes were the differences in the number of dentine caries lesions that developed between groups. The average sealant application time ranged from 5.40 min (for composite resin) to 8.09 min (for LED thermocured HVGIC), and the average cost per sealant for 1,000 performed per group (simulation sample) ranged from $US3.73 (for composite resin) to $US7.50 (for glass-carbomer). The incremental cost-effectiveness of LED thermocured HVGIC to prevent one additional caries lesion per 1,000 sealants performed was $US1,106 compared with composite resin. Sensitivity analyses showed that differences in the cost of materials across groups had minimal impact on the overall cost. Cost and effectiveness data enhance policymakers' ability to address issues of availability, access, and compliance associated with poor oral-health outcomes, particularly when large numbers of children are excluded from care, in economies where oral health services are still developing.

Value for money: economic evaluation of two different caries prevention programmes compared with standard care in a randomized controlled trial.

A cost-effectiveness analysis was conducted during a 3-year randomized controlled clinical trial in a general dental practice in the Netherlands in which 230 6-year-old children (± 3 months) were assigned to either regular dental care, an increased professional fluoride application (IPFA) programme or a non-operative caries treatment and prevention (NOCTP) programme. Information on resource use during the 3-year period was documented by the dental nurse at every patient visit, such as treatment time, travel time and travel distance. Caries increment scores (at D3MFS level) were used to assess effectiveness. Cost calculations were performed using bottom-up micro-costing. Incremental cost-effectiveness ratios (ICERs) were expressed as additional average costs per prevented DMFS. The ICERs compared with regular dental care from a health care system perspective and societal perspective were, respectively, EUR 269 and EUR 1,369 per prevented DMFS in the IPFA programme, and EUR 30 and EUR 100 in the NOCTP programme. The largest investments for the NOCTP group were made in the first year of the study; they decreased in the second and equalled the costs of control group in third year of the study. From both medical and economic points of view, the NOCTP strategy may be considered the preferred strategy for caries prevention.

A cost-minimization analysis of an RCT of three retention methods.

BACKGROUND: There are few cost evaluation studies of orthodontic retention treatment. The aim of this study was to compare the costs in a randomized controlled trial of three retention methods during 2 years of retention treatment. MATERIALS/METHODS: To determine which alternative has the lower cost, a cost-minimization analysis (CMA) was undertaken, based on that the outcome of the treatment alternatives was equivalent. The study comprised 75 patients in 3 groups consisting of 25 each. The first group had a vacuum-formed retainer (VFR) in the maxilla and a cuspid retainer in the mandible (group V-CTC), the second group had a VFR in the maxilla combined with stripping of the incisors and cuspids in the mandible (group V-S), and the third group had a prefabricated positioner (group P). Direct cost (premises, staff salaries, material and laboratory costs) and indirect costs (loss of time at school) were calculated. Societal costs were defined as the sum of direct and indirect costs. RESULTS: The societal costs/patient for scheduled appointments for 2 years of retention treatment in group V-CTC were €497, group V-S €451 and group P €420. Societal costs for unscheduled appointments in group V-CTC were €807 and in group V-S €303. In group P, there were no unscheduled appointments. CONCLUSIONS/IMPLICATIONS: After 2 years of retention in compliant patients, the cuspid retainer was the least cost-effective retention appliance. The CMA showed that for a clinically similar result, there were differences in societal costs, but treatment decisions should always be performed on an individual basis.

Cost analysis of periodontitis management in public sector specialist dental clinics.

BACKGROUND: The objective of this paper is to quantify the cost of periodontitis management at public sector specialist periodontal clinic settings and analyse the distribution of cost components. METHODS: Five specialist periodontal clinics in the Ministry of Health represented the public sector in providing clinical and cost data for this study. Newly-diagnosed periodontitis patients (N = 165) were recruited and followed up for one year of specialist periodontal care. Direct and indirect costs from the societal viewpoint were included in the cost analysis. They were measured in 2012 Ringgit Malaysia (MYR) and estimated from the societal perspective using activity-based and step-down costing methods, and substantiated by clinical pathways. Cost of dental equipment, consumables and labour (average treatment time) for each procedure was measured using activity-based costing method. Meanwhile, unit cost calculations for clinic administration, utilities and maintenance used step-down approach. Patient expenditures and absence from work were recorded via diary entries. The conversion from MYR to Euro was based on the 2012 rate (1€ = MYR4). RESULTS: A total of 2900 procedures were provided, with an average cost of MYR 2820 (€705) per patient for the study year, and MYR 376 (€94) per outpatient visit. Out of this, 90% was contributed by provider cost and 10% by patient cost; 94% for direct cost and 4% for lost productivity. Treatment of aggressive periodontitis was significantly higher than for chronic periodontitis (t-test, P = 0.003). Higher costs were expended as disease severity increased (ANOVA, P = 0.022) and for patients requiring surgeries (ANOVA, P < 0.001). Providers generally spent most on consumables while patients spent most on transportation. CONCLUSIONS: Cost of providing dental treatment for periodontitis patients at public sector specialist settings were substantial and comparable with some non-communicable diseases. These findings provide basis for identifying potential cost-reducing strategies, estimating economic burden of periodontitis management and performing economic evaluation of the specialist periodontal programme.

The impact of additional dental providers in the dental labor market on the income of private practice dentists.

This study estimates the impact that the entrance of hypothetical allied dental professionals into the dental labor market may have on the earnings of currently practicing private practice dentists. A simulation model that uses the most reliable available data was constructed and finds that the introduction of hypothetical allied dental professionals into the competitive California dental labor market is likely to have relatively small effects on the earnings of the average dentist in California.

The 'Secret' of success part 1.

Practice success is defined across the four'dimensions' of oral health, patient satisfaction, job satisfaction and financial profit. It is suggested that the 'secret' of success in dental practice is to make patient (customer) satisfaction the primary focus. Not a very earth shattering or surprising'secret' perhaps! This is hardly a new idea, and not a concept restricted to dental practice. This principle applies to all businesses. This series of articles reviews evidence from across a broad spectrum of publications: from populist business publications through to refereed scientific papers, this'secret' seems to be confirmed. The evidence for which aspects of our service are most important in achieving patient satisfaction (and therefore success) is explored. Good oral health outcomes for patients are defined as the primary purpose of dental practice and, therefore, an essential dimension of success. The link between positive patient perceptions of general care and their own oral health to practice success is explored.

Role and models for compensation of tobacco use prevention and cessation by oral health professionals.

Appropriate compensation of tobacco use prevention and cessation (TUPAC) would give oral health professionals better incentives to provide TUPAC, which is considered part of their professional and ethical responsibility and improves quality of care. Barriers for compensation are that tobacco addiction is not recognised as a chronic disease but rather as a behavioural disorder or merely as a risk factor for other diseases. TUPAC-related compensation should be available to oral health professionals, be in appropriate relation to other dental therapeutic interventions and should not be funded from existing oral health care budgets alone. We recommend modifying existing treatment and billing codes or creating new codes for TUPAC. Furthermore, we suggest a four-staged model for TUPAC compensation. Stages 1 and 2 are basic care, stage 3 is intermediate care and stage 4 is advanced care. Proceeding from stage 1 to other stages may happen immediately or over many years. Stage 1: Identification and documentation of tobacco use is part of each patient's medical history and included into oral examination with no extra compensation. Stage 2: Brief intervention consists of a motivational interview and providing information about existing support. This stage should be coded/reimbursed as a short preventive intervention similar to other advice for oral care. Stage 3: Intermediate care consists of a motivational interview, assessment of tobacco dependency, informing about possible support and pharmacotherapy, if appropriate. This stage should be coded as preventive intervention similar to an oral hygiene instruction. Stage 4: Advanced care. Treatment codes should be created for advanced interventions by oral health professionals with adequate qualification. Interventions should follow established guidelines and use the most cost-effective approaches.

Private practice of prosthodontists: current conditions of practice in the United States.

PURPOSE: The purpose of this article is to examine data and results from the 2008 Survey of Prosthodontists. Survey results are used to examine current trends and characteristics of prosthodontists in private practice. MATERIALS AND METHODS: Characteristics of prosthodontists and conditions of private practice are based on surveys conducted in 2002, 2005, and 2008 sponsored by the American College of Prosthodontists. Survey results are used to estimate several characteristics including age, gender, number of patient visits, hours in the practice, employment of staff, referral sources, and financial conditions (gross receipts, expenses of the practice, and net income of prosthodontists). RESULTS: The average age of a private-practicing prosthodontist reached 51 years in 2007; 12.3 is the number of years in the current practice; and most prosthodontists (71%) are solo private practitioners. The average amount of time per week by prosthodontists in the practice averaged 36.1 hours, and prosthodontists treated an average of 44.1 patient visits per week. The largest source of patient referrals is the patient themselves. The largest percentage of a prosthodontist's treatment time is spent rendering procedures in fixed prosthodontics, but this percentage has declined since 2001. In 2007, the average gross billings of a practicing prosthodontist reached $805,675; average total practice expenses were $518,255; the mean net earnings of practitioners were $268,930. CONCLUSION: In 2007, prosthodontists in private practice paid out about $1.4 billion in practice expenses to provide $2.2 billion dollars in prosthodontic care. Based on survey results from 2007 and the previous 6 years, specialization in prosthodontic care continues to be an economically attractive and productive healthcare profession in the United States.

Non-working dental therapists: opportunities to ameliorate workforce shortages.

BACKGROUND: Workforce development is acritical factor allowing delivery on government health priorities. Against a backdrop of increasingdemand for dental therapists being significantly higher than the levels of recruitment, it is widely acknowledged that rural and remote areas (having greater recruitment and retention issues) will face significant shortfall in therapist numbers as the workforce shortages take hold in dentistry. This study analysed the reasons for dental therapists leaving the profession, and factors that would promote the recruitment and retention of dental therapists, especially in rural and remote areas. METHODS: A postal survey was undertaken amongst all registered dental therapists in Western Australia between the years 1999-2003. RESULTS: Of all respondents, 28 per cent indicated that they do not work as dental therapists anymore. A number of reasons for leaving the profession were highlighted, including family reasons, careerchange, poor salaries, relocation, illness and injury, and stress. To increase retention and recruitment of dental therapists to rural areas, a number of opportunities were highlighted by respondents, including increased salaries, living support, travel assistance, access to continuing education, recruitment of more rural students and more flexibility (including job sharing). CONCLUSION: This survey has highlighted various opportunities to recruit and retain dental therapists in their profession and to increase the numbers of rural dental therapists. A broad integrated rural retention strategy is necessary to address these issues among the dental therapy workforce.

Dental establishment business activity in California counties at the start of the millennium.

The Bureau of the Census reports for 2002 were used to develop business data for "average" dental establishments in each of the counties in California. On average, between 1997 and 2002, when compared to national information, the number of California statewide dental establishments increased at a greater rate, had a smaller resident population per establishment, reported lower gross receipts, had fewer employees, and paid lower salaries to employees.

Hiring staff 101.

For the graduating dentist or the dentist in practice for only a few years, the best investment you can make in your future is to hire and keep the highest-quality staff. Dentists new to the role of employer have neither the HR training to attract, interview, and hire quality staff, nor the experience in dealing with what may just be the most important factor in the success of your practice: the people you hire.

Economic models to help periodontists evaluate their practices: how to analyze a practice to assess the potential impact of managed care contracts.

The purpose of this article is to examine 10 steps analyzing the financial impact on a periodontal practice accepting a proposed managed care dental plan. It is emphasized that this analysis should be conducted before formally agreeing to accept the proposed plan. The procedures for examining the 10 steps include the use of hypothetical data for a periodontal practice confronted with a discounted fee plan. Each step is identified, discussed, and the hypothetical data are used to develop results presented in a set of tables. The steps in the analysis process include constructing a practice profit and loss statement and developing a dataset of practice characteristics and productivity measures. Other estimates should be made of covered lives, new patient utilization, existing patient utilization, utilization of non-covered services, estimating other sources of revenue and expense, and the impact on capacity utilization of operatories and practice staff. Results are presented in a set of analysis tables. The importance of multiple analyses is discussed as is the importance of analyzing the impact on results from changing assumptions. Some of the higher risk variables faced by the practitioner are identified for submission to risk evaluation to examine the sensitivity of results. Finally, the relationship between the proposed plan and the additional time required by the periodontist to meet the plan's specifications is examined in light of the data developed in the 10 steps and the results tables.

Productive efficiency and its determinants in the Finnish Public Dental Service.

OBJECTIVE: Our objective was to investigate the cost efficiency of the Public Dental Service (PDS), which, until 2000, was responsible for organising dental care for children and younger adults born in 1956 and later. METHODS: Input and output data and information on various organisational and environmental characteristics were collected from 228 municipal PDS units in Finland. First, non-parametric data envelopment analysis (DEA) was employed to assess efficiency. In the second stage, econometric Tobit analysis was used to explore various predictors of cost efficiency, technical efficiency and allocative efficiency. As input in the DEA model we used personnel full-time equivalents and material and other costs expressed in monetary terms, and as output we used the number of treated patients. RESULTS: The study showed big differences in cost efficiency between the PDS units studied. The average cost inefficiency was 30%. Approximately two-thirds of the observed cost inefficiency was because of technical inefficiency and one-third because of allocative inefficiency. High state-subsidy levels, and a high proportion of young patients predicted inefficiency, and young population and low socioeconomic conditions in the municipality predicted efficiency. The results also indicated that many PDS units could have improved allocative efficiency by increasing the relative numbers of auxiliaries in relation to dentists. On the other hand, some units were too small to employ full-time dental hygienists efficiently. CONCLUSIONS: In the Finnish PDS, there are uncommitted resources that could be reallocated so as to improve overall efficiency.

Can organised dental care for children be both good and cheap?

Children's dental services evolved from emergency, pain-relieving and later amalgam-based care systems of the early and middle 20th century. The pattern of occurrence of dental caries is different today and young teenagers have very few teeth affected by caries. Restoration of lesions in permanent teeth, typically on occlusal or buccal/lingual surfaces, is technically simple. Paradoxically, dental students today are expected to master a vast amount of knowledge, including information on new dental materials and techniques. New dentists who choose to provide dental care for children as a career will spend most of their days placing fissure sealants, applying topical fluorides and inserting predominantly single-surface restorations. Because of their expensive training, new dentists will nevertheless expect high earnings, and this results in a high cost for children's dental care. The opportunity cost is other health services foregone. In developing countries where there are few dentists, they are almost not available for children at all. Costs could be reduced by reducing the number of interventions, and by reducing staff costs. Fewer interventions could be achieved by longer recall intervals: several studies and experience from places where this has been implemented indicate that is safe and effective. Widespread delegation of operative work to appropriately trained dental hygienists or therapists would reduce staff costs. Dental therapists are better substitutes for dentists in children's care because they are trained to do most of the clinical procedures that are necessary in children's dentistry. In Western Australia and South Australia, most dental care for children is provided by dental therapists. The costs of care are much lower and the outcome, as measured by caries experience and numbers of treated patients, is equivalent to or even better than European dentist-based services. Already, in some places, politicians and others are querying the need for organised children's dental care. Increased effectiveness will make continuation of children's dental services easier to sustain.