Cost-effectiveness analysis design for interventions to prevent children's oral disease.

Introduction: In 2015, the National Institute of Dental and Craniofacial Research (NIDCR) launched the Multidisciplinary Collaborative Research Consortium to Reduce Oral Health Disparities in Children, supporting four randomized trials testing strategies to improve preventive care. A Coordinating Center provides scientific expertise, data acquisition and quality assurance services, safety monitoring, and final analysis-ready datasets. This paper describes the trials' economic analysis strategies, placing these strategies within the broader context of contemporary economic analysis methods. Methods: The Coordinating Center established a Cost Collaborative Working Group to share information from the four trials about the components of their economic analyses. Study teams indicated data sources for their economic analysis using a set of structured tables. The Group meets regularly to share progress, discuss challenges, and coordinate analytic approaches. Results: All four trials will calculate incremental cost-effectiveness ratios; two will also conduct cost-utility analyses using proxy diseases to estimate health state utilities. Each trial will consider at least two perspectives. Key process measures include dental services provided to child participants. The non-preference-weighted Early Childhood Oral Health Impact Scale (ECOHIS) will measure oral health-related quality of life. All trials are measuring training, implementation, personnel and supervision, service, supplies, and equipment costs. Conclusions: Consistent with best practices, all four trials have integrated economic analysis during their planning stages. This effort is critical since poor quality or absence of essential data can limit retrospective analysis. Integrating economic analysis into oral health preventive intervention research can provide guidance to clinicians and practices, payers, and policymakers.

Monetary incentives for improving smartphone-measured oral hygiene behaviors in young children: A randomized pilot trial.

AIMS: To assess feasibility, acceptability, and early efficacy of monetary incentive-based interventions on fostering oral hygiene in young children measured with a Bluetooth-enabled toothbrush and smartphone application. DESIGN: A stratified, parallel-group, three-arm individually randomized controlled pilot trial. SETTING: Two Los Angeles area Early Head Start (EHS) sites. PARTICIPANTS: 36 parent-child dyads enrolled in an EHS home visit program for 0-3 year olds. INTERVENTIONS: Eligible dyads, within strata and permuted blocks, were randomized in equal allocation to one of three groups: waitlist (delayed monetary incentive) control group, fixed monetary incentive package, or lottery monetary incentive package. The intervention lasted 8 weeks. OUTCOMES: Primary outcomes were a) toothbrushing performance: mean number of Bluetooth-recorded half-day episodes per week when the child's teeth were brushed, and b) dental visit by the 2-month follow-up among children with no prior dental visit. The a priori milestone of 20% more frequent toothbrushing identified the intervention for a subsequent trial. Feasibility and acceptability measures were also assessed, including frequency of parents syncing the Bluetooth-enabled toothbrush to the smartphone application and plaque measurement from digital photographs. FINDINGS: Digital monitoring of toothbrushing was feasible. Mean number of weekly toothbrushing episodes over 8 weeks was 3.9 in the control group, 4.1 in the fixed incentive group, and 6.0 in the lottery incentive group. The lottery group had 53% more frequent toothbrushing than the control group and 47% more frequent toothbrushing than the fixed group. Exploratory analyses showed effects concentrated among children ≤24 months. Follow-up dental visit attendance was similar across groups. iPhone 7 more reliably captured evaluable images than Photomed Cannon G16. CONCLUSIONS: Trial protocol and outcome measures were deemed feasible and acceptable. Results informed the study protocol for a fully powered trial of lottery incentives versus a delayed control using the smart toothbrush and remote digital incentive program administration. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT03862443.

Mobilizing for a war on the home front against sugar-related morbidity and mortality.

In Israel today, there are 420,200 Israelis diagnosed with diabetes, and every year, Israelis sustain thousands of diabetes-related deaths and tens of thousands of diabetes-related amputations. As such, in Israel, as in much of the world, there is a silent and deadly public health war against obesity and diabetes taking place on the home front -- one in which clinicians, patients, and families fight thousands of life- and limb-threatening battles daily, involving preventable heart disease, diabetes, strokes and amputations. Yet the global clinical and scientific communities, indeed society at large, have barely begun to mobilize. Fighting this war requires confronting and altering "obesogenic" and "diabetogenic" economic and social factors, including food and beverage marketing and pricing that push diets engorged with processed sugars. Ginsberg, in a study recently published in IJHPR, contributes to our understanding of the combined sugar-related health burdens in Israel, producing an epidemiology and health economics study that estimates the health burdens of obesity, overweight, and dental caries in Israel today. He projects the reductions resulting from that portion of disease burden and associated costs if sugar consumption declined to 10 or 5% of daily caloric consumption as a result of multifaceted public health interventions. Projected over 70 years, these reductions in sugar consumption would prevent 16,590 and 34,580 deaths, respectively. These numbers of Israeli deaths averted are similar to, or exceed, the total resulting from armed conflict or terrorism over the past 70 years. While overconsumption of sugar is only one of many factors that drive cardio-metabolic disease, the study by Ginsberg suggests a path through which we can overcome the numerous internal and external obstacles that societies face in making a public policy commitment to fight the warm on the home front: promoting health by reducing added sugar exposure.