Early correction of posterior crossbite--a cost-minimization analysis.

There are few cost evaluation studies of orthodontic treatment. The aim of this study was to determine the costs of correcting posterior crossbites with Quad Helix (QH) or expansion plates (EPs) and to relate the costs to the effects. To determine which alternative has the lower cost, a cost-minimization analysis was undertaken, based on that the outcome of the treatment alternatives is identical. The study comprised 40 subjects in the mixed dentition, who had undergone treatment for unilateral posterior crossbite: 20 with QH and 20 with EPs. Duration of treatment, number of appointments, broken appointments, and cancellations were registered. Direct costs (for the premises, staff salaries, material and laboratory costs) and indirect costs (loss of income due to parent's assumed absence from work) were calculated and evaluated for successful treatment alone, for successful and unsuccessful treatment and re-treatment when required. The QH had significantly lower direct and indirect costs, with fewer failures requiring re-treatment. Even the costs for successful cases only were significantly lower in the QH than in the EP group. The results clearly show that in terms of cost-minimization, QH is the preferred method for correcting posterior crossbite in the mixed dentition.

Regional variation in use of exogenous and endogenous glomerular filtration rate (GFR) markers in Sweden.

BACKGROUND: Markers of renal function (glomerular filtration rate (GFR)) are frequently used in the Swedish health care. GFR is usually estimated based on plasma creatinine concentration, but plasma cystatin C concentration, creatinine clearance, iohexol clearance, and (51)Cr-EDTA clearance are also used. These markers are all part of the daily patient care, but there is little specific information on the clinical use of these markers. The aim of this study was to compare the use of these various GFR markers in different parts of Sweden and potential changes over time. METHODS: Retrospective study using questionnaires to collect information for the years 2006-2009 divided per county on the specific use of GFR markers with type of test reports. RESULTS: Plasma/serum creatinine concentration (96%) is by far the dominating GFR marker in Sweden, while cystatin C concentration (3.5%), creatinine clearance (0.1%), iohexol clearance (0.1%), and 51Cr-EDTA clearance (0.1%) are less frequently used. The use of GFR markers, including creatinine, continues to increase on a national level with the exception of creatinine clearance and 51Cr-EDTA clearance. There were considerable variations between different counties in the use of GFR markers and the type of test reports that the laboratories provided. CONCLUSIONS: The inter-county variations of GFR markers used in Sweden are large and indicate that savings associated with optimized test utilization in this regard could be substantial. Regional habits and traditions are likely to influence the variations in GFR marker use.

Immediate computed tomography or admission for observation after mild head injury: cost comparison in randomised controlled trial.

OBJECTIVE: To compare the costs of immediate computed tomography during triage for admission with those of observation in hospital in patients with mild head injury. DESIGN: Prospective cost effectiveness analysis within a multicentre, pragmatic randomised trial. SETTING: 39 acute hospitals in Sweden PARTICIPANTS: 2602 patients (aged > or = 6) with mild head injury. INTERVENTIONS: Immediate computed tomography or admission for observation. MAIN OUTCOME MEASURES: Direct and indirect costs related to the mild head injury during the acute and three month follow-up period. RESULTS: Outcome after three months was similar for both strategies (non-significantly in favour of computed tomography). For the acute stage and complications, the cost was 461 euros (314 pounds sterling, 582 dollars) per patient in the computed tomography group and 677 euros (462 pounds sterling, 854 dollars) in the observation group; an average of 32% less in the computed tomography group (216 euros, 95% confidence interval -272 to -164; P < 0.001). Sensitivity analysis showed that computed tomography was the most cost effective strategy under a broad range of assumptions. After three months, total costs were 718 euros and 914 euros per patient-that is, 196 euros less in the computed tomography group (- 281 to - 114; P < 0.001). The lower cost of the computed tomography strategy at the acute stage thus remained unchanged during follow-up. CONCLUSION: Patients with mild head injury attending an emergency department can be managed more cost effectively with computed tomography rather than admission for observation in hospital. TRIAL REGISTRATION: ISRCTN81464462.