Economische evaluatie van cariëspreventieprogramma’s
Steeds vaker wordt onderzoek gedaan naar de doelmatigheid van de (mond)zorg, met soms in het verlengde daarvan onderbouwing van bestaande en nieuwe behandelingen. Een literatuuronderzoek naar de kosteneffectiviteit van cariëspreventieprogramma’s toont de methodologische en analytische beperkingen van dergelijke onderzoeken.
The aim of this study was to perform a systematic review of economic evaluations (EEs) of dental caries prevention programs to objectively retrieve, synthesize and describe available information on the field. Several strategies were combined to search for literature published between January 1975 and April 2012. MEDLINE, EconoLit and ISI formed the basis of the literature search. The study selection was done using predefined inclusion and exclusion criteria. Bibliographic listings of all retrieved articles were hand-searched. The search identified 206 references. An evaluative framework was developed based on the Centre for Reviews and Dissemination's 'Guidance for undertaking reviews in health care' (York University, 2009). Background information included publication vehicle, year of publication, geographic focus, type of preventive program and type of economic analysis. 63 studies were included in the review. The most common preventive strategies evaluated were dental sealants (n = 13), water fluoridation (n = 12) and mixed interventions (n = 12). By type of EE undertaken, 30 were cost-effectiveness analyses, 22 were cost-benefit analyses, and 5 presented both cost-effectiveness and cost-benefit analyses. Few studies were cost-utility analyses (n = 5) or cost minimization analyses (n = 2). By year of publication, most were published after 2003. The review revealed that, although the number of publications reporting EEs has increased significantly in recent years, the quality of the reporting needs to be improved. The main methodological problems identified in the review were the limited information provided on adjustments for discounting in addition to inadequate sensitivity analyses. Attention also needs to be given to the analysis and interpretation of the results of the EEs.
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Mariño RJ, Khan AR, Morgan M. Systematic review of publications on economic evaluations of caries prevention programs. Caries Res 2013; 4: 265-272. doi: 10.1159/000346917. Epub 2013 Feb 12.