Work package 5: Cost-effectiveness

This work package measures “Cost effectiveness” of CBCT. Resources for the provision of health care are scarce, in that there are not enough resources to satisfy human wants completely. In choosing to use resources in one way, one forgoes the opportunity to use the same resources in another competing activity. Therefore, before we decide to include a new technique such as CBCT in our daily routines we must determine whether this technique will add to currently used methods and whether additional information is gained. The efficacy of an imaging method can be described at different levels. At the diagnostic level, efficacy is described as diagnostic accuracy in measures that attempt to determine the performance of the imaging method for the purpose of making diagnoses. In a more global context, an imaging method should, however, be part of a larger system. It is “diagnostic thinking” and therapeutic efficacy - the value of the method for supporting clinicians in their diagnoses and treatment decisions - that are important. Imaging examinations that have no impact on therapy cannot be expected to benefit the patient, except by means of reassurance of the clinician.

A current concern relates to whether results of cost analyses have any actual impact on decision making whether to utilize a radiographic technique or not. In our studies, assessments of the benefits versus costs could clarify choices on whether to include CBCT or not in different examinations. Benefit can be defined as described above: additional information gained, the influence on the clinicians' diagnostic thinking or impact on patients' treatment. Costs include not only economic resources spent but also risks from additional radiation dosage. There are several forms of economic evaluations: cost-minimization analysis, cost-effectiveness analysis, cost-benefit analysis, and cost-utility analysis. As the cost-effectiveness of a radiographic method often is compared to some other option, such as other radiographic methods or another clinical method - a form of cost-effectiveness analysis or cost-benefit analysis would be applicable. Scientific literature dealing with cost-effectiveness of radiographic methods applied in dentistry is scarce and our research will address this deficiency.

Objectives:

The main objective is to analyse the cost-effectiveness of CBCT in different clinical situations, health care contexts and countries.

The specific objectives are:

  1. To analyse the costs of CBCT examinations in terms of radiation dosage and monetary terms.
  2. To analyse additional diagnostic information (diagnostic accuracy and diagnostic thinking efficacy).
  3. To analyse additional therapeutic efficacy.
  4. To calculate costs and efficacy for different clinical situations i.e. the gain of CBCT in terms of efficacy.