A Cost Analysis of Treating Pediatric Dental Patients: DISCUSSION

In: Dental treatment

20 Jan 2010

Cost analysis

The second aim was to determine the relationship between societal costs and treatment rendered for both GA and CS models. The goal with this aim was to develop a model that would explain cost of GA and CS. Using regression analyses for the GA model, this study found that the RBVUs explained more than 70% of the variance in cost. For the CS model, the study found that the RBVUs explained more than 60% of the variance in cost. This can be interpreted to mean that treatment rendered, measured in RBVUs, had a significant effect on the costs of both GA and CS.

The third aim was to determine the relationship between GA and CS cost models. When the GA versus CS regression lines were plotted, the intersection represents the point at which the cost of GA and CS would be equal. The study found that at a RBVU of 66.5 and cost of $2677, CS cost surpasses GA cost. This critical intersection equates to 3.6 CS appointments.
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Outcomes for GA Versus CS

One of the major underlying assumptions in this study was that the treatment outcomes for GA versus CS would be the same. The authors recognize that this is a difficult assumption to make. For example, for CS some practitioners may be faced with making treatment decisions with no or poor-quality radiographs. However, the premise in undertaking a cost-minimization study was based on the assumption of all other things being equal, including outcomes of the treatment.

Decisions Based on Risks

In this clinical environment, when parents consider GA versus CS treatment for their children, they have already made an informed decision that no treatment is not an option with which they are comfortable. Typically, these children have more extensive restorative and surgical needs and many have already received emergency care for pain and swelling. For those parents who consider GA versus CS care, it seems logical that their decision should begin with a comparison of risks for the 2 mo dalities. However, such risk data are elusive. With reference to pediatric mortality using GA, 1:20,000 is cited in the literature by several authors. In the United States there are no published risk data of GA specific to the dental cases. In England and Wales, the dental GA mortality rate remained constant at 1: 215,000 between 1970 and 1990. These data included all dental GA cases, both pediatric and adult.

There are no published incidence data for the morbidity and mortality of pediatric CS. Goodman and Moore’s classic review in 1983 focused on 14 cases of sedation misadventures, but no incidence data were cited. A tragedy of pediatric CS does surface occasionally in the media. However, since the publication of the Guidelines for Monitoring and Management of Pediatric Patients During and After Sedation for Diagnostic and Therapeutic Procedures in 1985, subsequently revised in 1992 by the American Academy of Pediatrics and in 1996 by the American Academy of Pediatric Dentistry, the authors are aware of no pediatric patient fatalities that have occurred when the original 1985 guidelines have been fully used as the standard of care (American Academy of Pediatric Dentistry, written communication, 1999).

A parental decision to choose GA versus CS is difficult to make on the basis of risks, so parents often must consider other factors, one of which is cost. In selecting cost models, this investigation chose a model that values parents’ time away from work for appointment activities. erectalis


Under the conditions of the study, the quantity of the treatment rendered based on RBVUs was highly correlated with the total cost of care from the societal perspective, and if a child needed more than 3 CS appointments, the GA option offered cost savings over the CS treatment option.

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Blog invites submissions of review articles, reports on clinical techniques, case reports, conference summaries, and articles of opinion pertinent to the control of pain and anxiety in dentistry.