A Cost Analysis of Treating Pediatric Dental Patients: RESULTS

In: Dental treatment

19 Jan 2010

The sample included 12 boys (55%) and 10 girls (45%). The mean age of the sample was 40 months (SD, 5.1) with an age distribution as follows: 24-35 months, 32%; 36-47 months, 32%; and 48-60 months, 33%.

Table 2 illustrates the GA results. The mean time spent in the operating room was 2 hours 32 minutes. Most cases (64%) were completed in 3 hours or less. The mean GA charge, excluding the cost for dental procedures and opportunity cost, was $2326. The mean societal cost was $2698, a figure that includes opportunity costs but excludes costs for dental procedures.
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Table 2. General Anesthesia Results

No. (%) (N = 22)
Operating room time, h (mean, 2 hours 32 minutes)
1-2 7(32)
2-3 7(32)
3-4 5(23)
>4 3(13)
Total GA charges, $ (mean, $2326)t
1000-1500 2(9)
1500-2000 10 (45)
2000-2500 3(14)
2500-3000 7(32)
Total societal costs, $ (mean, $2698)1=
1000-2000 6(27)
2000-3000 9(41)
3000-4000 7(32)
RBVU, treatment rendered (mean, 53.75 ± 10.5)
0-35 3(14)
36-70 13 (59)
71-100 6(27)
* GA indicates general anesthesia; RBVUs, relative based value units.t Excluding costs for dental procedures and opportunity costs.

t Excluding costs for dental procedures but including opportunity costs.

The mean RBVU (treatment rendered) for GA carewas 53.75 (SD, 10.5). Table 3 illustrates the results when the same RBVU values were then applied to the CS estimation model. In the estimation model, 23% of the sample required 2 sedation appointments to complete treatment, 41% required 3 sedation appointments, and 36% required 4 or more appointments to complete their care. The mean CS charge, excluding costs for dental procedures and opportunity costs, was $1363, with the majority (54%) of the cases costing less than $2000. The mean societal cost was $2203, a figure that includes opportunity costs but no costs for dental procedures.
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Table 3. Conscious Sedation Results

No. (%) (N = 22)
No. of appointments
2 5(23)
3 9(41)
>4 8(36)
Total CS charges, $ (mean, $1363)t
500-1000 5(23)
1000-1500 9(41)
1500-2000 6(27)
2000-2500 2(9)
Total societal costs, $ (mean, $2203)f
1000-2000 12 (54)
2000-3000 5(23)
3000-4000 5(23)
* CS indicates conscious sedation.t Excluding costs for dental procedures and opportunity costs.

t Excluding costs for dental procedures, but including op­portunity costs

Two separate ordinary least squares regression models were executed. In both the GA and CS models, the association between RBVUs and total societal costs was found to be highly significant (P < .01) with an adjusted R2 of 0.77 and 0.63, respectively. The magnitude of effect was also significant, with the coefficients being 24.29 (SD, 4.21) for the GA model and 35.17 (SD, 4.33) for the CS model.

The Figure illustrates the relationship between the predicted regressions lines for the GA and CS models. The intersection of the predicted regression equations illustrates the level of treatment need at which there would be diminishing returns for using CS or the point at which cost savings would favor GA. At a RBVU of there are several alternative designs that might be used to derive a cost comparison of GA versus CS. This investigation chose the cost-minimization model using a GA sample that served as its own comparator for a CS estimation model. The advantage of this design was ability to control for social and demographic patient effects in both models. This design also reduced the selection that would be introduced by a parental choice of GA or CS on the basis of family convenience factors. Although such factors are important, this design eliminates bias related to parental choices.

The first aim of this study was to determine the societal costs of treating pediatric dental patients using GA and CS. The opportunity cost values that were used ranged from $73-$136 per day, depending on the county of residency. The state average was $105 per day or $22,583 per year for the average working adult. The mean total societal costs for 66.5 and a cost of $2677, the total cost for treatment using CS surpasses that for GA.
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About this blog

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.


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