Cost effectiveness of periodontal services.
This paper presents the combined use of decision trees and cost-effectiveness analysis to determine on which patients new diagnostic tests can be useful, and whether they can change the dentist's decision to provide different services and thus improve patient outcomes in 5 different categories of patients. A decision tree is constructed in which the primary decision branches are "test" and "no test". The treatment and outcome branches in the test branch are affected by the results of the test which is then either negative or positive. In contrast, the treatment and outcome branches in the no-test branch represent pathways for patient therapy when the new (or additional) test is not used. Results show that even with excellent test efficacy parameters (sensitivity 0.87 and specificity 0.84) it is not cost effective to use a diagnostic test in the general population or for adults under age 45 years. However for adults > 45 years, patients referred to a periodontist, and patients with a history of periodontal disease, the test would change treatment decisions and improve patient care outcomes.
Douglass
C W
CW
Harvard School of Dental Medicine, Department of Oral Health Policy and Epidemiology, MA, USA.
Fox
C H
CH
D000328:Adult; D000367:Age Factors; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D003657:Decision Making; D003663:Decision Trees; D006801:Humans; D008875:Middle Aged; D010510:Periodontal Diseases / Q000175:diagnosis / Q000191:economics* / Q000628:therapy; D010517:Periodontics / Q000191:economics; D011336:Probability; D012680:Sensitivity and Specificity; D016896:Treatment Outcome