Assessing The Outcomes of Prosthetic Treatment in Lower Overdenture Wearers

Abstract

A 8 0 7 -A 9 1 8 identified in the database. The randomized trial observed mean time to heal of 10.5 and 27.6 days for HCD and SSD, respectively (incremental effectiveness of -17.1 days). Evidence from smaller observational studies have reported intervals to HCD change of up to 14 days, while SSD requires two changes per day. Thus, the model estimated costs for the inpatient period assuming one dressing change for HCD and 28 for SSD. Cost per dressing change was estimated as 17.30BRL (BRL= Brazilian Reais) for HCD and 15.58BRL for SSD and overall treatment costs were 1,367.94BRL and 3,548.26BRL, respectively. Healthcare-related incremental costs were -1.72BRL indicating a cost-saving profile. Benefits in terms of reduction in length of stay were not accounted in this case based scenario. If average public hospital daily charges were included in the cost estimation, savings would reach -2,180.32BRL per patient or -479,617,192.42BRL for the cohort. ConClusions: HCD dressing has shown higher clinical efficacy when compared to SSD, with fewer overall costs, representing a robust cost reduction profile.Singapore objeCtives: Despite increasing use of economic evaluation to inform decisionmaking in Asia, decisions were made in the face of uncertainty due to poor quality evidence, if not absent. As wrong decision made comes with costly opportunity loss, value of information (VOI) analysis can provide a rational approach by estimating the monetary value of reducing uncertainty through future additional research. This study aims to investigate the use of VOI in a case of selection of strategies in the prevention of carbamazepine (CBZ)-induced Stevens-Johnson syndrome and toxic epidermal necrolysis among newly-diagnosed epilepsy patients in Malaysia. Methods: A hybrid model of decision tree and Markov model was developed to evaluate three strategies -(i) CBZ initiation without HLA-B*15:02 genetic screening (reflecting current practice); (ii) universal HLA-B*15:02 genetic screening prior CBZ initiation; and (iii) alternative treatment (valproic acid) without HLA-B*15:02 genetic screening. This analysis undertook the societal perspective over a lifetime time horizon. The population expected value of perfect information (PEVPI) and partial EVPI (EVPPI) were calculated for the three model parameter subsets: probabilities, direct medical costs, and utilities. A 10-year expected lifetime of the technology was assumed. Results: Based on a 10-year stream of 72,422 newlydiagnosed epilepsy population, the PEVPI was MYR739 million (USD185 million) at a willingness-to-pay threshold of MYR36,000 (USD9,000) per quality-adjusted life-year (QALY). The EVPPI results suggested that direct medical costs subset represented the largest amount of uncertainty, at MYR736 million (USD184 million). The EVPPIs of probabilities and utilities subsets were relatively modest at MYR18 million (USD5 million) and MYR11 million (USD3 million), respectively. ConClusions: This study demonstrated that VOI analysis is useful in quantifying and decreasing uncerta...