Quality-Adjusted Life Year Proxies for Caries in Primary Dentition: A Discrete Choice Experiment

Autor: T.K. Lin, D.E. Arriola Zarate, N. Iribarren, H. Lindau, F. Ramos-Gomez, S.A. Gansky
Rok vydání: 2023
Předmět:
Zdroj: JDR Clinical & Translational Research. :238008442211493
ISSN: 2380-0852
2380-0844
DOI: 10.1177/23800844221149337
Popis: Introduction: Cost-utility analysis (CUA)—a method to evaluate intervention cost-effectiveness—transforms benefits of alternatives into a measure of quantity and quality of life, such as quality-adjusted life year (QALY), to enable comparison across heterogeneous programs. Measurement challenges prevent directly estimating utilities and calculating QALYs for caries in primary dentition. Proxy disease QALYs are often used as a substitute; however, there lacks quantitative evidence that these proxy diseases are comparable to caries. Objective: To employ a discrete choice experiment (DCE) to quantitatively determine the most comparable proxy disease for different levels of caries in primary dentition. Methods: A cross-sectional DCE survey was administered to respondents ( N = 461) who resided in California, were aged ≥18 y, and were primary caretakers for ≥1 child aged 3 to 12 y. Four attributes were included: pain level, disease duration, treatment cost, and family life impacts. Mixed effects logistic regression and conditional logistic regression were used to analyze the survey data. Results: Respondents from the overall sample preferred no pain over mild (odds ratio [OR] = 0.50, P < 0.05), moderate (OR = 0.57, P < 0.05), and severe pain (OR = 0.48, P < 0.05). Acute gastritis (OR = 0.44, P < 0.05), chronic gastritis (OR = 0.31, P < 0.01), and cold sore (OR = 0.38, P < 0.05) were less preferred than stage 1 caries. Acute tonsilitis (OR = 0.43, P < 0.05), acute gastritis (OR = 0.38, P < 0.05), chronic gastritis (OR = 0.26, P < 0.01), and cold sore (OR = 0.33, P < 0.01) were less preferred than stage 2 caries. Chronic gastritis (OR = 0.42, P < 0.05) was less preferred than stage 4 caries. Conclusions: Parents viewed the characteristics of many diseases with similar QALYs differently. Findings suggest that otitis media and its QALY—as commonly used in CUAs—may be a suitable proxy disease and substitute. However, other disease states with slightly different QALYs may be suitable. As such, the recommendation is to consider a range of proxy diseases and their QALYs when conducting a CUA for child caries interventions. Knowledge Transfer Statement: This study reviews and systematically compares pediatric diseases that are comparable to caries in primary dentition. The findings may inform future research using cost-utility analysis to examine the incremental cost-effectiveness ratio of interventions to prevent and treat caries as compared with an alternative.
Databáze: OpenAIRE
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