Work package 5

Cost effectiveness

Participant responsibleMAHOD

Participants contributingCLUJ KUL

UNIMANVU

SEDENTEXCT consortium meeting Malmö, January 2010

To analyse the cost-effectiveness of

CBCT in different clinical situations,

health care contexts and countries

Overall objective of WP 5

Specific objectives

• To analyse the costs of CBCT examinations in terms of radiation dosage and monetary terms

• To analyse additional diagnostic information • To analyse additional therapeutical information• To calculate costs and efficacy for different clinical

situations i.e the gain of CBCT in terms of efficacy

Clinical situations agreed on

Retained maxillary canines

Lower wisdom teeth

Preoperative implants

Temporomandibular joints

Conventionalmethod

New method

Conventionalmethod

New method

COST-EFFECTIVENESS

COST ANALYSIS ANALYSIS OF CONSEQUENCES

D5.1 Analysis of time and cost spent on the ”key” CBCT examination in all participating radiology departments – M5.2, M 18

Valuation of cost per image of intraoral and panoraminc radiographs and volumes of CBCT in EURO.

Intra-oral Panoramic CBCT

Malmö 4,02 16,12 105,42 Cluj 2,42 3,79 36,44 Leuven 1,26 1,45 24,28 Vilnius 1,95 2,25 68,26 Average 2,41 5,90 58,6

Worked on further…..

Objectives for year 2

Milestone Delivery date

5.2 Cost analysis Month 24

5.3 WP5 clinical case collection completed

Month 21

5.5 WP5 diagnosis and treatment plan completed

Month 24

Milestone Delivery date

5.2 Cost analysis Month 24

5.3 WP5 clinical case collection completed

Month 21

5.4 Assessment of WP5 radiographs completed

Month 21

5.5 WP5 diagnosis and treatment plan completed

Month 24

Number of received patient protocols December 21, 2009

Retained canines

Implants Lower wisdom

teeth

TMJ

Cluj 9 50 24 3

Leuven 34

Malmö 51 65 35 20

Vilnius 35 50 31

Summary 129 165 90 23

Problems identified:

• recruitment of patients• patients examined with only one radiographic method (CBCT) in some centres • transfer of images to MAHOD

Problem solving:

• continuous recruitment of patients in MAHOD• UNIMAN entering clinical cases into WP5

Milestone Delivery date

5.2 Cost analysis Month 24

5.3 WP5 clinical case collection completed

Month 21

5.4 Assessment of WP5 radiographs completed

Month 21

5.5 WP5 diagnosis and treatment plan completed

Month 24

ANALYSIS OF CONSEQUENCES

Influence on the confidence of the radiologist – diagnostic thinking efficacy (M5.4)

Influence on the confidence of the clinicianin treatment decision (M5.5)

Influence on the treatment

Consequences for the patient

Retained canine Observer ………………..… Observation ………………. Date …………… Assessment of panoramic and intra-oral radiography Patient id:………………………. Canine: ………………. Name:…………………………………………………….. Impacted canine How confident are you in your

assessment?

Position YES NO Not confident Very confident Mediolateral position

NOT POSSIBLE TO ASSESS

Horisontal Vertical Mesioangular Distoangular Bucco-lingual position Crown central Crown buccal Crown palatal Root central Root buccal Root palatal Distance crown to marginal bone Crown tip through marginal bone 1 – 5mm from marginal bone 5 – 10mm from marginal bone > 10mm from marginal bone Not possible to assess Root morphology Root with open apex Root with closed apex Root curve or flex Curve at inferior 1/3 of root Curve at inferior 2/3 of root Curve at apical 1/3 of root Curve in buccal direction Curve in palatal direction Curve in mesial direction Curve in distal direction Follicular size < 3mm 3-5mm > 5mm

Resorption of neighbouring root Central incisor Lateral incisor First premolar Root resorption definitely not present Root resorption definitely not present Root resorption definitely not present Root resorption probably not present Root resorption probably not present Root resorption probably not present Unsure (uncertain) Unsure (uncertain) Unsure (uncertain) Root resorption probably present Root resorption probably present Root resorption probably present Root resorption definitely present Root resorption definitely present Root resorption definitely present IF resorption is present or probably present

How confident are you in your assessment?

Tooth…. Not confident Very confident Amount of resorption Superficial Reaching ½ to pulp Reaching pulp Not possible to assess Placement of resorption Mainly apical Mainly buccal Mainly palatal Mainly distal Mainly mesial Mainly other Tooth….

Amount of resorption Superficial Reaching ½ to pulp Reaching pulp Not possible to assess Placement of resorption Mainly apical Mainly buccal Mainly palatal Mainly distal Mainly mesial Mainly other Comments: ………………………………………………………………………………………………………………………………………… Time for assessment…………minut

Problems identified:

• recruitment of patients• patients examined with only one radiographic method (CBCT) in some centres • transfer of images to MAHOD

Milestone Delivery date

5.2 Cost analysis Month 24

5.3 WP5 clinical case collection completed

Month 21

5.4 Assessment of WP5 radiographs completed

Month 21

5.5 WP5 diagnosis and treatment plan completed

Month 24

Plans for Month 24 - 36

Month 27

M 5.4Retained canines and wisdom teeth

Month 30

M 5.5Retainedcanines

Month 32

M 5.5Wisdom teeth andImplant patients

Month 26

M 5.6Avalaibility of WP2dosimetry data forWP5 work

M 5.7 and 5.8Completion ofWP5 work

D5.2Completion of cost analysis of CBCT

D5.2, M26Completion of cost analysis of CBCT

D5.3, M36Analysis and calculations of cost-effectiveess completed