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Is Non-invasive Management Of Dental Caries In Private Practice Cost-effective? A Randomized Controlled Trial
Funder
National Health and Medical Research Council
Funding Amount
$325,136.00
Summary
Despite evidence to the contrary, dentists routinely fill decayed teeth that, managed preventively, would be likely to repair (arrest). The probable cost to society of this approach is enormous. Modeling indicates that each new dental filling is likely to cost an average of $1811 (US) over the life-cycle of a tooth. This figure includes re-treatment costs, and the increased likelihood of more expensive re-treatment in future, such as root canal treatment and tooth crowning. An examination of the ....Despite evidence to the contrary, dentists routinely fill decayed teeth that, managed preventively, would be likely to repair (arrest). The probable cost to society of this approach is enormous. Modeling indicates that each new dental filling is likely to cost an average of $1811 (US) over the life-cycle of a tooth. This figure includes re-treatment costs, and the increased likelihood of more expensive re-treatment in future, such as root canal treatment and tooth crowning. An examination of the societal costs involved is likely to reveal this amount to be an under-estimate; consider the costs borne by sectors outside health: days lost to work, lost productivity. Further, we should consider costs to families: travel time and costs, childcare, the opportunity cost of items forgone in order to pay for the dental treatment. Despite this, a recent systematic review of dental caries prevention concluded 'there is presently no proof, in published economic evaluations of the cost-effectiveness of caries-preventive measures'. The authors highlighted a lack of methodologically sound studies. This research will compare a targeted preventive program to standard care within private dental practices. Prior to an alternative approach being introduced, an assessment of effectiveness and cost-effectiveness is needed. It is through such assessment that the value of the comparator can be assessed and our precious health dollars saved. The radical surgical approach (filling) that evolved to deal with the caries problem is entrenched in both public and private institutions that teach and deliver dental care. The strategic element is to reorient the services provided by general practices towards to goal of delivering a substantial reduction in the need to drill teeth, while maximizing the opportunity for a non-invasive remineralization approach that has been successfully demonstrated in in-vitro, in-vivo, and in small scale clinical trials.Read moreRead less
Effectiveness, Cost-effectiveness And Equity Of Strategies To Reduce The Burden Of Obesity-related Conditions
Funder
National Health and Medical Research Council
Funding Amount
$46,900.00
Summary
Decision-makers need a systematic, coordinated approach to the targeting and prioritisation of preventive strategies. But the evidence base for obesity interventions is for the most part small, narrow in approach, limited in impact, and lacking in cost-effectiveness and equity information. This thesis will add to the evidence base regarding the nature of the obesity epidemic in Australia and internationally and the relative cost-effectiveness of strategies to reduce the obesity burden.
Systematic Practice-based Asthma Care In The Australian Setting
Funder
National Health and Medical Research Council
Funding Amount
$563,625.00
Summary
Asthma is an illness which increasingly is affecting the health and quality of life of millions of Australians. Much effort has been focused in recent years on ways of improving the management of those people who suffer from moderate and severe asthma. A recent government initiative has been to promote the use of the 3+ Visit Plan, which encourages a more proactive, systematic approach to assessing and treating asthma in general practice. There is currently no evidence about exactly how practice ....Asthma is an illness which increasingly is affecting the health and quality of life of millions of Australians. Much effort has been focused in recent years on ways of improving the management of those people who suffer from moderate and severe asthma. A recent government initiative has been to promote the use of the 3+ Visit Plan, which encourages a more proactive, systematic approach to assessing and treating asthma in general practice. There is currently no evidence about exactly how practices can best be organized to provide this systematic care, in a way which improves the process of care and the health outcomes for patients. This study aims to evaluate the effectiveness of changing aspects of practice organization and structure, such as setting up registers of asthma patients, providing recalls or reminders to patients to come in for regular review, having the GPs provide education and self-management skills to patients, focusing on the contributions which practice staff can make to the process, and initiating quality assurance measures such as audit and feedback to the GPs about their quality of care. We anticipate that these changes will provide positive benefits for the patients, but will also investigate what it costs the practices, patients and government to bring these changes about, within the perspective of efficiency and cost-effectiveness. The evidence generated by this study will provide an excellent base for providing advice to policy makers, as well as contributing to the development of best-practice models of care for asthma patients in general practice.Read moreRead less
Improving Outcomes For People With Depression In Community Settings: A Cluster RCT
Funder
National Health and Medical Research Council
Funding Amount
$803,554.00
Summary
Depression affects 350 million people worldwide. Given the pivotal role of primary care in the management of depression, effective strategies are needed to assist GPs in the delivery of patient-centred depression care. This study will test the effectiveness of providing GPs with education; as well as feedback about patients’ self-reported depressive scores using a standardised instrument and perceived need and preferences for help. This cluster RCT will be the first Australian trial of its kind.
Sedation Practice In Intensive Care Evaluation (SPICE) Randomised Controlled Trial.
Funder
National Health and Medical Research Council
Funding Amount
$2,752,725.00
Summary
Almost every patient in intensive care needs sedating drugs for comfort and provision of life-saving treatment. However, sedation causes side effects including coma, delirium and agitation. There is no high-level evidence to help doctors decide which sedatives to choose and the best way to administer them. The SPICE trial will test a new approach called Early Goal-Directed Sedation based on an alternative sedative agent to see whether it delivers safer, targeted light sedation with less delirium ....Almost every patient in intensive care needs sedating drugs for comfort and provision of life-saving treatment. However, sedation causes side effects including coma, delirium and agitation. There is no high-level evidence to help doctors decide which sedatives to choose and the best way to administer them. The SPICE trial will test a new approach called Early Goal-Directed Sedation based on an alternative sedative agent to see whether it delivers safer, targeted light sedation with less delirium.Read moreRead less
Population Dynamic Modelling Of The Public Health And Health Care Cost Implications Of Intervention To Prevent Lifestyle-related Disease And Injury
Funder
National Health and Medical Research Council
Funding Amount
$381,789.00
Summary
There is growing interest in a more preventive model of health care in Australia. More than a third of poor health is attributable to risky behaviours, such as tobacco and alcohol use, obesity and poor nutrition, with lower socio-economic and Indigenous populations particularly affected. This research will develop new techniques to identify intervention strategies that should be given funding priority to achieve maximum improvement in population health and reduce the health inequalities.
The Impact Of Declining Dental Needs Of Age Cohorts On The Cost-effectiveness Of Water Fluoridation & Supplementary Prev
Funder
National Health and Medical Research Council
Funding Amount
$85,600.00
Summary
This research will apply economic modelling, based on current trend-data by birth cohort on the effectiveness of water fluoridation to the evaluation of its continuing application to metropolitan water supplies. Wherever possible data from Victoria, and Australia as a whole, will be used in the modelling. It will explore the implications for policy-making in relation to maintenance of benefits gained and potential future application to non-fluoridated rural water supplies in Victoria. A key focu ....This research will apply economic modelling, based on current trend-data by birth cohort on the effectiveness of water fluoridation to the evaluation of its continuing application to metropolitan water supplies. Wherever possible data from Victoria, and Australia as a whole, will be used in the modelling. It will explore the implications for policy-making in relation to maintenance of benefits gained and potential future application to non-fluoridated rural water supplies in Victoria. A key focus is to identify and analyse data relating to the point at which there is a ‘plateauing-out’ of the benefits accruing from water fluoridation in middle and older age. The evaluation will also consider the policy implications of trends towards retention of more teeth into older age and the consequent increased exposure to both caries and periodontal disease.Read moreRead less
Making The First Osteoporotic Fracture The Last - Implementation And Analysis Of An Evidence-based, Integrated Model Of Care For Secondary Fracture Prevention
Funder
National Health and Medical Research Council
Funding Amount
$1,500,000.00
Summary
Despite the availability of effective treatments, 4 out of 5 Australians receive no therapy following an osteoporotic fracture. As a consequence, many patients sustain further fragility fractures, resulting in lengthy hospital stays & great cost to the community. This project will implement & evaluate an evidence-based model of fracture prevention that is integrated across health care sectors, establishing its feasibility and clinical effectiveness in preventing osteoporotic re-fractures.
Effectiveness, Cost-effectiveness And Cost-benefit Of A Single Annual Professional Intervention For The Prevention Of Childhood Dental Caries In A Remote Rural Indigenous Community
Funder
National Health and Medical Research Council
Funding Amount
$1,050,869.00
Summary
The aim of the study is to reduce the high prevalence of tooth decay in children in a remote, rural Indigenous community, by application of a single annual dental preventive intervention. Most dental preventive interventions require regular re-application (3 monthly), which is not possible in resource constrained communities. Importantly, the study will assess cost-benefit and cost-effectiveness for broader implementation across similar communities in Australia and internationally.