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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
Diagnostics For Mixture Regression Models: Applications To Public Health
Funder
National Health and Medical Research Council
Funding Amount
$128,250.00
Summary
In many public health studies, finite mixture regression models are often used to analyse data arising from heterogeneous populations. It is important to assess the stability of parameter estimates and the validity of statistical inferences when the underlying assumptions appear to be violated, but appropriate diagnostics are lacking in the literature. This research aims to develop effective diagnostic methods for assessing the adequacy of mixture regression models and the sensitivity of accompa ....In many public health studies, finite mixture regression models are often used to analyse data arising from heterogeneous populations. It is important to assess the stability of parameter estimates and the validity of statistical inferences when the underlying assumptions appear to be violated, but appropriate diagnostics are lacking in the literature. This research aims to develop effective diagnostic methods for assessing the adequacy of mixture regression models and the sensitivity of accompanying test statistics. The methodology developed will enable health care professionals to focus on substantive issues and to draw accurate and valid conclusions inferred from correlated and over-dispersed outcomes. In the presence of anomalous observations, the influence diagnostics can provide insights into the source of heterogeneity and the apparent over-dispersion, while accommodating the inherent correlation due to the longitudinal study design or nested data structure. Significance of the research lies in its scientific novelty and the breadth of its practical applications. The benefits to public health will accrue both nationally and internationally. For the empirical studies that motivated and are linked to this research, evaluation of health outcomes has significant implications in the prevention and control of recurrent urinary tract infections, hospital strategic planning, and post-stroke care and rehabilitation management. Moreover, appropriate assessment of a physical activity intervention for older adults is pertinent to falls prevention and reduction of musculoskeletal disorders among sedentary seniors.Read moreRead less
Hierarchical Finite Mixture Modelling Of Health Outcomes: A Risk-adjusted Random Effects Approach
Funder
National Health and Medical Research Council
Funding Amount
$117,000.00
Summary
In medical and health studies, finite mixture regression models have been used to analyze data arising from heterogeneous populations. Traditionally, the application of mixture models is mainly concerned with finite normal mixtures. Recent computational advances and methodological developments have enhanced the extension of the method to non-normal finite mixtures, such as the modelling of discrete responses in finite mixture of generalized linear models and overlapping phases of failure time da ....In medical and health studies, finite mixture regression models have been used to analyze data arising from heterogeneous populations. Traditionally, the application of mixture models is mainly concerned with finite normal mixtures. Recent computational advances and methodological developments have enhanced the extension of the method to non-normal finite mixtures, such as the modelling of discrete responses in finite mixture of generalized linear models and overlapping phases of failure time data in the context of survival analysis. However, due to the hierarchical study design or the data collection procedure, the inherent correlation structure and-or clustering effects present may contribute to extra variations and violation of the independence assumption, resulting in spurious associations and misleading inferences based on the finite mixture model. This project aims to present a unified approach to accommodate both heterogeneity and dependency of observations, by incorporating random effects into finite mixture regression models. The new methodology will provide an integrated framework to analyze heterogeneous and correlated health outcomes. Three empirical studies are considered, namely, evaluation of an occupational injury reduction intervention, length of hospital stay modeling, and analysis of survival times of patients after cardiac surgery. The long term benefits to bioscience are accurate and valid conclusions inferred from medical and health studies, as well as the correct identification of high-risk subgroups. For the three application areas of this project, the improved analyses will specifically enable the evaluation of a participatory ergonomics intervention, the assessment of hospital efficiency and factors influencing length of hospitalization, and the determination of effectiveness of treatments prescribed pre- and post- operation, respectively.Read moreRead less
Ear Health, Hearing, Speech And Language Development In Urban Aboriginal Children
Funder
National Health and Medical Research Council
Funding Amount
$445,617.00
Summary
Studies from the Northern Territory and Western Australia have established that Aboriginal children experience earlier, more frequent and more severe middle ear disease than any other children worldwide. There is little information on Aboriginal communities in urban setings or those living in NSW. This study will fill this knowledge gap by examining the burden of middle ear disease, hearing impairment and consequent speech and language delays in urban Aboriginal children in NSW.
Limiting Weight Gain In Overweight And Obese Women During Pregnancy To Improve Health Outcomes - A Randomised Trial.
Funder
National Health and Medical Research Council
Funding Amount
$1,541,444.00
Summary
Being overweight or obese is a major health issue for women during pregnancy and childbirth in Australia. There are well documented risks associated with obesity during pregnancy for both the mother and her baby. This randomised trial will assess whether the implementation of a package of dietary and lifestyle advice to overweight and obese pregnancy women to limit weight gain during pregnancy is effective in improving health outcomes for women and their babies.
Adolescent Population Health: Application Of Best-Worst Scaling Discrete Choice Experiments To Value Health States For Use In Economic Evaluation
Funder
National Health and Medical Research Council
Funding Amount
$178,779.00
Summary
Historically, economic evaluations of health care treatment and preventive programs developed for adolescents have failed to incorporate adolescent values about their preferred health outcomes. This project will apply a novel approach known as Best-Worst Scaling to ascertain adolescent specific values for health states for incorporation into economic evaluation, thereby enabling the views of adolescents to be incorporated directly into the health care priorities decision-making process.