Abstract
BackgroundEconomic evaluations provide policy makers with information to facilitate efficient resource allocation. To date, the quality and scope of economic evaluations in the field of child oral health has not been evaluated. Furthermore, whilst the involvement of children in research has been actively encouraged in recent years, the success of this movement in dental health economics has not yet been explored. This review aimed to determine the quality and scope of published economic evaluations applied to children’s oral health and to consider the extent of children’s involvement.MethodsThe following databases were searched: CINAHL, Cochrane Library, Econlit, EThOS, MEDLINE, NHS EED, OpenGrey, Scopus, Web of Science. Full economic evaluations, relating to any aspect of child oral health, published after 1997 were included and appraised against the Drummond checklist and the Consolidated Health Economic Evaluation Reporting Standards by a team of four calibrated reviewers. Data were also extracted regarding children’s involvement and the outcome measures used.ResultsTwo thousand seven hundred fifteen studies were identified, of which 46 met the inclusion criteria. The majority (n = 38, 82%) were cost-effectiveness studies, with most focusing on the prevention or management of dental caries (n = 42, 91%). One study quantified outcomes in Quality Adjusted Life Years (QALYs), and one study utilised a child-reported outcome measure.The mean percentage of applicable Drummond checklist criteria met by the studies in this review was 48% (median = 50%, range = 0–100%) with key methodological weaknesses noted in relation to discounting of costs and outcomes. The mean percentage of applicable CHEERS criteria met by each study was 77% (median = 83%, range = 33–100%), with limited reporting of conflicts of interest. Children’s engagement was largely overlooked.ConclusionsThere is a paucity of high-quality economic evaluations in the field of child oral health. This deficiency could be addressed through the endorsement of standardised economic evaluation guidelines by dental journals. The development of a child-centred utility measure for use in paediatric oral health would enable researchers to quantify outcomes in terms of quality adjusted life years (QALYs) whilst promoting child-centred research.
Highlights
Economic evaluations provide policy makers with information to facilitate efficient resource allocation
In the United Kingdom (UK), approximately 57,485 children aged up to 19-years were admitted to hospital in 2015–2016 with a diagnosis of dental caries, making it the most common reason for children to require an admission with an estimated cost of £39 million to the National Health Service (NHS) [2, 3]
The overall reporting quality of economic evaluations in the present study was relatively high, with a median score of 83% against the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) criteria. This was less than the median score of 92% identified in a recent systematic review of economic evaluations of oral health interventions by Hettiarachchi and coworkers, which used the same CHEERS checklist [11]
Summary
Economic evaluations provide policy makers with information to facilitate efficient resource allocation. Whilst the involvement of children in research has been actively encouraged in recent years, the success of this movement in dental health economics has not yet been explored. This review aimed to determine the quality and scope of published economic evaluations applied to children’s oral health and to consider the extent of children’s involvement. In the United Kingdom (UK), approximately 57,485 children aged up to 19-years were admitted to hospital in 2015–2016 with a diagnosis of dental caries, making it the most common reason for children to require an admission with an estimated cost of £39 million to the National Health Service (NHS) [2, 3]. A tenyear study of dental admission patterns from 2000 to 2009 in Western Australian children aged 14 years and younger identified 43,937 children who had been hospitalised for an oral health-related condition [4].
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