Cost-effectiveness of interceptive orthodontics: a long-term evaluation of early treatment strategies.

To evaluate the scope and short-term outcomes of interceptive orthodontic treatment delivered by general dental practitioners (GDPs) under the supervision of specialist orthodontists within a publicly funded healthcare system. This retrospective cohort study included all patients aged ≤18 years who received publicly funded interceptive orthodontic treatment in Region Västra Götaland, Sweden, during 2020-2024; the pediatric population (0-18 years) was approximately 400 000. In total, 22 000 cases were identified from electronic records. Analyses focused on four appliances: Activator, Extraoral Traction, Quad Helix, and Removable Plate. Detailed outcome assessment was performed for all cases from year 2020 (n = 4400), with extraction of age, sex, treatment indication, treatment duration, number of visits, and appliance-specific outcomes. In total, 21 946 treatments were registered over 5 years. The most common appliances were Removable Plates (n = 10 511), Activators (n = 6455), Quad Helix (n = 3164), and Extraoral Traction (n = 1816). On average, 4389 interceptive treatments were delivered annually, accounting for nearly 100 000 visits. Treatments were typically initiated in the late mixed dentition (mean age, 10.2-11.2 years; range, 8-13 years), with equal gender distribution. Mean treatment duration ranged from 11 months (Quad Helix) to 20 months (Activator). Success rates were highest for Quad Helix (82%) and Removable Plates (65%), while lower rates were recorded for Extraoral Traction (57%) and Activators (56%). Failures were mainly linked to poor compliance. The results from this large cohort study on interceptive orthodontics provide real-world evidence that although success rates were lower than in randomized trials, the outcomes reflect routine care conditions. The findings highlight the importance of compliance, appliance selection, and treatment timing. The dataset offers a foundation for future longitudinal evaluations of long-term outcomes and cost-effectiveness.

In several health economic analyses of rotavirus vaccines in Japan, all were not cost-effective from the healthcare payer perspective (HPP) but generally cost-effective from the societal perspective (SP). However, few studies have incorporated clinically significant factors of vaccine herd immunity, convulsions with gastroenteritis, encephalopathies, nosocomial infections, death, and intussusception as a vaccine side effect. A cost-utility analysis incorporating these were conducted. We used Bakir's decision-tree model and data in Japan with 94% coverage rate, 5-year time horizon, and 2% discount. We compared the incremental cost-effectiveness ratio (ICER) with a willingness-to-pay of Japanese Yen (JPY) 5 million from HPP and SP. Scenario 1 examined items based on existing research; scenario 2 additionally examined the above-mentioned items. In scenario 2, break-even prices were determined, and one-way and probabilistic sensitivity analyses were performed. In scenario 1, the ICER was JPY 6,057,281 from the HPP and dominant from the SP. In scenario 2, it was JPY 3,713,488 from the HPP. From the HPP in scenario 2, break-even prices were JPY 34,227 for an ICER of JPY 5 million and JPY 17,798 for cost-saving. One-way sensitivity analysis showed ICERs fluctuated widely with ambulatory visits and vaccination costs. In the probabilistic sensitivity analysis, ICERs of 54.8% were less than the willingness-to-pay. In scenario 2, from the SP, vaccines were dominant. From the HPP in scenario 2, the vaccines were cost-effective. In the sensitivity analyses, ICERs also improved from the HPP over previous studies. Herd immunity for ambulatory visits contributed most to the decline.

Management options for colorectal cancer have expanded in recent years. We estimated average lifetime cost of care for colorectal cancer in Ireland in 2008, from the health care payer perspective. A decision tree model was developed in Microsoft EXCEL. Site and stage-specific treatment pathways were constructed from guidelines and validated by expert clinical opinion. Health care resource use associated with diagnosis, treatment and follow-up were obtained from the National Cancer Registry Ireland (n=1,498 cancers diagnosed during 2004-2005) and three local hospital databases (n=155, 142 and 46 cases diagnosed in 2007). Unit costs for hospitalisation, procedures, laboratory tests and radiotherapy were derived from DRG costs, hospital finance departments, clinical opinion and literature review. Chemotherapy costs were estimated from local hospital protocols, pharmacy departments and clinical opinion. Uncertainty was explored using one-way and probabilistic sensitivity analysis. In 2008, the average (stage weighted) lifetime cost of managing a case of colorectal cancer was €39,607. Average costs were 16% higher for rectal (€43,502) than colon cancer (€37,417). Stage I disease was the least costly (€23,688) and stage III most costly (€48,835). Diagnostic work-up and follow-up investigations accounted for 4 and 5% of total costs, respectively. Cost estimates were most sensitive to recurrence rates and prescribing of biological agents. This study demonstrates the value of using existing data from national and local databases in contributing to estimating the cost of managing cancer. The findings illustrate the impact of biological agents on costs of cancer care and the potential of strategies promoting earlier diagnosis to reduce health care resource utilisation and care costs.

Carbon and nitrogen stable-isotope ratios were compared of fin and muscle tissue from 15 fish species collected from seven headwater rivers in eastern and western Thailand. In addition, two-source stable-isotope mixing models were used to derive estimates of each fish's reliance on allochthonous and autochthonous energy based on fin and muscle tissues. Across the dataset, fish fin was enriched in 13 C relative to muscle by c. 1·5‰. Variation in δ15 N between tissues was below statistically significant levels. Estimates of autochthonous resource use calculated from fin tissue were on average 15% greater than those calculated from muscle. Linear mixed-effects models indicated that inter-tissue variation in estimates of resource use was predominantly related to inter-tissue variation in δ13 C. Fish fin is a credible and desirable alternative to tissues such as muscle or liver which require destructive sampling of fishes. Care must be taken, however, when estimating resource use or interpreting previous estimates of resource use derived from different tissues.

The field of stable isotope ecology is moving away from lethal sampling (internal organs and muscle) towards non-lethal sampling (fins, scales and epidermal mucus). Lethally and non-lethally sampled tissues often differ in their stable isotope ratios due to differences in metabolic turnover rate and isotopic routing. If not accounted for when using non-lethal tissues, these differences may result in inaccurate estimates of resource use and trophic position derived from stable isotopes. To address this, the authors tested whether tissue type, season and their interaction influence the carbon and nitrogen stable isotope ratios of fishes and whether estimates of species trophic position and resource use are affected by tissue type, season and their interaction. This study developed linear conversion relationships between two fin types and dorsal muscle, accounting for seasonal variation. The authors focused on three common temperate freshwater fishes: northern pike Esox lucius, yellow perch Perca flavescens and lake whitefish Coregonus clupeaformis. They found that fins were enriched in 13 C and depleted in 15 N compared to muscle in all three species, but the effect of season and the interaction between tissue type and season were species and isotope dependent. The estimates of littoral resource use based on fin isotope ratios were between 13% and 36% greater than those based on muscle across species. Season affected this difference for some species, suggesting the potential importance of using season-specific conversions when working with non-lethal tissues. Fin and muscle stable isotopes produced similar estimates of trophic position for northern pike and yellow perch, but fin-based estimates were 0.2-0.4 trophic positions higher than muscle-based estimates for lake whitefish. The effect of season was negligible for estimates of trophic position in all species. Strong correlations existed between fin and muscle δ13 C and δ15 N values for all three species; thus, linear conversion relationships were developed. The results of this study support the use of non-lethal sampling in stable isotope studies of fishes. The authors suggest that researchers use tissue conversion relationships and account for seasonal variation in these relationships when differences between non-lethal tissues and muscle, and seasonal effects on those differences, are large relative to the scale of isotope values under investigation and/or the trophic discrimination factors under use.

Patient-level resource use for injury admissions in Canada: A multicentre retrospective cohort study

Background Three recent randomized controlled trials demonstrated that, in patients with symptomatic paroxysmal atrial fibrillation (PAF), first-line pulmonary vein isolation (PVI) with cryoballoon ablation reduces atrial arrhythmia recurrence when compared to initial antiarrhythmic drug (AAD) therapy. Purpose To evaluate the cost-effectiveness of initial rhythm control therapy from a German healthcare service payer perspective. Methods The cost-effectiveness model (CEM) structure consisted of a hybrid decision tree and Markov model, where the decision tree informed the initial health state allocation in the first cycle of the Markov model and had a one-year time horizon. The Markov model had a 40-year time horizon using a three-month cycle length. Health benefits were expressed in quality-adjusted life years (QALYs). Costs and benefits were discounted at 3.5% p.a. Individual patient-level data from 703 participants with untreated PAF enrolled into Cryo-FIRST (NCT01803438), STOP AF First (NCT03118518) and EARLY-AF (NCT02825979) were used to estimate efficacy, resource use and health-related quality of life parameters. Cost inputs were sourced from diagnosis-related groups and the Institute for the Hospital Remuneration System (InEK). Where parameters could not be derived, inputs were sourced from available published literature or determined through clinical expert opinion. Probabilistic sensitivity analyses were conducted to explore the impact of any assumptions on model outputs. Results In those treated with cryoablation, the three-month rate of AF recurrence was reduced by 46.7% (p<0.001) on average. Similarly, the average monthly rate of receiving an ablation following initial treatment was reduced by 72.8% (p<0.001). Cryoablation was also associated with a 4.3% (p=0.025) increase in health-related quality of life at 12 months, assessed through the standard EQ-5D-3L instrument. There was no difference in the rate of AF resolution in those who failed initial treatment. CEM results are shown in Table 1. Analysis shows that cryoablation is cost-effective, incurring a cost of ∼€1,000 per patient over a lifetime compared to AADs, while offering an increase in QALYs. Cryoablation attains an average ICER of ∼€5,500, with a 94.1% probability of being cost-effective at a willingness-to-pay threshold of €35,000 per QALY gained. Through 5,000 iterations, the probabilistic sensitivity analysis indicates that cryoablation has ∼20% probability of being cost-saving. Individuals are expected to receive a total of ∼1.2 ablations over a lifetime, regardless of initial treatment. Although, those initially treated with cryoablation as opposed to AADs experience a 45% reduction in time spent in AF health states. Conclusion Initial rhythm control with cryoballoon ablation in PAF is a cost-effective treatment option in a German healthcare setting.Table 1:Key results (per patient)

Cost-effectiveness of universal rotavirus vaccination in reducing rotavirus gastroenteritis in Ireland

Background: Class III dentoskeletal malocclusion presents a significant clinical challenge, particularly in adult patients, due to limited skeletal growth potential and complex occlusal discrepancies. Non-surgical management often relies on dental compensation strategies, including selective extractions and transverse expansion to achieve functional and aesthetic outcomes. Objectives: This report aims to demonstrate the successful management of a mild skeletal Class III malocclusion using first mandibular molar extractions and maxillary expansion via quad helix appliance, as an alternative to orthognathic surgery. Case: A 20-year-old female patient presented with ectopic canines, chewing difficulty, and facial aesthetic concerns. Clinical and radiographic evaluations revealed a skeletal Class III relationship, bilateral anterior and posterior crossbites, and crowding. Notably, the patient had large composite restorations and overfilled endodontic treatments on her lower first molars. Case Management: A non-surgical orthodontic treatment was planned and executed. This included bilateral extraction of the first lower molars, maxillary expansion using a quad helix appliance, and fixed appliance therapy with a Roth-prescription straight-wire system. The treatment was followed by midline correction, retraction, and use of Class III elastics to achieve Class I molar and canine relationships. The retention phase involved clear retainers for both arches. Conclusion: The combination of lower first molar extraction and quad helix expansion provided an effective camouflage for a mild skeletal Class III malocclusion, improving facial aesthetics, correcting crossbites, and achieving stable functional occlusion. This case supports the viability of non-surgical orthodontic compensation in carefully selected adult Class III patients. Keywords: class III dentoskeletal malocclusion, first lower molar extraction, quad helix

To assess (1) the extent to which office resources (eg, chart aids, educational materials, office staff) are used by primary care physicians in the provision of preventive care; (2) the characteristics of physicians associated with this use; and (3) the relationship of office resource use to reported preventive service provision. Survey. Randomly selected active members of the American Academy of Family Physicians, Kansas City, Mo, American Academy of Pediatrics, Elk Grove Village, III, American College of Obstetricians and Gynecologists, Washington, DC, and American College of Physicians, Philadelphia, Pa. MALE OUTCOME MEASURES: Use rates for each of 14 types of office resources, and scores for total office resource use, total preventive service provision, and counseling, screening, and immunization provision. Most types of office resources were used by less than 50% of the physicians. Physicians in small private practices reported less use of resources than those in other settings. The chart flow sheet was the resource that was most strongly and consistently related to preventive service provision. For all organizations, the total resource use score was significantly correlated with scores for total preventive service provision, and counseling and immunization provision. For most organizations, the total resource use score was more highly related to total preventive service provision than was the age or sex of the physician, the percentage of patients uninsured or with Medicaid coverage, or community size. The use of office resources is an important factor in the provision of preventive care. Intervention efforts to improve office resource use may benefit from targeting by resource type, practice setting, physician specialty, and other physician and practice characteristics.

Cost Effectiveness of Mechanical Thrombectomy Versus Anticoagulation for Treating Iliofemoral Deep Vein Thrombosis in the UK.

Comparison of Jones jig molar distalization appliance with extraoral traction

Central line-associated bloodstream infections (CLABSI) are a serious complication in children with intestinal failure. This study assessed the incremental costs of 4% tetrasodium ethylenediaminetetraacetic acid (EDTA) compared with taurolidine lock and heparin lock per quality-adjusted life-year (QALY) gained in children with intestinal failure from the healthcare payer and societal perspective. A Markov cohort model of a 1-year-old child with intestinal failure was simulated until the age of 17 years (time horizon), with a cycle length of 1 month. The health outcome measure was QALYs, with results expressed in terms of incremental costs and QALYs. Model parameters were obtained from published literature and institutional data. Deterministic, probabilistic, and scenario sensitivity analyses were performed. 4% Tetrasodium EDTA was dominant (more effective and less expensive) compared with taurolidine and heparin, yielding an additional 0.17 QALYs with savings of CAD$88,277 compared with heparin, and an additional 0.06 QALYs with savings of CAD$52,120 compared with taurolidine lock from the healthcare payer perspective. From the societal perspective, 4% tetrasodium EDTA resulted in savings of CAD$90,696 compared with heparin and savings of CAD$36,973 compared with taurolidine lock. This model-based analysis indicates that 4% tetrasodium EDTA can be considered the optimal strategy compared with taurolidine and heparin in terms of cost-effectiveness. The decision uncertainty can be reduced by conducting further research on the model input parameters. An expected value of perfect information analysis can identify what model input parameters would be most valuable to focus on.

To compare the effects of quad helix (QH) anchored on permanent molars versus rapid maxillary expansion (RME) anchored on deciduous teeth on palatal morphology in early mixed dentition patients. A two-arm randomized controlled trial, together with a non-randomized normal bite data for comparison. Seventy-one patients (mean age: QH=9.3years; RME=9.4years) with unilateral posterior crossbite were analysed. The QH group (n=36) and RME group (n=35) were evaluated at baseline (T0), post-retention (T2), and one-year post-treatment (T3). A third age- and sex-matched control group (n=22; mean age=9.1years) served as a normative reference. Evaluated outcomes were 3D palatal measurements, as well as treatment success rate and total treatment duration. Both treatment groups showed significant increases in palatal surface area, projection plane area, and volume from T0 to T3. The RME group experienced a greater increase in palatal surface area (7.0%) compared to the QH group (4.2%) over the same period (P=0.045). Palatal volume increased notably more in the RME group during active treatment (T0-T2), with an 11.2% gain versus 6.8% in the QH group (P=0.046). By T3, palatal vault dimensions had normalized in both groups compared to the control group. The RME group completed treatment 97days earlier than the QH group. Treatment with either QH or RME resulted in normalized palatal vaults compared to the control group. RME had a significantly shorter treatment time but achieved similar success in correcting posterior crossbite as QH. This trial was registered at ClinicalTrials.gov (ID NCT04458506) and Researchweb.org (project number 260581).

Environmental health impacts of feeding crops to farmed fish