Pedram Sendi, Mojdeh Walterscheidt, Michael M Bornstein
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引用次数: 0
Abstract
Background: The number of published cost-effectiveness analyses in dental medicine has substantially increased in recent years. A key methodological issue in these analyses is how to address uncertainty in costs and effects, which also impacts uncertainty around the expected cost-effectiveness ratio. The cost-effectiveness acceptability curve has become the standard method to summarize uncertainty in probabilistic cost-effectiveness analyses. However, it does not inform decision-makers about budget impact or account for the fact that they are often risk-averse. The cost-effectiveness affordability curve and the cost-effectiveness risk-aversion curve have been proposed to address these limitations. In this systematic review, we assess how uncertainty has been handled in cost-effectiveness analyses in dental medicine, with a particular focus on affordability and risk-aversion.
Methods: We conducted a systematic literature search across electronic databases (MEDLINE, Web of Science, Cochrane Library, EconLit, Embase) on April 18, 2025, and performed manual searches of selected references. Articles published after January 1, 2021, were included. From each study, we extracted information on the first author, year of publication, country, intervention evaluated, study design (model-based, trial-based, or combined), use of deterministic and/or probabilistic sensitivity analysis, and whether budget impact and risk-aversion were considered.
Results: From a total of 57 published cost-effectiveness analyses, 49 (85%) used a deterministic sensitivity analysis and 37 (65%) used a probabilistic sensitivity analysis. Budget impact analysis was performed in five studies (9%), and only one study formally applied both the cost-effectiveness affordability curve and the cost-effectiveness risk-aversion curve.
Conclusion: The use of methods to address uncertainty related to budget constraints and risk-aversion remains limited in dental medicine. As decision-makers often operate within budget constraints and health is considered the most valuable good, incorporating methods that address affordability and risk-aversion could enhance the relevance and impact of cost-effectiveness analyses in dental care.
背景：近年来，发表的牙科医学成本效益分析的数量大幅增加。在这些分析中，一个关键的方法问题是如何处理成本和效果的不确定性，这也会影响预期成本-效果比的不确定性。成本效益可接受度曲线已成为概率成本效益分析中总结不确定性的标准方法。然而，它并没有告诉决策者预算的影响，也没有解释他们往往厌恶风险的事实。成本-效益可负担性曲线和成本-效益风险厌恶曲线被提出以解决这些限制。在这篇系统综述中，我们评估了牙科医学成本效益分析中如何处理不确定性，特别关注可负担性和风险规避。方法：我们于2025年4月18日对MEDLINE、Web of Science、Cochrane Library、EconLit、Embase等电子数据库进行了系统的文献检索，并对选定的文献进行了人工检索。在2021年1月1日之后发表的文章也被纳入其中。从每项研究中，我们提取了有关第一作者、发表年份、国家、评估干预措施、研究设计（基于模型、基于试验或联合）、确定性和/或概率敏感性分析的使用，以及是否考虑了预算影响和风险规避的信息。结果：在总共57篇已发表的成本-效果分析中，49篇（85%）采用确定性敏感性分析，37篇（65%）采用概率敏感性分析。预算影响分析在五项研究（9%）中进行，只有一项研究正式应用了成本效益可负担性曲线和成本效益风险厌恶曲线。结论：利用方法来解决预算约束和风险规避相关的不确定性在牙科医学中仍然有限。由于决策者往往在预算限制的范围内运作，而且健康被认为是最有价值的利益，因此，纳入解决负担能力和规避风险问题的方法，可以加强牙科保健成本效益分析的相关性和影响。
期刊介绍：
Cost Effectiveness and Resource Allocation is an Open Access, peer-reviewed, online journal that considers manuscripts on all aspects of cost-effectiveness analysis, including conceptual or methodological work, economic evaluations, and policy analysis related to resource allocation at a national or international level. Cost Effectiveness and Resource Allocation is aimed at health economists, health services researchers, and policy-makers with an interest in enhancing the flow and transfer of knowledge relating to efficiency in the health sector. Manuscripts are encouraged from researchers based in low- and middle-income countries, with a view to increasing the international economic evidence base for health.
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