Title: Dental ExtraCtion versus filling of adult teeth In chilDren: A cost Effectiveness analysis (DECIDE)
Funder: Department of Health and Social Care

Abstract: Research Question Dental ExtraCtion versus filling of adult teeth In chilDren: A cost Effectiveness analysis (DECIDE) Background Dental disease is a global issue. First adult molar teeth are the most commonly compromised, with 25% of UK children having dental decay and 15% having a developmental condition. Compromised first permanent molars (cFPM) cause pain and impact general health, growth, well-being and educational attainment.Clear guidance on managing cFPM in children does not exist. Dental professionals (specialist and generalists) are unsure whether to extract or restore these teeth. No UK economic evaluations, comparing retention with early removal, have been performed. Aims & Objectives Aim: To identify the most cost-effective pathway for adult teeth in children, comparing extraction versus restoration and specialists versus generalists including establishing and incorporating public values. Objectives: Build an economic model comparing the relative efficiency of alternative cFPM pathways over the life-course of a child Design two discrete choice experiments (DCE), to elicit adolescent patients' and the public's preferences for each pathway including determining societal willingness to pay (WTP) Evaluate the model's validity and explore an implementation strategyMethods This project comprises of three parallel work packages (WP) and will be informed by: Panel1: Parents/patients will provide public input Panel2: Eight dentists/two parents will provide clinical/patient expertise WP1: Cost-effectiveness modelUsing nominal group technique, with panel2, cFPM pathways will be defined. An individual patient simulation model (Markov model with embedded decision trees) will be constructed to follow patients over the life-course. Data for the model will be determined from a scoping review plus further evidence synthesis and micro-costing where needed. Panel1/panel2 opinions will be sought where limited data exists. The model will adopt a societal perspective. Number of future treatment visits needed will be the effectiveness measure. Public WTP values, derived from WP2, will be fed into the model as a further measure of benefit. Probabilistic and deterministic sensitivity analyses will be applied. WP2: Discrete choice experiment (DCE), to elicit patient's willingness to pay and preferences Attributes and levels for the DCEs will be established from existing data, Panels1/2 opinions, and semi-structured interviews with adolescents/members of the public. The DCE will be completed online by a representative UK sample. Adolescents recruited from multiple centres who have/had cFPM will complete an adolescent DCE. WP3: Evaluation of economic model validity and implications of emerging findings (including engagement of panel1/panel2 and PPIE) Two workshops with patients, public and professionals, using a combination of qualitative and co-design approaches, will evaluate the economic model's validity and how findings can be implemented. Timelines for Delivery WP1: Gathering evidence (months: 0-12); Build model (months: 12-26) WP2: Design (months: 0-14); Dissemination (months: 14-17); Analysis (months: 17-23) WP3: Evaluation/discuss implementation strategy (months: 26-30) Expected Outcome & Anticipated Benefits The intended outcome is to identify the most cost-effective pathway for managing cFPM in children, which if adopted will mean less visits for patients/parents and a preference-based pathway, clarity for dentists and more efficient use of NHS resources. I will develop links with key policy makers and produce a policy-brief.

Lay abstract: Title Dental ExtraCtion versus filling of adult teeth In chilDren: A cost Effectiveness analysis (DECIDE) Problem Children often suffer from problems with their teeth. Pain can prevent a child from eating and sleeping properly impacting upon their growth and development. It also interferes with daily activities, including performance and attendance at school. The most common tooth to cause children problems is the first molar (back) tooth because it is the first adult tooth to emerge into their mouth (at age 6). First molars can be damaged either by tooth decay and/or because they did not form properly. One in four children in the UK have dental decay and one in seven have a poorly formed molar tooth. If the first molar is damaged it is more likely to further decay causing the child pain and infection. This means they are unlikely to last the child's lifetime. Currently, dentists are unsure whether it is best to fill or remove these teeth. It is not known whether a specialist in children's dentistry or a general dentist is the best person to decide how to treat children and/or actually treat children with this problem. A recent survey of UK dentists found they had a large variety of different opinions about how best to treat damaged first molars with some filling the teeth and some removing them. This means we do not know which is better for children and their families. Therefore, we need to research whether these teeth should be: a) filled, with fillings needing replacements over time; or b) removed to allow the other teeth to grow in and possibly fill the space left behind. Aims In this study, I will work out the most cost-effective treatment pathway for children with damaged first adult molar teeth. This will help us understand how to change the way these children are treated to benefit them, their family and the NHS. Project Plans This project will have three sub-projects ongoing simultaneously. Two separate groups have agreed to provide specific input into each sub-project: Group 1: Fourteen parents and representatives from adult/young people's groups will provide specific public opinions needed for the study. Group 2: Eight dentists and two parents will provide clinical/patient expertise where scientific evidence may be not available. Sub-project 1 Obtain information including patients' preferences, previous research evidence and opinions from groups 1 and 2 about treating damaged first adult molar teeth. Simulate what would happen over a child's lifetime when these teeth are either filled or extracted.This will tell us which option provides the best value in terms of costs and benefits to the patient and the NHS. Sub-project 2 Interviews and group discussions with adolescents with damaged adult molar teeth and members of the public to identify aspects that are important to them when choosing different treatment options for damaged first adult molar teeth. Develop a questionnaire to find out how adolescents with the problem and members of the public value these different aspects.This will tell us what parts of each treatment option they prefer by looking at their responses and how much they value these. Sub-project 3 Using representatives of groups 1 and 2 and others, form a combined group of children, parents, members of the public, healthcare professionals and NHS managers. With this group discuss: a) if sub-projects 1/2 reflect reality; and b) how best we can use these results to change the way we fund and deliver treatments in the NHS.Findings will be distributed to patients, parents, and professionals to highlight the importance of this study and to change the way we treat this problem.

Research activity codes: 6.4 SURGERY
Health categories: ORAL AND GASTROINTESTINAL