Peebles, Heather Guthrie (2011)

Permanent URL: https://etd.library.emory.edu/concern/etds/q811kk505?locale=zh


Poverty and a shortage of dental providers present significant barriers to obtaining dental care for residents of rural, Southeast Georgia. To address these barriers the Southeast Health District (SEHD) obtained federal grant funding to support a school-based teledentistry program. This thesis seeks to examine the cost-effectiveness of the SEHD program. One hundred sixty-four children received teledentistry services during the study.

Data was gathered about the costs of equipment, personnel, facilities, parent travel and wages. Cost-effectiveness analysis software was used to perform decision analysis, sensitivity analysis, and a tornado analysis. Some cost-effectiveness equations were performed manually (Average Cost-Effectiveness Ratio, Incremental Cost-Effectiveness Ratio and Marginal Cost-Effectiveness Ratio).An attempt was made to quantify the intangible cost of children's self-esteem based on the results of a parent survey. The analysis was performed with and without considering this intangible cost.

Teledentistry was found to be a cost-effective alternative to traditional dentistry, especially when a dollar value was assigned to the intangible cost. The results indicate that teledentistry is a feasible option for improving access to preventive dental care.

Table of Contents

CHAPTER 1: INTRODUCTION 1 Public Health Problem 1 Oral Health Disparities 1

Long-term Effects of Untreated Dental Decay 2

Burden of Poor Dental Health 3 Interventions That Work 4 Program Description 5 Purpose of Economic Evaluation 6

Questions to be Answered by the Economic Evaluation 7

Definition of Terms 8


Introduction 10 Body 10 Telemedicine 10 Teledentistry 17 Summary 26 CHAPTER 3: METHODOLGY 28

Introduction 28

Population and Sample 28

Population 28

Sample 29

Procedures 29

Introduction 29

Perspective 29

Timeframe 29

Analytic Horizon 30

Costs (Tangible) 31

Costs (Intangible) 32

Cost Adjustment 33

Instruments 33

Cost Data Sources (Tangible) 33

Cost Data Sources (Intangible) 35

Data Analysis 35

Data Analysis (Tangible) 35

Data Analysis (Intangible) 36

Sensitivity Analysis 38

Limitations 38

Delimitations 39


Introduction 40

Findings 40

Health Outcome 40

Tangible Costs-Teledentistry 41

Tangible Costs-Traditional Dentistry 43

Dental Charges 45 Annuitization 46

Intangible Cost 47

Calculations and Interpretations 48

Average Cost-Effectiveness Ratio 48 Incremental Cost Ratio 48 Marginal Cost-Effectiveness Ratio 49

Decision Analysis 52

Decision Analysis without Intangible Cost 54 Decision Analysis with Intangible Cost 54

Sensitivity Analysis 55

Sensitivity Analysis without Intangible Cost 56

Sensitivity Analysis with Intangible Cost 59

Additional Survey Results 63

Other Findings 69

Summary 71


Introduction 73

Summary of Study 73

Conclusions 74

Implications 75

Recommendations 76

Limitations 76 Delimitations 78

Recommendations for the SEHD Teledentistry Program 79

Recommendations for Future Studies 79

REFERENCES 80 APPENDIX A: Parent Survey 86 APPENDIX B: Parent Survey Results 87 LIST OF TABLES

Table 1. Time Horizon Based on Age When Child First Receives Teledentistry Services 31

Table 2. Tangible Costs and Descriptions 32

Table 3. Data Sources Used to Obtain Costs 34

Table 4. Teledentistry Costs 42 Table 5. Traditional Dentistry Costs 44

Table 6. Traditional Dentistry Dental Service Charges 45

Table 7. Annuitization Values for Capital Equipment 46

Table 8. Average Cost-Effectiveness Ratios 48

Table 9. MCER Teledentistry Costs 50 LIST OF FIGURES Figure 1. 2006 Dental Expenditures 3 Figure 2. Decision Analysis Tree 52

Figure 3. Decision Analysis Tree with Expected Value Results, without Intangible Cost 54

Figure 4. Decision Analysis Tree with Expected Value Results, with Intangible Cost 55

Figure 5. Tornado Diagram without Intangible Cost 57

Figure 6. One-Way Sensitivity Analysis-Probability of Getting Teledentistry without

Intangible Cost 58

Figure 7. One-Way Sensitivity Analysis probability of Getting Teledentistry

Intangible Cost 59

Figure 8. Tornado Diagram with Intangible Cost 60

Figure 9. One-Way Sensitivity Analysis-Probability of Getting Traditional Dentistry with

Intangible Cost 61

Figure 10. One-Way Sensitivity Analysis-Cost of Getting Traditional Dentistry with

Intangible Cost 62

Figure 11. One-Way Sensitivity Analysis-Cost of Getting Teledentistry with Intangible

Cost 63

Figure 12. Results of Parent Survey Question #1 64

Figure 13. Results of Parent Survey Question #2a 65

Figure 14. Results of Parent Survey Question #3 66

Figure 15. Results of Parent Survey Question #4 67

Figure 16. Results of Parent Survey Question #5 67

Figure 17. Results of Parent Survey Question #6 68

Figure 18. Results of Parent Survey Question #7 69

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