本文選題：成本效益分析　切入點(diǎn)：根管治療　出處：《山東大學(xué)》2016年碩士論文

【摘要】：目的臨床上對(duì)爭(zhēng)議牙保留的治療方法主要是根管治療和種植修復(fù)。相對(duì)生活費(fèi)較高的根管治療或植牙治療費(fèi)用使得患者對(duì)治療效果的預(yù)期很高,所以不具備專業(yè)知識(shí)的患者對(duì)不同的治療方案會(huì)有很高的要求。目前我國(guó)在口腔領(lǐng)域的研究中運(yùn)用經(jīng)濟(jì)學(xué)評(píng)價(jià)方法的文獻(xiàn)鮮少,本文通過(guò)回顧國(guó)內(nèi)外相關(guān)文獻(xiàn),運(yùn)用經(jīng)濟(jì)學(xué)評(píng)價(jià)的方法和決策樹(shù)模型就根管治療和種植義齒的成本-效果進(jìn)行分析對(duì)比,為患者和醫(yī)生的臨床決策提供參考。方法根據(jù)《山東省統(tǒng)計(jì)年鑒2015))、《中國(guó)統(tǒng)計(jì)年鑒2015》、現(xiàn)場(chǎng)調(diào)查和專家咨詢,確定前牙根管治療+樁核冠修復(fù)(PCET, Post-core-crown on endodontically treated teeth)、種植修復(fù)的直接成本和間接成本,并用患者的滿意度來(lái)衡量治療方法的效益。通過(guò)綜合國(guó)內(nèi)外與治療方案相關(guān)的meta分析研究,獲得前牙種植修復(fù)、根管治療+樁核冠修復(fù)的成功率、并發(fā)癥的概率和相關(guān)的貼現(xiàn)率,并建立馬爾可夫模型,運(yùn)用TreeagePro2009軟件對(duì)模型的成本效益進(jìn)行計(jì)算分析,并用成本效益比率和增量效益成本比作為評(píng)價(jià)兩個(gè)方案的指標(biāo),最終進(jìn)行優(yōu)選。結(jié)果通過(guò)TreeagePro2009的計(jì)算,以五十年年為周期,PCET的初期成本明顯低于種植修復(fù),PCET的成本為2011.231-+320.112元與種植修復(fù)的7320.112+820.230元,相差約55%。而種植修復(fù)總成本也明顯高于PCET,種植修復(fù)的總成本在10030.451+811.220元,PCET的總成本為3021.453+23.232元,其差值約55%。前10年,PCET的成本明顯低于種植修復(fù),且增量成本效益比說(shuō)明PCET為首選。經(jīng)五十年后,PCET每1質(zhì)量調(diào)整修復(fù)體年(QAPY, qualityadjusted prosthodontic year)的成本低于種植修復(fù),患者可考慮種植修復(fù)。結(jié)論從成本相對(duì)低很多的PCET方案,和與種植修復(fù)相似的長(zhǎng)期存留率來(lái)看,根管治療+樁核冠修復(fù)比種植牙修復(fù)比較合算,但經(jīng)五十年后,隨著醫(yī)保制度的完善和生活水平的提高,種植修復(fù)也能作為“保牙”和有咀嚼功能的好的選擇。
[Abstract]:Objective to treat the disputed teeth by root canal therapy and implant repair.The higher cost of root canal therapy or dental implants makes patients expect high therapeutic effect, so patients with no professional knowledge will have a high demand for different treatment options.At present, there are few literatures on the use of economic evaluation methods in the field of stomatology in China. This paper reviews the relevant literature at home and abroad.The cost-effect of root canal therapy and implant denture was analyzed and compared by using the method of economic evaluation and decision tree model to provide reference for the clinical decision of patients and doctors.Methods according to Shandong Statistical Yearbook 2005 and China Statistical Yearbook 2015, field investigation and expert consultation were carried out to determine the direct and indirect costs of anterior root canal treatment with post and core crown prosthesis, Post-core-crown on endodontically treated teethet, and implant restoration.The benefits of the treatment were measured by patient satisfaction.The success rate of anterior tooth implant restoration, root canal treatment post and core crown restoration, the probability of complications and the related discount rate were obtained by synthesizing the meta analysis of the treatment plan at home and abroad, and the Markov model was established.The TreeagePro2009 software is used to calculate and analyze the cost benefit of the model, and the cost benefit ratio and the incremental cost benefit ratio are used as the indexes to evaluate the two schemes. Finally, the optimal selection is carried out.Results according to the calculation of TreeagePro2009, the initial cost of PCET with a period of 50 years was obviously lower than that of implant restoration with the cost of RMB 2011.231-320.112 yuan compared with 7320.112 820.230 Yuan of implant restoration, the difference being about 55%.The total cost of planting and restoration is also higher than that of PCET. The total cost of planting and repairing is 3021.453 23.232 yuan at 10030.451 811.220 yuan, the difference is about 55.In the first 10 years, the cost of PCET was significantly lower than that of plant restoration, and the incremental cost benefit ratio indicated that PCET was the first choice.After 50 years, the cost of QAPY (qualityadjusted prosthodontic) per 1 quality adjusted prosthesis is lower than that of implant restoration.Conclusion in terms of the relatively low cost PCET scheme and the similar long-term survival rate as implant restoration, root canal treatment with post and core crown is more cost-effective than dental implant restoration, but after 50 years,With the improvement of medical system and living standard, implant restoration can also be used as a good choice for keeping teeth and chewing.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R783.6;R781.05

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