全身麻醉与单纯保护性固定下儿童牙齿治疗的卫生经济学分析

Economic evaluation of treatments under dental general anesthesia and protective stabilization

目的通过研究和比较全身麻醉（全麻）与单纯保护性固定下儿童牙齿治疗所需的治疗成本及治疗效果，对两种方法进行卫生经济学评估，为临床提供参考。方法对2012年1月至2013年3月于北京大学口腔医学院·口腔医院儿童口腔科接受全麻下牙齿治疗患者26例（全麻组）、接受保护性固定下治疗患者27例（保护性固定组）2-4岁儿童进行回顾性队列研究。收集患者基本信息、治疗情况及总治疗成本信息。分别以患者及患牙的生存时间作为治疗的效果指标，比较两组的治疗总成本以及成本-生存时间比。在以患者为单位比较时，以治疗牙数作为变量分组进行比较；在以患牙为单位比较时，将进行充填治疗与根管治疗的牙齿进行分组比较。将全麻的治疗收费按照门诊收费标准进行再核算后统计并比较。结果按照北京大学口腔医学院·口腔医院现行收费标准，全麻组每例患者每颗牙的平均治疗成本及成本-生存时间比分别为[（1 133.87±87.37）元]和[3.51（1.30，5.72）元/d]，保护性固定组分别为[（303.81±155.34）元]和[1.54（0.95，2.13）元/d]，全麻组均显著高于保护性固定组（P〈0.01）。不同的治疗牙数以及不同的牙齿治疗方式并不影响结果，全麻组的治疗成本及成本-生存时间比均显著高于保护性固定组（P〈0.05）。按照门诊收费标准重新计算后，全麻组平均每人每颗牙的成本-生存时间比[1.63（0.72，2.55）元/d]与保护性固定组[1.54（0.95，2.13）元/d]相比差异无统计学意义（P=0.455）。结论本组资料以患者及患牙分别进行分析时，保护性固定下儿童牙齿治疗较全麻下儿童牙齿治疗具有更低的成本及成本-生存时间比；当全麻治疗收费与门诊治疗收费持平时，保护性固定下治疗的卫生经济学优势将减少。

ObjectiveTo conduct economic evaluation of treatments under dental general anesthesia （DGA） and protective stabilization （PS）, in order to compare the cost and the final therapeutic effect of these two treatments.MethodsRetrospectively studied twenty-six 2 to 4 years old patients treated under DGA and twenty-seven treated under PS in the Department of Pediatric Dentistry, Peking University School and Hospital of Stomatology. The general information, treatment information and total treatment cost information of patients were collected. The cost and cost-survival time ratio of the two groups were compared in units of people and tooth respectively. When compared in unit of people, patients were divided into two groups depending on the number of teeth treated, when compared in unit of tooth, teeth were divided into two groups depending on the treatment received, i.e. restoration or root canal treatment. In addition, we recalculated and compared two groups under the assumption that the treatment charges of DGA was consistent with common outpatient charges.ResultsThe tooth average cost and cost-survival time ratio of each patient in DGA group which were [（1 133.87±87.37） yuan] and [3.51 （1.30, 5.72） yuan/d] respectively were significantly higher than those in PS group which were [（303.81±155.34） yuan] and [1.54 （0.95, 2.13） yuan/d] respectively （P〈0.01）. The number of teeth and the way of treatments wouldn＇t change the result. The recalculated result of the cost-survival time ratio of each patient in DGA group [1.63 （0.72, 2.55） yuan/d] and PS group [1.54 （0.95, 2.13） yuan/d] showed no significant difference （P=0.455）.ConclusionsPatients treated in Peking University School and Hospital of Stomatology showed a significant higher cost and cost-survival time radio in DGA group than that in PS group. If the treatment charges of DGA group was consistent with common outpatient charges, PS group will no longer have economic advantage.