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ORIGINAL ARTICLE
Year : 2017  |  Volume : 15  |  Issue : 4  |  Page : 354-358

Perception and practice of application of economic evaluation among teaching dental faculty of Bengaluru City, India


Department of Public Health Dentistry, The Oxford Dental College and Hospital, Bengaluru, Karnataka, India

Date of Web Publication13-Dec-2017

Correspondence Address:
Dr. V M Ameena Musareth
Department of Public Health Dentistry, The Oxford Dental College and Hospital, Bengaluru, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaphd.jiaphd_78_17

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  Abstract 

Introduction: Economic evaluation of healthcare programs is now commonplace in medicine and is becoming increasingly important in dentistry. As faculty members are involved in academic research activities and publication of various studies which help in decision-making, it is imperative to have the basic knowledge of economic evaluations to contribute significant results for the implementation of new programs and to modify the existing ones. Aim: To assess the knowledge about economic evaluation on research and practice by the teaching dental faculty of Bengaluru city, to assess the attitude toward application of economic evaluation, and to assess its practical applications. Materials and Methods: A cross-sectional study was conducted in Bengaluru city. Among 17 dental colleges located in the city, eight colleges were randomly selected, and 300 participants were included. A self-administered questionnaire was prepared and validated. Participants who were present and willing to participate on the date of visit were included. Results: Among 300 participants, 16.7% participants responded as this was purely public health topic but refused to participate in the study after giving consent. Nearly 53% participants had knowledge regarding health economics and around 8% participants had learned the method of application in various aspects and used in research purposes. Around 18.4% participants viewed lack of training and credibility of studies as important barriers. Moreover, participants wished for a better explanation of the practical relevance of studies. Conclusion: Knowledge and practice was poor among the participants. Better explanation of the practical relevance, continuing dental education programs, and workshops pertaining to health economics should be conducted to create awareness and to improve knowledge and application of these techniques.

Keywords: Dental faculty, economic evaluation, perception


How to cite this article:
Ameena Musareth V M, Murthy AK, Malavika J, Das M. Perception and practice of application of economic evaluation among teaching dental faculty of Bengaluru City, India. J Indian Assoc Public Health Dent 2017;15:354-8

How to cite this URL:
Ameena Musareth V M, Murthy AK, Malavika J, Das M. Perception and practice of application of economic evaluation among teaching dental faculty of Bengaluru City, India. J Indian Assoc Public Health Dent [serial online] 2017 [cited 2020 Nov 26];15:354-8. Available from: https://www.jiaphd.org/text.asp?2017/15/4/354/220722


  Introduction Top


Evaluation addresses different programs and project components, generally focusing on inputs, outputs, processes, and outcomes. These indicators should tell how well a project or program is functioning and how well it is meeting the intended goals and objectives. Evaluations of clinical trials focus primarily on health outcomes that generate important information on the safety, efficacy, or effectiveness of a single intervention. However, they reveal little about how resources were used to achieve health outcome.[1]

Economic evaluation may be defined as “the comparative analysis of alternative courses of action in terms of both their costs and consequences.” It involves two main areas: first, the costs and consequences of program, and second, choices which have to be made in allocation of resources. Although sometimes viewed with suspicion by both clinicians and the general public, economic evaluation does aim to determine how resources can give the greatest benefit.[1]

Economic evaluations provide decision-makers with information on the tradeoffs in resource costs and public health benefits involved in choosing one intervention over another. The most popular method has been cost-effectiveness analysis, which simultaneously evaluates the outcomes and costs of interventions, designed to improve health. In theory, cost-effectiveness analysis is an important tool for improving the efficiency of health service delivery.[2]

Economic evaluation is now an accepted method for the appraisal of healthcare programs. Although it is used widely in medicine, its use in the field of dentistry is only just beginning to achieve popularity. Economic evaluation in dentistry is likely to become increasingly important in the future. Increased research in the field of economic evaluation in conjunction with clinical trials is required in dentistry in both primary care and hospital settings. It is important that those individuals who are involved in the provision and purchase of healthcare fully understand the background to this concept and understand some of the terms which are commonly used. Without good economic analysis, healthcare is unlikely to progress, and only by undertaking systematic reviews, it is possible to identify alternatives to existing or new programs. Such evaluation is dependent on the quality of underlying medical evidence, and because of this, clinical trials are now viewed as a natural vehicle for economic analysis. Economic evaluation is still used less frequently in dentistry than in medicine.[3]

Given the importance of health economics and its rise in recent decades, healthcare providers should have basic knowledge about it and actively implement in diagnostic decision-making, therapeutic interventions, prevention programs, epidemiology, and research.[4] As faculty members are involved in academic research activities and publication of various studies which help in decision-making, it is imperative to have the basic knowledge of economic evaluations to contribute significant results for the implementation of new programs and to modify the existing ones. Hence, there is a need to conduct studies to assess the knowledge, attitude, and practice of application of economic evaluation among dental teaching faculty. This study was conducted with the aim to assess perception and practice of application of economic evaluation among teaching dental faculty of Bengaluru city, India.


  Materials and Methods Top


A cross-sectional exploratory study was conducted among teaching dental faculty of Bengaluru city. Ethical approval was obtained from the institutional review board, and written informed consent was obtained by the participants before including in the study. Permission to conduct the study was obtained from the principals of the respective dental colleges where the study was conducted. Sample size was estimated using EPI-Info (Statcalc, Version 3, open source calculator SSPropor) by assuming 80% power, 0.05 as alpha error, and effect size 1, assuming 50% prevalence of correct answers. A total of 300 participants were included in the final sample. The study was conducted for 45 days till the sample was obtained.

A set of questions were prepared based on different texts of general health economics.[1],[2],[3],[5],[6] Main domains identified were sociodemographic characteristics containing six items, questions to assess knowledge, attitude, and practice regarding application of economic evaluation among teaching dental faculty. Care was taken to make the items/questions as simple as possible for the participants to comprehend. A pilot testing for face validity was carried out following content validity among 30 teaching dental faculty members of The Oxford Dental College and Hospital, Bengaluru. Face validity was carried out to check the relevance and feasibility of questionnaire. Feedback was obtained from all the participants, and necessary correction was done in the final questionnaire.

A self-administered questionnaire was used to collect the data from respondents using a prevalidated questionnaire with 16 items. Participants who were willing to participate in the study and present on the date of visit to the dental colleges were included in the study. The respondents were asked to select one option which is most appropriate to relevant question according to them. The response was reviewed and analysis was done.

Descriptive and inferential statistical analyses were done. Significance was assessed at 5% (P< 0.05). Chi-square test and Fisher's exact test were used to find the significance of study parameters on categorical scale between two groups. R software version 3.3.1 is used for the analysis of the data, and Microsoft Word and Excel have been used to generate graphs and tables.


  Results Top


A total of 300 participants were included in the study. Among them, 50 participants were excluded for the analysis as they did not complete the questionnaire after giving the consent.

Majority of the participants were in the age group of 31–40 years. About 54% participants were females and 46% participants were males, and majority of the participants had MDS qualification (98%). Distribution of study subjects according to designation, specialty, and their formal training in health economics is described in [Table 1].
Table 1: Distribution of study subjects according to designation, specialty, and their formal training in health economics

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Among 250 participants, only 1.6% had taken formal training in health economics. Among 116 male participants, only 3%, and among 134 females, only 1% had taken training in health economics. More males were trained as compared to females and the difference was not statistically significant (P = 0.339). None of the tutors and senior lecturers had undergone training in health economics, whereas among 80 readers and 60 professors, only 3% had taken formal training.

Willingness to undergo training, knowledge about economic evaluation, and use of economic evaluation in research by the participants are described in [Table 2]. Among 250 faculty members, 79% were willing to participate in training programs. Among 250 participants, 52.8% had answered correctly about what is health economics. Knowledge of health economics was more among public health dentists and least being among prosthodontists. No statistical significant difference was found when comparison was done among different specialty (P = 0.29). Among 250 dental faculty members, only 13.6% participants had carried out economic evaluation in their research process. When compared with other specialty members, among all the specialty members, majority of pedodontists (8.8%) and public health dentists (8.4%) carried out economic evaluation during their research process.
Table 2: Distribution of study subjects according to willingness to undergo training, knowledge about economic evaluation, and use of economic evaluation in their research

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Among 13.6% participants who had carried out economic evaluation, 85% performed for research purposes and only 14% performed to maximize the benefits from the resources available. None of the participants performed to provide more efficient delivery of healthcare than existing or to help in policymaking. When compared according to their specialty, all faculty members from oral medicine and radiology, oral and maxillofacial surgery, Conservative Density and Endodontics, and public health dentistry performed economic evaluation for their research purpose [Table 3].
Table 3: Distribution of study subjects according to their response to the question, “Why did you perform economic evaluation?”

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Among 250 participants, 78% always considered cost and outcomes of health, safety, and staff time; 60% considered training the worker; and 74% considered planning, promotion, and evaluation. About 59% participants sometimes considered cost and outcomes of the ongoing supplies and 50% considered equipment purchase. Only few of the participants stated that they never considered these parameters [Figure 1].
Figure 1: Distribution of study subjects to the question, “Which of the following costs and outcomes do you consider during your research process?”

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Majority (80.8%) of them said lack of training, whereas 47.6% said lack of available economic evaluation studies, about 46.4% said economic evaluations are not accepted as a tool by the dental professionals, and about 30.4% participants said lack of resources and time required to perform an economic evaluation as a potential barrier [Figure 2].
Figure 2: Distribution of study subjects to the question, “What are the potential barriers to the use of economic evaluations?”

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  Discussion Top


The present study, which was conducted on the teaching faculty members of Bengaluru city, succeeded in finding the perception and practice of application of economic evaluation in their research and practice. To our knowledge, this is the first cross-sectional study assessing the perception and practice in application of economic evaluation among teaching dental faculty in Bengaluru city. Hence, a cautious comparison is made with cross-sectional studies carried out among the medical faculty members and postgraduate students and qualitative studies carried out among the decision-makers.

In the present study, training in health economics was less (1.6%) which was similar to the study conducted by Zwart-van Rijkom et al.[6] and Hoffmann and Graf von der Schulenburg.[3] In a study conducted by Zwart-van Rijkom et al.,[6] only one physician participated in a 1-day retraining course on pharmacoeconomics for physicians. Two physicians said that they learned about economic evaluations in healthcare through self-education, one of whom is now actually teaching health economics courses, whereas in a study conducted by Hoffmann and Graf von der Schulenburg,[3] only 1% of the participants were trained and willingness to undergo training among the participants was 75%, which was found to be statistically significant among males and females (P = 0.032). It could be due to the lack of interest and awareness regarding the subject. In the study conducted by Savkar et al.,[4] willingness to participate in the study was extremely low.

In this study, 53.6% of the participants had knowledge about the economic evaluation, which was higher than the study presented by Savkar et al. (30%)[4] and Zwart-van Rijkom et al.[6] Knowledge was <13% among the study participants. Only 13.6% of the study participants had used economic evaluation in the research, whereas in the study by Savkar et al.,[4] 35% of participants had used, in the study by Zwart-van Rijkom et al.,[6] only five physicians, and in the study reported by Ross,[7] 38% had used economic evaluation.

In the present study, following barriers were recognized; they are that economic evaluation studies are not accepted as a tool by the dental professionals, lack of training, lack of available economic evaluation studies, and lack of resources and time. Similar barriers were found in the studies conducted by Savkar et al.,[4] Zwart-van Rijkom et al.,[6] Hoffmann and Graf von der Schulenburg,[3] Eddama and Coast,[2] and Ross.[7] Findings of the present study regarding knowledge, attitude, and practice are similar to the studies done by Savkar et al.[4] Zwart-van Rijkom et al.,[6] Hoffmann and Graf von der Schulenburg [3] Eddama and Coast,[2] and Ross,[7] though the participants were not teaching dental faculty members.

Economic evaluation is an under-used component of oral health evaluation. If, as health professionals, dentist should be able to define the most efficient use of scarce health resources for the benefit of the population, we must be prepared to utilize the basic principles of economic evaluation. Economic evaluation requires a degree of expertise, and readers are encouraged to expand their current knowledge and efforts to include an economic evaluation in future endeavors, thus contributing to a solid body of economic information about oral disease prevention. The effective use of economic evaluations will in turn make important research information accessible to a broad audience of policymakers, researchers, practitioners, and community leaders. Economic evaluation can assist program managers and decision-makers who must weigh all the information available in the context of competing health interventions and limited resources in a number of ways.[8]

As this was a cross-sectional study, the information given by the participants is completely subjective. Investigators were unaware of their involvement in any economic evaluation analyses. Participants were not interviewed to check the accuracy of the answers given by them in the questionnaire.

Hence, it is advisable to include economic evaluation concepts and practical exercises in the curriculum of dental undergraduates that would help them realize the enormous differences in cost of various treatments available and will also increase the awareness of indirect cost and intangible cost associated with the treatment. Second, to increase the awareness, it is desirable to conduct continuing dental education, workshops and symposiums in dental colleges and also by conducting national as well as international conferences on health economics which will help healthcare providers to create more awareness, refresh, and update their knowledge.


  Conclusion Top


Knowledge levels of dental faculty members in day-to-day use of health economics concepts were limited. Providing them with basic knowledge at various levels of their dental education and training will go a long way in improving their basic knowledge in health economics concepts. Increasing the awareness among dental professional on the economic evaluation approach will improve their usage in their decision-making.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Cunningham SJ. Economic evaluation of healthcare – Is it important to us? Br Dent J 2000;188:250-4.  Back to cited text no. 1
[PUBMED]    
2.
Eddama O, Coast J. Use of economic evaluation in local health care decision-making in England: A qualitative investigation. Health Policy 2009;89:261-70.  Back to cited text no. 2
[PUBMED]    
3.
Hoffmann C, Graf von der Schulenburg JM. The influence of economic evaluation studies on decision making. A European survey. The EUROMET group. Health Policy 2000;52:179-92.  Back to cited text no. 3
    
4.
Savkar MK, Bhat NP, Shwetha DG. Evaluation of pharmacoeconomics awareness among post graduates: A questionnaire based study. Indian J Basic Appl Med Res 2014;3:135-41.  Back to cited text no. 4
    
5.
Kumar S, Williams AC, Sandy JR. How do we evaluate the economics of health care? Eur J Orthod 2006;28:513-9.  Back to cited text no. 5
[PUBMED]    
6.
Zwart-van Rijkom JE, Leufkens HG, Busschbach JJ, Broekmans AW, Rutten FF. Differences in attitudes, knowledge and use of economic evaluations in decision-making in the Netherlands. The Dutch results from the EUROMET project. Pharmacoeconomics 2000;18:149-60.  Back to cited text no. 6
[PUBMED]    
7.
Ross J. The use of economic evaluation in health care: Australian decision makers' perceptions. Health Policy 1995;31:103-10.  Back to cited text no. 7
[PUBMED]    
8.
Morgan M, Mariño R, Wright C, Bailey D, Hopcraft M. Economic evaluation of preventive dental programs: What can they tell us? Community Dent Oral Epidemiol 2012;40 Suppl 2:117-21.  Back to cited text no. 8
    


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