Cunningham, Susan Jane; (2000) Outcomes of orthognatic treatment. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

In recent years health care evaluation has become consumer based. The main source of new information regarding health outcomes is the standardised patient survey, for example: generic measures of well-being. To date, there is little research looking at outcomes of orthognathic treatment in this way. The first part of this research (Chapter 2) studied the economic evaluation of orthognathic treatment, in particular cost-utility analysis and willingness-to-pay (WTP). Utility values obtained from patients and controls were found to be comparable for two of the three methods used and confirmed the view that nonpatients may provide accurate values if the health state in question is described well. A longitudinal study of patients allowed calculation of quality adjusted life years (QALYs) gained as a result of treatment, with mean non-discounted values of between 8.13 and 14.02, depending on the methodology used. The mean cost per QALY varied from a minimum value of £205.79 to a maximum of £1,073.78. The concept of WTP was also introduced and went some way to confirming that it measures strength of preference. The second part of the study (Chapter 3) aimed to develop a condition-specific quality of life measure for patients requesting orthognathic treatment. Evidence was presented for the reliability, validity and responsiveness of the questionnaire. Significant improvements in quality of life were noted following treatment. The final section (Chapter 4) used the relatively new method of statistical modelling to study changes in a number of psychometric instruments during treatment. There were differences in psychological profile between patients and controls at the start of treatment and significant positive changes were noted following intervention. In conclusion, all three chapters found that orthognathic treatment was associated with positive outcomes. Research methodology of this type is increasingly important in dentistry and larger scale multi-centre trials are recommended for the future.

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