Inhalation Sedation. Is it Cost Effective?

Here I offer my personal views and some results based on 38 years experience in both NHS General Dental practice (1977- 1989  practice , mixed practice (1989 to 1991) and wholly private practice (1991 to 2015).

This post is written from the purely financial standpoint of a GDP in private practice. Those is NHS practice will have to seek funding from their paymasters and/or look at the non-financial cost-benefits, of which there are many.

So is it worth getting involved and can I afford to get started with Inhalation Sedation?

In this blog post I want to take an overview of my experience. If you wish to drill down (excuse the pun) to the detailed figures, I will be publishing these in the form of an e-book(let) soon ( see below) but I will let you in to the secret here of why I am writing this now, after 10 years of running my “RA” courses.

I have been utilizing, what I believe to this very remarkable technique to help anxious dental patients, those with a gag reflex, those requiring extensive treatment for 38 years pretty much on a daily basis. I use it for children from about 4 years of age to adults of all ages. From single extractions, to multiple crown and bridge or implant rehabilitation.  So is it cost effective?

I’d have to say yes, based on my gut instinct of the clinical usefulness, the range of uses it has and the patients who can benefit and of course the way its use positively impacts on the daily working lives of everyone at the practice from the receptionist to the dentist and everyone in between. We have received a steady stream of terrific testimonials, posted on our website (when I owned my practice) these helped attract new patients to the practice.

Lies, damn lies and statistics

This section may be skipped if you take my word for it or can’t be bothered!

Gut reaction must rank pretty low on the evidence-base scale- indeed I’d say it must be the lowest value of evidence possible. So, at this stage I have sought to increase the validity of the evidence I have gathered at least several levels.

In a paper published in 2006, The Ranking and Reliability of Evidence, Dr. M. Sutter[i], Professor emeritus at the University of British Columbia. offered the following evidence strength ranking to answer the question he posed, “at what point does information become evidence?”

Running from (1) the least reliable to (11) the most reliable the following table was offered in his article.

1. Advertisements (including political speeches)


2. Hearsay


3. Testimonials (including most Internet sites)


4. Testimonials from friends or authorities


5. Sworn testimony


6. Recorded observations


7. Recorded systematic observations


8. Recorded results of interventional experimentation with randomization and appropriate controls (including blinding of the observer(s) and subjects when necessary)


9. Recorded results from replications of experiments as in 8


10. Successful predictions based on a model derived from recorded systematic observations (e.g., tide tables and eclipses) 


11. Successful predictions based on a model derived from experimentation (e.g., atomic fission and fusion)

So let us ignore 8,9,10 and 11 above as being irrelevant to the type of information and evidence we are looking at here.

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[i] BCMJ, Vol. 48, No. 1, January, February 2006, page(s) 16-19 Premise; Morley Sutter, MD, PhD

So if you consider that this blog post is nothing more than an advert for the courses I run, then everything that follows has little if any credible value. So be it.

If you would like to hear, that which I would be happy to swear an affidavit to, then that would bring what I have to report, at least to no. (5) on this list above.

Given that the results I will be reporting are taken directly from my computerized clinical and financial records (ExAct / SOE reports) then, without further scrutiny, the evidence that will be presented will increase in reliability to at least that of (6) Recorded observations.

Since we have discounted, for these purposes, 8-11, then the top ranking evidence for this type of report might be considered to be (7) Recorded systematic observations – so not too far away from reliable evidence then.

Regarding “Recorded systematic observations“ Sutter states The important features are that the record be written down and that the observations be made in a consistent and systematic way over a prolonged period. Once having been made, the observations often are used to build models, either mathematical or physical (i.e., mechanical, electronic, or chemical). …..

Much of the research in medicine falls into this category of systematic observation including anatomical, physiological, biochemical, and pharmacodynamic studies. Epidemiological studies are also of this type and often identify correlations between phenomena.”

So given my figures are derived from “records that are written down (contemporaneously of course) in a consistent and systematic way, over a prolonged period (initially at this stage approx. 15 months but records could be mined back to 1998), then the results I will be publishing are not to far off level(7) top-ranking, in terms of reliability.

That is as far I am prepared to go with evidence and stats. for these purposes.

The practicalities

While discussing the general point of whether incorporating Inhalation Sedation into a practice’s offering was worthwhile, at a recent “RA” course, a thought occurred to me.

I could immediately bring to mind 3 patients, just three specific patients, who over about the last 12 months had had close to 40 units of crowns, bridges and veneers with other significant composite restorations completed and fitted.  I was unsure of the precise numbers as I had not been through my records at that time.

Any dentist can do a back of the envelope calculation as to what that might mean in terms of turnover.

So today I undertook part 1 of the exercise.

1  1)     To Identify the 3 specific patients I had remembered.

2  2)     To work out the value of the treatment that I had completed,

3  3)     To identify the fees generated by the sedation service alone and

4  4)     To identify the total number of Inhalation Sedation cases undertaken in the same period.

IMPORTANT NOTES:

During this study period I have only been working 2 days per week.

There were 55 working weeks was in 15 month period of time studied.

Various extrapolations can be made from these, the most obvious being what the likely figures would have been had I been working 5 days per week.

For the purpose of this blog post, I will say this. The figure of the 3 patients who I recalled had had fairly extensive treatment, was extended to 4 once I examined my records. 42 units of crown, Bridge and veneers were completed.

I should state here that highlighting these 4 patients disregards all of the other patients attending for more routine treatment under inhalation sedation and the revenue accrued from them.

The initial study period

1^st Jan 2013 to 23^rd April 2014.

The sedation fees for the above-mentioned 4 patients alone, over the 15 month period in question, comes close to covering the entire capital cost of installing the Inhalation Sedation equipment, which could be expected to  last for very many years. These figures do not calculate the profit margin available to set against those set-up costs. I'll leave that to the accountants out there.

The gross fees earned for the sedation sessions alone for these 4 patients was £5,083.00

over 29 sedation sessions for this period. The sessions varied in length from 1-3 hours. The average fee per session was £175.28.

The additional sedation sessions for all other patients, treated for a variety of reasons and for varying fees and lengths of sessions totalled £4116. Thus total “RA” sedation fees for the period was £9199 in addition to the dental fees for the treatment that the sedation permitted for the period of the study.

Remember this was for a 2-day working week throughout the period!

Extrapolating to a 5 day week, these gross sedation fees would come to £23,000 for 177.50 cases

Naturally there are additional costs involved.

1   1)     Initial education/training course – One-off

2   2)     Competency mentoring – One-off

3   3)     12 hours vCPD every 5 years. Cost depends on how that vCPD is attained.

Gases

1   4)     Gas cylinder rental

2   5)     Gas Cylinder collection/delivery charge

3   6)     Cost of gases

The main additional on-going costs will include:

1. ·       Annual servicing costs for the mixing head (as with many items of equipment that we use)
2. ·       Possibly, disposable items if these are the items of choice:

·       Nasal masks

·       Tubing to and from the nasal mask

So have I repeated this pattern of extensive treatment for 4 patients like these, every year for 38 years? No.

Have I undertaken extensive treatment for patients using Inhalation Sedation before? Yes. Many times.

It would of course be up to the practitioner to market the availability of this safe, effective, non-invasive technique (with rapid recovery and no need for an escort) to their potential patients and existing patient base. It offers a way for anxious patients or gaggers to seek out the solution to the dental problems that they have been denying or just putting them off.

If you want the detailed breakdown of the figures that prove my point, including the gross treatment fees earned for these patients, these will be available as a mini e-booklet via a Dropbox download for a nominal fee. No fees should be sent or offered to me yet but please send me your e-mail address to study1@inhalationsedationtraining.com and I will send details of how to pay. Once the e-booklet has been paid for I will forward a link to download it.  I have decided to do this to ensure that only those who have a serious interest in the topic can take advantage of the results.

Thanks for getting this far.

Details of the courses I run…

Richard Charon.