Competing Risk Model in Dental Cost-Effective Research

Over the years, few attempts have been made to use survival analysis techniques in dental research. Moreover, the use of survival analysis was restricted to a simple method of drawing a survival curve using the Kaplan-Meier technique, but later prognostic factors were included utilizing the Cox Proportional Hazard (CPH) model. More recently, the CPH model has been incorporated with a frailty parameter to account for the correlation of observations within a subject. A recent publication has utilized a subdistribution hazard model with time-dependent covariates. In actual dental practice, a tooth failure could be due to a variety of reasons other than the cause of failure of interest. To have a realistic estimate of the risk of failure for cause i, one should also include the risk of failure due to causes j, j=1(1) n, which could occur prior to cause i. This competing risk scenario has been attempted in the last ten to fifteen years or so to estimate the probability of failure in the presence of competing event(s). Precise estimate of survival (failure) probabilities using competing risk model has implications in the dental cost-effectiveness and cost-utility studies.