F Schwendicke1, M Stolpe2, N Innes3. 1. Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Berlin, Germany. 2. Kiel Institute for the World Economy, Kiel, Germany. 3. Paediatric Dentistry, Dental School, University of Dundee, Dundee, UK.
Abstract
AIM: To compare the cost-effectiveness of three strategies for treating primary molars with cavitated carious lesions and sensible (vital), asymptomatic pulps. METHODOLOGY: Conventional excavation and restoration, Hall Technique (caries sealing using a preformed crown), and pulpotomy were compared. As the latter would not be applied to all teeth in clinical reality, decision-making under perfect information was modelled, with teeth at-risk for pulpal complications receiving immediate pulpotomy, whilst all others were treated conventionally. A Markov model was constructed and transition probabilities derived from randomized trials and systematic reviews. A carious molar in a 5-year-old child was followed until exfoliation. Cost-effectiveness was assessed within the German healthcare system using a public-payer perspective. Monte Carlo microsimulations were performed to evaluate the primary outcome, costs (in Euros) per year of tooth retention. RESULTS: Conventional treatment was least effective and more expensive than the Hall Technique. Risk-based pulpotomy was more costly, but also more effective than alternatives. Overall, the Hall Technique was most cost-effective (9.77 Euros year-1 ), followed by pulpotomy (11.75 Euros year-1 ) and conventional treatment (13.31 Euros year-1 ). For payers willing to invest >59 Euros per additional year of tooth retention, risk-based pulpotomy was most cost-effective. Providing pulpotomy to all teeth was not cost-effective. CONCLUSIONS: The Hall Technique was most cost-effective, whilst conventional treatment was least effective and more costly. Performing pulpotomy for molars at-risk of pulpal complications might be effective, but was more expensive than alternatives. Moreover, accurately predicting such pulpal complications is currently not possible. Risk-based decision-making does not necessarily reduce costs.
AIM: To compare the cost-effectiveness of three strategies for treating primary molars with cavitated carious lesions and sensible (vital), asymptomatic pulps. METHODOLOGY: Conventional excavation and restoration, Hall Technique (caries sealing using a preformed crown), and pulpotomy were compared. As the latter would not be applied to all teeth in clinical reality, decision-making under perfect information was modelled, with teeth at-risk for pulpal complications receiving immediate pulpotomy, whilst all others were treated conventionally. A Markov model was constructed and transition probabilities derived from randomized trials and systematic reviews. A carious molar in a 5-year-old child was followed until exfoliation. Cost-effectiveness was assessed within the German healthcare system using a public-payer perspective. Monte Carlo microsimulations were performed to evaluate the primary outcome, costs (in Euros) per year of tooth retention. RESULTS: Conventional treatment was least effective and more expensive than the Hall Technique. Risk-based pulpotomy was more costly, but also more effective than alternatives. Overall, the Hall Technique was most cost-effective (9.77 Euros year-1 ), followed by pulpotomy (11.75 Euros year-1 ) and conventional treatment (13.31 Euros year-1 ). For payers willing to invest >59 Euros per additional year of tooth retention, risk-based pulpotomy was most cost-effective. Providing pulpotomy to all teeth was not cost-effective. CONCLUSIONS: The Hall Technique was most cost-effective, whilst conventional treatment was least effective and more costly. Performing pulpotomy for molars at-risk of pulpal complications might be effective, but was more expensive than alternatives. Moreover, accurately predicting such pulpal complications is currently not possible. Risk-based decision-making does not necessarily reduce costs.
Authors: N P T Innes; D J P Evans; C C Bonifacio; M Geneser; D Hesse; M Heimer; M Kanellis; V Machiulskiene; J Narbutaité; I C Olegário; A Owais; M P Araujo; D P Raggio; C Splieth; E van Amerongen; K Weber-Gasparoni; R M Santamaria Journal: Br Dent J Date: 2017-03-24 Impact factor: 1.626
Authors: Falk Schwendicke; Soraya Leal; Peter Schlattmann; Sebastian Paris; Ana Paula Dias Ribeiro; Marta Gomes Marques; Leandro Augusto Hilgert Journal: BMJ Open Date: 2018-12-14 Impact factor: 2.692
Authors: Falk Schwendicke; Tanya Walsh; Thomas Lamont; Waraf Al-Yaseen; Lars Bjørndal; Janet E Clarkson; Margherita Fontana; Jesus Gomez Rossi; Gerd Göstemeyer; Colin Levey; Anne Müller; David Ricketts; Mark Robertson; Ruth M Santamaria; Nicola Pt Innes Journal: Cochrane Database Syst Rev Date: 2021-07-19
Authors: F Schwendicke; J G Rossi; G Göstemeyer; K Elhennawy; A G Cantu; R Gaudin; A Chaurasia; S Gehrung; J Krois Journal: J Dent Res Date: 2020-11-16 Impact factor: 6.116