Philipp Kanzow1, Annette Wiegand2, Falk Schwendicke3. 1. Department of Preventive Dentistry, Periodontology and Cariology, University Medical Center Göttingen, Germany. Electronic address: philipp.kanzow@med.uni-goettingen.de. 2. Department of Preventive Dentistry, Periodontology and Cariology, University Medical Center Göttingen, Germany. 3. Department of Operative and Preventive Dentistry, Charité-Universitätsmedizin Berlin, Germany.
Abstract
OBJECTIVES: Repairing instead of replacing partially defective composite or amalgam restorations might reduce the initial treatment risks and costs, but could be less advantageous long-term due to repeated re-interventions being required. This study aimed to compare the cost-effectiveness of repairing versus replacing composite or amalgam restorations. METHODS: A mixed public-private-payer perspective from the German healthcare setting was adopted. A permanent molar with a three-surfaced partially defective composite or amalgam restoration in need of repair or replacement was modelled. Risks of complications after repair or complete replacement were derived by a rapid systematic literature review. The health outcome measure was tooth retention years. Costs were estimated from the German public and private fee catalogues. Monte-Carlo microsimulations were performed and incremental-cost-effectiveness ratios (ICERs) were used to express cost differences per gain or loss of effectiveness. RESULTS: Compared with complete composite replacement, composite repairs were marginally more costly and more effective (€326 versus €321; 24.7 versus 24.0 years; ICER: €7.14). Amalgam repairs were more costly and more effective than complete replacement (€467 versus €326; 24.3 versus 23.7 years; ICER: €235). If composite repair costs were €<67 or complete replacement costs €>166, composite repair was always cost-effective. This was not the case for amalgam repair. The size of the restoration, the reason for repair/replacement, and patients' age were found to influence the cost-effectiveness. CONCLUSIONS: Repair was found to be more effective, but not necessarily less costly than complete replacement of restorations. CLINICAL SIGNIFICANCE: Repairing instead of replacing partially defective restorations is likely to retain teeth for longer compared with complete replacement. When considering cost-effectiveness, repairing composite can be recommended more strongly than repairing amalgam restorations.
OBJECTIVES: Repairing instead of replacing partially defective composite or amalgam restorations might reduce the initial treatment risks and costs, but could be less advantageous long-term due to repeated re-interventions being required. This study aimed to compare the cost-effectiveness of repairing versus replacing composite or amalgam restorations. METHODS: A mixed public-private-payer perspective from the German healthcare setting was adopted. A permanent molar with a three-surfaced partially defective composite or amalgam restoration in need of repair or replacement was modelled. Risks of complications after repair or complete replacement were derived by a rapid systematic literature review. The health outcome measure was tooth retention years. Costs were estimated from the German public and private fee catalogues. Monte-Carlo microsimulations were performed and incremental-cost-effectiveness ratios (ICERs) were used to express cost differences per gain or loss of effectiveness. RESULTS: Compared with complete composite replacement, composite repairs were marginally more costly and more effective (€326 versus €321; 24.7 versus 24.0 years; ICER: €7.14). Amalgam repairs were more costly and more effective than complete replacement (€467 versus €326; 24.3 versus 23.7 years; ICER: €235). If composite repair costs were €<67 or complete replacement costs €>166, composite repair was always cost-effective. This was not the case for amalgam repair. The size of the restoration, the reason for repair/replacement, and patients' age were found to influence the cost-effectiveness. CONCLUSIONS: Repair was found to be more effective, but not necessarily less costly than complete replacement of restorations. CLINICAL SIGNIFICANCE: Repairing instead of replacing partially defective restorations is likely to retain teeth for longer compared with complete replacement. When considering cost-effectiveness, repairing composite can be recommended more strongly than repairing amalgam restorations.
Authors: Michael Raedel; Andrea Hartmann; Steffen Bohm; Heinz-Werner Priess; Stefanie Samietz; Ioannis Konstantinidis; Michael H Walter Journal: Clin Oral Investig Date: 2017-02-28 Impact factor: 3.573
Authors: Françoise H van de Sande; Rafael R Moraes; Raquel V Elias; Anelise F Montagner; Paulo A Rodolpho; Flávio F Demarco; Maximiliano S Cenci Journal: Clin Oral Investig Date: 2018-10-27 Impact factor: 3.573