Falk Schwendicke1, Michael Stolpe2. 1. Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Germany. Electronic address: falk.schwendicke@charite.de. 2. Institute for the World Economy, Kiel, Germany.
Abstract
OBJECTIVES: Root-canal treated molars can be directly restored, usually using resin-based-composite restorations (RBCs), or indirectly restored using full or partial crowns (FCs/PCs). Both the initial treatment costs and the risks of restorative and endodontic complications differ between RBCs and FCs/PCs. We aimed to assess the cost-effectiveness of RBCs versus FCs/PCs for restoring root-canal treated molars. METHODS: A mixed public-private payer's perspective within German healthcare was taken. Risks of complications were extracted from large cohort studies or systematic reviews. Costs were estimated using fee-items catalogues of public and private German insurance. A Markov-model was constructed to follow up a root-canal treated molar receiving different restorations in an initially 50-year-old patient over his lifetime. Monte Carlo-microsimulations were performed to assess lifetime costs and effectiveness (tooth retention time), and the resulting cost-effectiveness. RESULTS: RBCs were less costly than FCs/PCs (749 Euro versus 782 Euro), but also less effective (22 years versus 24 years), the incremental-cost-effectiveness-ratio was 10.80 Euro/year. This ratio increased if costs for direct restorations decreased, or costs for indirect restorations increased. If no teeth were replaced, RBC was far more cost-effective (the incremental cost-effectiveness ratios was 52.95 Euro/year). If all teeth were replaced, FC was both more effective and less costly. CONCLUSIONS: RBCs showed lower costs, but also lower effectiveness than FCs/PCs. Consequently, the cost-effectiveness of both strategies depended on the willingness-to-pay of patients or other payers, i.e. their willingness to invest in higher effectiveness. Clinically, a large number of tooth, patient and dentist-related factors will impact on decision-making and should be considered. CLINICAL SIGNIFICANCE: We found composite restorations to be less costly, but also less effective than indirect restorations for root-canal treated teeth. Over a long-term period, the initial treatment costs and associated cost-differences between strategies may be outweighed by costs of follow-up treatments.
OBJECTIVES: Root-canal treated molars can be directly restored, usually using resin-based-composite restorations (RBCs), or indirectly restored using full or partial crowns (FCs/PCs). Both the initial treatment costs and the risks of restorative and endodontic complications differ between RBCs and FCs/PCs. We aimed to assess the cost-effectiveness of RBCs versus FCs/PCs for restoring root-canal treated molars. METHODS: A mixed public-private payer's perspective within German healthcare was taken. Risks of complications were extracted from large cohort studies or systematic reviews. Costs were estimated using fee-items catalogues of public and private German insurance. A Markov-model was constructed to follow up a root-canal treated molar receiving different restorations in an initially 50-year-old patient over his lifetime. Monte Carlo-microsimulations were performed to assess lifetime costs and effectiveness (tooth retention time), and the resulting cost-effectiveness. RESULTS: RBCs were less costly than FCs/PCs (749 Euro versus 782 Euro), but also less effective (22 years versus 24 years), the incremental-cost-effectiveness-ratio was 10.80 Euro/year. This ratio increased if costs for direct restorations decreased, or costs for indirect restorations increased. If no teeth were replaced, RBC was far more cost-effective (the incremental cost-effectiveness ratios was 52.95 Euro/year). If all teeth were replaced, FC was both more effective and less costly. CONCLUSIONS: RBCs showed lower costs, but also lower effectiveness than FCs/PCs. Consequently, the cost-effectiveness of both strategies depended on the willingness-to-pay of patients or other payers, i.e. their willingness to invest in higher effectiveness. Clinically, a large number of tooth, patient and dentist-related factors will impact on decision-making and should be considered. CLINICAL SIGNIFICANCE: We found composite restorations to be less costly, but also less effective than indirect restorations for root-canal treated teeth. Over a long-term period, the initial treatment costs and associated cost-differences between strategies may be outweighed by costs of follow-up treatments.