A cost-effectiveness evaluation of enamel matrix derivatives alone or in conjunction with regenerative devices in the treatment of periodontal intra-osseous defects.
OBJECTIVE
To identify the most cost-effective approach to treatment of infrabony lesions with enamel matrix derivatives (EMD).


METHODS
We incorporated costs and clinical outcomes of 12 different treatment techniques (including flap operation, EMD alone, and EMD in association with other reconstructive devices) within a decision tree model in which costs were based on insurance regulations in Germany and health outcomes followed a recent meta-analysis. The most cost-effective treatment option was identified on the basis of the maximum net benefit criterion.


RESULTS
Treatment techniques using EMD were cost-efficient if the decision maker's willingness-to-pay (WTP) was at least €150-175 per incremental mm of pocket probing depth reduction and clinical attachment level gain, respectively (1-year perspective). When EMD was affordable, the maximum net benefit was achieved by treatment with EMD in conjunction with bioactive glass or bovine bone substitutes. Additional application of platelet-rich plasma (PRP) or a resorbable membrane came at relatively high costs.


CONCLUSIONS
If EMD use is indicated, EMD in conjunction with either bioactive glass or bovine bone substitutes is more cost-effective than EMD alone. The additional use of PRP or a resorbable membrane may only be justifiable when monetary resources for treatment are very generous.
Listl
Stefan
S
Department of Conservative Dentistry, University of Heidelberg, Heidelberg, Germany. stefan.listl@med.uni-heidelberg.de
Tu
Yu-Kang
YK
Faggion
Clovis Mariano
CM
D016301:Alveolar Bone Loss / Q000191:economics* / Q000601:surgery*; D018786:Bone Substitutes / Q000191:economics; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D003746:Dental Enamel Proteins / Q000191:economics* / Q000627:therapeutic use*; D005858:Germany; D016557:Guided Tissue Regeneration, Periodontal / Q000191:economics; D006801:Humans; D007347:Insurance, Dental; D008567:Membranes, Artificial; D015201:Meta-Analysis as Topic; D009010:Monte Carlo Method; D053657:Platelet-Rich Plasma; D016896:Treatment Outcome
D018786:Bone Substitutes; D003746:Dental Enamel Proteins; D008567:Membranes, Artificial