Cost-effectiveness of one- and two-step incomplete and complete excavations.
The treatment of deep caries lesions carries significant risks for the integrity of the pulp and often initiates a cascade of re-interventions. Incomplete caries removal may reduce these risks and avoid or delay re-treatment. The present study analyzed the cost-effectiveness of one- and two-step incomplete as well as complete excavations. We used Markov models to simulate treatment of a molar tooth with a deep caries lesion in a 15-year-old patient. Retention of the tooth and its vitality as effectiveness measures as well as accruing costs were analyzed over the patient's lifetime. The model adopted a public-private-payer perspective within German health care. Transition probabilities were calculated based on literature reviews. Monte-Carlo microsimulations were performed with 6-month cycles. One-step incomplete excavation resulted in lower long-term costs and in longer-retained teeth and their vitality (means: 53.5 and 41.0 yrs) compared with two-step incomplete (52.5 and 37.5 yrs) and complete excavations (49.5 and 31.0 yrs), and dominated the other strategies in 70% to 100% of simulations. Regardless of the assumed willingness-to-pay ceiling value, one-step incomplete excavation had the highest probability of being cost-effective. Despite limited evidence levels of input data, we expect one-step incomplete excavation to reduce costs while retaining deeply carious teeth and their vitality for longer.
Clinic for Conservative Dentistry and Periodontology, Christian-Albrechts-University, Kiel, Germany.
F
F
Schwendicke
M
M
Stolpe
H
H
Meyer-Lueckel
S
S
Paris
C E
CE
Dörfer
D000293:Adolescent; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D003731:Dental Caries / Q000601:surgery*; D003737:Dental Cavity Preparation / Q000191:economics* / Q000379:methods*; D003804:Dentin / Q000473:pathology; D005858:Germany; D006801:Humans; D008390:Markov Chains; D018803:Models, Economic
Monte Carlo method; dental caries; dental cavity preparation; dental economics; economic model; health care economics