title: Cost-effectiveness of implant-supported mandibular removable partial dentures.
abstract: OBJECTIVE
  The aim of this study was to conduct a cost-effectiveness analysis comparing conventional removable partial dentures (RPDs) and implant-supported RPDs (ISRPDs) treatment in patients with an edentulous maxilla and a bilateral free-ending situation in the mandible.
  
  
  METHODS
  Thirty subjects were included. A new RPD was made and implant support was provided 3 months later. Treatment costs (opportunity costs and costs based on tariffs) were calculated. Treatment effect was expressed by means of the Dutch Oral Health Impact Profile questionnaire (OHIP-NL49), a chewing ability test (Mixing Ability Index, MAI) and a short-form health survey measuring perceived general health (SF-36), which was subsequently converted into quality-adjusted-life-years (QALYs). The incremental cost-effectiveness ratio (ICER) was the primary outcome measure of cost-effectiveness, comparing both treatment strategies.
  
  
  RESULTS
  The mean total opportunity costs were €981 (95% CI €971-€991) for the RPD treatment and €2.480 (95% CI €2.461-€2.500) for the ISRPD treatment. The total costs derived from the national tariff structure were €850 for the RPD treatment and €2.610 for the ISRPD treatment. The ICER for OHIP-NL49 and MAI using the opportunity costs was €80 and €786, respectively. When using the tariff structure, corresponding ICERs were €94 and €921. The effect of supporting an RPD with implants when expressed in QALYs was negligible; hence an ICER was not determined.
  
  
  CONCLUSIONS
  It is concluded that depending on the choice of outcome measure and monetary threshold, supporting an RPD with implants is cost-effective when payers are willing to pay more than €80 per OHIP point gained. Per MAI point gained, an additional €786 has to be invested.
authors.affiliation: Department of Fixed and Removable Prosthodontics and Biomaterials, Center for Dentistry and Oral Hygiene, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Jensen
authors.affiliation: Department of Oral-Maxillofacial Surgery, Prosthodontics and Special Dental Care, University of Utrecht, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Jamila
authors.initials: J
authors.lastname: Ross
authors.affiliation: Department of Epidemiology, Health Technology Assessment Unit, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
authors.forename: Talitha L
authors.initials: TL
authors.lastname: Feenstra
authors.affiliation: Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
authors.forename: Gerry M
authors.initials: GM
authors.lastname: Raghoebar
authors.affiliation: Department of Oral-Maxillofacial Surgery, Prosthodontics and Special Dental Care, University of Utrecht, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Caroline
authors.initials: C
authors.lastname: Speksnijder
authors.affiliation: Department of Fixed and Removable Prosthodontics and Biomaterials, Center for Dentistry and Oral Hygiene, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.|Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
authors.forename: Henny J A
authors.initials: HJA
authors.lastname: Meijer
authors.affiliation: Department of Fixed and Removable Prosthodontics and Biomaterials, Center for Dentistry and Oral Hygiene, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.|Department of Oral-Maxillofacial Surgery, Prosthodontics and Special Dental Care, St. Antonius Hospital Nieuwegein, Nieuwegein, the Netherlands.
authors.forename: Marco S
authors.initials: MS
authors.lastname: Cune
mesh_terms: D003362:Cost-Benefit Analysis; D019094:Dental Prosthesis, Implant-Supported / Q000191:economics*; D003832:Denture, Partial, Removable / Q000191:economics*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008334:Mandible; D008409:Mastication; D008875:Middle Aged; D009909:Oral Health / Q000191:economics; D011795:Surveys and Questionnaires
keywords: dental implants; economic evaluation; mastication; patient outcomes; quality of life; removable prosthodontics