Cost-effectiveness of Different Post-retained Restorations.
OBJECTIVE
Dentists can choose between metal and fiber post systems to provide post-retained restorations. The risk of tooth loss and other complications differs between different post systems, as do the initial treatment costs. We aimed to assess the cost-effectiveness of (1) cast metal (MC), (2) preformed metal (MP), (3) glass fiber (GF), and (4) carbon fiber (CF) post-retained restorations.


METHODS
A mixed public-private payer's perspective within German healthcare was taken. Risks of complications were extracted from systematic reviews. Costs were estimated by using fee items and 2016 material costs. A Markov model was constructed to follow up an endodontically treated molar receiving a post-retained crown in an initially 50-year-old patient during his lifetime. Monte Carlo microsimulations were performed to assess lifetime costs and tooth retention time.


RESULTS
MPs were least costly (€692€), retaining teeth for 26.7 years. GFs were more costly (€745€), retaining teeth for 27.6 years. MCs were minimally more effective but also more costly than GFs (€774€). CFs were less effective and most expensive (€825€, 26.7 years). For payers willing to invest more than €60€ per tooth retention year, GF was cost-effective. Payers willing to invest an additional €670€ found MC to be cost-effective. These findings were found robust in sensitivity analyses.


CONCLUSIONS
For payers not willing to invest additional money for longer tooth retention, MP seemed most suitable to retain restorations. For payers with additional willingness to pay, GF seemed suitable, retaining teeth for longer. MC was only cost-effective under very high willingness to pay. CF is not recommendable on the basis of their cost-effectiveness.
Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Berlin, Germany. Electronic address: falk.schwendicke@gmail.com.
Falk
F
Schwendicke
Kiel Institute for the World Economy, Kiel, Germany.
Michael
M
Stolpe
D003362:Cost-Benefit Analysis; D003442:Crowns / Q000191:economics; D003793:Dental Restoration, Permanent / Q000191:economics* / Q000379:methods; D005858:Germany; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D011176:Post and Core Technique / Q000191:economics*; D016388:Tooth Loss / Q000191:economics
Computer modelling; Markov model; dental care; fiber posts; health economics; prosthetics