Kolker Justine L, Damiano Peter C, Flach Stephen D, Bentler Suzanne E, Armstrong Steven R, Caplan Daniel J, Kuthy Raymond A, Warren John J, Jones Michael P, Dawson Deborah V
University of Iowa, College of Dentistry, Department of Operative Dentistry, S229 DSB, Iowa City, IA 52242, USA.
J Public Health Dent. 2006 Winter;66(1):57-63. doi: 10.1111/j.1752-7325.2006.tb02552.x.
To assist clinical decision making for an individual patient or on a community level, this study was done to determine the differences in costs and effectiveness of large amalgams and crowns over 5 and 10 years when catastrophic subsequent treatment (root canal therapy or extraction) was the outcome.
Administrative data for patients seen at the University of Iowa, College of Dentistry for 1735 large amalgam and crown restorations in 1987 or 1988 were used. Annual costs and effectiveness values were calculated. Costs of initial treatment (large amalgam or crown), and future treatments were determined, averaged and discounted. The effectiveness measure was defined as the number of years a tooth remained in a state free of catastrophic subsequent treatment. Years free of catastrophic treatment were averaged, and discounted. The years free of catastrophic treatment accounted for individuals who dropped out or withdrew from the study.
Teeth with crowns had higher effectiveness values at a much higher cost than teeth restored with large amalgams. The cost of an addition year free of catastrophic treatment for crowns was 1088.41 dollars at 5 years and 500.10 dollars at 10 years. Teeth in women had more favorable cost-effectiveness ratios than those in men, and teeth in the maxillary arch had more favorable cost-effectiveness ratios than teeth in the mandibular arch.
Neither the large amalgam or crown restoration had both the lowest cost and the highest effectiveness. The higher incremental cost-effectiveness ratio for crowns should be considered when making treatment decisions between large amalgam and crown restorations.
为协助针对个体患者或社区层面的临床决策，本研究旨在确定当灾难性后续治疗（根管治疗或拔牙）作为结果时，大型银汞合金修复体和牙冠在5年和10年期间的成本及效果差异。
使用了爱荷华大学牙科学院1987年或1988年1735例大型银汞合金修复体和牙冠修复患者的管理数据。计算年度成本和效果值。确定初始治疗（大型银汞合金或牙冠）及未来治疗的成本，并进行平均和贴现。效果指标定义为牙齿保持无灾难性后续治疗状态的年数。对无灾难性治疗的年数进行平均和贴现。无灾难性治疗的年数涵盖了退出或退出研究的个体。
与用大型银汞合金修复的牙齿相比，牙冠修复的牙齿效果值更高，但成本也高得多。牙冠修复额外一年无灾难性治疗的成本在5年时为1088.41美元，在10年时为500.10美元。女性牙齿的成本效益比优于男性，上颌牙弓的牙齿成本效益比优于下颌牙弓的牙齿。
大型银汞合金修复体和牙冠修复都不是成本最低且效果最高的。在大型银汞合金修复体和牙冠修复之间做出治疗决策时，应考虑牙冠修复更高的增量成本效益比。
