Schwendicke Falk, Göstemeyer Gerd
Department for Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Germany.
Department for Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Germany.
J Dent. 2017 Jan;56:58-64. doi: 10.1016/j.jdent.2016.10.016. Epub 2016 Oct 29.
With a growing number of individuals retaining their teeth lifelong, often with periodontitis-induced root surface exposure, there is the need for cost-effective management strategies for root caries lesions. The present study aimed to assess the cost-effectiveness of root caries preventive treatments.
Patients were simulated over 10 years using a Markov model. Four treatments were compared: No treatment, daily 225-800ppm fluoride rinses, chlorhexidine (CHX) varnish (2×/year), silver diamine fluoride (SDF) varnish (2×/year). Data from a systematic review were submitted to network meta-analysis for inferring relative efficacies of treatments. The health outcome was years of teeth being free of root caries. A mixed public-private payer perspective within 2016 German healthcare was taken, with costs being estimated from fee item catalogues or based on market prices. Populations with different numbers of teeth and tooth-level risks were modelled. Monte-Carlo microsimulations, univariate- and probabilistic sensitivity analyses were performed.
In populations with 16 teeth at risk and low tooth-level risk for root caries, providing no preventive treatment was least costly, but also least effective (130 Euro, 144 years). SDF ranked next, being more costly (180 Euro), but also more effective (151 years). Payers willing to invest 8.30 Euro per root caries-free tooth-year found SDF most cost-effective. CHX varnish and fluoride rinse were not cost-effective. In populations with more teeth and high tooth-level risk, SDF was the most effective and least costly option.
Root caries preventive treatments (like SDF) are effective and might even be cost-saving in high risk populations.
Application of SDF can be recommended as a cost-saving treatment for prevention of root caries in patients with high risk of root caries.
随着越来越多的人终身保留牙齿，且常伴有牙周炎导致的牙根表面暴露，因此需要针对根龋病变制定具有成本效益的管理策略。本研究旨在评估根龋预防治疗的成本效益。
使用马尔可夫模型对患者进行了为期10年的模拟。比较了四种治疗方法：不治疗、每日使用225 - 800ppm含氟漱口水、洗必泰（CHX） varnish（每年2次）、氟化银胺（SDF） varnish（每年2次）。将系统评价的数据提交至网络荟萃分析，以推断各治疗方法的相对疗效。健康结局为牙齿无根龋的年数。采用2016年德国医疗保健体系中公私合营支付方的综合视角，费用根据收费项目目录或市场价格估算。对不同牙齿数量和牙齿水平风险的人群进行了建模。进行了蒙特卡洛微观模拟、单变量和概率敏感性分析。
在有16颗患根龋风险牙齿且牙齿水平根龋风险较低的人群中，不进行预防治疗成本最低，但效果也最差（130欧元，144年）。SDF位居其次，成本更高（180欧元），但效果也更好（151年）。愿意为每颗无根龋牙齿年投资8.30欧元的支付方认为SDF最具成本效益。CHX varnish和含氟漱口水不具有成本效益。在牙齿较多且牙齿水平风险较高的人群中，SDF是最有效且成本最低的选择。
根龋预防治疗（如SDF）是有效的，甚至在高风险人群中可能节省成本。
对于根龋风险高的患者，可推荐应用SDF作为预防根龋的节省成本的治疗方法。
