Department of Oral Function and Prosthetic Dentistry, College of Dental Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
Department of Oral Function and Prosthetic Dentistry, College of Dental Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
J Dent. 2018 Mar;70:80-86. doi: 10.1016/j.jdent.2017.12.012. Epub 2017 Dec 28.
When planning primary oral health care services the cost implications of adopting new intervention practices are important, especially in resource-strapped countries. Although on a trajectory to be phased-out, amalgam remains the standard of care in many countries.
Adopting a government perspective, this study compared the costs of performing amalgam and ART/high-viscosity glass-ionomer cement (HVGIC) restorations and the consequences of failed restorations over 3 years in suburban Brasilia, Brazil. Cost data were collected prospectively; cost estimates were developed for the study sample and a projection of 1000 single- and 1000 multiple-surface restorations per group. Probabilistic sensitivity analysis was conducted in TreeAge Pro.
Results were mixed. For single-surface restorations, ART/HVGIC will cost US$51 per failure prevented, while for multiple-surface restorations, ART/HVGIC was cost-effective with a savings of US$11 compared to amalgam. Probabilistic sensitivity analysis (Monte Carlo simulation) predicted amalgam would be cost-effective 49.2% of the time compared to HVGIC at 50.6% of the time at a willingness to pay threshold of US$237 per failure prevented. Personnel accounted for more than half the cost burden for both methods; instruments and supplies accounted for about one third. The per restoration cost to replace amalgam with HVGIC ranges from US$1 to a savings of US$0.84.
Replacing amalgam with a high-viscosity glass-ionomer as part of the ART method comes at a minimal increase in cost for governments. Increasing the number of restorations seems to diminish the cost burden.
ART/HVGIC could be considered a viable alternative to amalgam in primary teeth.
在规划初级口腔保健服务时，采用新干预措施的成本影响非常重要，尤其是在资源匮乏的国家。尽管银汞合金正在逐步淘汰，但在许多国家它仍是标准的治疗方法。
本研究从政府角度出发，比较了在巴西首都巴西利亚郊区进行银汞合金和 ART/高粘度玻璃离子水门汀（HVGIC）修复的成本，以及 3 年内修复失败的后果。成本数据是前瞻性收集的；为研究样本制定了成本估算，并对每组 1000 个单表面和 1000 个多表面修复体进行了预测。在 TreeAge Pro 中进行了概率敏感性分析。
结果喜忧参半。对于单表面修复体，ART/HVGIC 每预防一次失败将花费 51 美元，而对于多表面修复体，ART/HVGIC 比银汞合金节省 11 美元，具有成本效益。概率敏感性分析（蒙特卡罗模拟）预测，在愿意支付 237 美元/次失败预防的阈值下，银汞合金的成本效益将在 49.2%的时间内超过 HVGIC，而 HVGIC 的成本效益将在 50.6%的时间内超过银汞合金。对于这两种方法，人员成本都占了超过一半的费用负担；器械和用品占了大约三分之一。用 HVGIC 替代银汞合金的每修复体成本范围从 1 美元到节省 0.84 美元。
将 HVGIC 作为 ART 方法的一部分替代银汞合金，对政府来说成本增加很小。增加修复体的数量似乎可以减轻成本负担。
ART/HVGIC 可能是乳牙中替代银汞合金的可行选择。
