1 Department of Operative and Preventive Dentistry, Charité-Universitätsmedizin Berlin, Berlin, Germany.
2 Kiel Institute for the World Economy, Kiel, Germany.
J Dent Res. 2018 Nov;97(12):1317-1323. doi: 10.1177/0022034518782671. Epub 2018 Jun 21.
We aimed to assess the cost-effectiveness of amalgam alternatives-namely, incrementally placed composites (IComp), composites placed in bulk (BComp), and glass ionomer cements (GIC). In a sensitivity analysis, we also included composite inlays (CompI) and incrementally placed bulk-fills (IBComp). Moreover, the value of information (VOI) regarding the effectiveness of all strategies was determined. A mixed public-private-payer perspective in the context of Germany was adopted. Bayesian network meta-analyses were performed to yield effectiveness estimates (relative risk [RR] of failure). A 3-surfaced restoration on a permanent molar in initially 30-y-old patients was followed over patients' lifetime using a Markov model. Restorative and endodontic complications were modeled; our outcome parameter was the years of tooth retention. Costs were derived from insurance fee items. Monte Carlo microsimulations were used to estimate cost-effectiveness, cost-effectiveness acceptability, and VOI. Initially, BComp/GIC were less costly (110.11 euros) than IComp (146.82 euros) but also more prone to failures (RRs [95% credible intervals (CrI)] were 1.6 [0.8 to 3.4] for BComp and 1.3 [0.5 to 5.6] for GIC). When following patients over their lifetime, IComp was most effective (mean [SD], 41.9 [1] years) and least costly (2,076 [135] euros), hence dominating both BComp (40.5 [1] years; 2,284 [126] euros) and GIC (41.2 years; 2,177 [126] euros) in 90% of simulations. Eliminating the uncertainty around the effectiveness of the strategies was worth 3.99 euros per restoration, translating into annual economic savings of 87.8 million euros for payers. Including CompI and IBComp into our analyses had only a minimal impact, and our findings were robust in further sensitivity analyses. In conclusion, the initial savings by BComp/GIC compared with IComp are very likely to be compensated by the higher risk of failures and costs for retreatments. CompI and IBComp do not seem cost-effective. All alternatives are likely to be inferior to amalgam. The VOI was considerable, and future studies may yield significant economic benefits.
我们旨在评估汞合金替代物的成本效益，即增量复合树脂（IComp）、块状复合树脂（BComp）和玻璃离子水门汀（GIC）。在敏感性分析中，我们还包括复合嵌体（CompI）和增量块状填充（IBComp）。此外，还确定了所有策略有效性的信息价值（VOI）。采用德国公私混合支付者的观点进行贝叶斯网络荟萃分析，以产生有效性估计值（失败的相对风险[RR]）。对最初 30 岁的患者的恒磨牙进行了 3 个表面修复，并使用马尔可夫模型对患者的终生进行了随访。对修复和牙髓并发症进行建模；我们的结果参数是牙齿保留的年数。成本来自保险费用项目。蒙特卡罗微模拟用于估计成本效益、成本效益可接受性和 VOI。最初，BComp/GIC 的成本较低（110.11 欧元）比 IComp（146.82 欧元），但更容易失败（RR[95%可信区间（CrI）]分别为 1.6[0.8 至 3.4]对于 BComp 和 1.3[0.5 至 5.6]对于 GIC）。当对患者进行终生随访时，IComp 最有效（平均值[标准差]，41.9[1]年）且成本最低（2076[135]欧元），因此在 90%的模拟中，IComp 优于 BComp（40.5[1]年；2284[126]欧元）和 GIC（41.2 年；2177[126]欧元）。消除策略有效性的不确定性价值为每次修复 3.99 欧元，这意味着为支付者每年节省 8780 万欧元的经济成本。将 CompI 和 IBComp 纳入我们的分析中，其影响很小，我们的研究结果在进一步的敏感性分析中是稳健的。总之，与 IComp 相比，BComp/GIC 的初始节省很可能会因失败风险和再治疗成本增加而被抵消。CompI 和 IBComp 似乎没有成本效益。所有替代方案都可能不如汞合金。VOI 相当可观，未来的研究可能会带来显著的经济效益。
