Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Germany.
Institute for the World Economy, Kiel, Germany.
J Dent. 2018 Oct;77:37-42. doi: 10.1016/j.jdent.2018.07.007. Epub 2018 Jul 10.
Root-canal treated molars can be directly restored, usually using resin-based-composite restorations (RBCs), or indirectly restored using full or partial crowns (FCs/PCs). Both the initial treatment costs and the risks of restorative and endodontic complications differ between RBCs and FCs/PCs. We aimed to assess the cost-effectiveness of RBCs versus FCs/PCs for restoring root-canal treated molars.
A mixed public-private payer's perspective within German healthcare was taken. Risks of complications were extracted from large cohort studies or systematic reviews. Costs were estimated using fee-items catalogues of public and private German insurance. A Markov-model was constructed to follow up a root-canal treated molar receiving different restorations in an initially 50-year-old patient over his lifetime. Monte Carlo-microsimulations were performed to assess lifetime costs and effectiveness (tooth retention time), and the resulting cost-effectiveness.
RBCs were less costly than FCs/PCs (749 Euro versus 782 Euro), but also less effective (22 years versus 24 years), the incremental-cost-effectiveness-ratio was 10.80 Euro/year. This ratio increased if costs for direct restorations decreased, or costs for indirect restorations increased. If no teeth were replaced, RBC was far more cost-effective (the incremental cost-effectiveness ratios was 52.95 Euro/year). If all teeth were replaced, FC was both more effective and less costly.
RBCs showed lower costs, but also lower effectiveness than FCs/PCs. Consequently, the cost-effectiveness of both strategies depended on the willingness-to-pay of patients or other payers, i.e. their willingness to invest in higher effectiveness. Clinically, a large number of tooth, patient and dentist-related factors will impact on decision-making and should be considered.
We found composite restorations to be less costly, but also less effective than indirect restorations for root-canal treated teeth. Over a long-term period, the initial treatment costs and associated cost-differences between strategies may be outweighed by costs of follow-up treatments.
根管治疗后的磨牙可以直接修复，通常使用树脂基复合材料修复（RBC），也可以间接修复使用全冠或部分冠（FC/PC）。RBC 和 FC/PC 在初始治疗成本和修复及根管并发症风险方面存在差异。本研究旨在评估 RBC 与 FC/PC 修复根管治疗后的磨牙的成本效益。
本研究从德国混合公共和私人支付者的角度出发。并发症风险从大型队列研究或系统评价中提取。使用公共和私人德国保险的费用项目目录估算成本。为了随访一名最初 50 岁接受不同修复的根管治疗后的磨牙，构建了一个马尔可夫模型，该患者在其一生中。通过蒙特卡罗微模拟评估终生成本和效果（保留时间），并得出成本效益。
RBC 的成本低于 FC/PC（749 欧元对 782 欧元），但效果也较低（22 年对 24 年），增量成本效益比为 10.80 欧元/年。如果直接修复的成本降低，或间接修复的成本增加，该比率会增加。如果没有牙齿被替换，RBC 具有更高的成本效益（增量成本效益比为 52.95 欧元/年）。如果所有牙齿都被替换，FC 既更有效，成本也更低。
RBC 的成本较低，但效果也低于 FC/PC。因此，两种策略的成本效益取决于患者或其他支付者的支付意愿，即他们对提高疗效的意愿。在临床实践中，许多与牙齿、患者和牙医相关的因素会影响决策，应予以考虑。
我们发现复合修复体的成本低于间接修复体，但效果也较差，适用于根管治疗后的牙齿。在长期内，初始治疗成本和策略之间的相关成本差异可能会被随访治疗的成本所抵消。
