School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK; Newcastle upon Tyne Hospital NHS Foundation Trust, Newcastle upon Tyne, UK.
Evid Based Dent. 2020 Dec;21(4):128-129. doi: 10.1038/s41432-020-0134-2.
Design A cost-effectiveness analysis of caries management in primary molars using Hall technique (HT) versus conventional restoration (CR) from a pre-existing dataset from a randomised split-mouth trial, within primary care in Scotland, with a five-year follow-up.Case selection Computer-generated block randomisation was used to match asymptomatic primary molars of 3-10-year-old children recruited from primary care, to either HT or CR arms.Economic evaluation A cost-effectiveness analysis was undertaken. A five-year horizon was chosen. A societal perspective was adopted. Estimation of direct, indirect and opportunity costs were presented. Costs were discounted at 1.5%. Molar survival was chosen as the effectiveness measure.Data analysis Statistical significance of primary outcome (survival) was examined using the log-rank test. Bootstrapping produced a sampling distribution of mean cost and effectiveness with a 95% confidence interval around a mean value. An incremental cost-effectiveness ratio (ICER) was provided.Results HT molars had superior survival of 99% (95% CI: 98-100%) compared to CR at 92% (95% CI: 87-97%). Initials costs indicated HT to be more expensive than CR; however, direct costs, including retreatments, were cheaper for HT when using both NHS Scotland and NHS England cost data. Indirect/opportunity costs, including time and travel of parents, were significantly less for HT. Total cumulative costs were significantly lower in HT (32 GBP; 95% CI: 31-34) than CR (49 GBP; 34-69). HT dominated CR, being less costly and more effective with a mean ICER of 2.38 GBP spent additionally while losing 1% of molar survival with CR over HT.Conclusions HT molars are cost-effective, compared to CR, when managing asymptomatic carious primary molars after five years' follow-up.
采用 Hall 技术（HT）与传统修复（CR）治疗 3-10 岁儿童无症状龋坏乳磨牙的成本效果分析：一项基于苏格兰初级保健中随机分组、五年随访的裂口腔试验的回顾性研究。
采用计算机生成的区组随机化方法，将招募自初级保健的无症状乳磨牙匹配至 HT 或 CR 组。
进行了成本效果分析。选择五年时间范围，采用社会视角。报告了直接、间接和机会成本的估计值。成本以 1.5%贴现。采用生存作为效果测量指标。
采用对数秩检验检验主要结局（生存）的统计学意义。采用自举法生成平均成本和效果的抽样分布，其中包含平均值的 95%置信区间。提供了增量成本效果比（ICER）。
HT 组的磨牙生存率为 99%（95%CI：98-100%），优于 CR 组的 92%（95%CI：87-97%）。初始成本表明 HT 比 CR 更昂贵；然而，当使用苏格兰国民健康服务和英格兰国民健康服务成本数据时，HT 的直接成本（包括再治疗）更便宜。间接/机会成本（包括父母的时间和旅行）显著降低。HT 的总累计成本显著低于 CR（32 英镑；95%CI：31-34）（49 英镑；34-69）。HT 对 CR 具有优势，在失去 HT 中 1%的磨牙生存率的情况下，每额外花费 2.38 英镑就可以获得更多的效果。
在五年随访后，HT 治疗无症状龋坏乳磨牙比 CR 更具成本效果。
