Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
Section for Ethics and Health Economics, Department of Global Health and Primary Care, University of Bergen, Bergen, Norway.
PLoS One. 2022 Apr 29;17(4):e0267236. doi: 10.1371/journal.pone.0267236. eCollection 2022.
There are many patients in general practice with health complaints that cannot be medically explained. Some of these patients attribute their health complaints to dental amalgam restorations. This study examined the cost-effectiveness of the removal of amalgam restorations in patients with medically unexplained physical symptoms (MUPS) attributed to amalgam fillings compared to usual care, based on a prospective cohort study in Norway. Costs were determined using a micro-costing approach at the individual level. Health outcomes were documented at baseline and approximately two years later for both the intervention and the usual care using EQ-5D-5L. Quality adjusted life year (QALY) was used as a main outcome measure. A decision analytical model was developed to estimate the incremental cost-effectiveness of the intervention. Both probabilistic and one-way sensitivity analyses were conducted to assess the impact of uncertainty in costs and effectiveness. In patients who attribute health complaints to dental amalgam restorations and fulfil the inclusion and exclusion criteria, amalgam removal is associated with modest increase in costs at societal level as well as improved health outcomes. In the base-case analysis, the mean incremental cost per patient in the amalgam group was NOK 19 416 compared to the MUPS group, while mean incremental QALY was 0.119 with a time horizon of two years. Thus, the incremental costs per QALY of the intervention was NOK 162 680, which is usually considered cost effective in Norway. The estimated incremental cost per QALY decreased with increasing time horizon, and amalgam removal was found to be cost saving over both 5 and 10 years. This study provides insight into the costs and health outcomes associated with the removal of amalgam restorations in patients who attribute health complaints to dental amalgam fillings, which are appropriate instruments to inform health care priorities.
有许多在一般实践中出现健康问题的患者，这些问题无法从医学角度解释。其中一些患者将其健康问题归因于汞合金修复体。本研究基于挪威的一项前瞻性队列研究，考察了将汞合金修复体从归因于汞合金填充物的有无法医学解释的躯体症状（MUPS）的患者中去除的成本效益，与常规护理相比。使用个体层面的微观成本法来确定成本。在干预组和常规护理组中，在基线和大约两年后，使用 EQ-5D-5L 记录健康结果。质量调整生命年（QALY）作为主要结果测量指标。开发了决策分析模型来估计干预措施的增量成本效益。进行了概率和单向敏感性分析，以评估成本和效果不确定性的影响。在将健康问题归因于汞合金修复体且符合纳入和排除标准的患者中，从社会层面来看，去除汞合金与适度增加成本以及改善健康结果有关。在基本分析中，与 MUPS 组相比，汞合金组每位患者的平均增量成本为 19416 挪威克朗，而两年时间内的平均增量 QALY 为 0.119。因此，该干预措施的增量成本效益比为 162680 挪威克朗，在挪威通常被认为是具有成本效益的。随着时间的推移，估计的增量成本效益比逐渐降低，并且在 5 年和 10 年内，去除汞合金都是节省成本的。本研究深入了解了将汞合金修复体从将健康问题归因于汞合金填充物的患者中去除所涉及的成本和健康结果，这是确定医疗保健优先级的适当工具。
