Naved N, Umer F, Khowaja A R
Operative Dentistry & Endodontics, Aga Khan University Hospital, Pakistan.
Faculty of Applied Health Sciences, Brock University, Canada.
JDR Clin Trans Res. 2024 Jul;9(3):231-238. doi: 10.1177/23800844231191515. Epub 2023 Aug 9.
With the introduction of stem cell engineering in dentistry, regenerative endodontics has emerged as a potential alternative to mineral trioxide aggregate (MTA) apexification in the management of necrotic immature permanent teeth. However, the utility of this modality in terms of cost-effectiveness has not yet been established. Therefore, we performed cost-effectiveness analysis to determine the dominant treatment modality that would influence decision making from the private payer perspective.
A Markov model was constructed with a necrotic immature permanent tooth in a 7-y-old patient, followed over the lifetime using TreeAge Pro Healthcare 2022. Transition probabilities were estimated based on the existing literature. Costs were estimated based on United States health care, and cost-effectiveness was determined using Monte Carlo microsimulations. The model was validated internally by sensitivity analyses, and face validation was performed by an experienced endodontist and health economist.
In the base-case scenario, regenerative endodontics did not turn out to be a dominant treatment option as it was associated with an additional cost of USD$1,012 and fewer retained tooth-years (15.48 y). Likewise, in the probabilistic sensitivity analysis, regenerative endodontics was again dominated by apexification against different willingness-to-pay values.
Based on current evidence, regenerative endodontic treatment was not cost-effective compared with apexification in the management of necrotic immature permanent teeth over an individual's lifetime.
The study provides valuable insight regarding the cost valuation and cost-efficacy of regenerative endodontic treatment versus apexification in the management of necrotic immature permanent teeth, as this would aid in effective clinical decision making, allowing for the functional allocation of resources.
随着牙科领域干细胞工程技术的引入，再生性牙髓治疗已成为处理坏死未成熟恒牙时一种可能替代矿物三氧化物凝聚体（MTA）根尖诱导成形术的方法。然而，这种治疗方式在成本效益方面的效用尚未确立。因此，我们进行了成本效益分析，以确定从私人支付方角度来看会影响决策的主要治疗方式。
构建了一个马尔可夫模型，以一名7岁患者的坏死未成熟恒牙为研究对象，使用TreeAge Pro Healthcare 2022软件跟踪其一生的情况。根据现有文献估计转移概率。基于美国医疗保健情况估计成本，并使用蒙特卡洛微观模拟确定成本效益。通过敏感性分析对模型进行内部验证，并由一名经验丰富的牙髓病医生和卫生经济学家进行表面效度验证。
在基础案例分析中，再生性牙髓治疗并非主要治疗选择，因为它会带来额外1012美元的成本，且保留牙年数较少（15.48年）。同样，在概率敏感性分析中，针对不同的支付意愿值，再生性牙髓治疗再次被根尖诱导成形术所主导。
根据目前的证据，在个体一生中处理坏死未成熟恒牙时，与根尖诱导成形术相比，再生性牙髓治疗不具有成本效益。
该研究为再生性牙髓治疗与根尖诱导成形术在处理坏死未成熟恒牙方面的成本估值和成本效益提供了有价值的见解，这将有助于有效的临床决策，实现资源的合理分配。
