乳磨牙ART和玻璃离子水门汀修复术的经济学评价

Economic Evaluation of ART and Hall in Primary Molars.

作者信息

de Araujo Mariana Pinheiro, Garbim Jonathan Rafael, Innes Nicola Patricia, Hesse Daniela, Bonifácio Clarissa Calil, Olegário Isabel Cristina, Braga Mariana Minatel, Mendes Fausto Medeiros, Raggio Daniela Prócida

机构信息

University of Geneve, Geneva, Switzerland.

Department of Orthodontics and Pediatric Dentistry, Universidade de São Paulo, São Paulo, Brazil.

出版信息

BMC Oral Health. 2025 Aug 19;25(1):1336. doi: 10.1186/s12903-025-06528-8.

DOI:10.1186/s12903-025-06528-8

PMID:40830451

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12362891/

Abstract

BACKGROUND

This study reports an economic evaluation from the perspective of the Brazilian healthcare system. This is a secondary outcome of a three-year randomised controlled trial that compared Atraumatic Restorative Treatment (ART) to the Hall Technique (HT) for managing occluso-proximal caries lesions in primary molars. The primary outcome showed that the HT had a higher survival rate compared to ART and the economic evaluation was to test cost-effectiveness.

METHODS

Children (5-10 years old) in public schools of Tietê-SP/Brazil, were randomly allocated to either the ART or HT arm. Treatment survival was assessed using Kaplan-Meier analysis. The economic evaluation considered baseline and cumulative material and professional costs based on the Brazilian National Health System (SUS) perspective. For the economic analysis, direct and indirect costs were collected and calculated. When retreatment was necessary, an incremental cost of only one retreatment per child was considered for the analysis. All costs were collected in reais and converted and reported in euros. A discount rate of 5% was considered and a bootstrap regression was used to assess material costs' dynamics over time (α = 5%). Monte-Carlo simulation generated cost-effectiveness scatter plots.

RESULTS

The study included 131 participants (ART = 65; HT = 66) and 112 (85.5%) were followed up over three years. Survival was higher in HT compared to ART restorations (ART = 32.7%; HT = 93.4% p < 0.001). The HT (€13.02) cost less compared to ART (€16.79) (p < 0.001 95% CI: -10.07 to -1.87) due to ART higher treatment failure and cumulative costs. Although baseline costs were lower in the ART group, the cumulative cost due to the need for restoration replacement was higher after 3 years.

CONCLUSION

Hall Technique is a cost-effective strategy compared to Atraumatic Restorative Treatment for managing occluso-proximal carious lesions in primary molars in a school setting after 36 months, particularly from the perspective of the Brazilian public health system.

TRIAL REGISTRATION

This trial was registered in ClinicalTrials.gov (NCT02569047) on 2015-10-06.

摘要

背景

本研究从巴西医疗保健系统的角度进行了一项经济评估。这是一项为期三年的随机对照试验的次要结果，该试验比较了非创伤性修复治疗（ART）与霍尔技术（HT）在治疗乳牙咬合面近中龋损方面的效果。主要结果表明，与ART相比，HT的生存率更高，而经济评估旨在测试成本效益。

方法

巴西圣保罗州蒂埃特市公立学校的儿童（5 - 10岁）被随机分配到ART组或HT组。使用Kaplan-Meier分析评估治疗生存率。经济评估从巴西国家卫生系统（SUS）的角度考虑了基线以及累积的材料和专业成本。对于经济分析，收集并计算了直接和间接成本。当需要再次治疗时，分析中仅考虑每个儿童一次再次治疗的增量成本。所有成本均以雷亚尔收集，然后换算成欧元并报告。考虑了5%的贴现率，并使用自举回归来评估材料成本随时间的动态变化（α = 5%）。蒙特卡洛模拟生成了成本效益散点图。

结果

该研究纳入了131名参与者（ART组 = 65名；HT组 = 66名），其中112名（85.5%）在三年中接受了随访。与ART修复相比，HT的生存率更高（ART = 32.7%；HT = 93.4%，p < 0.001）。由于ART的治疗失败率和累积成本较高，HT（13.02欧元）的成本低于ART（16.79欧元）（p < 0.001，95%可信区间：-10.07至-1.87）。虽然ART组的基线成本较低，但三年后由于需要更换修复体，累积成本更高。