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Cost-effectiveness of managing cavitated primary molar caries lesions: A randomized trial in Germany

Schwendicke, Falk, Krois, Joachim, Splieth, Christian H., Innes, Nicola ORCID: https://orcid.org/0000-0002-9984-0012, Robertson, Mark, Schmoeckel, Julian and Santamaria, Ruth M. 2018. Cost-effectiveness of managing cavitated primary molar caries lesions: A randomized trial in Germany. Journal of Dentistry 78 , pp. 40-45. 10.1016/j.jdent.2018.05.022

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Abstract

The Hall Technique (HT), Non-Restorative Cavity Control (NRCC) and conventional carious tissue removal and restoration (CR) are strategies for managing cavitated caries lesions in primary molars. A randomized controlled three-arm parallel group trial in a university clinic in Germany was used to measure the cost-effectiveness of these strategies. 142 children (HT: 40; NRCC: 44; CR: 58) were followed over a mean 2.5 years. A German healthcare perspective was chosen. The primary outcome was estimated molar survival; secondary outcomes were not needing extraction, not having pain or needing endodontic treatment/extraction, or not needing any re-intervention at all. Initial, maintenance and endodontic/restorative/extraction re-treatment costs were derived from fee items of the statutory insurance. Cumulative cost-effectiveness and cost-effectiveness acceptability were estimated from bootstrapped samples. HT molars survived longer (estimated mean; 95% CI: 29.7; 26.6–30.5 months) than NRCC (25.3; 21.2–28.7 months) and CR molars (24.1; 22.0–26.2 months). HT was also less costly (66; 62–71 Euro) than NRCC (296; 274–318 Euro) and CR (83; 73–92 Euro). HT was more cost-effective than NRCC and CR in >96% of samples, and had acceptable cost-effectiveness regardless of a payer’s willingness-to-pay. This superior cost-effectiveness was confirmed for secondary health outcomes. Cost-advantages were even more pronounced when costs were calculated per year of tooth retention (mean annual costs were HT: 29, NRCC: 154, CR: 61 Euro). HT was more cost-effective than CR or NRCC for managing cavitated caries lesions in primary molars, yielding better dental health outcomes at lower costs. If choosing between these three strategies for managing cavitated caries lesions in primary molars, dentists should prefer HT over NRCC or CR. This would also save costs for the healthcare payer.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Dentistry
Publisher: Elsevier
ISSN: 0300-5712
Date of Acceptance: 29 May 2018
Last Modified: 07 Nov 2022 11:06
URI: https://orca.cardiff.ac.uk/id/eprint/134498

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