Cost-effectiveness of repairing versus replacing composite or amalgam restorations

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• 作者：Philipp Kanzow^a ; ^{philipp.kanzow@med.uni-goettingen.de" class="auth_mail" title="E-mail the corresponding author} ; Annette Wiegand^a ; Falk Schwendicke^b
• 关键词：Restoration repair ; Decision-making ; Economic evaluation ; Mathematical modelling ; Minimally invasive dentistry ; Restorative dentistry
• 刊名：Journal of Dentistry
• 出版年：2016
• 出版时间：November 2016
• 年：2016
• 卷：54
• 期：Complete
• 页码：41-47
• 全文大小：780 K

文摘

Repairing instead of replacing partially defective composite or amalgam restorations might reduce the initial treatment risks and costs, but could be less advantageous long-term due to repeated re-interventions being required. This study aimed to compare the cost-effectiveness of repairing versus replacing composite or amalgam restorations.

Methods

A mixed public-private-payer perspective from the German healthcare setting was adopted. A permanent molar with a three-surfaced partially defective composite or amalgam restoration in need of repair or replacement was modelled. Risks of complications after repair or complete replacement were derived by a rapid systematic literature review. The health outcome measure was tooth retention years. Costs were estimated from the German public and private fee catalogues. Monte-Carlo microsimulations were performed and incremental-cost-effectiveness ratios (ICERs) were used to express cost differences per gain or loss of effectiveness.

Results

Compared with complete composite replacement, composite repairs were marginally more costly and more effective (€326 versus €321; 24.7 versus 24.0 years; ICER: €7.14). Amalgam repairs were more costly and more effective than complete replacement (€467 versus €326; 24.3 versus 23.7 years; ICER: €235). If composite repair costs were € < 67 or complete replacement costs € > 166, composite repair was always cost-effective. This was not the case for amalgam repair. The size of the restoration, the reason for repair/replacement, and patients’ age were found to influence the cost-effectiveness.

Conclusions

Repair was found to be more effective, but not necessarily less costly than complete replacement of restorations.

Clinical significance

Repairing instead of replacing partially defective restorations is likely to retain teeth for longer compared with complete replacement. When considering cost-effectiveness, repairing composite can be recommended more strongly than repairing amalgam restorations.