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Randomized Controlled Trial
. 2018 Nov:78:40-45.
doi: 10.1016/j.jdent.2018.05.022. Epub 2018 May 30.

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

Falk Schwendicke  1 , Joachim Krois  2 , Christian H Splieth  3 , Nicola Innes  4 , Mark Robertson  4 , Julian Schmoeckel  3 , Ruth M Santamaria  3
Affiliations
Randomized Controlled Trial

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

Falk Schwendicke et al. J Dent. 2018 Nov.

Abstract

Objectives: 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.

Methods: 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.

Results: 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).

Conclusions: 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.

Clinical significance: 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.

Keywords: Caries; Dental; Effectiveness; Health economics; Pediatric dentistry; Primary teeth; Restorative dentistry.

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