Costs and Effectiveness of Treatment Alternatives for Proximal Caries Lesions

Falk Schwendicke,Michael Stolpe,Hendrik Meyer-Lueckel,Christof Edmund Dörfer,Sebastian Paris,Michel Drancourt

doi:10.1371/journal.pone.0086992

Abstract

ObjectivesInvasive therapy of proximal caries lesions initiates a cascade of re-treatment cycles with increasing loss of dental hard tissue. Non- and micro-invasive treatment aim at delaying this cascade and may thus reduce both the health and economic burden of such lesions. This study compared the costs and effectiveness of alternative treatments of proximal caries lesions.MethodsA Markov-process model was used to simulate the events following the treatment of a proximal posterior lesion (E2/D1) in a 20-year-old patient in Germany. We compared three interventions (non-invasive; micro-invasive using resin infiltration; invasive using composite restoration). We calculated the risk of complications of initial and possible follow-up treatments and modelled time-dependent non-linear transition probabilities. Costs were calculated based on item-fee catalogues in Germany. Monte-Carlo-microsimulations were performed to compare cost-effectiveness of non- versus micro-invasive treatment and to analyse lifetime costs of all three treatments.ResultsMicro-invasive treatment was both more costly and more effective than non-invasive therapy, with ceiling-value-thresholds for willingness-to-pay between 16.73 € for E2 and 1.57 € for D1 lesions. Invasive treatment was the most costly strategy. Calculated costs and effectiveness were sensitive to lesion stage, patient’s age, discounting rate and assumed initial treatment costs.ConclusionsNon- and micro-invasive treatments have lower long-term costs than invasive therapy of proximal lesions. Micro-invasive therapy had the highest cost-effectiveness for treating D1 lesions in young patients. Decision makers with a willingness-to-pay over 16.73 € and 1.57 € for E2 and D1 lesions, respectively, will find micro-invasive treatment more cost-effective than non-invasive therapy.

Highlights

With the prevalence of cavitated proximal caries lesions declining in most industrialised countries [1,2], the majority of proximal lesions are non-cavitated enamel- or enamel-dentin lesions [3,4]
We modelled only complications related to the treatment of proximal caries lesions and did not, for example, simulate periodontal complications (Fig. 1)
Transition probability (p) per cycle p = 3.09846(2a)21.343 p = 1.6526(2a)22.078 p = 0.42896(2a)21.391 p = 68.8696(2a)22.078 range p = 0.011–0.019

Summary

Introduction

With the prevalence of cavitated proximal caries lesions declining in most industrialised countries [1,2], the majority of proximal lesions are non-cavitated enamel- or enamel-dentin lesions [3,4] The prevalence of such lesions has been reported to be 39% at the age of 12, increasing to 72% at the age of 20–21 [5], with most of these lesions being active and slowly but continuously progressing [4,5]. The second approach, in contrast, does not greatly depend on the patient’s cooperation, but involves substantial loss of dental tissue, especially if proximal lesions are restored, and is usually the start of a cycle of re-interventions due to the limited longevity of dental restorations [6] This vicious cycle of re-restorations is associated with a further and increasing loss of tooth substance and can compromise both the vitality and retention of the treated tooth [7]

Objectives

Methods

Results

Discussion

Conclusion