Klinisch-ökonomische Evaluation von Epikutantests bei putativer dentaler Werkstoffunverträglichkeit

Abstract

Background: Putative and symptomatic allergies towards dental materials are an issue of increasing relevance in the context of dental-prosthetic treatments. Allergy passport information enables dentists to decide about certain dental materials; however, this decision process calls for sensitive consideration of validity and clinical relevance of the information provided by the allergy passport and the underlying epicutaneous tests. Materials and methods: In order to evaluate dentists' recommendations for individual dental materials when the results of epicutaneous tests are involved, the data of 83 patients were analyzed whose cost-funding applications were based on epicutaneous test results. Furthermore, the performance quality and the validity of interpretations concerning the choice of dental materials based on these tests were evaluated both from a clinical and a health-economic point of view. An interdisciplinary expert panel rated the validity of the test and its suitability for the decision process at hand. Based on the clinical data, the panel derived a recommendation for an appropriate and cost-efficient dental supplementation. The cost estimates for these recommendations were compared to the dentists' treatment and cost proposals in order to characterize the financial damage of material recommendations based on incorrect applications or interpretations of epicutaneous tests. Results: Epicutaneous testing is indicated only for manifest symptoms which were present in 8% of the analyzed cases. 66 of 83 cases could present an allergy passport; however, the results of the epicutaneous tests were stated correctly in these allergy passports for only 70% of these 66 cases. Furthermore, the clinical relevance of the test results was only documented in 3 of these 66 allergy passports. Only 10 of the 83 suggested material changes could be confirmed by the expert panel, for 42 patients (51%) a more suitable and cost-efficient supplementation was suggested. The submitted cost-funding applications exceeded the recalculation of the expert panel in median by 680 Euro (interquartile range: 297 - 1,966 Euro). The total cost deviation for the 83 patients amounted to 113,186 Euro, mainly due to the rather large fraction (65%) of applications intending a prosthetic restoration made of gold. Conclusion: The results of the present examination demonstrate the limited suitability of allergy passports as a tool in dental decision making with respect to the selection of dental materials. Nevertheless, allergy passports are often used rather uncritically by dentists as a legitimation for material changes, which may result in both clinically and economically relevant consequences.