Cost-effectiveness of repairing versus replacing composite or amalgam restorations. (November 2016)

• Record Type: Journal Article
• Authors: Kanzow, Philipp; Wiegand, Annette; Schwendicke, Falk
• Is Part Of: Journal of dentistry. Volume 54(2016:Nov.)
• Page Start: 41
• Page End: 47
• Publication Date: 2016-11
• Subjects: Restoration repair -- Decision-making -- Economic evaluation -- Mathematical modelling -- Minimally invasive dentistry -- Restorative dentistry; Dentistry -- Periodicals; Dentistry -- Periodicals; Dentisterie -- Périodiques; Electronic journals; 617.6005
• DOI: 10.1016/j.jdent.2016.08.008
• Languages: English
• ISSNs: 0300-5712

Abstract

Abstract: Objectives: 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.