Costs and effectiveness of treatment alternatives for proximal caries lesions
Falk Schwendicke, Hendrik Meyer-Lueckel, Michael Stolpe, Christof Edmund Dörfer, Sebastian Paris, Falk Schwendicke, Hendrik Meyer-Lueckel, Michael Stolpe, Christof Edmund Dörfer, Sebastian Paris
Abstract
Objectives: Invasive 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.
Methods: A 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.
Results: Micro-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.
Conclusions: Non- 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.
Conflict of interest statement
Competing Interests: The authors have read the journal’s policy and have the following conflicts: HML and SP are appointed as inventors US and European patents for an infiltration technique for dental caries lesions, held by Charité-Universitätsmedizin Berlin, and receive royalties from DMG. This does not alter the authors’ adherence to all the PLOS ONE policies on sharing data and materials. The following are the patents in more detail, including the country code, the patent number, and the patent’s title. US - US 11/040,442 - Salzsäuregel und Infiltrat zur Versiegelung von kariösen Läsionen; WO/US - US 12/300,437 - Infiltration zur Penetration von Karies; WO/EP - EP 07725124.7 - Infiltration zur Penetration von Karies; WO/KR – KR - Infiltration zur Penetration von Karies; WO/RU – RU - Infiltration zur Penetration von Karies; WO/JP - JP 2009-508257 - Method and means of infiltrating enamel lesions; WO/JP - JP 2009536633 - Infiltration zur Penetration von Karies; WO - PCT/EP2007/004204 - Infiltration zur Penetration von Karies; WO/CN - CN 200780013643.8 - Infiltration zur Penetration von Karies; US - US 11/432,271 - Infiltration zur Penetration von Karies; WO/BR - BR PI07116004 - METODO E MElOS PARA INFILTRACÄO EM LESÖES DO ESMALTE; WO/IN - IN 6789CHENP2008 - Infiltration zur Penetration von Karies; WO/CA - CA 2652045 - METHOD AND MEANS FOR INFILTRATING ENAMEL LESIONS; JP - JP 2013-190681 - Method and means of infiltrating enamel lesions; EP/DE - Method and means for infiltrating enamel lesions; EP/GB - EP 06021966.4 - Method and means for infiltrating enamel lesions; EP/CH - EP 06021966.4 - Method and means for infiltrating enamel lesions; EP/LI - EP 06021966.4 - Method and means for infiltrating enamel lesions; EP/FR - EP 06021966.4 - Method and means for infiltrating enamel lesions; EP/IT - EP 06021966.4 - Method and means for infiltrating enamel lesions; EP - EP 06021966.4 - Method and means for infiltrating enamel lesions; DE - DE 20 2008 006 814.2 - Vorrichtung zum Halten eines Röntgenfilms im Dentalbereich; WO/BR - Vorrichtung zur Infiltration approximaler Schmelzläsionen von Zähnen; WO/KR - KR 20107013471 - Vorrichtung zur Infiltration approximaler Schmelzläsionen von Zähnen; WO/CA - CA 2708491 - DEVICE FOR INFILTRATION OF APPROXIMAL ENAMEL LESIONS OF TEETH; WO/CN - CN 20088121095 - Device for infiltration of approximal enamel lesions of teeth; EP - EP 07024508.9 - Vorrichtung zur Infiltration approximaler Schmelzläsionen von Zähnen; WO - PCT/EP2008/008968 - Vorrichtung zur Infiltration approximaler Schmelzläsionen von Zähnen; WO/JP - JP 2010538376 - Vorrichtung zur Infiltration approximaler Schmelzläsionen von Zähnen; WO/RU - RU 2010129959 - Device for the infiltration of enamel lesions in teeth; WO/EP - EP 08861037.3 - Vorrichtung zur Infiltration approximaler Schmelzläsionen von Zähnen; WO/IN - Vorrichtung zur Infiltration approximaler Schmelzläsionen von Zähnen; WO/US - US 12/808,539 Device for Infiltration of Approximal Enamel Lesions of Teeth
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Source: PubMed