Detecting and treating occlusal caries lesions: a cost-effectiveness analysis

Area of Science:

• Dental Public Health
• Health Economics
• Diagnostic Accuracy

Background:

• Caries detection strategies' health gains and costs depend on method accuracy and subsequent treatment, varying by population prevalence.
• Evaluating diagnostic methods solely on accuracy against a gold standard may not reflect real-world health outcomes or cost-effectiveness.

Purpose of the Study:

• To compare the lifetime cost-effectiveness of various caries detection methods combined with different treatment strategies.
• To analyze how population caries prevalence (low vs. high) influences the optimal choice of detection and treatment.

Main Methods:

• A lifetime Markov model simulated an occlusal surface in a German patient, incorporating literature-derived prevalence data and transition probabilities.
• Validity parameters for visual-tactile, radiographic, and laser-fluorescence methods were synthesized from systematic reviews.
• Microsimulations were performed from a mixed public-private payer perspective within a German healthcare setting.

Main Results:

• In low-prevalence populations, visual-tactile or radiographic detection with microinvasive treatment maximized tooth retention (66 years) at the lowest cost (€329-€332).
• In high-prevalence populations, radiographic detection with microinvasive treatment was most cost-effective (63 years, €528).
• Overtreatment occurred with radiographic and fluorescence methods, particularly in low-prevalence groups. Invasive treatments combined with sensitive detection were consistently least cost-effective across prevalence levels.

Conclusions:

• The effectiveness of caries detection methods is population-dependent and significantly influenced by the chosen treatment strategy.
• Cost-effectiveness analyses must consider long-term health outcomes and population-specific factors beyond mere diagnostic accuracy.