Cost-effectiveness of caries excavations in different risk groups - a micro-simulation study

Area of Science:

• Dentistry
• Public Health
• Health Economics

Background:

• Dental caries is a prevalent global disease, disproportionately affecting high-risk populations.
• Evaluating new caries treatments requires assessing cost-effectiveness across diverse populations.
• Current deep caries treatments include selective, stepwise, and complete excavation.

Purpose of the Study:

• To compare the cost-effectiveness of selective, stepwise, and complete caries excavation strategies.
• To analyze these strategies in both low-risk and high-risk patient groups.
• To hypothesize that selective excavation offers greater cost-effectiveness advantages in high-risk patients.

Main Methods:

• A tooth-level Markov model simulated lifetime treatment costs for individuals (initially 18 years old) with low or high caries risk.
• Risk factors included oral hygiene, social position, and dental service utilization.
• Cost-effectiveness analysis employed micro-simulations with parameter uncertainty and cohort analyses.

Main Results:

• Selective excavation proved more effective and less costly than alternatives for all risk levels.
• All strategies were less effective and more costly in high-risk versus low-risk patients.
• Selective excavation's cost-effectiveness advantages were most significant in high-risk groups, reducing their out-of-pocket expenses.

Conclusions:

• Selective excavation is the most suitable strategy for deep caries, especially in high-risk individuals.
• High-risk patients gain disproportionately from selective excavation's health and cost benefits.
• While not addressing underlying causes, selective excavation optimizes treatment outcomes for deep lesions.