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Amalgam Alternatives: Cost-Effectiveness and Value of Information Analysis
F Schwendicke1, G Göstemeyer1, M Stolpe2
11 Department of Operative and Preventive Dentistry, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Journal of Dental Research
|June 22, 2018
Summary
Incrementally placed composites (IComp) are the most cost-effective amalgam alternative, offering longer tooth retention than bulk-fill composites (BComp) or glass ionomer cements (GIC). Further research on effectiveness could yield significant economic benefits for payers.
Area of Science:
- Dental materials science
- Health economics
- Clinical dentistry
Background:
- Dental amalgam is a common restorative material.
- Alternatives like composites and glass ionomers are increasingly used.
- Assessing the long-term cost-effectiveness of these alternatives is crucial for healthcare systems.
Purpose of the Study:
- To compare the cost-effectiveness of incrementally placed composites (IComp), bulk-fill composites (BComp), and glass ionomer cements (GIC) against amalgam.
- To determine the value of information (VOI) regarding the effectiveness of different restorative strategies.
- To adopt a mixed public-private-payer perspective within the German healthcare context.
Main Methods:
- Bayesian network meta-analyses were used to estimate the relative risk (RR) of failure for each material.
- A lifetime Markov model followed 30-year-old patients with 3-surfaced molar restorations.
- Monte Carlo microsimulations estimated cost-effectiveness, cost-effectiveness acceptability, and VOI.
Main Results:
- IComp proved most effective (41.9 years tooth retention) and least costly (2,076 euros) over a lifetime, dominating BComp and GIC.
- BComp and GIC were initially less costly but had higher failure rates and long-term costs.
- The VOI was substantial (3.99 euros per restoration), indicating potential annual savings of 87.8 million euros for payers.
Conclusions:
- Initial cost savings from BComp/GIC are likely offset by higher failure and retreatment costs compared to IComp.
- Composite inlays (CompI) and incrementally placed bulk-fills (IBComp) were not found to be cost-effective.
- All assessed alternatives appear inferior to amalgam, but further research on effectiveness is warranted due to considerable VOI.
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