Maintaining pulpal vitality: Cost-effectiveness analysis on carious tissue removal and direct pulp capping

Area of Science:

• Dental Public Health
• Health Economics
• Restorative Dentistry

Background:

• Managing deep carious lesions requires strategies to maintain pulp vitality.
• Current options include selective (SE) versus non-selective (NS) carious tissue removal and direct pulp capping with mineral-trioxide-aggregate (MTA) versus calcium hydroxide (CH).

Purpose of the Study:

• To assess the cost-effectiveness of different management strategies for deep carious lesions.
• To compare selective (SE) versus non-selective (NS) carious tissue removal.
• To evaluate direct pulp capping with MTA versus CH for exposed pulps.

Main Methods:

• A Markov-model lifetime simulation from a German mixed public-private-payer perspective.
• Informed by meta-analyses and micro-costing data for a 30-year-old patient.
• Probabilistic and univariate sensitivity analyses, including value-of-information analysis (VOI).

Main Results:

• Selective carious tissue removal with MTA direct pulp capping resulted in longer tooth retention (37.37 years) at lower mean costs (€2140).
• This strategy demonstrated a >95% probability of being cost-effective.
• Alternative strategies were less effective and more costly; VOI was €1.18 per case.

Conclusions:

• Selective carious tissue removal and direct pulp capping with MTA is the most cost-effective strategy.
• Avoiding pulp exposure is more critical for cost-effectiveness than the capping material.
• Dentists may tailor strategies based on expertise and patient expectations.