Cost-Effectiveness Analysis of Regenerative Endodontics versus MTA Apexification

Area of Science:

• Dental regenerative medicine
• Health economics
• Clinical decision making

Background:

• Regenerative endodontics offers a novel approach for managing necrotic immature permanent teeth.
• The cost-effectiveness of regenerative endodontics compared to traditional apexification remains unestablished.
• Evaluating treatment modalities is crucial for informed clinical and financial decisions.

Purpose of the Study:

• To conduct a cost-effectiveness analysis comparing regenerative endodontics and mineral trioxide aggregate (MTA) apexification.
• To determine the dominant treatment strategy for necrotic immature permanent teeth from a private payer's perspective.
• To guide decision-making in dental regenerative treatments.

Main Methods:

• A lifetime Markov model was developed for a 7-year-old patient with a necrotic immature permanent tooth.
• Transition probabilities were derived from existing literature, and costs were based on US healthcare data.
• Monte Carlo microsimulations and sensitivity analyses were employed for validation.

Main Results:

• Regenerative endodontics was not cost-effective, incurring an additional cost of $1,012 and yielding fewer retained tooth-years (15.48 years).
• Probabilistic sensitivity analysis confirmed that apexification dominated regenerative endodontics across various willingness-to-pay thresholds.
• The findings indicate a clear economic advantage for apexification.

Conclusions:

• Regenerative endodontic treatment is not cost-effective compared to apexification for managing necrotic immature permanent teeth over a lifetime.
• Apexification remains the more economically favorable option based on current evidence.
• This study provides critical cost-valuation insights for optimizing resource allocation in endodontic treatments.