Amalgam versus composite restorations: a cost-consequence analysis

Aims Amalgam is being phased out globally by 2034. Under English NHS provision, amalgam is predominantly used to restore posterior teeth. A broad evaluation of the comparative costs and consequences of using amalgam versus various composite formulations to restore posterior permanent teeth in adults was therefore required to inform a phase-out.Methods Multiple research strands (a large clinician survey, a discrete choice experiment to obtain public values for relevant aspects of direct restorations, and a model-based cost-effectiveness analysis) alongside new data were synthesised. Costs and consequences to patients, funders and clinicians of using amalgam and direct alternatives over varying timeframes under English NHS provision were quantified in a cost-consequence analysis.Results Differences in tooth survival (4 years; 12 years non-discounted), patient valuation (£33), and lifetime cost to patients (£70 direct; £15 indirect), funders (£34) and clinicians (£83) favour amalgam over composite restorations in English NHS care.Conclusions Except for appearance, all other outcomes and costs favoured the use of amalgam over composites for the direct restoration of posterior teeth for all stakeholders. If amalgam is phased-out in the near future without fundamental change, there are significant implications for the most at need in society and the survival of NHS dental services.