Cost-effectiveness of partial versus stepwise caries removal of deep caries lesions - a decision-analytic approach

The aim was to compare the cost-effectiveness of partial caries removal (PCR) and stepwise caries removal (SW) in mature permanent teeth diagnosed with deep caries lesions, in a Swedish Public Dental Care organization. A decision tree model was used to calculate the cost-effectiveness for PCR and SW. Probability values were obtained through a literature search in PubMed and Scopus. Treatment times were estimated by a group of dentists practicing at public dental care clinics in Västra Götaland county, Sweden. The expected costs for PCR and SW were 187,63 and 414,35 €, respectively, indicating that PCR was more cost-effective. Four articles were identified through the literature search. The <i>p</i>-values for PCR outcomes were 94% (success), 0% (pulp exposure) and 6% (pulpitis/apical periodontitis etc.). For SW, the <i>p</i>-values were 76% (success), 2% (pulp exposure during the first visit), 13% (pulp exposure during the second visit) and 9% (pulpitis/apical periodontitis etc.). Given the presumptions in this decision analysis, the PCR method used on mature permanent teeth is more cost-effective (<i>p</i> &lt; ,05) compared to the SW method in protecting the pulp from exposure and avoiding the need for root canal treatment.

本研究旨在对比瑞典公立牙科医疗体系中，针对确诊为深龋病变的成熟恒牙采用部分龋坏组织去除术（partial caries removal, PCR）与分步龋坏组织去除术（stepwise caries removal, SW）的成本效益。研究采用决策树模型计算两种术式的成本效益。概率参数通过PubMed与Scopus数据库的文献检索获取。治疗时长由瑞典西约塔兰郡公立牙科诊所的执业牙医团队估算得出。两种术式的预期成本分别为187.63欧元与414.35欧元，提示部分龋坏组织去除术的成本效益更优。本次文献检索共纳入4篇相关文献。部分龋坏组织去除术的结局p值分别为：成功率94%、牙髓暴露率0%、牙髓炎/根尖周炎等并发症发生率6%。分步龋坏组织去除术的结局p值则为：成功率76%、首次就诊时牙髓暴露率2%、第二次就诊时牙髓暴露率13%、牙髓炎/根尖周炎等并发症发生率9%。基于本决策分析的预设前提，在保护牙髓免受暴露以及避免根管治疗需求方面，针对成熟恒牙实施的部分龋坏组织去除术成本效益优于分步龋坏组织去除术（p < 0.05）。