The economic impact of two diagnostic strategies in the management of restorations in primary teeth: a trial-based economic evaluation

Author(s)

Raíza Dias de Freitas

• Document type: Doctoral Thesis
• Press: São Paulo.
• Institution: Universidade de São Paulo (USP). Faculdade de Odontologia (FO/SDO)
• Defense date: 2021-12-03

Examining board members

Mariana Minatel Braga Fraga; Daniela Prócida Raggio; Clarissa Araujo Gurgel Rocha; Tamara Kerber Tedesco

• Advisor: Mariana Minatel Braga Fraga; Fausto Medeiros Mendes

Abstract

The aim of this thesis was to evaluate the economic impact of using the Caries Around Restorations and Sealants (CARS) strategy instead of the World Dental Federation (FDI) strategy for the assessment and management of restorations in primary teeth. The thesis comprises two chapters, related to the aim of the thesis. The first chapter is a health economic analysis plan and the second chapter is an economic evaluation with different Cost-Effectiveness Analyses (CEAs). The first chapter proposes a series of analyses based on a randomised clinical trial. The Caries Detection in Children - 3 (CARDEC-03) trial included children from 3 to 10 years with at least one restoration in a primary tooth. Children were randomly allocated to one of thw two groups, according to the diagnostic strategy (FDI or CARS). Participants were followed up for 2 years. For all economic evaluations, the societal perspective will be used. CEAs and Cost-Utility Analysis will be performed considering FDI as the reference strategy. Intention-to-treat analysis will be performed and differences in costs and effects between the strategies will be evaluated. Deterministic and probabilistic sensitivity analyses will be carried out and acceptability curves will be plotted according to different willingness-to-pay values. Additionally, a Markov model will be used to evaluate a wider time horizon. In addition to the analysis plan, this thesis also assessed the cost-effectiveness of using the CARS strategy instead of the FDI strategy for the assessment of restorations in primary teeth. Four effects were evaluated: number of new operative interventions, time to the first new operative intervention, need for new operative interventions, and the number of new replacements. Costs and effects were compared between groups by relative measures, according to the number of restorations included per group. Monte-Carlo simulations assessed uncertainties around the parameters and acceptability curves were plotted. Data from 163 patients and 650 restorations were used for the economic evaluation. There was no statistically significant difference between costs and number of new operative interventions of the two strategies after 2 years of follow-up. Simulated data demonstrated that CARS was mostly cost-effective for the four CEAs. Considering a willingness-to-pay threshold of 100 dollars, this strategy showed positive Net Monetary Benefits (NMBs) for the effects number of new operative interventions, time to the first new operative intervention, and number of new replacements. Considering a willingness-to-pay threshold of 100 dollars, CARS has a probability of approximately 90% of being cost-effective considering the time to the first new operative intervention. The worst-case scenario was for the effect of need for new operative interventions, in which CARS presented negative NMB and a probability of approximately 50% of being cost-effective, considering a threshold of willingness to pay of 100 dollars. In conclusion, CARS is a cost-effective alternative to FDI, especially considering the postponing new operative interventions in primary teeth. (AU)

• FAPESP's process: 18/03199-6 - The economic impact of different diagnostic criteria assessing caries lesions around restorations in primary teeth
• Grantee: Raíza Dias de Freitas
• Support Opportunities: Scholarships in Brazil - Doctorate