Cost-effectiveness of the Hall Technique in a Randomized Trial

F. Schwendicke (Lead / Corresponding author), J. Krois, M. Robertson, C. Splieth, R. Santamaria, N. Innes

Research output: Contribution to journalArticle

Abstract

Clinical and patient-reported outcomes were reported for carious primary molars treated with the Hall technique (HT) as compared with conventional carious tissue removal and restorations (i.e., conventional restoration [CR]) in a 5-y randomized controlled practice-based trial in Scotland. We interrogated this data set further to investigate the cost-effectiveness of HT versus CR. A total of 132 children who had 2 matched occlusal/occlusal-proximal carious lesions in primary molars ( n = 264 teeth) were randomly allocated to HT or CR, provided by 17 general dental practitioners. Molars were followed up for a mean 5 y. A societal perspective was taken for the economic analysis. Direct dental treatment costs were estimated from a Scottish NHS perspective (an NHS England perspective was taken for a sensitivity analysis). Initial, maintenance, and retreatment costs, including rerestorations, endodontic treatments, and extractions, were estimated with fee items. Indirect/opportunity costs were estimated with time and travel costs from a UK perspective. The primary outcome was tooth survival. Secondary outcomes included 1) not having pain or needing endodontic treatments/extractions and 2) not needing rerestorations. Cost-effectiveness and acceptability were estimated from bootstrapped samples. Significantly more molars in HT survived (99%, 95% CI: 98% to 100%) than in CR (92%; 87% to 97%). Also, the proportion of molars retained without pain or requiring endodontic treatment/extraction was significantly higher in HT than CR. In the base case analysis (NHS Scotland perspective), cumulative direct dental treatment costs (Great British pound [GBP]) of HT were 24 GBP (95% CI: 23 to 25); costs for CR were 29 (17 to 46). From an NHS England perspective, the cost advantage of HT (29 GBP; 95% CI: 25 to 34) over CR (107; 86 to 127) was more pronounced. Indirect/opportunity costs were significantly lower for HT (8 GBP; 95% CI: 7 to 9) than CR (19; 16 to 23). Total cumulative costs were significantly lower for HT (32 GBP; 95% CI: 31 to 34) than CR (49; 34 to 69). Based on a long-term practice-based trial, HT was more cost-effective than CR with HT retained for longer and experiencing less complications at lower costs.

LanguageEnglish
Pages61-67
Number of pages7
JournalJournal of Dental Research
Volume98
Issue number1
Early online date14 Sep 2018
DOIs
Publication statusPublished - Jan 2019

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Cost-Benefit Analysis
Costs and Cost Analysis
Tooth
Endodontics
Scotland
England
Health Care Costs
Pain
Retreatment
Fees and Charges
General Practitioners
Therapeutics
Maintenance
Economics

Keywords

  • caries
  • clinical studies
  • economic evaluation
  • health services research
  • pediatric dentistry
  • restorative dentistry

Cite this

Schwendicke, F. ; Krois, J. ; Robertson, M. ; Splieth, C. ; Santamaria, R. ; Innes, N. / Cost-effectiveness of the Hall Technique in a Randomized Trial. In: Journal of Dental Research. 2019 ; Vol. 98, No. 1. pp. 61-67.
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Cost-effectiveness of the Hall Technique in a Randomized Trial. / Schwendicke, F. (Lead / Corresponding author); Krois, J.; Robertson, M.; Splieth, C.; Santamaria, R.; Innes, N.

In: Journal of Dental Research, Vol. 98, No. 1, 01.2019, p. 61-67.

Research output: Contribution to journalArticle

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AU - Krois, J.

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AU - Splieth, C.

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AU - Innes, N.

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