Mineral trioxide aggregate (MTA) and calcium hydroxide (CH) both can be used for direct pulp capping (DPC). A recent study using model-based simulation, though, shows that MTA is more cost-effective than CH despite higher initial treatment costs because expensive retreatments are avoided later.
Based in Germany, the researchers adopted a mixed public-private payer perspective in the context of German healthcare. They modeled a permanent molar with a vital asymptomatic, exposed pulp treated via DPC with either MTA or CH.
Next, the researchers followed the tooth over the lifetime of a 20-year-old patient using Markov models. Transition probabilities were obtained from systematically and nonsystematically collected data, with tooth retention time used as the primary health outcome.
The costs for DPC were estimated via microcosting. The researchers also estimated the required personnel time for application using a survey among German specialized and general dentists. They calculated material expenses based on 2015 market prices. All other costs were derived from public and private item fee catalogues. Uncertainty was introduced via probabilistic and univariate sensitivity analyses.
DPC using MTA proved to be more effective and less costly (52 years retention, lifetime costs = 1,368 Euro) than CH (49 years, 1,527 Euro). Regardless of a payer’s willingness to pay, DPC with MTA was more likely to be cost-effective.
The identified ranking was not affected by parameter or structural uncertainty or heterogeneity. The researchers note that their estimates apply only on the basis of current evidence and within the German healthcare setting. From a payer’s perspective, though, they say that MTA should be used for DPC.
The study, “Calcium Hydroxide Versus Mineral Trioxide Aggregate for Direct Pulp Capping: A Cost-effectiveness Analysis,” was published by the Journal of Endodontics. It was written by Falk Schwendicke, DDS, PhD, and Fredrik Brouwer, DDS, of the department of operative and preventative dentistry, Charité-Universitätsmedizin Berlin, and Michael Stolpe, PhD, of the Keil Institute of for the World Economy, Kiel, Germany.
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