BMC Oral Health
volume 20, Article number:
45 (
2020)
Abstract
Background
A
three-arm parallel group, randomised controlled trial set in general
dental practices in England, Scotland, and Wales was undertaken to
evaluate three strategies to manage dental caries in primary teeth.
Children, with at least one primary molar with caries into dentine, were
randomised to receive Conventional with best practice prevention
(C + P), Biological with best practice prevention (B + P), or best
practice Prevention Alone (PA).
Methods
Data
on costs were collected via case report forms completed by clinical
staff at every visit. The co-primary outcomes were incidence of, and
number of episodes of, dental pain and/or infection avoided. The three
strategies were ranked in order of mean cost and a more costly strategy
was compared with a less costly strategy in terms of incremental
cost-effectiveness. Costs and outcomes were discounted at 3.5%.
Results
A total of 1144 children were randomised with data on 1058 children (C + P
n = 352, B + P
n = 352, PA
n = 354)
used in the analysis. On average, it costs £230 to manage dental caries
in primary teeth over a period of up to 36 months. Managing children in
PA was, on average, £19 (97.5% CI: -£18 to £55) less costly than
managing those in B + P. In terms of effectiveness, on average, there
were fewer incidences of, (− 0.06; 97.5% CI: − 0.14 to 0.02) and fewer
episodes of dental pain and/or infection (− 0.14; 97.5% CI: − 0.29 to
0.71) in B + P compared to PA. C + P was unlikely to be considered
cost-effective, as it was more costly and less effective than B + P.
Conclusions
The
mean cost of a child avoiding any dental pain and/or infection
(incidence) was £330 and the mean cost per episode of dental pain and/or
infection avoided was £130. At these thresholds B + P has the highest
probability of being considered cost-effective. Over the willingness to
pay thresholds considered, the probability of B + P being considered
cost-effective never exceeded 75%.
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