To assess the cost-effectiveness of silicone compared to alginate for impressions used to mould new dentures.
Method:
Cost-effectiveness analyses were undertaken alongside a UK single centre double-blind, randomised, controlled, crossover clinical trial. The analyses take the perspective of the health care sector. Effectiveness is measured using (i) the EQ-5D to produce quality adjusted life years (QALYS); and (ii) the Oral Health Impact Profile (OHIP-EDENT). The outcome of the cost-effectiveness analysis was an incremental cost per QALY/OHIP point. Incremental cost effectiveness ratios (ICERs) representing the additional cost per one unit of outcome gained were calculated.
Result: The mean health care costs associated with provision of the dentures and associated health care use by the patients was higher in the silicone impression group (£388.57 vs. £363.18). Negligible between-group differences were observed in QALY gains; for this analysis the silicon group had higher costs with less QALY gains. Within the second analyses the silicone group had greater mean OHIP gains but the higher mean total costs. The analysis showed an additional cost using silicone per patient of £3.41 per change of one point in the OHIP-EDENT.
Conclusion:
The silicone group was more costly, driven by the cost of materials. Changes in the EQ-5D and QALY gains over time and between groups were not statistically significant. However, the change in OHIP-EDENT score showed greater improvement in the silicone group and the difference between groups was statistically significant at 95% level. Considering the negligible QALY gains observed and low level of resource use, any results must be treated with caution; it is difficult to make robust claims about the comparative cost-effectiveness of either material. Given the apparent insensitivity of the generic preference based measure (EQ-5D) future research should explore development of an oral health related quality of life measure for use in cost-effectiveness analysis.