COST/EFFECTIVENESS OF CONVENTIONAL PROTHETIC TREATMENT AND MANDIBULAR IMPLANT-RETAINED OVERDENTURES IN CHILEAN EDENTULOUS ELDERLY PATIENTS

Objectives: Mandibular overdentures on 2 anterior implants (2IOD) provide significantly greater satisfaction, quality of life, and better mastication than do conventional dentures (CD) in edentulous subjects and the aim was to determine whether 2IOD is cost-effective compared with CD for elderly edentulous patients living in North Zone of Metropolitan region of Chile.
Methods: The analysis was from the Hospitalo-Universitary Health Service of University of Chile Dental Faculty. The model considered 98 eldery edentulous treated with maxilo-mandibular CD (n=17) or with maxillary CD and mandibular 2OID (n=90) following by two-years. We modelled treatment effect using data from a clinical trial for FONIS SA#07I20025 and SA#11i2197. Baseline characteristics of the model population, treatment resource utilization and utilities were from these trials. We estimated the direct costs associated with manufacturing, maintenance, faults and failures for both treatments. Cost-effectiveness was compared using unit effectiveness as the quality of life related to oral health (OHIP49-Sp) and Markov analysis.
DESIGN: Decision modeling using Markov chains compared costs and effects over 30 years.
Results: The manufacturing cost was 725, 17 US ($455,407 pesos) for maxilo-mandibular-CD and 1.129,50 US ($709,329 pesos) for implant alternative. The average of maintenance cost/person was 5, 68 US ($3,568) for implant alternative and 3, 61 US ($2,268) for CD, 13, 24 US ($8,317) and 13, 18 US ($8,279) in faults and 29, 46 US ($18,500) and 87, 58 US ($55,001) in failures respectively. Markov analysis showed that Implant alternative was more effective and more cost. The incremental cost-effectiveness ratio (ICER) of Implant alternative was 2,71 US ($1,699) per quality of life related to oral health gained. Sensitivity analyses showed that the conclusion was robust.
Conclusions: Maxillary CD and mandibular 2OID can be seen as a cost-effective treatment for elderly edentulous Chilean patients, with substantial public health benefits.