Cost-effectiveness of implant-supported mandibular removable partial dentures

ObjectivesThe aim of this study was to conduct a cost-effectiveness analysis comparing conventional removable partial dentures (RPDs) and implant-supported RPDs (ISRPDs) treatment in patients with an edentulous maxilla and a bilateral free-ending situation in the mandible.

Material and methodsThirty subjects were included. A new RPD was made and implant support was provided 3months later. Treatment costs (opportunity costs and costs based on tariffs) were calculated. Treatment effect was expressed by means of the Dutch Oral Health Impact Profile questionnaire (OHIP-NL49), a chewing ability test (Mixing Ability Index, MAI) and a short-form health survey measuring perceived general health (SF-36), which was subsequently converted into quality-adjusted-life-years (QALYs). The incremental cost-effectiveness ratio (ICER) was the primary outcome measure of cost-effectiveness, comparing both treatment strategies.

ResultsThe mean total opportunity costs were Euro981 (95% CI Euro971-Euro991) for the RPD treatment and Euro2.480 (95% CI Euro2.461-Euro2.500) for the ISRPD treatment. The total costs derived from the national tariff structure were Euro850 for the RPD treatment and Euro2.610 for the ISRPD treatment. The ICER for OHIP-NL49 and MAI using the opportunity costs was Euro80 and Euro786, respectively. When using the tariff structure, corresponding ICERs were Euro94 and Euro921. The effect of supporting an RPD with implants when expressed in QALYs was negligible; hence an ICER was not determined.

ConclusionsIt is concluded that depending on the choice of outcome measure and monetary threshold, supporting an RPD with implants is cost-effective when payers are willing to pay more than Euro80 per OHIP point gained. Per MAI point gained, an additional Euro786 has to be invested.