Cost-Utility Analysis of Molar Single Implant Versus Fixed Dental Prosthesis

PURPOSE: To calculate the incremental cost-effectiveness ratio (ICER) of prosthetic treatment of a single missing intermediate molar by performing cost-utility analysis on implants, insurance fixed dental prostheses (IFDPs), and private fixed dental prostheses (PFDPs). MATERIALS AND METHODS: Transition probability (based on the results of past research) and the Markov model were used for cost-utility analysis, and Monte Carlo simulations were performed for sensitivity analysis. The utility values for various types of missing teeth were collected in September 2017, and dental prosthetic treatment was performed in general members of the Japanese population, distributed by sex and age. The time trade-off (TTO) method, which is an index scale (0-1), was used for measuring the utility values. RESULTS: The utility value was the highest when measured at the state in which implant treatment was performed and the lowest when measured in the untreated missing-tooth state. This model showed that compared to FDPs, implant treatment resulted in higher quality-adjusted life years (QALYs). However, the estimated cost over 30 years was lower for IFDPs. The results also showed that PFDPs were in a more extended, dominant state than both IFDPs and implants. The implant-to-IFDP ICER was €2,454.37. CONCLUSION: The results suggest that implants can be used to obtain higher utility values in comparison to IFDPs and PFDPs. The ICER threshold for 1 QALY in Japan is approximately €37,037 to €44,444, and the implant-to-IFDP ICER was found to be below that found in this study. Accordingly, it appears that implants offer superior cost-effectiveness.