Cost-effectiveness of ART restorations in elderly adults: a randomized clinical trial
Version of Record online: 19 AUG 2013
© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Community Dentistry and Oral Epidemiology
Volume 42, Issue 1, pages 79–87, February 2014
How to Cite
Cost-effectiveness of ART restorations in elderly adults: a randomized clinical trial. Community Dent Oral Epidemiol 2014; 42: 79–87. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd, , , , , .
- Issue online: 16 JAN 2014
- Version of Record online: 19 AUG 2013
- Manuscript Accepted: 6 JUL 2013
- Manuscript Received: 27 OCT 2012
- Irish Health Research Board. Grant Number: HRAPOR/2010/154
- atraumatic restorative treatment;
- clinical trials;
- health economics
As the world population ages, the requirement for cost-effective methods of treating chronic disease conditions increases. In terms of oral health, there is a rapidly increasing number of dentate elderly with a high burden of maintenance. Population surveys indicate that older individuals are keeping their teeth for longer and are a higher caries risk group. Atraumatic Restorative Treatment (ART) could be suitable for patients in nursing homes or house-bound elderly, but very little research has been done on its use in adults.
To compare the cost-effectiveness of ART and a conventional technique (CT) for restoring carious lesions as part of a preventive and restorative programme for older adults.
In this randomized clinical trial, 82 patients with carious lesions were randomly allocated to receive either ART or conventional restorations. Treatment costs were measured based on treatment time, materials and labour. For the ART group, the cost of care provided by a dentist was also compared to the cost of having a hygienist to provide treatment. Effectiveness was measured using percentage of restorations that survived after a year.
Eighty-two patients received 260 restorations, that is, 128 ART and 132 conventional restorations. 91.1% of the restorations were on one surface only. After a year, 252 restorations were assessed in 80 patients. The average cost for ART and conventional restorations was €16.86 and €28.71 respectively; the restoration survival percentages were 91.1% and 97.7%, respectively. This resulted in a cost-effectiveness ratio of 0.18 (ART) and 0.29 (CT). When the cost of a hygienist to provide ART was inserted in the analysis, the resulting ratio was 0.14.
Atraumatic restorative treatment was found to be a more cost-effective alternative to treat older adults after 1 year, compared to conventional restorations, especially in out of surgery facilities and using alternative workforce such as hygienists. Atraumatic restorative treatment can be a useful tool to provide dental care for frail and fearful individuals who might not access dental treatment routinely.