A cost-effectiveness evaluation of enamel matrix derivatives alone or in conjunction with regenerative devices in the treatment of periodontal intra-osseous defects

Authors

  • Stefan Listl,

    1. Department of Conservative Dentistry, University of Heidelberg, Heidelberg, Germany
    2. Mannheim Research Institute for the Economics of Aging (MEA), University of Mannheim, Mannheim, Germany
    Search for more papers by this author
  • Yu-Kang Tu,

    1. Department of Periodontology, Leeds Dental Institute and Division of Biostatistics, Leeds Institute of Genetics, Health & Therapeutics, University of Leeds, Leeds, UK
    Search for more papers by this author
  • Clovis Mariano Faggion Jr.

    1. Department of Prosthodontics, University of Heidelberg, Heidelberg, Germany
    Search for more papers by this author

  • Conflict of interest and source of funding statement
    The authors declare that they have no conflict of interests.
    S. L. and C. M. F. are both affiliated with the University of Heidelberg. S. L. is also affiliated with MEA, which is funded by two-thirds through public third-party means. MEA's basic funding is provided by the state of Baden-Württemberg and the German Insurance Association. Y.-K. T. was funded by the United Kingdom governments Higher Education Funding Council for England (HEFCE) and currently holds a UK Research Council Fellowship.

Address:
Stefan Listl
Department of Conservative Dentistry
University of Heidelberg
Im Neuenheimer Feld 400
69120 Heidelberg
Germany
E-mail: stefan.listl@med.uni-heidelberg.de

Abstract

Listl S, Tu Y-K, Faggion CM Jr. A cost-effectiveness evaluation of enamel matrix derivatives alone or in conjunction with regenerative devices in the treatment of periodontal intra-osseous defects. J Clin Periodontol 2010; 37: 920–927. doi: 10.1111/j.1600-051X.2010.01611.x.

Abstract

Purpose: To identify the most cost-effective approach to treatment of infrabony lesions with enamel matrix derivatives (EMD).

Methods: We incorporated costs and clinical outcomes of 12 different treatment techniques (including flap operation, EMD alone, and EMD in association with other reconstructive devices) within a decision tree model in which costs were based on insurance regulations in Germany and health outcomes followed a recent meta-analysis. The most cost-effective treatment option was identified on the basis of the maximum net benefit criterion.

Results: Treatment techniques using EMD were cost-efficient if the decision maker's willingness-to-pay (WTP) was at least €150–175 per incremental mm of pocket probing depth reduction and clinical attachment level gain, respectively (1-year perspective). When EMD was affordable, the maximum net benefit was achieved by treatment with EMD in conjunction with bioactive glass or bovine bone substitutes. Additional application of platelet-rich plasma (PRP) or a resorbable membrane came at relatively high costs.

Conclusions: If EMD use is indicated, EMD in conjunction with either bioactive glass or bovine bone substitutes is more cost-effective than EMD alone. The additional use of PRP or a resorbable membrane may only be justifiable when monetary resources for treatment are very generous.

Ancillary