Cost-effectiveness of one- and two-step incomplete and complete excavations

The treatment of deep caries lesions carries significant risks for the integrity of the pulp and often initiates a cascade of re-interventions. incomplete caries removal may reduce these risks and avoid or delay re-treatment. the present study analyzed the cost-effectiveness of one- and two-step incomplete as well as complete excavations. we used markov models to simulate treatment of a molar tooth with a deep caries lesion in a 15-year-old patient. retention of the tooth and its vitality as effectiveness measures as well as accruing costs were analyzed over the patient's lifetime. the model adopted a public-private-payer perspective within german health care. transition probabilities were calculated based on literature reviews. monte-carlo microsimulations were performed with 6-month cycles. one-step incomplete excavation resulted in lower long-term costs and in longer-retained teeth and their vitality (means: 53.5 and 41.0 yrs) compared with two-step incomplete (52.5 and 37.5 yrs) and complete excavations (49.5 and 31.0 yrs),and dominated the other strategies in 70% to 100% of simulations. regardless of the assumed willingness-to-pay ceiling value,one-step incomplete excavation had the highest probability of being cost-effective. despite limited evidence levels of input data,we expect one-step incomplete excavation to reduce costs while retaining deeply carious teeth and their vitality for longer. © international & american associations for dental research.