Cost/effectiveness analysis of treatment options for the rehabilitation of the total edentulous mandible

Purpose: The aim of this research was to perform a cost-effectiveness (CE) analysis of the main rehabilitative solutions of totally edentulous mandibles. Methods: decision tree models were built using TreeAge Pro Healthcare 2021 software to compare the following strategies: Conventional Denture (CD), Overdenture retained by two implants (OD-2), Overdenture retained by a bar on two implants (ODbar), Overdenture retained by 4 mini-implants (ODmini) and Fixed denture supported by 4 implants (FD). Costs were estimated using data from public rate tables. Effectiveness measures were obtained from a meta-analysis of literature data, normalizing the different scales in 0-1 range. A value of 30000€ per 1 normalized utility points was set as threshold of willingness to pay (WTP). Probabilistic Sensitivity Analysis (PSA) with 1000 Monte Carlo Simulations was performed to characterize uncertainty. Results: Total costs ranged between 1804,40€ for CD and 10008,80€ for FD rehabilitations, with an effectiveness of 0,69 and 0,95 normalized points (0-1 scale) for the two solutions. The ODbar resulted to be the most CE strategy at the established WTP value, with the highest Net Monetary Benefit (22001,20€), followed by the OD-2 rehabilitation (21866,80€). PSA analysis confirmed the dominance of OD-2 and ODbar strategies, confirming a net separation from the other alternatives. Conclusions: OD stabilized by 2 implants could represent a good rehabilitative solution for patients with edentulous mandible, being a good trade-off in terms of costs and effectiveness. Nevertheless, a standardized measure of oral health-related quality of life is needed to obtain more reliable results.