Calcium Hydroxide versus Mineral Trioxide Aggregate for Direct Pulp Capping: A Cost-effectiveness Analysis

Introduction: Recent evidence finds mineral trioxide aggregate (MTA) more effective than calcium hydroxide (CH) for direct pulp capping (DPC). The present study assessed the cost-effectiveness of MTA versus CH for DPC using a model-based simulation approach. Methods: A mixed public/private payer perspective in the context of German health care was adopted. We modeled a permanent molar with a vital asymptomatic, exposed pulp treated via DPC with either MTA or CH. The tooth was followed over the lifetime of a 20-year-old patient using Markov models. Transition probabilities were obtained from systematically and nonsystematically collected data. The primary health outcome was tooth retention time. Costs for DPC were estimated via microcosting. Required personnel time for application was estimated using a survey among German specialized and general dentists. Material expenses were calculated based on market prices in 2015. All other costs were derived from public and private item fee catalogues. Uncertainty was introduced via probabilistic and univariate sensitivity analyses. Results: DPC using MTA was both more effective and less costly (52 years retention, lifetime costs = 1368 Euro) than CH (49 years, 1527 Euro). Regardless of a payer's willingness to pay, DPC with MTA had the higher probability of being cost-effective. The identified ranking was not affected by parameter or structural uncertainty or heterogeneity. Conclusions: MTA was more cost-effective than CH for DPC despite higher initial treatment costs because expensive retreatments were avoided. Our estimates apply only on the basis of current evidence and within the chosen health care setting. From a payer's perspective, MTA should be used for DPC.