An example of technology assessment in dental care by evaluating the (cost-)effectiveness of types of three-surface inlays (gold, laboratory-fabricated ceramic, and chairside CAD/CAM ceramic) is provided.
MEDLINE, EMBASE, and the Cochrane Library were searched for studies published between 1966 and June 2003 that reported annual survival probabilities and annual observations. The longevity of different types of inlays was measured by the number of failure-free years. Annual survival rates from different studies were pooled by weighing the rates of each study by the inverse of the variance of the effect estimate. A cost-effectiveness analysis from the perspective of German private health insurers was performed using billing charges.
Three, five, and two case series on laboratory-fabricated ceramic, chairside CAD/CAM ceramic, and gold inlays, respectively, were included. Over a 9-year observation period, the number of undiscounted failure-free years was 8.62 (95 percent confidence interval, 8.40-8.85), 8.65 (8.58-8.73), and 8.76 (8.72-8.80) for laboratory-fabricated ceramic, chairside CAD/CAM ceramic, and gold inlays, respectively. Laboratory-fabricated ceramic inlays were the most expensive.
While laboratory-fabricated ceramic, chairside CAD/CAM ceramic, and gold inlays had a strikingly similar failure-free survival rate, laboratory-fabricated ceramic inlays had the highest costs and, thus, were less cost-effective than chairside CAD/CAM ceramic and gold inlays.
[Show abstract][Hide abstract] ABSTRACT: The objective of this follow-up study was to examine the performance of Cerec inlays and onlays, all of which were placed by the same clinician, in terms of clinical quality over a functional period of 15 years.
Of 200 Cerec inlays and onlays placed consecutively in a private practice by one of the authors (TO) between 1989 and early 1991, 187 were closely monitored over a period of 15 years. All ceramic inlays and onlays had been placed chairside using the Cerec 1 method and had been luted with a bonding composite. Up to 17 years after their placement, a follow-up assessment was conducted, and the restorations were classified using modified United States Public Health Service criteria.
According to Kaplan-Meier analysis, the success rate of Cerec inlays and onlays was 88.7% after 17 years. A total of 21 failures (11%) were found in 17 patients. Of these failures, 76% were attributed to ceramic fractures (62%) or tooth fractures (14%). The reasons for the remaining failures were caries (19%) and endodontic problems (5%). Restorations of premolars presented a lower failure risk than those of molars.
The survival rate probability of 88.7% after up to 17 years of clinical service for Cerec computer-aided design/computer-assisted machining restorations made of Vita Mk I feldspathic ceramic is regarded as a very respectable clinical outcome.
The International journal of prosthodontics 01/2008; 21(1):53-9. DOI:10.5167/uzh-12825 · 1.46 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Technological development in the medical and dentistry fields can determine a gap between technology availability and health professionals’ knowledge. Moreover, effectiveness and safety are not sufficient for guiding the choices of health professionals due to scarcity of resources, on one hand, and the increasing number of available health technologies and health expenditure, on the other hand. In the dentistry care field, technology can be represented by systems such as water fluoridation, clinical procedures such as sealants, or clinical protocols such as antibiotics therapy for patients who underwent a cardiac surgery. At the national level, HTA development could help decision makers in defining the dentistry level of care. In fact, the National Health Service provides dentistry care for children and adolescents and for some category of vulnerable patients, and needs to be at the same time equitable, efficient and effective. In order to do that, a systematic approach is needed involving not only epidemiological and economic aspects, but a more comprehensive process involving also organizational, legal, social and ethical aspects, typical of the HTA approach.
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