Efetividade e custo-efetividade de três alternativas de tratamento para reabilitação do desdentado mandibular: ensaio clínico randomizado com acompanhamento de 1 ano
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2019-08-23
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Universidade Federal de Goiás
Resumo
This randomized trial compared the effectiveness and cost-effectiveness (cost x patient
centered outcomes) of three treatment alternatives for mandibular edentulism rehabilitation:
unit-implant-retained mandibular overdenture (Group I), two-implant-retained mandibular
overdenture (Group II) and four-implant-supported mandibular fixed prosthesis (Group III).
We included 50 fully edentulous patients who initially received new conventional total
dentures (baseline) and were later randomly allocated to one of the treatment groups.
External hexagon implants (Titamax TI Cortical, Neodent, Curitiba, Brazil) were installed
following the conventional loading installation protocol. Generalized Estimating Equations
(GEE) was used to calculate the primary outcome variables were the direct dental costs which
were identified, measured and valued; oral health-related quality of life (OHIP-Edent) and
patient satisfaction with prostheses in all groups for a follow-up period of 1 year. Masticatory
performance, prosthetic complications, maintenance events and peri-implant evaluation
(marginal bone loss, peri-implant tissue status, implant stability quotient - ISQ) were
evaluated as secondary outcomes. Data from 37 participants: Group I (n = 11); Group II (n =
13); Group III (n = 13) were collected and were similar in relation to baseline clinical
characteristics and outcomes of initial treatment with conventional full dentures. Incremental
cost-effectiveness - ICER ranged for Group II (compared to Group I) from R$ 36.20 to
R$ 81.46 for a 1-point increase in patient satisfaction (base value = R$ 54.30) for Group III
(compared to Group I) ranged from R$ 1321.12 to R$ 2972.52 (base value = R$ 1981.68).
The total cost of treatment for the surgical and prosthetic phases was R$ 2,370.70 for Group
I, R$ 3,185.20 for Group II and R$ 5,739.50 for Group III. There was a significant difference
between the costs in the three groups (p <0.001). The greatest impacts on total treatment
cost were related to the initial laboratory, implant and component costs in Group III. The
satisfaction questionnaires and OHIP-Edent satisfaction scores in the 12 months improved in
all groups compared to baseline. and were similar in intergroup comparison at baseline (with
new conventional full dentures) and 1 year after implant prosthesis capture. In intra- and
inter-group comparisons there was no significant change regarding satisfaction with the
maxillary prosthesis. Regarding masticatory performance, there was no difference between
groups evaluated in the same period for the different cycles (20 and 50 cycles) with gradual
improvement for all groups up to 6 months and a slight decrease in 12 months for all groups.
It was concluded that the rehabilitation of edentulous patients with implants significantly
improved patient-reported outcomes in all treatment groups. Regarding the economic aspects
of the treatments, the direct dental cost and the clinical time spent to perform the treatment
and follow-up during the 1 year period in the fixed prosthesis (Group III) was approximately
three times higher than in Group I, which did not correspond to a proportional gain in
effectiveness as well as the additional cost of overdenture retained by two implants did not
result in significant effectiveness gain over overdenture retained per unit implant. The implant
survival was 100% in all groups after the 1-year follow-up. Considering the limitations of the
study, implant-retained overdentures were the most cost-effective modalities.
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HARTMANN, R. Efetividade e custo-efetividade de três alternativas de tratamento para reabilitação do desdentado mandibular: ensaio clínico randomizado com acompanhamento de 1 ano. 2019. 102 f. Tese (Doutorado em Odontologia) - Universidade Federal de Goiás, Goiânia, 2019.