A cost-minimization analysis of measures against metallic dental restorations for head and neck radiotherapy

Abstract

The aim of this study was to compare the estimated public medical care cost of measures to address metallic dental restorations (MDRs) for head and neck radiotherapy using high-energy mega-voltage X-rays. This was considered a first step to clarify which MDR measure was more cost-effective. We estimated the medical care cost of radiotherapy for two representative MDR measures: (i) with MDR removal or (ii) without MDR removal (non-MDR removal) using magnetic resonance imaging and a spacer. A total of 5520 patients received head and neck radiation therapy in 2018. The mean number of MDRs per person was 4.1 dental crowns and 1.3 dental bridges. The mean cost per person was estimated to be 121 720 yen for MDR removal and 54 940 yen for non-MDR removal. Therefore, the difference in total public medical care cost between MDR removal and non-MDR removal was estimated to be 303 268 800 yen. Our results suggested that non-MDR removal would be more cost-effective than MDR removal for head and neck radiotherapy. In the future, a national survey and cost-effectiveness analysis via a multicenter study are necessary; these investigations should include various outcomes such as the rate of local control, status of oral mucositis, frequency of hospital visits and efforts of the medical professionals.

The Relationship between the Contouring Time of the Metal Artifacts Area and Metal Artifacts in Head and Neck Radiotherapy

“…In practice, MDR removal is often unrealistic for the following reasons: it is likely to cause tooth extraction, patients often refuse to undergo MDR removal, and no dental service is available within or around the cancer treatment facilities. In addition, the medical cost of MDR removal has been estimated to be higher than that of non-MDR removal [ 6 ]. On the other hand, non-MDR removal increases the contouring workload more than MDR removal.…”

Magnetic resonance imaging investigations in patients with metallic dental prosthesis: “The associated dilemma for medical fraternity and the dentist's role”

“…Some authors have mentioned the use of a mouthpiece as a spacer for avoiding backscatter and other prototypes of field correcting devices. [ 24 25 ] The MRI safe splint is an innovative technique and is helpful to assure safety during the MRI, it can be advised and fabricated during the pre MRI dental examination.…”