Cost‐effectiveness of three different concepts for the rehabilitation of edentulous mandibles: Overdentures with 1 or 2 implant attachments and hybrid prosthesis on four implants

Abstract

Background There are scarce data regarding the combined assessment of the costs and effects of implant treatments for edentulous patients when multiple options are available. Aim This randomised clinical trial aimed to assess the cost‐effectiveness of three different concepts for treatment: mandibular overdenture retained by a single (Group I; n = 11) or two implants (Group II; n = 13) and fixed hybrid prosthesis on four implants (Group III; n = 13). Methods Treatment effectiveness was measured as the 1‐year before‐after changes in patient satisfaction with the mandibular prosthesis. Costs were prospectively quantified from the perspective of the health provider, including all direct cost items attributed to the delivery of treatments and up to the 1‐year follow‐up, using a “bottom‐up” costing estimation method. Results Patient satisfaction after treatment improved significantly for the three groups. The overall costs were R$ 2370.66, R$ 3185.21 and R$ 5739.52 for Groups I, II and III, respectively (P < .001). Analysis of incremental cost‐effectiveness ratios suggested that the overdentures retained by one or two implants were more cost‐effective than the fixed implant treatment, considering the mean cost and effectiveness values and the ±20% one‐way sensitivity analysis. Conclusion This study suggests that the incremental costs for the fixed hybrid prosthesis, compared to the overdenture treatments, is not proportional to the respective gain in effectiveness. Therefore, although all treatment options had satisfactory outcomes, the use of implants to retain a mandibular overdenture, irrespective of the use of one or two implants, is more cost‐effective than the fixed implant treatment for the edentulous mandible.

Dental implant therapy in the Brazilian Public System

“…Recent papers by Hartmann et al 28,29 have found that the incremental costs for fullarch fixed prosthesis compared to overdentures retained by a single implant is not proportional to the respective gain in effectiveness, and that simplified implant treatments for edentulous patients result in favourable outcomes. Considering that, we also suggest the standardization of overdentures retained by a single implant by SUS, considering that it would reduce the costs and provide high-quality services to the population.…”

Bone Loss Around Mandibular Implant Supported Overdentures. A Seven Year Follow Up.

“…Several authors have argued that two implants with solitary ball abutments are enough to retain and stabilize an overdenture. They are also less technique sensitive and more economical [4][5][6][7] .…”

One‐year prospective study on single short (7‐mm) implant overdentures in patients with severely resorbed mandibles

“…The use of a single implant has been suggested as an effective and more conservative treatment to improve the retention and stability of a mandibular denture. Previous studies indicated that this treatment option requires a low extra cost when the conventional denture is converted into a single‐implant mandibular overdenture (SIMO), and this approach may be a more cost‐effective alternative when compared to other complex solutions with a higher number of implants (Hartmann et al, 2020; Padmanabhan et al, 2020). Also, SIMO may be comparable to the standard treatment using two implants (Alqutaibi et al, 2017; Resende et al, 2021; Walton et al, 2009) and might be regarded as a viable alternative for patients demanding less extensive and less costly interventions with implants.…”