The analysis of cost-effectiveness of implant and conventional fixed dental prosthesis
Identifieur interne : 000413 ( Pmc/Checkpoint ); précédent : 000412; suivant : 000414The analysis of cost-effectiveness of implant and conventional fixed dental prosthesis
Auteurs : June Sang Chun [Corée du Sud] ; Alix Har [États-Unis] ; Hyun-Pil Lim [Corée du Sud] ; Hoi-Jeong Lim [Corée du Sud]Source :
- The Journal of Advanced Prosthodontics [ 2005-7806 ] ; 2016.
Abstract
This study conducted an analysis of cost-effectiveness of the implant and conventional fixed dental prosthesis (CFDP) from a single treatment perspective.
The Markov model for cost-effectiveness analysis of the implant and CFDP was carried out over maximum 50 years. The probabilistic sensitivity analysis was performed by the 10,000 Monte-Carlo simulations, and cost-effectiveness acceptability curves (CEAC) were also presented. The results from meta-analysis studies were used to determine the survival rates and complication rates of the implant and CFDP. Data regarding the cost of each treatment method were collected from University Dental Hospital and Statistics Korea for 2013. Using the results of the patient satisfaction survey study, quality-adjusted prosthesis year (QAPY) of the implant and CFDP strategy was evaluated with annual discount rate.
When only the direct cost was considered, implants were more cost-effective when the willingness to pay (WTP) was more than 10,000 won at 10th year after the treatment, and more cost-effective regardless of the WTP from 20th year after the prosthodontic treatment. When the indirect cost was added to the direct cost, implants were more cost-effective only when the WTP was more than 75,000 won at the 10th year after the prosthodontic treatment, more than 35,000 won at the 20th year after prosthodontic treatment.
The CFDP was more cost-effective unless the WTP was more than 75,000 won at the 10th year after prosthodontic treatment. But the cost-effectivenss tendency changed from CFDP to implant as time passed.
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DOI: 10.4047/jap.2016.8.1.53
PubMed: 26949488
PubMed Central: 4769890
Affiliations:
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<author><name sortKey="Chun, June Sang" sort="Chun, June Sang" uniqKey="Chun J" first="June Sang" last="Chun">June Sang Chun</name>
<affiliation wicri:level="1"><nlm:aff id="A1">School of Dentistry, Chonnam National University, Gwangju, Korea.</nlm:aff>
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<author><name sortKey="Har, Alix" sort="Har, Alix" uniqKey="Har A" first="Alix" last="Har">Alix Har</name>
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<author><name sortKey="Lim, Hyun Pil" sort="Lim, Hyun Pil" uniqKey="Lim H" first="Hyun-Pil" last="Lim">Hyun-Pil Lim</name>
<affiliation wicri:level="1"><nlm:aff id="A3">Department of Prosthodontics, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju, Korea.</nlm:aff>
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<author><name sortKey="Lim, Hoi Jeong" sort="Lim, Hoi Jeong" uniqKey="Lim H" first="Hoi-Jeong" last="Lim">Hoi-Jeong Lim</name>
<affiliation wicri:level="1"><nlm:aff id="A4">Department of Orthodontics, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju, Korea.</nlm:aff>
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<wicri:regionArea>Department of Orthodontics, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju</wicri:regionArea>
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">The analysis of cost-effectiveness of implant and conventional fixed dental prosthesis</title>
<author><name sortKey="Chun, June Sang" sort="Chun, June Sang" uniqKey="Chun J" first="June Sang" last="Chun">June Sang Chun</name>
<affiliation wicri:level="1"><nlm:aff id="A1">School of Dentistry, Chonnam National University, Gwangju, Korea.</nlm:aff>
<country xml:lang="fr" wicri:curation="lc">Corée du Sud</country>
<wicri:regionArea>School of Dentistry, Chonnam National University, Gwangju</wicri:regionArea>
<wicri:noRegion>Gwangju</wicri:noRegion>
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<author><name sortKey="Har, Alix" sort="Har, Alix" uniqKey="Har A" first="Alix" last="Har">Alix Har</name>
<affiliation wicri:level="1"><nlm:aff id="A2">Northwestern University, USA.</nlm:aff>
<country xml:lang="fr" wicri:curation="lc">États-Unis</country>
<wicri:regionArea>Northwestern University</wicri:regionArea>
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<author><name sortKey="Lim, Hyun Pil" sort="Lim, Hyun Pil" uniqKey="Lim H" first="Hyun-Pil" last="Lim">Hyun-Pil Lim</name>
<affiliation wicri:level="1"><nlm:aff id="A3">Department of Prosthodontics, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju, Korea.</nlm:aff>
<country xml:lang="fr" wicri:curation="lc">Corée du Sud</country>
<wicri:regionArea>Department of Prosthodontics, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju</wicri:regionArea>
<wicri:noRegion>Gwangju</wicri:noRegion>
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</author>
<author><name sortKey="Lim, Hoi Jeong" sort="Lim, Hoi Jeong" uniqKey="Lim H" first="Hoi-Jeong" last="Lim">Hoi-Jeong Lim</name>
<affiliation wicri:level="1"><nlm:aff id="A4">Department of Orthodontics, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju, Korea.</nlm:aff>
<country xml:lang="fr" wicri:curation="lc">Corée du Sud</country>
<wicri:regionArea>Department of Orthodontics, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju</wicri:regionArea>
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<series><title level="j">The Journal of Advanced Prosthodontics</title>
<idno type="ISSN">2005-7806</idno>
<idno type="eISSN">2005-7814</idno>
<imprint><date when="2016">2016</date>
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<front><div type="abstract" xml:lang="en"><sec><title>PURPOSE</title>
<p>This study conducted an analysis of cost-effectiveness of the implant and conventional fixed dental prosthesis (CFDP) from a single treatment perspective.</p>
</sec>
<sec><title>MATERIALS AND METHODS</title>
<p>The Markov model for cost-effectiveness analysis of the implant and CFDP was carried out over maximum 50 years. The probabilistic sensitivity analysis was performed by the 10,000 Monte-Carlo simulations, and cost-effectiveness acceptability curves (CEAC) were also presented. The results from meta-analysis studies were used to determine the survival rates and complication rates of the implant and CFDP. Data regarding the cost of each treatment method were collected from University Dental Hospital and Statistics Korea for 2013. Using the results of the patient satisfaction survey study, quality-adjusted prosthesis year (QAPY) of the implant and CFDP strategy was evaluated with annual discount rate.</p>
</sec>
<sec><title>RESULTS</title>
<p>When only the direct cost was considered, implants were more cost-effective when the willingness to pay (WTP) was more than 10,000 won at 10<sup>th</sup>
year after the treatment, and more cost-effective regardless of the WTP from 20<sup>th</sup>
year after the prosthodontic treatment. When the indirect cost was added to the direct cost, implants were more cost-effective only when the WTP was more than 75,000 won at the 10<sup>th</sup>
year after the prosthodontic treatment, more than 35,000 won at the 20<sup>th</sup>
year after prosthodontic treatment.</p>
</sec>
<sec><title>CONCLUSION</title>
<p>The CFDP was more cost-effective unless the WTP was more than 75,000 won at the 10<sup>th</sup>
year after prosthodontic treatment. But the cost-effectivenss tendency changed from CFDP to implant as time passed.</p>
</sec>
</div>
</front>
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<pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">J Adv Prosthodont</journal-id>
<journal-id journal-id-type="iso-abbrev">J Adv Prosthodont</journal-id>
<journal-id journal-id-type="publisher-id">JAP</journal-id>
<journal-title-group><journal-title>The Journal of Advanced Prosthodontics</journal-title>
</journal-title-group>
<issn pub-type="ppub">2005-7806</issn>
<issn pub-type="epub">2005-7814</issn>
<publisher><publisher-name>The Korean Academy of Prosthodontics</publisher-name>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">26949488</article-id>
<article-id pub-id-type="pmc">4769890</article-id>
<article-id pub-id-type="doi">10.4047/jap.2016.8.1.53</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Original Article</subject>
</subj-group>
</article-categories>
<title-group><article-title>The analysis of cost-effectiveness of implant and conventional fixed dental prosthesis</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Chun</surname>
<given-names>June Sang</given-names>
</name>
<xref ref-type="aff" rid="A1">1</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Har</surname>
<given-names>Alix</given-names>
</name>
<xref ref-type="aff" rid="A2">2</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Lim</surname>
<given-names>Hyun-Pil</given-names>
</name>
<xref ref-type="aff" rid="A3">3</xref>
</contrib>
<contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid" authenticated="true">http://orcid.org/0000-0002-0795-8305</contrib-id>
<name><surname>Lim</surname>
<given-names>Hoi-Jeong</given-names>
</name>
<xref ref-type="aff" rid="A4">4</xref>
</contrib>
</contrib-group>
<aff id="A1"><label>1</label>
School of Dentistry, Chonnam National University, Gwangju, Korea.</aff>
<aff id="A2"><label>2</label>
Northwestern University, USA.</aff>
<aff id="A3"><label>3</label>
Department of Prosthodontics, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju, Korea.</aff>
<aff id="A4"><label>4</label>
Department of Orthodontics, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju, Korea.</aff>
<author-notes><corresp>Corresponding author: Hoi-Jeong Lim. Department of Orthodontics, School of Dentistry, Dental Science Research Institute, Chonnam National University Yongbong-ro 33, Buk-gu, Gwangju 61186, Republic of Korea. Tel. 82 62 530 5830, <email>hjlim@jnu.ac.kr</email>
</corresp>
</author-notes>
<pub-date pub-type="ppub"><month>2</month>
<year>2016</year>
</pub-date>
<pub-date pub-type="epub"><day>23</day>
<month>2</month>
<year>2016</year>
</pub-date>
<volume>8</volume>
<issue>1</issue>
<fpage>53</fpage>
<lpage>61</lpage>
<history><date date-type="received"><day>26</day>
<month>11</month>
<year>2015</year>
</date>
<date date-type="rev-recd"><day>26</day>
<month>1</month>
<year>2016</year>
</date>
<date date-type="accepted"><day>03</day>
<month>2</month>
<year>2016</year>
</date>
</history>
<permissions><copyright-statement>© 2016 The Korean Academy of Prosthodontics</copyright-statement>
<copyright-year>2016</copyright-year>
<license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc/3.0/"><license-p>This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by-nc/3.0/">http://creativecommons.org/licenses/by-nc/3.0/</ext-link>
) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p>
</license>
</permissions>
<abstract><sec><title>PURPOSE</title>
<p>This study conducted an analysis of cost-effectiveness of the implant and conventional fixed dental prosthesis (CFDP) from a single treatment perspective.</p>
</sec>
<sec><title>MATERIALS AND METHODS</title>
<p>The Markov model for cost-effectiveness analysis of the implant and CFDP was carried out over maximum 50 years. The probabilistic sensitivity analysis was performed by the 10,000 Monte-Carlo simulations, and cost-effectiveness acceptability curves (CEAC) were also presented. The results from meta-analysis studies were used to determine the survival rates and complication rates of the implant and CFDP. Data regarding the cost of each treatment method were collected from University Dental Hospital and Statistics Korea for 2013. Using the results of the patient satisfaction survey study, quality-adjusted prosthesis year (QAPY) of the implant and CFDP strategy was evaluated with annual discount rate.</p>
</sec>
<sec><title>RESULTS</title>
<p>When only the direct cost was considered, implants were more cost-effective when the willingness to pay (WTP) was more than 10,000 won at 10<sup>th</sup>
year after the treatment, and more cost-effective regardless of the WTP from 20<sup>th</sup>
year after the prosthodontic treatment. When the indirect cost was added to the direct cost, implants were more cost-effective only when the WTP was more than 75,000 won at the 10<sup>th</sup>
year after the prosthodontic treatment, more than 35,000 won at the 20<sup>th</sup>
year after prosthodontic treatment.</p>
</sec>
<sec><title>CONCLUSION</title>
<p>The CFDP was more cost-effective unless the WTP was more than 75,000 won at the 10<sup>th</sup>
year after prosthodontic treatment. But the cost-effectivenss tendency changed from CFDP to implant as time passed.</p>
</sec>
</abstract>
<kwd-group><kwd>Cost-effectiveness</kwd>
<kwd>Implant</kwd>
<kwd>CFDP</kwd>
<kwd>QAPY</kwd>
<kwd>Markov model</kwd>
<kwd>Monte-Carlo simulation</kwd>
<kwd>Cost-effectiveness acceptability curve</kwd>
</kwd-group>
<funding-group><award-group><funding-source country="KR"><institution-wrap><institution>National Research Foundation of Korea</institution>
<institution-id institution-id-type="CrossRef">http://dx.doi.org/10.13039/501100003725</institution-id>
</institution-wrap>
</funding-source>
<award-id>2011-0012875</award-id>
</award-group>
</funding-group>
</article-meta>
</front>
<floats-group><fig id="F1" orientation="portrait" position="float"><label>Fig. 1</label>
<caption><title>Markov model framework.</title>
</caption>
<graphic xlink:href="jap-8-53-g001"></graphic>
</fig>
<fig id="F2" orientation="portrait" position="float"><label>Fig. 2</label>
<caption><title>Cost-effectiveness acceptability curve according to time horizon up to 5 year, 10 year, 20 year, 50 year; (A) Direct cost, (B) Total cost.</title>
</caption>
<graphic xlink:href="jap-8-53-g002"></graphic>
</fig>
<fig id="F3" orientation="portrait" position="float"><label>Fig. 3</label>
<caption><title>(A) Cost-effectiveness acceptability curve according to time horizon up to 5 year, (B) Scatter plot of the bootstrapped incremental cost and incremental effectiveness (QAPY) pairs for Implant vs. CFDP.</title>
</caption>
<graphic xlink:href="jap-8-53-g003"></graphic>
</fig>
<table-wrap id="T1" orientation="portrait" position="float"><label>Table 1</label>
<caption><title>QAPY evaluated from patient's satisfaction survey on Implant, CFDP, and Missing Tooth</title>
</caption>
<alternatives><graphic xlink:href="jap-8-53-i001"></graphic>
<table frame="hsides" rules="rows"><thead><tr><th valign="middle" align="left" rowspan="2" colspan="1">Level of Satisfaction (Score)</th>
<th valign="middle" align="center" rowspan="1" colspan="3">Implant</th>
<th valign="middle" align="center" rowspan="1" colspan="3">CFDP<sup>*</sup>
</th>
<th valign="middle" align="center" rowspan="1" colspan="3">Missing Tooth</th>
</tr>
<tr><th valign="middle" align="center" rowspan="1" colspan="1">A (%)<sup>†</sup>
</th>
<th valign="middle" align="center" rowspan="1" colspan="1">F (%)<sup>†</sup>
</th>
<th valign="middle" align="center" rowspan="1" colspan="1">P (%)<sup>†</sup>
</th>
<th valign="middle" align="center" rowspan="1" colspan="1">A (%)<sup>†</sup>
</th>
<th valign="middle" align="center" rowspan="1" colspan="1">F (%)<sup>†</sup>
</th>
<th valign="middle" align="center" rowspan="1" colspan="1">P (%)<sup>†</sup>
</th>
<th valign="middle" align="center" rowspan="1" colspan="1">A (%)<sup>†</sup>
</th>
<th valign="middle" align="center" rowspan="1" colspan="1">F (%)<sup>†</sup>
</th>
<th valign="middle" align="center" rowspan="1" colspan="1">P (%)<sup>†</sup>
</th>
</tr>
</thead>
<tbody><tr><td valign="middle" align="left" rowspan="1" colspan="1">Strongly satisfied (5)<sup>‡</sup>
</td>
<td valign="middle" align="right" rowspan="1" colspan="1">92</td>
<td valign="middle" align="right" rowspan="1" colspan="1">82</td>
<td valign="middle" align="right" rowspan="1" colspan="1">92</td>
<td valign="middle" align="right" rowspan="1" colspan="1">26</td>
<td valign="middle" align="right" rowspan="1" colspan="1">32</td>
<td valign="middle" align="right" rowspan="1" colspan="1">44</td>
<td valign="middle" align="right" rowspan="1" colspan="1">6</td>
<td valign="middle" align="right" rowspan="1" colspan="1">8</td>
<td valign="middle" align="right" rowspan="1" colspan="1">28</td>
</tr>
<tr><td valign="top" align="left" rowspan="1" colspan="1">Satisfied (4)<sup>‡</sup>
</td>
<td valign="top" align="right" rowspan="1" colspan="1">8</td>
<td valign="top" align="right" rowspan="1" colspan="1">8</td>
<td valign="top" align="right" rowspan="1" colspan="1">8</td>
<td valign="top" align="right" rowspan="1" colspan="1">54</td>
<td valign="top" align="right" rowspan="1" colspan="1">38</td>
<td valign="top" align="right" rowspan="1" colspan="1">48</td>
<td valign="top" align="right" rowspan="1" colspan="1">34</td>
<td valign="top" align="right" rowspan="1" colspan="1">20</td>
<td valign="top" align="right" rowspan="1" colspan="1">52</td>
</tr>
<tr><td valign="top" align="left" rowspan="1" colspan="1">Neutral (3)<sup>‡</sup>
</td>
<td valign="top" align="right" rowspan="1" colspan="1">0</td>
<td valign="top" align="right" rowspan="1" colspan="1">10</td>
<td valign="top" align="right" rowspan="1" colspan="1">0</td>
<td valign="top" align="right" rowspan="1" colspan="1">18</td>
<td valign="top" align="right" rowspan="1" colspan="1">24</td>
<td valign="top" align="right" rowspan="1" colspan="1">8</td>
<td valign="top" align="right" rowspan="1" colspan="1">20</td>
<td valign="top" align="right" rowspan="1" colspan="1">22</td>
<td valign="top" align="right" rowspan="1" colspan="1">14</td>
</tr>
<tr><td valign="top" align="left" rowspan="1" colspan="1">Dissatisfied (2)<sup>‡</sup>
</td>
<td valign="top" align="right" rowspan="1" colspan="1">0</td>
<td valign="top" align="right" rowspan="1" colspan="1">0</td>
<td valign="top" align="right" rowspan="1" colspan="1">0</td>
<td valign="top" align="right" rowspan="1" colspan="1">2</td>
<td valign="top" align="right" rowspan="1" colspan="1">6</td>
<td valign="top" align="right" rowspan="1" colspan="1">0</td>
<td valign="top" align="right" rowspan="1" colspan="1">38</td>
<td valign="top" align="right" rowspan="1" colspan="1">50</td>
<td valign="top" align="right" rowspan="1" colspan="1">6</td>
</tr>
<tr><td valign="top" align="left" rowspan="1" colspan="1">Strongly dissatisfied (1)<sup>‡</sup>
</td>
<td valign="top" align="right" rowspan="1" colspan="1">0</td>
<td valign="top" align="right" rowspan="1" colspan="1">0</td>
<td valign="top" align="right" rowspan="1" colspan="1">0</td>
<td valign="top" align="right" rowspan="1" colspan="1">0</td>
<td valign="top" align="right" rowspan="1" colspan="1">0</td>
<td valign="top" align="right" rowspan="1" colspan="1">0</td>
<td valign="top" align="right" rowspan="1" colspan="1">2</td>
<td valign="top" align="right" rowspan="1" colspan="1">0</td>
<td valign="top" align="right" rowspan="1" colspan="1">0</td>
</tr>
<tr><td valign="top" align="left" rowspan="1" colspan="1">Total Score = ∑(Score × percent)</td>
<td valign="top" align="right" rowspan="1" colspan="1">492</td>
<td valign="top" align="right" rowspan="1" colspan="1">472</td>
<td valign="top" align="right" rowspan="1" colspan="1">492</td>
<td valign="top" align="right" rowspan="1" colspan="1">404</td>
<td valign="top" align="right" rowspan="1" colspan="1">396</td>
<td valign="top" align="right" rowspan="1" colspan="1">436</td>
<td valign="top" align="right" rowspan="1" colspan="1">304</td>
<td valign="top" align="right" rowspan="1" colspan="1">286</td>
<td valign="top" align="right" rowspan="1" colspan="1">402</td>
</tr>
<tr><td valign="top" align="left" rowspan="1" colspan="1">WA = ∑(Score × percent) / 1500</td>
<td valign="top" align="center" rowspan="1" colspan="3">WA (I) = 0.97067</td>
<td valign="top" align="center" rowspan="1" colspan="3">WA (C) = 0.82400</td>
<td valign="top" align="center" rowspan="1" colspan="3">WA (M) = 0.66133</td>
</tr>
<tr><td valign="top" align="left" rowspan="1" colspan="1">QAPY<sup>§</sup>
</td>
<td valign="top" align="center" rowspan="1" colspan="3">0.91339</td>
<td valign="top" align="center" rowspan="1" colspan="3">0.48031</td>
<td valign="top" align="center" rowspan="1" colspan="3">0</td>
</tr>
</tbody>
</table>
</alternatives>
<table-wrap-foot><fn><p><sup>*</sup>
CFDP (conventional fixed dental prosthesis).</p>
<p><sup>†</sup>
A (aesthetic), F (function), P (phonation)</p>
<p><sup>‡</sup>
Referred to Al-Quran et al. (2011)</p>
<p><sup>§</sup>
QAPY = (WA (I) - WA (M)) / (1 - WA (M)) for Implant; QAPY = (WA (C) - WA (M)) / (1 - WA (M)) for CFDP</p>
<p>Where WA: Weighted Average</p>
</fn>
</table-wrap-foot>
</table-wrap>
<table-wrap id="T2" orientation="portrait" position="float"><label>Table 2</label>
<caption><title>Average management cost of the complications (Korean Won)</title>
</caption>
<alternatives><graphic xlink:href="jap-8-53-i002"></graphic>
<table frame="hsides" rules="rows"><thead><tr><th valign="middle" align="left" rowspan="1" colspan="1"></th>
<th valign="middle" align="center" rowspan="1" colspan="1">Complications</th>
<th valign="middle" align="center" rowspan="1" colspan="1">Treatments</th>
<th valign="middle" align="center" rowspan="1" colspan="1">Direct Costs<sup>†</sup>
</th>
<th valign="middle" align="center" rowspan="1" colspan="1">Indirect Costs</th>
<th valign="middle" align="center" rowspan="1" colspan="1">Total Costs</th>
</tr>
</thead>
<tbody><tr><td valign="top" align="left" rowspan="9" colspan="1">Implant</td>
<td valign="top" align="left" rowspan="1" colspan="1">Bone loss > 2 mm</td>
<td valign="top" align="left" rowspan="1" colspan="1">GBR<sup>*</sup>
, etc</td>
<td valign="top" align="right" rowspan="1" colspan="1">252,638</td>
<td valign="top" align="right" rowspan="1" colspan="1">86,580.9</td>
<td valign="top" align="right" rowspan="1" colspan="1">339,218.9</td>
</tr>
<tr><td valign="top" align="left" rowspan="1" colspan="1">Soft tissue complications</td>
<td valign="top" align="left" rowspan="1" colspan="1">Curettage, Laser therapy</td>
<td valign="top" align="right" rowspan="1" colspan="1">20,176</td>
<td valign="top" align="right" rowspan="1" colspan="1">38,735.23</td>
<td valign="top" align="right" rowspan="1" colspan="1">58,911.23</td>
</tr>
<tr><td valign="top" align="left" rowspan="1" colspan="1">Aesthetic complications</td>
<td valign="top" align="left" rowspan="1" colspan="1">Crown remake</td>
<td valign="top" align="right" rowspan="1" colspan="1">740,850</td>
<td valign="top" align="right" rowspan="1" colspan="1">66,071.26</td>
<td valign="top" align="right" rowspan="1" colspan="1">806,921.26</td>
</tr>
<tr><td valign="top" align="left" rowspan="1" colspan="1">Implant fracture</td>
<td valign="top" align="left" rowspan="1" colspan="1">Failure</td>
<td valign="top" align="right" rowspan="1" colspan="1">57,330</td>
<td valign="top" align="right" rowspan="1" colspan="1">35,005.16</td>
<td valign="top" align="right" rowspan="1" colspan="1">92,335.16</td>
</tr>
<tr><td valign="top" align="left" rowspan="1" colspan="1">Abutment or screw fracture</td>
<td valign="top" align="left" rowspan="1" colspan="1">Abutment or screw changing</td>
<td valign="top" align="right" rowspan="1" colspan="1">16,000</td>
<td valign="top" align="right" rowspan="1" colspan="1">35,005.16</td>
<td valign="top" align="right" rowspan="1" colspan="1">51,005.16</td>
</tr>
<tr><td valign="top" align="left" rowspan="1" colspan="1">Loose abutments or screw</td>
<td valign="top" align="left" rowspan="1" colspan="1">Tightening</td>
<td valign="top" align="right" rowspan="1" colspan="1">10,000</td>
<td valign="top" align="right" rowspan="1" colspan="1">35,005.16</td>
<td valign="top" align="right" rowspan="1" colspan="1">45,005.16</td>
</tr>
<tr><td valign="top" align="left" rowspan="1" colspan="1">Loss of retention</td>
<td valign="top" align="left" rowspan="1" colspan="1">Re-cementation</td>
<td valign="top" align="right" rowspan="1" colspan="1">10,000</td>
<td valign="top" align="right" rowspan="1" colspan="1">35,005.16</td>
<td valign="top" align="right" rowspan="1" colspan="1">45,005.16</td>
</tr>
<tr><td valign="top" align="left" rowspan="1" colspan="1">Ceramic chipping</td>
<td valign="top" align="left" rowspan="1" colspan="1">Crown remake</td>
<td valign="top" align="right" rowspan="1" colspan="1">740,850</td>
<td valign="top" align="right" rowspan="1" colspan="1">66,071.26</td>
<td valign="top" align="right" rowspan="1" colspan="1">806,921.26</td>
</tr>
<tr><td valign="top" align="left" rowspan="1" colspan="1">Framework fracture</td>
<td valign="top" align="left" rowspan="1" colspan="1">Crown remake</td>
<td valign="top" align="right" rowspan="1" colspan="1">740,850</td>
<td valign="top" align="right" rowspan="1" colspan="1">66,071.26</td>
<td valign="top" align="right" rowspan="1" colspan="1">806,921.26</td>
</tr>
<tr><td valign="top" align="left" rowspan="7" colspan="1">CFDP<sup>*</sup>
</td>
<td valign="top" align="left" rowspan="1" colspan="1">Caries of abutment teeth</td>
<td valign="top" align="left" rowspan="1" colspan="1">Caries removal & re-CFDP<sup>*</sup>
</td>
<td valign="top" align="right" rowspan="1" colspan="1">1,360,615</td>
<td valign="top" align="right" rowspan="1" colspan="1">56,639.68</td>
<td valign="top" align="right" rowspan="1" colspan="1">1,417,254.68</td>
</tr>
<tr><td valign="top" align="left" rowspan="1" colspan="1">CFDPs<sup>*</sup>
lost (caries)</td>
<td valign="top" align="left" rowspan="1" colspan="1">Failure</td>
<td valign="top" align="right" rowspan="1" colspan="1">17,526</td>
<td valign="top" align="right" rowspan="1" colspan="1">28,799.43</td>
<td valign="top" align="right" rowspan="1" colspan="1">46,325.43</td>
</tr>
<tr><td valign="top" align="left" rowspan="1" colspan="1">Loss of abutment teeth vitality</td>
<td valign="top" align="left" rowspan="1" colspan="1">RCT<sup>*</sup>
& re-CFDP<sup>*</sup>
</td>
<td valign="top" align="right" rowspan="1" colspan="1">1,370,492</td>
<td valign="top" align="right" rowspan="1" colspan="1">145,430.65</td>
<td valign="top" align="right" rowspan="1" colspan="1">1,515,922.65</td>
</tr>
<tr><td valign="top" align="left" rowspan="1" colspan="1">CFDPs<sup>*</sup>
lost (periodontal disease)</td>
<td valign="top" align="left" rowspan="1" colspan="1">Failure</td>
<td valign="top" align="right" rowspan="1" colspan="1">17,526</td>
<td valign="top" align="right" rowspan="1" colspan="1">28,799.43</td>
<td valign="top" align="right" rowspan="1" colspan="1">46,325.43</td>
</tr>
<tr><td valign="top" align="left" rowspan="1" colspan="1">Loss of retention</td>
<td valign="top" align="left" rowspan="1" colspan="1">Re-cementation</td>
<td valign="top" align="right" rowspan="1" colspan="1">7,636</td>
<td valign="top" align="right" rowspan="1" colspan="1">35,625.16</td>
<td valign="top" align="right" rowspan="1" colspan="1">43,261.16</td>
</tr>
<tr><td valign="top" align="left" rowspan="1" colspan="1">CFDPs<sup>*</sup>
lost (abutment tooth fracture)</td>
<td valign="top" align="left" rowspan="1" colspan="1">Failure</td>
<td valign="top" align="right" rowspan="1" colspan="1">17,526</td>
<td valign="top" align="right" rowspan="1" colspan="1">28,799.43</td>
<td valign="top" align="right" rowspan="1" colspan="1">46,325.43</td>
</tr>
<tr><td valign="top" align="left" rowspan="1" colspan="1">Fractures of material</td>
<td valign="top" align="left" rowspan="1" colspan="1">Re-CFDP<sup>*</sup>
</td>
<td valign="top" align="right" rowspan="1" colspan="1">1,300,492</td>
<td valign="top" align="right" rowspan="1" colspan="1">57,867.12</td>
<td valign="top" align="right" rowspan="1" colspan="1">1,358,359.12</td>
</tr>
</tbody>
</table>
</alternatives>
<table-wrap-foot><fn><p><sup>*</sup>
CFDP (conventional fixed dental prosthesis), GBR (guided bone regeneration), RCT (root canal therapy)</p>
<p><sup>†</sup>
The costs were averaged over all the management costs of specialist and generalist. These were calculated from medical histories of outpatients which were collected for a period of one year (2013) at Chonnam National University Dental Hospital. The number of patients was 3,051.</p>
</fn>
</table-wrap-foot>
</table-wrap>
<table-wrap id="T3" orientation="portrait" position="float"><label>Table 3</label>
<caption><title>Incremental cost-effectiveness ratios of implant versus conventional fixed dental prosthesis</title>
</caption>
<alternatives><graphic xlink:href="jap-8-53-i003"></graphic>
<table frame="hsides" rules="rows"><thead><tr><th valign="top" align="left" rowspan="2" colspan="2">(a) Direct cost</th>
<th valign="middle" align="center" rowspan="1" colspan="6"> </th>
</tr>
<tr><th valign="middle" align="center" rowspan="1" colspan="1">Cost<sup>*</sup>
</th>
<th valign="middle" align="center" rowspan="1" colspan="1">Effectiveness<sup>†</sup>
</th>
<th valign="middle" align="center" rowspan="1" colspan="1">CE<sup>‡</sup>
</th>
<th valign="middle" align="center" rowspan="1" colspan="1">IC<sup>*</sup>
</th>
<th valign="middle" align="center" rowspan="1" colspan="1">IE<sup>†</sup>
</th>
<th valign="middle" align="center" rowspan="1" colspan="1">ICER<sup>‡</sup>
</th>
</tr>
</thead>
<tbody><tr><td valign="top" align="center" rowspan="2" colspan="1">0 year</td>
<td valign="top" align="center" rowspan="1" colspan="1">Implant</td>
<td valign="top" align="center" rowspan="1" colspan="1">1,441,776</td>
<td valign="top" align="right" rowspan="1" colspan="1">0.91</td>
<td valign="top" align="right" rowspan="1" colspan="1">1,587,379</td>
<td valign="top" align="right" rowspan="2" colspan="1">83,608</td>
<td valign="top" align="right" rowspan="2" colspan="1">0.43</td>
<td valign="top" align="right" rowspan="2" colspan="1">194,437</td>
</tr>
<tr><td valign="top" align="center" rowspan="1" colspan="1">CFDP</td>
<td valign="top" align="center" rowspan="1" colspan="1">1,358,168</td>
<td valign="top" align="right" rowspan="1" colspan="1">0.47</td>
<td valign="top" align="right" rowspan="1" colspan="1">2,860,876</td>
</tr>
<tr><td valign="top" align="center" rowspan="2" colspan="1">5 year</td>
<td valign="top" align="center" rowspan="1" colspan="1">Implant</td>
<td valign="top" align="center" rowspan="1" colspan="1">1,539,254</td>
<td valign="top" align="right" rowspan="1" colspan="1">5.06</td>
<td valign="top" align="right" rowspan="1" colspan="1">303,946</td>
<td valign="top" align="right" rowspan="2" colspan="1">34,082</td>
<td valign="top" align="right" rowspan="2" colspan="1">2.45</td>
<td valign="top" align="right" rowspan="2" colspan="1">13,911</td>
</tr>
<tr><td valign="top" align="center" rowspan="1" colspan="1">CFDP</td>
<td valign="top" align="center" rowspan="1" colspan="1">1,505,172</td>
<td valign="top" align="right" rowspan="1" colspan="1">2.62</td>
<td valign="top" align="right" rowspan="1" colspan="1">575,537</td>
</tr>
<tr><td valign="top" align="center" rowspan="2" colspan="1">10 year</td>
<td valign="top" align="center" rowspan="1" colspan="1">Implant</td>
<td valign="top" align="center" rowspan="1" colspan="1">1,623,212</td>
<td valign="top" align="right" rowspan="1" colspan="1">8.64</td>
<td valign="top" align="right" rowspan="1" colspan="1">187,788</td>
<td valign="top" align="right" rowspan="2" colspan="1">-5,443</td>
<td valign="top" align="right" rowspan="2" colspan="1">4.23</td>
<td valign="top" align="right" rowspan="2" colspan="1">-1,287</td>
</tr>
<tr><td valign="top" align="center" rowspan="1" colspan="1">CFDP</td>
<td valign="top" align="center" rowspan="1" colspan="1">1,628,655</td>
<td valign="top" align="right" rowspan="1" colspan="1">4.41</td>
<td valign="top" align="right" rowspan="1" colspan="1">369,037</td>
</tr>
<tr><td valign="top" align="center" rowspan="2" colspan="1">20 year</td>
<td valign="top" align="center" rowspan="1" colspan="1">Implant</td>
<td valign="top" align="center" rowspan="1" colspan="1">1,757,813</td>
<td valign="top" align="right" rowspan="1" colspan="1">14.38</td>
<td valign="top" align="right" rowspan="1" colspan="1">122,218</td>
<td valign="top" align="right" rowspan="2" colspan="1">-61,693</td>
<td valign="top" align="right" rowspan="2" colspan="1">7.19</td>
<td valign="top" align="right" rowspan="2" colspan="1">-8,580</td>
</tr>
<tr><td valign="top" align="center" rowspan="1" colspan="1">CFDP</td>
<td valign="top" align="center" rowspan="1" colspan="1">1,819,506</td>
<td valign="top" align="right" rowspan="1" colspan="1">7.19</td>
<td valign="top" align="right" rowspan="1" colspan="1">252,983</td>
</tr>
<tr><td valign="top" align="center" rowspan="2" colspan="1">50 year</td>
<td valign="top" align="center" rowspan="1" colspan="1">Implant</td>
<td valign="top" align="center" rowspan="1" colspan="1">1,981,918</td>
<td valign="top" align="right" rowspan="1" colspan="1">24.94</td>
<td valign="top" align="right" rowspan="1" colspan="1">79,476</td>
<td valign="top" align="right" rowspan="2" colspan="1">-128,604</td>
<td valign="top" align="right" rowspan="2" colspan="1">12.63</td>
<td valign="top" align="right" rowspan="2" colspan="1">-10,182</td>
</tr>
<tr><td valign="top" align="center" rowspan="1" colspan="1">CFDP</td>
<td valign="top" align="center" rowspan="1" colspan="1">2,110,522</td>
<td valign="top" align="right" rowspan="1" colspan="1">12.43</td>
<td valign="top" align="right" rowspan="1" colspan="1">169,797</td>
</tr>
<tr><td valign="top" align="left" rowspan="1" colspan="8"><sup>*</sup>
Korean won; <sup>†</sup>
Quality-adjusted prosthesis year; <sup>‡</sup>
Korean won per Quality-adjusted prosthesis year</td>
</tr>
</tbody>
</table>
<table frame="hsides" rules="rows"><thead><tr><th valign="top" align="left" rowspan="2" colspan="2">(b) Total cost including Indirect cost</th>
<th valign="top" align="center" rowspan="1" colspan="6"> </th>
</tr>
<tr><th valign="top" align="center" rowspan="1" colspan="1">Cost<sup>*</sup>
</th>
<th valign="top" align="center" rowspan="1" colspan="1">Effectiveness<sup>†</sup>
</th>
<th valign="top" align="center" rowspan="1" colspan="1">CE<sup>‡</sup>
</th>
<th valign="top" align="center" rowspan="1" colspan="1">IC<sup>*</sup>
</th>
<th valign="top" align="center" rowspan="1" colspan="1">IE<sup>†</sup>
</th>
<th valign="top" align="center" rowspan="1" colspan="1">ICER<sup>‡</sup>
</th>
</tr>
</thead>
<tbody><tr><td valign="top" align="center" rowspan="2" colspan="1">0 year</td>
<td valign="top" align="center" rowspan="1" colspan="1">Implant</td>
<td valign="top" align="center" rowspan="1" colspan="1">1,714,585</td>
<td valign="top" align="right" rowspan="1" colspan="1">0.91</td>
<td valign="top" align="right" rowspan="1" colspan="1">1,887,737</td>
<td valign="top" align="right" rowspan="2" colspan="1">321,066</td>
<td valign="top" align="right" rowspan="2" colspan="1">0.43</td>
<td valign="top" align="right" rowspan="2" colspan="1">746,665</td>
</tr>
<tr><td valign="top" align="center" rowspan="1" colspan="1">CFDP</td>
<td valign="top" align="center" rowspan="1" colspan="1">1,393,519</td>
<td valign="top" align="right" rowspan="1" colspan="1">0.47</td>
<td valign="top" align="right" rowspan="1" colspan="1">2,935,280</td>
</tr>
<tr><td valign="top" align="center" rowspan="2" colspan="1">5 year</td>
<td valign="top" align="center" rowspan="1" colspan="1">Implant</td>
<td valign="top" align="center" rowspan="1" colspan="1">1,830,638</td>
<td valign="top" align="right" rowspan="1" colspan="1">5.06</td>
<td valign="top" align="right" rowspan="1" colspan="1">361,483</td>
<td valign="top" align="right" rowspan="2" colspan="1">277,907</td>
<td valign="top" align="right" rowspan="2" colspan="1">2.45</td>
<td valign="top" align="right" rowspan="2" colspan="1">113,431</td>
</tr>
<tr><td valign="top" align="center" rowspan="1" colspan="1">CFDP</td>
<td valign="top" align="center" rowspan="1" colspan="1">1,552,731</td>
<td valign="top" align="right" rowspan="1" colspan="1">2.62</td>
<td valign="top" align="right" rowspan="1" colspan="1">593,710</td>
</tr>
<tr><td valign="top" align="center" rowspan="2" colspan="1">10 year</td>
<td valign="top" align="center" rowspan="1" colspan="1">Implant</td>
<td valign="top" align="center" rowspan="1" colspan="1">1,930,596</td>
<td valign="top" align="right" rowspan="1" colspan="1">8.64</td>
<td valign="top" align="right" rowspan="1" colspan="1">223,349</td>
<td valign="top" align="right" rowspan="2" colspan="1">244,129</td>
<td valign="top" align="right" rowspan="2" colspan="1">4.23</td>
<td valign="top" align="right" rowspan="2" colspan="1">57,714</td>
</tr>
<tr><td valign="top" align="center" rowspan="1" colspan="1">CFDP</td>
<td valign="top" align="center" rowspan="1" colspan="1">1,686,467</td>
<td valign="top" align="right" rowspan="1" colspan="1">4.41</td>
<td valign="top" align="right" rowspan="1" colspan="1">382,129</td>
</tr>
<tr><td valign="top" align="center" rowspan="2" colspan="1">20 year</td>
<td valign="top" align="center" rowspan="1" colspan="1">Implant</td>
<td valign="top" align="center" rowspan="1" colspan="1">2,090,847</td>
<td valign="top" align="right" rowspan="1" colspan="1">14.38</td>
<td valign="top" align="right" rowspan="1" colspan="1">145,374</td>
<td valign="top" align="right" rowspan="2" colspan="1">197,680</td>
<td valign="top" align="right" rowspan="2" colspan="1">7.19</td>
<td valign="top" align="right" rowspan="2" colspan="1">27,494</td>
</tr>
<tr><td valign="top" align="center" rowspan="1" colspan="1">CFDP</td>
<td valign="top" align="center" rowspan="1" colspan="1">1,893,167</td>
<td valign="top" align="right" rowspan="1" colspan="1">7.19</td>
<td valign="top" align="right" rowspan="1" colspan="1">263,219</td>
</tr>
<tr><td valign="top" align="center" rowspan="2" colspan="1">50 year</td>
<td valign="top" align="center" rowspan="1" colspan="1">Implant</td>
<td valign="top" align="center" rowspan="1" colspan="1">2,363,358</td>
<td valign="top" align="right" rowspan="1" colspan="1">24.94</td>
<td valign="top" align="right" rowspan="1" colspan="1">97,896</td>
<td valign="top" align="right" rowspan="2" colspan="1">148,834</td>
<td valign="top" align="right" rowspan="2" colspan="1">12.63</td>
<td valign="top" align="right" rowspan="2" colspan="1">11,784</td>
</tr>
<tr><td valign="top" align="center" rowspan="1" colspan="1">CFDP</td>
<td valign="top" align="center" rowspan="1" colspan="1">2,214,524</td>
<td valign="top" align="right" rowspan="1" colspan="1">12.43</td>
<td valign="top" align="right" rowspan="1" colspan="1">192,351</td>
</tr>
</tbody>
</table>
</alternatives>
<table-wrap-foot><fn><p><sup>*</sup>
Korean won; <sup>†</sup>
Quality-adjusted prosthesis year; <sup>‡</sup>
Korean won per Quality-adjusted prosthesis year</p>
</fn>
</table-wrap-foot>
</table-wrap>
</floats-group>
</pmc>
<affiliations><list><country><li>Corée du Sud</li>
<li>États-Unis</li>
</country>
</list>
<tree><country name="Corée du Sud"><noRegion><name sortKey="Chun, June Sang" sort="Chun, June Sang" uniqKey="Chun J" first="June Sang" last="Chun">June Sang Chun</name>
</noRegion>
<name sortKey="Lim, Hoi Jeong" sort="Lim, Hoi Jeong" uniqKey="Lim H" first="Hoi-Jeong" last="Lim">Hoi-Jeong Lim</name>
<name sortKey="Lim, Hyun Pil" sort="Lim, Hyun Pil" uniqKey="Lim H" first="Hyun-Pil" last="Lim">Hyun-Pil Lim</name>
</country>
<country name="États-Unis"><noRegion><name sortKey="Har, Alix" sort="Har, Alix" uniqKey="Har A" first="Alix" last="Har">Alix Har</name>
</noRegion>
</country>
</tree>
</affiliations>
</record>
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