Cost-effectiveness of Single- Versus Multistep Root Canal Treatment

Introduction: Single-visit root canal treatment requires fewer visits and reduces treatment time and material use compared with multiple-visit treatment. However, it might result in a higher risk of complications. We aimed to assess the long-term cost-effectiveness of single- versus multivisit root canal treatment using a model-based approach. Methods: A mixed public private-payer perspective in German health care was adopted. Permanent teeth were simulated over the lifetime of 40-year-old patients. Different tooth types and preoperative conditions were modeled. Teeth could experience endodontic and nonendodontic complications. The risk of endodontic complications after single versus multiple-visit treatment was estimated based on systematically collected data and adjusted depending on the preoperative conditions. The health outcome was tooth retention time. Costs were calculated based on the German dental fee catalogs and the Monte Carlo microsimulations were performed for analysis. Results: For nonvital molars without periapical lesions, single visit treatment was minimally less costly (1703 Euro vs 1729 Euro) and more effective (19.9 vs 19.8 years) than multiple-visit treatment. This cost-effectiveness ranking also applied to vital molars or those with periapical lesions. In single-rooted teeth, multiple-visit treatment was less costly (1667 vs 1770 Euro) and more effective (18.9 vs 15.1 years). Conclusions: The overall cost-effectiveness difference between treatments seems limited. The resulting cost-effectiveness differs in subgroups of teeth, whereas data supporting such subgroup analyses are scarce. Practical aspects in scheduling treatments as well as patients' and dentists' preferences should be considered for decision making.