LAUSR

PURPOSE The aim of this research was to perform a cost-effectiveness (CE) analysis of the main rehabilitative solutions of totally edentulous mandibles. METHODS decision tree models were built using TreeAge Pro Healthcare 2021 software to compare the following strategies: Conventional Denture (CD), Overdenture retained by two implants (OD-2), Overdenture retained by a bar on two implants (ODbar), Overdenture retained by 4 mini-implants (ODmini) and Fixed denture supported by 4 implants (FD). Costs were estimated using data from public rate tables. Effectiveness measures were obtained from a meta-analysis of literature data, normalizing the different scales in 0-1 range. A value of 30000€ per 1 normalized utility points was set as threshold of willingness to pay (WTP). Probabilistic Sensitivity Analysis (PSA) with 1000 Monte Carlo Simulations was performed to characterize uncertainty. RESULTS Total costs ranged between 1804,40€ for CD and 10008,80€ for FD rehabilitations, with an effectiveness of 0,69 and 0,95 normalized points (0-1 scale) for the two solutions. The ODbar resulted to be the most CE strategy at the established WTP value, with the highest Net Monetary Benefit (22001,20€), followed by the OD-2 rehabilitation (21866,80€). PSA analysis confirmed the dominance of OD-2 and ODbar strategies, confirming a net separation from the other alternatives. CONCLUSIONS OD stabilized by 2 implants could represent a good rehabilitative solution for patients with edentulous mandible, being a good trade-off in terms of costs and effectiveness. Nevertheless, a standardized measure of oral health-related quality of life is needed to obtain more reliable results.