Cost‐effectiveness of root canal treatment compared with tooth extraction in a Swedish Public Dental Service: A prospective controlled cohort study

Abstract

ObjectivesTo evaluate the cost‐effectiveness of root canal treatment (RCT) compared with a tooth extraction in a general dental practice setting, with reference to cost per quality‐adjusted life‐year (QALY) gained over 1 year.Material and MethodsThis is a prospective controlled cohort study based on patients either starting RCT or undergoing extraction at one of six Public Dental Service clinics in the county of Västra Götaland, Sweden. From a total of 65 patients, 2 comparable groups were formed: 37 started RCT and 28 underwent extraction. A societal perspective was used for the cost calculations. QALYs were estimated, based on the EQ‐5D‐5L given to the patients at their first treatment appointment and then after 1, 6, and 12 months.ResultsThe total mean cost of RCT ($689.1) was higher than for extraction ($280.1). For those patients whose extracted tooth was replaced, the costs were even higher ($1245.5). There were no significant intergroup differences in QALYs, but a significant improvement in health state values in the tooth‐preserving group.ConclusionsIn the short term, extraction was cost‐effective compared with preserving a tooth with RCT. However, the potential need for future replacement of the extracted tooth, by an implant, fixed prosthesis, or removable partial dentures, may change the calculation in favor of RCT.

General dental practitioners' fees for root canal treatment, coronal restoration and follow‐on treatment in the adult population in Sweden: A 10‐year follow‐up of data from the Swedish Dental Register

“…Registry come, including extraction in some cases. There are few studies that have analyzed the fees for root canal treatment and the resources required to maintain the root-filled tooth as a functional unit over time (Wigsten et al, 2023). Under ideal conditions, once the tooth has been root-filled and permanently restored, no further treatment should be required.…”

“…Nevertheless, this study confirms that based on the evidence of the fees charged, teeth which are treated by general dental practitioners can require further treatment in years to come, including extraction in some cases. There are few studies that have analyzed the fees for root canal treatment and the resources required to maintain the root‐filled tooth as a functional unit over time (Wigsten et al, 2023 ). Under ideal conditions, once the tooth has been root‐filled and permanently restored, no further treatment should be required.…”

“…Further intervention entails additional costs for the individual patient as well as for other stakeholders such as dentists, and any insurance companies or government benefit schemes which subsidize dental care (Schwendicke & Herbst, 2022;Wigsten et al, 2023;Zaror & Mariño, 2022).…”

“…In some cases, extraction with possible replacement is considered instead, particularly when the outcome of the root canal treatment is unsatisfactory. Further intervention entails additional costs for the individual patient as well as for other stakeholders such as dentists, and any insurance companies or government benefit schemes which subsidize dental care (Schwendicke & Herbst, 2022 ; Wigsten et al, 2023 ; Zaror & Mariño, 2022 ).…”

“…There are remarkably limited studies assessing the long‐term cost associated with preserving a root‐filled tooth in the dentition. Likewise, there are a limited number of health economics studies in which endodontic treatment is compared with other relevant dental treatment (Schwendicke & Herbst, 2022 ; Wigsten et al, 2023 ). It is not unusual for a root‐filled tooth to require additional care, incurring further costs.…”