Managing root caries with silver diamine fluoride, sodium fluoride and direct restorations: A cost-effectiveness analysis

OBJECTIVE: To assess the cost-effectiveness of silver diamine fluoride (SDF) relative to sodium fluoride (NaF) and traditional resin-modified glass ionomer cements (RMGIC) restorations for the management of root caries in older adults aged 60 and above.

METHODS: A Markov model design was chosen and two models were constructed: 1) Clinic-based model - with access to dental facility that allows for placement of traditional restorations, 2) Community-based model - without access to dental facility due to mobility, lack of executive function, or financial barriers. Modelling was done over a 10-year time horizon with a cycle length of one year. Data on transition probabilities and relative risks were obtained from published literature for the base case. Outcomes of interest were incremental cost per incremental caries-controlled year and incremental cost per incremental extraction-free year. Probabilistic sensitivity analyses were conducted to account for uncertainty in the base case.

RESULTS: In the clinic-based model, both SDF and NaF were dominated by traditional RMGIC restorations, which had lower cost, and higher number of caries-controlled and extraction-free years, with a 90% probability of being cost-effective. In the community-based model, NaF was dominated by SDF, which incurred lower cost and resulted in a higher number of caries-controlled and extraction-free years, with almost 100% probability of being cost-effective.

CONCLUSIONS: Traditional RMGIC restoration was the most cost-effective option for managing root caries when full dental facility is available. In situations where treatment is provided in a community setting, SDF was more cost-effective than NaF.

CLINICAL SIGNIFICANCE: Based on limited clinical studies and within the Singapore oral health system, traditional RMGIC restoration was most cost-effective in clinical settings for managing root caries, while SDF was most cost-effective in community settings.