A decision analysis to assess the cost and cost-effectiveness of surgical removal and non surgical treatment in the management of mandibular third molars

Abstract

Mandibular third molars are associated with significant pre- and postoperative morbidity. Management of these teeth involves an economic and opportunity cost to both the patient and Health Service. The aims of this research were to determine the optimal management from the dual perspective of the patient and National Health Service (NHS) by assessing the probability, patient health state utilities and the costs of outcomes of mandibular third molar management. A decision tree model was constructed of the possible outcomes following mandibular third molar management. Probability data for each possible outcome were obtained by a literature search and entered in the decision tree. A total of 275 patients were included in the study. These data were entered in the tree as effectiveness data (utilities) and patient incurred cost data. NHS procedure cost data were also collected and entered in the tree. Utility, cost and cost-effectiveness analyses were then conducted. The optimal management assessed by patient health state utilities, the least costly and the most cost-effective management of mandibular third molars was non surgical treatment. This confirmed and extended work previous in this field and emphasised the dynamics of clinical decision making. The role of the contributory factors (patient values and costs and NHS Procedure costs) was also explained. The similarities between the probabilities and utilities in this and previous work suggests that there is a valid decision tree base structure that could be implemented in the field of mandibular third molar treatment planning.