Restoration of endodontically treated teeth: A cost-effectiveness analysis of an endocrown versus a complete crown

Statement of problem Endocrowns have been proposed as an alternative to post-and-core retained complete crowns for structurally compromised endodontically treated teeth. However, an analysis of their cost-effectiveness is lacking. Purpose The purpose of this simulation study was to assess the cost-effectiveness of an endocrown versus a complete crown as a definitive restoration for structurally compromised endodontically treated teeth. Material and methods A Markov simulation model was constructed with endodontically treated permanent molar teeth using TreeAge Pro Healthcare (2023) as a starting point for an 18-year-old patient. Costs were extrapolated from the ADA dental survey based on the United States healthcare, and the probabilities of transition were derived from existing literature. The cost-effectiveness was determined by using Monte Carlo microsimulations. A sensitivity analysis was performed to validate the model internally, whereas an experienced health expert and an endodontist performed the face validation. Results The complete crown was associated with additional health benefits (1.36 and 0.9 more years over a period of 5 years and lifetime, respectively) but at an increased cost (an additional 1143 USD and 1535 USD over a period of 5 years and lifetime, respectively). Moreover, the endocrown was cost-effective at lower Willingness-To-Pay (WTP) values (92% acceptable at 250 USD for 5 years and 73% acceptable at 250 USD for the lifetime of an individual), whereas at increased WTP threshold values, the complete crown was a cost-effective restoration (98.6% acceptable at 1250 USD for 5 years and 99.5% acceptable at 8000 USD over an individual’s lifetime). Conclusions The endocrown was a cost-effective restorative option at lower WTP values. However, at an increased WTP threshold, the complete crown became a more cost-effective restoration.