Overdentures as an alternative to conventional dentures: a micro-costing analysis for Public Health Service in Brazil

Cavalcante, Denise de Fátima Barros; Pereira, Antonio Carlos; Cavalcanti, Yuri Wanderley; Probst, Livia Fernandes; Ambrosano, Gláucia Maria Bovi

doi:10.1590/1413-81232021268.10002020

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TEMAS LIVRES • Ciênc. saúde coletiva 26 (08) • Aug 2021 • https://doi.org/10.1590/1413-81232021268.10002020 copy

Overdentures as an alternative to conventional dentures: a micro-costing analysis for Public Health Service in Brazil

Overdentures como alternativa às próteses convencionais: uma análise de micro-custeio para o Sistema Único de Saúde

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

This study aimed to estimate cost and compatibility with public financial incentives of two technologies for treating the edentulous mandible: lower complete dentures (CD) and overdentures retained by two dental implants (OD). This study consisted of a partial economic evaluation, with a micro-costing bottom-up approach for the calculation of direct costs. The estimates involved the number of consultations, proportion of materials, equipment, instruments’ lifetime, and human resources, described in the price panel website of the Ministry of Economy in Brazil. Complementary information was obtained from a panel of experts. A sensitivity analysis was based on 20% variation. The estimated cost of a CD was R$ 189.89 (base scenario), and this varied between R$ 151.91 and R$ 227.89 according to sensibility analysis. The cost of an OD was R$ 663.05 (ranging from R$ 795.66 to R$ 530.44 - 1US=R$ 3.80/July 2019). The Ministry of Health covers appropriately the costs of the CD and OD. Both technologies showed costs that are within the limits of financial public incentives obtained by municipalities. The technologies are economically viable and should be induced through public policies due to their positive impacts on several functional domains of health.

Key words:
Economic evaluation; Micro costing; Denture; Overdenture

Clinical and Laboratory steps		Human Resources		Type of Resource	Associated costs (R$)
1	Initial Molding/Impression	Clinical	Dentist	Materials, Instruments, and Equipment	3.52
1	Initial Molding/Impression	Clinical	Dentist	Human Resources	16.56
2	Pouring the model and custom tray manufacturing	Laboratory	Dental Prosthesis Technician	Materials, Instruments, and Equipment	7.75
2	Pouring the model and custom tray manufacturing	Laboratory	Dental Prosthesis Technician	Human Resources	21.05
3	Wax registry and fitting proof of custom tray	Clinical	Dentist	Materials, Instruments, and Equipment	1.16
3	Wax registry and fitting proof of custom tray	Clinical	Dentist	Human Resources	24.84
4	Articulation of the models and setting up the teeth	Laboratory	Dental Prosthesis Technician	Materials, Instruments, and Equipment	13.69
4	Articulation of the models and setting up the teeth	Laboratory	Dental Prosthesis Technician	Human Resources	19.14
5	Functional proof and Functional Molding	Clinical	Dentist	Materials, Instruments, and Equipment	4.83
5	Functional proof and Functional Molding	Clinical	Dentist	Human Resources	24.84
6	Acrylic pressing and denture polymerization	Laboratory	Dental Prosthesis Technician	Materials, Instruments, and Equipment	6.83
6	Acrylic pressing and denture polymerization	Laboratory	Dental Prosthesis Technician	Human Resources	19.14
7	Denture installation	Clinical	Dentist	Materials, Instruments, and Equipment	4.35
7	Denture installation	Clinical	Dentist	Human Resources	16.56
Individual protection equipment		All		Materials	5.63
Global Costs for Conventional Complete Denture Manufacturing (R$)					189.89
Global Costs for Conventional Complete Denture manufacturing (US$)					49.97

Clinical and Laboratory steps		Human Resources		Type of Resource	Associated costs (R$)
1 to 7	Steps from conventional denture manufacturing	Clinical and Laboratory	Dentist and Dental ProsthesisTechnician	Conventional Complete Denture	189.89
8	Diagnosis and complementary exams	Clinical	Dentist	Complementary Exams	30.00
8	Diagnosis and complementary exams	Clinical	Dentist	Human Resources	8.28
9	Fabrication of surgical guide	Laboratory	Prosthesis Technician	Materials and Lab time	27.48
10	Surgical step for the installation of dental implants	Clinical	Dentist	Materials, Instrumentals and Equipment	26.22
				Human Resources	76.32
				Dental Implants (x2)	140.00
				Prosthetic Components (x2)	140.00
11/12	Removal of Sutures and follow-up evaluation	Clinical	Dentist	Materials, Instrumentals and Equipment	0.018
11/12	Removal of Sutures and follow-up evaluation	Clinical	Dentist	Human Resources	8.28
Costs for Complete Denture adaptation on Implants (Overdenture manufacturing from complete denture)				Total for steps 8 to 12 (R$)	473.16
Global Costs for Overdenture manufacturing (R$)					663.05
Global Costs for Overdenture manufacturing (US$)					174.49

Technology and Scenarios		Human Resources Costs (R$)	Materials, Instrumentals and Equipment costs (R$)	Global Costs (R$)
Conventional Complete Denture	Base Scenario	142.12	47.76	189.89(US$ 49.97)
	Most Optimistic Scenario	113.70	38.21	151.91(US$ 39.97)
	Most Pessimistic Scenario	170.54	57.31	227.85(US$ 59.96)
Overdenture	Base Scenario	109.44	363.72	189.89 + 473.16 = 663.05 (US$ 174.49)
	Most Optimistic Scenario	87.55	290.98	151.91 + 378.53 = 530.44 (US$ 139.59)
	Most Pessimistic Scenario	131.33	436.46	227.85+ 567.79 = 795.66 (US$ 209.38)

Clinical Situation	Ministry of Health Transfer	Global Costs for Overdenture provision within public health system
Clinical Situation	Ministry of Health Transfer	Base Scenario	Most Optimistic Scenario	Most Pessimistic Scenario
Re-use of conventional denture	R$ 670 (US$ 176.31)	Costs: R$ 663.05 (US$ 174.49) Difference from transfer: R$ 6.95 (US$ 1.82)	Costs: R$ 530.44 (US$ 139.59) Difference from transfer: R$ 139.56 (US$ 36.72)	Costs: R$ 795.66 (US$ 209.38) Difference from transfer: R$ -125.66 (US$ -33.07)
Overdenture as first choice	R$ 820 (US$ 215.79)	Costs: R$ 663.05 (US$ 174.49) Difference from transfer: R$ 156.95 (US$ 41.30)	Costs: R$ 530.44 (US$ 139.59) Difference from transfer: R$ 289.56 (US$ 76.20)	Costs: R$ 795.66 (US$ 209.38) Difference from transfer: R$ 24.34 (US$ 6.41)

ABRASCO - Associação Brasileira de Saúde Coletiva Av. Brasil, 4036 - sala 700 Manguinhos, 21040-361 Rio de Janeiro RJ - Brazil, Tel.: +55 21 3882-9153 / 3882-9151 - Rio de Janeiro - RJ - Brazil
E-mail: cienciasaudecoletiva@fiocruz.br

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[1] Collaborations

DFB Cavalcante, AC Pereira and GMB Ambrosano conceptualized and designed the study. DFB Cavalcante, LF Probst, YW Cavalcanti and AC Pereira collected and analyzed data. DFB Cavalcante and LF Probst drafted the manuscript. YW Cavalcanti, AC Pereira and GMB Ambrosano revised and gave contributed for important intellectual content. All authors revised and approved the final version of the manuscript. All authors contributed significantly for taking part at manuscript’s authorship.