现代根管治疗与种植修复的成本—效益分析与比较

发布时间：2018-04-08 18:17

本文选题：成本效益分析　切入点：根管治疗　出处：《山东大学》2016年硕士论文

【摘要】：目的临床上对争议牙保留的治疗方法主要是根管治疗和种植修复。相对生活费较高的根管治疗或植牙治疗费用使得患者对治疗效果的预期很高,所以不具备专业知识的患者对不同的治疗方案会有很高的要求。目前我国在口腔领域的研究中运用经济学评价方法的文献鲜少,本文通过回顾国内外相关文献,运用经济学评价的方法和决策树模型就根管治疗和种植义齿的成本-效果进行分析对比,为患者和医生的临床决策提供参考。方法根据《山东省统计年鉴2015))、《中国统计年鉴2015》、现场调查和专家咨询,确定前牙根管治疗+桩核冠修复(PCET, Post-core-crown on endodontically treated teeth)、种植修复的直接成本和间接成本,并用患者的满意度来衡量治疗方法的效益。通过综合国内外与治疗方案相关的meta分析研究,获得前牙种植修复、根管治疗+桩核冠修复的成功率、并发症的概率和相关的贴现率,并建立马尔可夫模型,运用TreeagePro2009软件对模型的成本效益进行计算分析,并用成本效益比率和增量效益成本比作为评价两个方案的指标,最终进行优选。结果通过TreeagePro2009的计算,以五十年年为周期,PCET的初期成本明显低于种植修复,PCET的成本为2011.231-+320.112元与种植修复的7320.112+820.230元,相差约55%。而种植修复总成本也明显高于PCET,种植修复的总成本在10030.451+811.220元,PCET的总成本为3021.453+23.232元,其差值约55%。前10年,PCET的成本明显低于种植修复,且增量成本效益比说明PCET为首选。经五十年后,PCET每1质量调整修复体年(QAPY, qualityadjusted prosthodontic year)的成本低于种植修复,患者可考虑种植修复。结论从成本相对低很多的PCET方案,和与种植修复相似的长期存留率来看,根管治疗+桩核冠修复比种植牙修复比较合算,但经五十年后,随着医保制度的完善和生活水平的提高,种植修复也能作为“保牙”和有咀嚼功能的好的选择。
[Abstract]:Objective to treat the disputed teeth by root canal therapy and implant repair.The higher cost of root canal therapy or dental implants makes patients expect high therapeutic effect, so patients with no professional knowledge will have a high demand for different treatment options.At present, there are few literatures on the use of economic evaluation methods in the field of stomatology in China. This paper reviews the relevant literature at home and abroad.The cost-effect of root canal therapy and implant denture was analyzed and compared by using the method of economic evaluation and decision tree model to provide reference for the clinical decision of patients and doctors.Methods according to Shandong Statistical Yearbook 2005 and China Statistical Yearbook 2015, field investigation and expert consultation were carried out to determine the direct and indirect costs of anterior root canal treatment with post and core crown prosthesis, Post-core-crown on endodontically treated teethet, and implant restoration.The benefits of the treatment were measured by patient satisfaction.The success rate of anterior tooth implant restoration, root canal treatment post and core crown restoration, the probability of complications and the related discount rate were obtained by synthesizing the meta analysis of the treatment plan at home and abroad, and the Markov model was established.The TreeagePro2009 software is used to calculate and analyze the cost benefit of the model, and the cost benefit ratio and the incremental cost benefit ratio are used as the indexes to evaluate the two schemes. Finally, the optimal selection is carried out.Results according to the calculation of TreeagePro2009, the initial cost of PCET with a period of 50 years was obviously lower than that of implant restoration with the cost of RMB 2011.231-320.112 yuan compared with 7320.112 820.230 Yuan of implant restoration, the difference being about 55%.The total cost of planting and restoration is also higher than that of PCET. The total cost of planting and repairing is 3021.453 23.232 yuan at 10030.451 811.220 yuan, the difference is about 55.In the first 10 years, the cost of PCET was significantly lower than that of plant restoration, and the incremental cost benefit ratio indicated that PCET was the first choice.After 50 years, the cost of QAPY (qualityadjusted prosthodontic) per 1 quality adjusted prosthesis is lower than that of implant restoration.Conclusion in terms of the relatively low cost PCET scheme and the similar long-term survival rate as implant restoration, root canal treatment with post and core crown is more cost-effective than dental implant restoration, but after 50 years,With the improvement of medical system and living standard, implant restoration can also be used as a good choice for keeping teeth and chewing.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R783.6;R781.05

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