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.