Cost-efficiency analysis of atraumatic restorative treatment with and without chemical-mechanical caries removal agents based on pain and time for selective removal of carious tissue: a public health perspective.

OBJECTIVE: To evaluate the Cost-Efficiency of Atraumatic Restorative Treatment (ART) with a chemical-mechanical caries removal agent (CMCRA, Papacarie Duo Gel(Ⓡ)) compared to conventional ART, based on pain perceived and time for selective removal of carious tissue, from the perspective of the Brazilian Unified Health System (SUS). MATERIALS AND METHODS: The Cost-Efficiency analysis was conducted using TreeAgePro software, considering a 12-month horizon and a hypothetical cohort based on Monte Carlo microsimulation. ART + CMCRA was compared to ART in deciduous teeth, based on 26,700 treatments performed on children attended by SUS in Rio de Janeiro. Direct costs were calculated in Brazilian currency using the microcosting technique. Efficiency measures related to pain and caries removal time were extracted from a high-quality randomized clinical trial. Probabilistic simulation considered a 95% confidence interval and a 5% variation in parameters, generating acceptability curves to estimate the probability of treatment choice. RESULTS: ART + CMCRA proved superior (p < 0,001) in terms of benefit. For pain perceived efficiency, ART + CMCRA resulted in a cost increase of R$ 0.23 per procedure, with an additional benefit of 47.53%. For time efficiency, there was a cost increase of R$ 0.24 per procedure, with an additional benefit of 14.19%. CONCLUSION: ART + CMCRA is a cost-efficient option for SUS. The implementation of this technique in Rio de Janeiro's public health system can be recommended due to the reduced pain, despite requiring a higher willingness to pay for the additional benefits. CLINICAL RELEVANCE: The adoption of ART + CMCRA in SUS can significantly improve the experience of pediatric patients by reducing pain, making dental treatment more efficient and humane.