O tratamento restaurador atraumático como Programa da Política de Saúde Bucal no Brasil: análise econômica

Abstract

The latest national oral health surveys revealed that 5-year-old children are not having adequate access to dental treatment. The general objective of this study was to economically analyze the Atraumatic Restorative Treatment (ART) as a program for oral health policy in Brazil. To answer the objective, the dissertation was divided into three work plans. The first plan is a scoping review outlined in accordance with the precepts of the Joana Brigges Institute to verify which aspects support ART as an oral health program. The bibliographic search was carried out in the following databases: PubMed, Scopus, Web of Science, Lilacs, Embase, Livivo, Open Grey, Academic Google, Cochrane. For the second plan, a complete cost-effectiveness-type economic analysis was outlined. Survival rates after 1 year (effectiveness) were obtained from Randomized Clinical Trials and the cost of ART was defined by microcosting. Decision trees were modeled to compare glass ionomer cements (GIC) used in ART in simple and composite cavities, from the perspective of the local health manager. A Monte Carlo microsimulation estimated the cost-effectiveness for treating 1000 primary teeth. TreeAge Pro software was used to perform the analyses. The last plan simulated the financial impact of implementing this program in a hypothetical municipality with a population of 1 million inhabitants. To compose the analysis, information was extracted from: National Surveys of Oral Health (SBBrasil) 2003 and 2010; IBGE; and background work results. Hypothetical scenarios were generated in Excel 2019 software. In the scoping review, 1,699 studies were identified, 37 of which were read in full. It was observed as favorable points for ART: Its effectiveness, early intervention in dental caries, high acceptability of patients and the increase in the offer of dental treatments. From the complete economic analysis, it was found that for ART in simple cavities, the choice for Maxxion R (FGM) was less costly (R$ 22,945.23), while Ketac Molar (3M ESPE) was more effective (891,3 teeth). The most cost-effective alternatives were FUJI IX (GC America, ICER=3.12) and Ketac Molar (ICER=5.27). For composite cavities, Vidrion had the highest cost-effectiveness ratio (184.594), while Ketac Molar (ICER=3.65) was more cost-effective. The financial impact analysis revealed that in a scenario where the tooth could be retracted up to twice, the costs with Maxxion would be 24% higher than Ketac and 23% higher than FUJI. At the end xii of 4 years, the number of teeth with failures is 3.18 times higher in Maxxion than in Ketac, and 2.27 times higher than in Fuji. It is concluded that ART is an economically feasible oral health program in Brazil. The materials used for ART differ in terms of cost-effectiveness and those with lower cost may be less effective. Therefore, the investment that the health manager will make to implement ART as an oral health policy program must take into account the effectiveness of the materials, considering that the need to repeat the treatment will increase oral health costs in long term.