OBJECTIVES: With the advances in adhesive dentistry, endocrown has been proposed as an alternative to post-retained restoration along with a complete crown for structurally compromised teeth. However, one aspect that has not been studied so far is their cost-effectiveness. Therefore, the present study aimed to assess the cost-effectiveness of endocrown versus complete crowns as a definitive restoration for structurally compromised endodontically treated permanent molar teeth.

METHODS: A Markov simulation model was constructed with endodontically treated permanent molar teeth as a starting point in an 18-year-old patient using TreeAge Pro Healthcare (2023). 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 using Monte Carlo microsimulations. A sensitivity analysis was performed for internally validating the model whereas an experienced health expert as well as an endodontist performed the face validation.

RESULTS: Complete crown was associated with additional health benefits but at an increased cost (1.36 more years with an incremental cost of 1143 USD over a period of 5 years and 0.9 more years with an incremental cost of 1535 USD over an individual’s lifetime) in the base case scenario. The probabilistic sensitivity analysis revealed endocrown to be cost-effective at lower Willingness-To-Pay (WTP) values (92% acceptable at 250USD for 5 years and 73% acceptable at 250 USD for the lifetime of an individual) whereas at increased WTP threshold values, complete crown was a cost-effective treatment option (98.6% acceptable at 1250 USD for 5 years and 99.5% acceptable at 8000 USD over an individual’s lifetime).

CONCLUSIONS: Based on current evidence, endocrown was a cost-effective restorative option at lower WTP values. However, at increased WTP threshold, complete crown became a more cost-effective restoration both over a period of 5 years as well as the lifetime of an individual.