GuREx-MIH: cost-effectiveness analysis of extraction versus restorative treatment for first permanent molars affected by Molar-Incisor Hypomineralisation in 11-year-old Swedish children

The aim of this study was to evaluate the cost-effectiveness of extraction compared with restorative treatment of first permanent molars (FPMs) affected by Molar–Incisor Hypomineralisation (MIH) in 11-year-olds in Sweden. Seventy-five patients from the GuREx-MIH project were included. Of these, 43 were randomised to the Restorative treatment group (ReTG) and 32 to the Extraction treatment group (ExTG). Healthcare costs were calculated from dental records, while non-healthcare costs, were collected through surveys. Effectiveness was measured using the Child Perceptions Questionnaire (CPQ11-14) and the proportion of patients achieving a minimally important difference (MID). Incremental cost-effectiveness ratios (ICERs) were calculated as the difference in costs divided by the difference in effectiveness between groups. The ExTG incurred higher mean healthcare (€1,417 vs. €1,051; p = 0.029) and total costs (€2,950 vs. €2,161; p = 0.029) compared with the ReTG, almost entirely due to general anaesthesia (GA), while non-healthcare costs were (€1,531 vs. €1,111; p = 0.117). When patients treated under GA were excluded, the ExTG became less costly, with lower healthcare costs (€868 vs. €1,051; p = 0.039), fewer visits (9.2 vs. 11.4; p = 0.025), and shorter chair time (324 vs. 401 min; p = 0.040). ICERs showed that with GA, extraction was associated with higher incremental costs per MID responder (€2,593 healthcare; €6,110 total). Without GA, extraction was either dominant when only healthcare costs were considered or showed a cost of €4,201 per MID responder when considering total costs. Compared with restorative treatment, extraction was associated with higher healthcare and total costs, primarily due to general anaesthesia, but also linked with a greater proportion of patients achieving clinically meaningful improvements in oral health-related quality of life at the age of 11 years. The study was retrospectively registered on ClinicalTrials.gov 29th of January 2024, registration number: NCT06228989.