OBJECTIVE: To evaluate the Cost-Efficiency of Atraumatic Restorative Treatment (ART) with a chemical-mechanical caries removal agent (CMCRA, Papacárie Duo Gel 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 R0.23 per procedure, with an additional benefit of 47.53%. For time efficiency, there was a cost increase of R0.24 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.