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. 2024 Jul;24(5):765-775.
doi: 10.1016/j.acap.2024.02.006. Epub 2024 Mar 26.

A Cost-Effectiveness Analysis of Population-Level Dental Caries Prevention Strategies in US Children

Cara B Janusz  1 , Tran T Doan  2 , Acham Gebremariam  3 , Angela Rose  3 , Martha A Keels  4 , Rocio B Quinonez  5 , George Eckert  6 , Emily Yanca  6 , Margherita Fontana  7 , Lisa A Prosser  8
Affiliations

A Cost-Effectiveness Analysis of Population-Level Dental Caries Prevention Strategies in US Children

Cara B Janusz et al. Acad Pediatr. 2024 Jul.

Abstract

Objective: To improve oral health disparities and outcomes among US children impacted by dental caries, there is a need to understand the cost-effectiveness of a targeted, risk-based versus universal-based approach for caries prevention.

Methods: Health and economic outcomes were simulated in a cohort of 50,000 US children aged 1-18 years, comparing current practice (CP) to risk-based-prevention (RBP) and prevention-for-all (PFA) strategies using health care sector and limited societal perspectives. Prevention included biannual oral health exams and fluoride varnish application, and one-time dental sealant placement. The primary outcome is the cost-effectiveness ratio (ICER), defined as the additional cost per quality-adjusted life year (QALY) gained when comparing each strategy to the next least costly one.

Results: For RBP compared to CP, the ICER was US$83,000/QALY from the health care sector perspective; for PFA compared to RBP the ICER was US$154,000/QALY. Using a limited societal perspective that includes caregiver time spent attending dental or medical setting visits, RBP compared to CP yielded a ratio of $119,000/QALY and PFA compared to RBP was $235,000/QALY. Results were most sensitive to changes in the probability of pain from an episode of dental caries, costs for prevention and restoration, and the loss in health-related quality of life due to dental caries pain. Scenario analyses evaluating a reduced intensity of prevention services yielded lower ICERs.

Conclusion: Using a risk-based approach that identifies and targets children at increased risk for dental caries to guide the delivery of prevention services represents an economic value similar to other pediatric prevention programs.

Keywords: cavities; child health; economic evaluation; oral health; prevention.

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Conflict of interest statement

Declaration of Competing Interest None.

Figures

Figure 1.
Figure 1.
Simplified schematic of dental caries prevention cost-effectiveness and health impact simulation model Abbreviations: ICDAS = International Caries Detection And Assessment System
Figure 1.
Figure 1.
Simplified schematic of dental caries prevention cost-effectiveness and health impact simulation model Abbreviations: ICDAS = International Caries Detection And Assessment System
Figure 2.
Figure 2.
One-way and multi-way sensitivity analysis
Figure 2.
Figure 2.
One-way and multi-way sensitivity analysis
See this image and copyright information in PMC

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