Economic evaluation on dental caries preventive interventions for Australian children using a priority-setting approach

Abstract

This study aims to economically evaluate three preventive interventions for dental caries among Australian children from low household income. The interventions included: (1) anticipatory guidance provided by oral health therapists via 1a) home visits or 1b) telehealth consultations; (2) school-based dental screening and fluoride varnish program delivered by 2a) dental practitioners or 2b) non-dental health professionals (no screening); and (3) school-based fissure sealant program. The base-case scenario included intervention and dental treatment costs, with six-year (1a and 1b) and two-year (2a, 2b and 3) time horizons. Sensitivity analysis included other healthcare costs (e.g. pulp therapy, extractions, etc.). Additionally, extrapolation modelling extended the 12-year time horizon (all interventions). Probability for cost-effectiveness applied AUD$50,000 per disability-adjusted life year (DALY) averted, and AUD$28,033 per quality-adjusted life year (QALY) gained willingness-to-pay thresholds. Under the base-case scenario, none of the interventions were cost-effective. Cost-effectiveness results were sensitive when including other healthcare costs and the 12-year time horizon. Probability for cost-effectiveness (DALYs averted/QALYs gained) with extrapolation modelling in order of ranking were: (1) 91.5%/94.7% for fluoride varnish, (2) 43.9%/48.6% for dental screening and fluoride varnish, (3) 28.7%/29.8% for anticipatory guidance via telehealth, (4) 17.1%/20.0% for fissure sealant, and (5) 2.2%/2.2% for anticipatory guidance via home visits.

Keywords: Children; Dental caries; Economic evaluation; Fluorides; Resource allocation.