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

• DOI: 10.1016/j.acap.2024.02.006
• Publication Date: 2024-03-26T17:19:03Z
• Authors: Cara B. Janusz; Tran T. Doan; Acham Gebremariam; Angela Rose; Martha A. Keels; Rocio B. Quinonez; George Eckert; Emily Yanca; Margherita Fontana; Lisa A. Prosser
• Keywords: Male; Pit and Fissure Sealants; Adolescent; Child, Preschool; Cost-Effectiveness Analysis; Humans; Infant; Female; Fluorides, Topical; Quality-Adjusted Life Years; Dental Caries; Child; United States

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.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.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.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.