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Simulating cost-effectiveness of fluoride varnish during well-child visits for Medicaid-enrolled children
Rocio B Quiñonez1, Sally C Stearns, Bhavna S Talekar
1Department of Pediatric Dentistry, School of Dentistry, University of North Carolina at Chapel Hill, NC 27599, USA. quinoner@dentistry.unc.edu
Insights
Fluoride varnish applied during well-child visits effectively reduces early childhood caries in low-income children. However, it is not cost-saving within the first 42 months, with potential savings emerging under specific cost conditions.
Area of Science:
- Pediatric Health
- Dental Public Health
- Health Economics
Background:
- Early childhood caries (ECC) is a significant public health concern, particularly in low-income populations.
- Preventive dental interventions in primary care settings can improve access for underserved children.
Purpose of the Study:
- To evaluate the cost-effectiveness of fluoride varnish application by medical providers within a well-child schedule for Medicaid-enrolled children.
- To determine the economic impact of universal fluoride varnish interventions on preventing early childhood caries.
Main Methods:
- Cost-effectiveness analysis using published data on fluoride varnish efficacy (35.4%), application costs ($16.00), caries increment (14%), and treatment costs.
- Comparison of universal fluoride varnish application at 9, 18, 24, and 36 months versus no intervention.
- Analysis from a Medicaid payer's perspective, measuring cost per cavity-free month and averted treatments.
Main Results:
- Fluoride varnish improved outcomes by 1.52 cavity-free months but incurred a cost of $7.18 per month gained and $203 per averted treatment.
- The intervention was cost-saving only when dental services and non-hospital treatment costs were 1.5 to 2 times higher than estimated.
- Sensitivity analysis revealed considerable uncertainty in parameter estimates.
Conclusions:
- Fluoride varnish in medical settings is effective for reducing ECC in low-income children but not cost-saving within the first 42 months.
- Further longitudinal cohort evaluations are recommended to fully assess long-term cost-effectiveness.
- Findings suggest potential cost reductions under specific economic scenarios.
Objective:
To examine the cost-effectiveness of fluoride varnish application by medical providers when implemented within a well-child periodicity schedule for Medicaid-enrolled children.
Design:
Cost-effectiveness was analyzed using published probabilities and costs. Input parameters included the effectiveness of fluoride varnish (35.4%) applied according to the well-child periodicity schedule up to 3 years of age at $16.00 per application, annual caries increment (14%), age-specific dental care usage rates (0.2% at 9 months to 19% at 42 months), and age-related nonhospital treatment costs ($292.00-$503.00) and hospital treatment costs ($2191.00-$2940.00). Sensitivity analysis was conducted to assess the effects for varying input parameters.
Setting:
Well-child visits during primary care.
Participants:
Children aged 9 to 42 months.
Intervention:
Application of universal fluoride varnish (fluoride varnish-all) at 9, 18, 24, and 36 months vs no intervention (fluoride varnish-none) was compared.
Main Outcome Measures:
Cost per month without cavities and treatment averted during the first 42 months of life from a Medicaid payer's perspective.
Results:
Fluoride varnish improved clinical outcomes by 1.52 cavity-free months but at a cost of $7.18 for each cavity-free month gained per child and $203 for each treatment averted. Considerable uncertainty existed for some parameters. Fluoride varnish was cost saving when dental services and nonhospital treatment costs were 1.5 to 2 times greater, respectively, than our base case estimate.
Conclusions:
Based on these assumptions, fluoride varnish use in the medical setting is effective in reducing early childhood caries in low-income populations but is not cost saving in the first 42 months of life. Potential total cost reductions with varying parameters suggest that evaluations using a longitudinal cohort are needed.