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An Economic Evaluation of a Comprehensive School-Based Caries Prevention Program.
S S Huang1, R R Ruff1,2, R Niederman1
1Department of Epidemiology and Health Promotion, College of Dentistry, New York University, New York, NY, USA.
JDR Clinical and Translational Research
|April 23, 2019
Summary
Comprehensive school-based caries prevention programs (SCPPs) are more cost-effective when they treat all teeth, not just first molars. Current evaluations may underestimate SCPP value by focusing narrowly on limited tooth types.
Area of Science:
- Dental Public Health
- Health Economics
- Preventive Dentistry
Background:
- Current economic evaluations of school-based caries prevention programs (SCPPs) often lack comparative analyses between different SCPP types.
- Existing assessments frequently focus solely on permanent first molars, potentially overlooking broader impacts.
Purpose of the Study:
- To evaluate the cost-effectiveness of a comprehensive SCPP compared to a sealant-only SCPP and no intervention.
- To analyze these comparisons considering impacts on permanent first molars exclusively and on all posterior teeth.
Main Methods:
- A simulation model was developed from a societal perspective, using data from the CariedAway comprehensive SCPP.
- Evaluated incremental cost-effectiveness ratios (ICERs) for three approaches: comprehensive, sealant-only, and no program.
- Sensitivity analyses (probabilistic, 1-way, 2-way) were performed to ensure robustness.
Main Results:
- When considering only permanent first molars, the comprehensive SCPP was less cost-effective than sealant-only programs (ICER: $283,455/averted DALY).
- However, when including all posterior teeth, the comprehensive SCPP became cost-saving compared to sealant-only programs (ICER: -$943,460.88/averted DALY) and no program (ICER: -$400,645.52/averted DALY).
Conclusions:
- Economic evaluations limited to permanent first molars may underestimate the cost-effectiveness of comprehensive SCPPs.
- Comprehensive SCPPs demonstrate greater value when their scope includes preventing and arresting decay across all teeth.
- Future economic evaluations of SCPPs should encompass health and cost impacts beyond just permanent first molars.
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