A Cost Analysis of Three Pharmacologic Behavior Guidance Modalities in Pediatric Dentistry

Purpose: The aims of this study was to compare dental treatment costs for three pharmacologic behavior guidance modalities: (1) dental office-based moderate sedation (SED); (2) hospital-based general anesthesia (GA-H); and (3) dental office-based general anesthesia (GA-OFF). Methods: Data were collected for healthy two- to six-year-olds who had full-mouth rehabilitation using GA-H at the University of North Carolina Children's Hospital, Chapel Hill, N.C., USA. Patients served as their own controls to compare costs across the three modalities. Rendered treatments were quantified using relative value units (RVUs). Costs included opportunity costs and administrative data. We relied upon ordinary least squares analyses to examine the relationship between total costs and RVUs. Results: Of 200 consecutive hospital records, 65 met the inclusion criteria. The mean age was 4.4 years old (range equals two to six years old; 41 ASA I, 24 ASA II). Dental treatment using GA-H averaged 118 minutes (range equals 62 to 256 minutes), with a mean of 12 teeth (range equals six to 20) treated. GA-H costs were 4.1 times greater than GA-OFF costs (range equals 1.1 to 4.9), and 4.5 times greater than SED costs (range equals 0.9 to 7.1); GA-OFF costs were 1.1 times greater than SED costs (range equals 0.7 to 1.6). Conclusions: Treatment completed (measured in relative value units) was correlated highest with costs for dental office-based moderate sedation and least for hospital-based general anesthesia. If more than four SED appointments are needed, GA-OFF may provide cost-savings; however, at no point does GA-H offer cost-savings.