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Economic evaluation on dental caries preventive interventions for Australian children using a priority-setting
Tan Minh Nguyen1,2,3, Long Khanh-Dao Le4, Hanny Calache5
1Health Economics Group, School of Public Health & Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Level 4, 553 St Kilda Road, VIC, 3004, Melbourne, Australia. tan.nguyen@monash.edu.
Summary
Preventive dental interventions for low-income Australian children showed varying cost-effectiveness. Fluoride varnish programs were most promising, especially when combined with screening, over a 12-year period.
Area of Science:
- Public Health
- Health Economics
- Pediatric Dentistry
Background:
- Dental caries is a significant public health issue, particularly affecting children from low socioeconomic backgrounds.
- Effective preventive strategies are crucial for reducing the burden of dental caries in vulnerable populations.
- Economic evaluations are essential for guiding resource allocation in public health interventions.
Purpose of the Study:
- To conduct an economic evaluation of three distinct preventive interventions for dental caries in Australian children from low-income households.
- To compare the cost-effectiveness of anticipatory guidance, school-based fluoride varnish programs, and school-based fissure sealants.
- To assess the impact of different time horizons and inclusion of additional healthcare costs on intervention cost-effectiveness.
Main Methods:
- Economic modeling was used to evaluate interventions including anticipatory guidance (home visits/telehealth), fluoride varnish programs (delivered by dental/non-dental professionals), and fissure sealants.
- Cost-effectiveness analysis was performed using willingness-to-pay thresholds for disability-adjusted life years (DALYs) averted and quality-adjusted life years (QALYs) gained.
- Sensitivity analyses and extrapolation modeling up to a 12-year time horizon were conducted to assess the robustness of the findings.
Main Results:
- In the base-case scenario, none of the evaluated interventions were found to be cost-effective.
- Cost-effectiveness improved significantly when including other healthcare costs and extending the time horizon to 12 years through extrapolation modeling.
- Under the 12-year extrapolation model, fluoride varnish programs demonstrated the highest probability of cost-effectiveness (91.5% for DALYs, 94.7% for QALYs), followed by combined screening and fluoride varnish.
Conclusions:
- School-based fluoride varnish programs, particularly when combined with dental screening, emerge as the most cost-effective strategy for preventing dental caries in low-income Australian children over the long term.
- Anticipatory guidance via telehealth shows moderate cost-effectiveness, while home visits and fissure sealants appear less cost-effective within the evaluated parameters.
- Policy decisions regarding pediatric dental caries prevention should consider long-term economic modeling and the specific delivery model of interventions.
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