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Benefit-Cost Analysis of Noninvasive Early Childhood Caries Interventions among Latvian Children
I Maldupa1,2, S E Uribe1,3,4,2, O Sļepcova1,2
1Department of Conservative Dentistry and Oral Health, Riga Stradins University, Riga, Latvia.
Insights
Biannual silver diamine fluoride (SDF) applications are the most cost-effective strategy for managing early childhood caries (ECC) in Latvian preschoolers. This approach significantly reduces health care complications and associated costs compared to other interventions.
Area of Science:
- Pediatric Dentistry
- Dental Public Health
- Health Economics
Background:
- Early childhood caries (ECC) poses a significant public health challenge, necessitating effective and cost-efficient management strategies.
- Noninvasive approaches are increasingly favored for managing ECC in preschool populations.
- Evaluating the economic impact of different ECC management strategies is crucial for healthcare policy and resource allocation.
Purpose of the Study:
- To conduct a benefit-cost analysis of noninvasive early childhood caries management strategies in Latvian preschoolers compared to a placebo.
- To evaluate these strategies from a healthcare perspective over a 12-month period.
- To determine the most cost-effective intervention for ECC management in this population.
Main Methods:
- A randomized, blinded, placebo-controlled trial was conducted with 6 intervention strategies: placebo (P1, P2), silver diamine fluoride (SDF1, SDF2), and Tiefenfluorid (TF1, TF2), with varying recall intervals and behavioral modification.
- Probabilistic sensitivity analysis was employed from a healthcare perspective.
- Incremental benefit-cost ratios (IBCRs) were calculated, with health care complications averted (teeth with pulp involvement due to caries) as the primary economic outcome measure.
Main Results:
- All tested strategies were more effective than the comparator in averting health care complications and caries lesions.
- Biannual SDF applications (SDF2) and biannual Tiefenfluorid applications (TF2) were dominant interventions, showing negative IBCRs (-0.98 and -0.80, respectively), indicating cost savings.
- SDF1 and TF1 demonstrated positive IBCRs (2.95 and 10.67, respectively), signifying economically beneficial interventions with a lower return on investment.
Conclusions:
- Biannual silver diamine fluoride (SDF2) applications represent the most cost-effective strategy for managing early childhood caries (ECC), significantly outperforming Tiefenfluorid (TF2) and placebo (P2).
- While TF2 and P2 showed slight improvements over placebo (P1) due to added behavioral modification, SDF2 demonstrated superior economic benefits.
- Implementing biannual SDF applications in Latvia is recommended to reduce ECC-related health care complications and associated costs.
Objectives:
Analyze the benefit-cost analysis of noninvasive early childhood caries (ECC) management in Latvian preschoolers versus placebo, from a health care perspective, over 12 mo.
Methods:
Randomized, blinded, placebo-controlled trial (September 2020-August 2022) at Riga Stradins University, Latvia. A factorial trial was conducted with 3 interventions (placebo, silver diamine fluoride [SDF], Tiefenfluorid) and 2 recall intervals (none: 1 and 6 mo: 2), all including behavioral modification. The 6 strategies were placebo (P1, P2), SDF (SDF1, SDF2), and Tiefenfluorid (TF1, TF2). Probabilistic sensitivity analysis was calculated from the health care perspective. Costs associated with each ECC management program and associated treatments were identified and measured. Incremental benefit-cost ratios (IBCRs) were calculated to determine the margin by which each program was more beneficial than P1 (comparator). The primary outcome measure used for economic evaluation was health care complications averted, defined as teeth with pulp involvement due to dental caries. The economic costs associated with health care complications averted were quantified in monetary terms as benefits.
Results:
All alternative strategies were more effective than the comparator in averting health care complications and dental caries lesions. Over 12 mo, SDF2, TF2, and P2 were dominant interventions, yielding an IBCR of -0.98, -0.80, and -0.70, respectively. SDF1 and TF1 had an IBCR of 2.95 and 10.67, respectively, rending these interventions economically beneficial but with lower return on investment.
Conclusion:
Biannual SDF applications (SDF2) were the most cost-effective for ECC, significantly outperforming Tiefenfluorid® (TF2) and placebo (P2). TF2 and P2 slightly improved over placebo (P1) due to additional behavioral modification and counseling. Implementing SDF2 in Latvia would likely reduce health care complications and costs.Knowledge Transfer Statement:This study compared 5 noninvasive early childhood caries management strategies with a placebo "no treatment" group over a 12-mo period. The primary outcome measure was health care complications averted, quantified in monetary terms. The results showed that the 6-monthly applications of SDF and fluoride varnish demonstrated cost savings compared with the placebo group. The study recommends implementing SDF and fluoride varnish into routine clinical practice to reduce health care complications and associated costs.
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