Assessing Cost-Effectiveness of Sealant Placement in Children

Objective: The lack of cost‐effectiveness information regarding sealant placement strategies is thought to have influenced reimbursement policies and subsequent sealant utilization in dental practice. This study compared three strategies for managing the occlusal surfaces of first permanent molars:...

Full description

Saved in:
Bibliographic Details
Published in:Journal of public health dentistry 2005-06, Vol.65 (2), p.82-89
Main Authors: Quiñonez, Rocio B., Downs, Stephen M., Shugars, Dan, Christensen, John, Vann Jr, William F.
Format: Article
Language:English
Subjects:
Child
Cost-Benefit Analysis
cost-effectiveness
decision analysis
Decision Trees
Dental Restoration, Permanent - economics
Dentistry
Humans
Markov Chains
Markov model
Molar
Pit and Fissure Sealants - economics
sealant
Sensitivity and Specificity
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Objective: The lack of cost‐effectiveness information regarding sealant placement strategies is thought to have influenced reimbursement policies and subsequent sealant utilization in dental practice. This study compared three strategies for managing the occlusal surfaces of first permanent molars: seal all (SA), risk‐based (RBS), and seal none (SN). Methods: A decision tree was developed for various possible outcomes following each of the above strategies. Due to the complexity of the decision tree, a Markov model was used to allow for the construction of a chain of events representing the natural history of sealant retention, caries formation, and their associated health states. The outcome measures were the incremental cost per month gained in a cavity‐free state over a ten‐year period. Results: Our theoretical model showed that RBS strategy improved clinical outcomes, in the form of cavity‐free months, and saved money over SN. The strategy of sealing both high and low risk teeth (SA) further improved outcomes but at an additional cost compared to RBS. However, the cost was small, $08 for each additional cavity‐free month gained per tooth. Further, minor changes in the baseline assumptions resulted in the SA strategy being the dominant strategy. Conclusion: This study provides evidence that sealing children's first permanent molars can improve outcomes and save money by delaying or avoiding invasive treatment and the destructive cycle of caries. In a time of limited funds for dental services, these results can assist payers in establishing more rational sealant reimbursement policies.
ISSN:0022-4006
1752-7325
DOI:10.1111/j.1752-7325.2005.tb02791.x