An Economic Evaluation of a Comprehensive School-Based Caries Prevention Program

Huang, Shulamite S.; Ruff, Ryan Richard; Niederman, Richard

doi:10.1177/2380084419837587

Cited by 16 publications

(30 citation statements)

References 15 publications

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“…A total of 738 articles were initially identified and reviewed and 15 met the inclusion criteria 16‐30 . Figure S1 outlines the results of the search process 31 …”

Section: Resultsmentioning

confidence: 99%

“…Nearly 80% of the studies assessed the cost‐effectiveness of interventions based on topical fluoride therapy and fissure sealants at school premises 16‐18,21,23‐25,27,29,30 . Only two studies reported preference‐based health outcomes, 19,28 while all but one 16 reported an Incremental Cost‐Effectiveness Ratio (ICER).…”

Section: Resultsmentioning

confidence: 99%

“…Further, a patient‐centred comprehensive preventive programme was found to be more effective, but costlier than standard care in Finland, 2009 20 . One study reported that school‐based caries preventive programme was cost‐effective for the high‐risk group under lower threshold 17 and it was cost‐effective in all groups if a higher threshold was adapted 28 . More details of the included studies are in Supplementary material .…”

Section: Resultsmentioning

confidence: 99%

“…The quality of the reporting as evidenced by compliance with the CHEERS reporting guidelines moderately differed between studies (Table 3). Four of 15 studies 19,25,28,30 met all relevant criteria in the CHEERS checklist. More details are in Supplementary material .…”

Section: Resultsmentioning

confidence: 99%

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A scoping review of cost‐effectiveness analyses of school‐based interventions for caries

Amilani

Carter

Senanayake

et al. 2020

Comm Dent Oral Epid

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Objectives The aims of this study were to: identify the evidence on cost‐effectiveness of school‐based interventions for caries prevention globally up to 2019; summarize key characteristics of interventions applied within this setting; summarize the reporting quality of previous studies; and to identify and analyse knowledge gaps. Methods A scoping review of published literature on the cost‐effectiveness of school‐based interventions to prevent child tooth decay was conducted. A search in Medline, Cinahl and Embase was performed with no date restriction. Reporting quality of the included studies was assessed against Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. Results Of the 738 records identified in the initial search, 15 studies met the pre‐specified inclusion criteria. The majority were published after 2011 (n = 9,) and applied to high‐income countries (n = 12). Nearly 80% of the studies assessed the cost‐effectiveness of the interventions based on topical fluoride therapies and fissure sealants at school premises. Although, the outcome measures differed across the studies, almost all the caries preventive interventions were cost‐saving or cost‐effective when compared with usual care. Compliance with the CHEERS checklist differed. Conclusions There is evidence to suggest that school‐based caries preventive interventions are cost‐effective, and in some cases cost‐saving. Further evidence is required from low‐ to middle‐income countries to confirm the generalizability of these findings. Future studies should consider adopting Quality Adjusted Life Years as a generic outcome measure that would enable the cost‐effectiveness findings to be compared across different types of interventions and diseases. Improved standardization and quality of reporting are also required.

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“…A total of 738 articles were initially identified and reviewed and 15 met the inclusion criteria 16‐30 . Figure S1 outlines the results of the search process 31 …”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

A scoping review of cost‐effectiveness analyses of school‐based interventions for caries

Amilani

Carter

Senanayake

et al. 2020

Comm Dent Oral Epid

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“…In order to ensure maximum population coverage, we propose that SAFER Dentistry be universally available with no co-payments. Initial economic modeling for children shows that SAFER Dentistry is cost-saving and cost-effective compared to conventional aerosol-generating interventions ( 35 ).…”

Section: Healthy System Options For Implementing Safer Dentistrymentioning

confidence: 99%

A Dental Response to the COVID-19 Pandemic—Safer Aerosol-Free Emergent (SAFER) Dentistry

Benzian

Niederman

2020

Front. Med.

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Dental services are significantly impacted by the COVID-19 pandemic. Almost all dental procedures carry a high infection risk for providers and patients due to the spread of aerosols. As a consequence, public health agencies and professional associations have issued guidelines for enhanced infection control and personal protection equipment and have also limited care to urgent or emergency services. However, there is no dental service concept for pandemic disaster preparedness or response that might be applied. Moreover, pathways to dental care provision in a post-pandemic future with persisting risks are needed. We propose Safer Aerosol-Free Emergent Dentistry (SAFER Dentistry) as one approach to dental services during and emerging from the pandemic. The concept's starting point is the identification of the most common patient needs. The next step is to replace common treatments addressing the most frequent needs with alternative interventions involving a lower infection risk because they do not generate aerosols. SAFER Dentistry is innovative, avoids risk, and responds to the requirements of a pandemic and post-pandemic emergency where the risk of airborne disease transmission remains high. SAFER Dentistry thereby ensures continuity of dental services while protecting providers and patients from infectious pathogens. Moreover, SAFER Dentistry allows dental service providers to remain operational and generate income even under pandemic conditions. Potential implementation and policy options for SAFER Dentistry include universal availability without co-payments by patients and a uniform bundled payment scheme for providers to simplify budgeting, reimbursement, and administration during a pandemic. Adaptations and adjustments of the concept are possible and encouraged as long as the principle of avoiding aerosol-generating procedures is maintained.

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Effect of Silver Diamine Fluoride on Caries Arrest and Prevention

2023

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ImportanceDental caries is the most common global childhood disease. To control caries, the Centers for Disease Control and Prevention recommends school-based caries prevention, and the World Health Organization lists glass ionomer cement and silver diamine fluoride as essential medicines for oral disease.ObjectiveTo determine the noninferiority of silver diamine fluoride with fluoride varnish vs traditional glass ionomer sealants with fluoride varnish after 2 years when provided to children via a school-based health care program.Design, Setting, and ParticipantsThe CariedAway study is an ongoing single-blind, cluster randomized, noninferiority trial conducted between February 1, 2019, and June 1, 2023, among 2998 children in 47 New York City primary schools. Children aged 5 to 13 years of any race and ethnicity were recruited from block-randomized schools. Inclusion criteria for schools were a student population of at least 50% Hispanic or Latino or Latina ethnicity and/or Black race and at least 80% of students receiving free or reduced-cost lunch. Statistical analysis is reported through March 2022.InterventionsChildren received a single application of silver diamine fluoride with fluoride varnish or an active comparator of glass ionomer sealants and atraumatic restorations with fluoride varnish.Main Outcomes and MeasuresPrimary outcomes were caries arrest and incidence after a 2-year follow-up, assessed using mixed-effects multilevel models and clustered 2-sample proportion tests. The noninferiority margin was 10%. Intention-to-treat analysis was performed using multiple imputation.ResultsA total of 2998 children (1566 girls [52.2%]; mean [SD] age at baseline, 6.6 [1.2] years; 1397 Hispanic or Latino or Latina children [46.6%]; 874 [29.2%] with untreated dental caries) were recruited and treated from September 16, 2019, to March 12, 2020. Follow-up observations were completed for 1398 children from June 7, 2021, to March 2, 2022. The mean (SE) proportion of children with arrested caries was 0.56 (0.04) after experimental treatment and 0.46 (0.04) after control treatment (difference, −0.11; 95% CI, −0.22 to 0.01). The mean (SE) proportion of patients without new caries was 0.81 (0.02) after experimental treatment and 0.82 (0.02) after control treatment (difference, 0.01; 95% CI, −0.04 to 0.06). Analysis of imputed data for the full sample did not deviate from per-protocol analyses. There were no adverse events.Conclusions and RelevanceIn this randomized clinical trial, silver diamine fluoride with fluoride varnish was noninferior to sealants and atraumatic restorations with fluoride varnish for caries arrest and prevention. Results may support the use of silver diamine fluoride as an arresting and preventive agent in school-based oral health programs.Trial RegistrationClinicalTrials.gov Identifier: NCT03442309

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An Economic Evaluation of a Comprehensive School-Based Caries Prevention Program

Cited by 16 publications

References 15 publications

A scoping review of cost‐effectiveness analyses of school‐based interventions for caries

A scoping review of cost‐effectiveness analyses of school‐based interventions for caries

A Dental Response to the COVID-19 Pandemic—Safer Aerosol-Free Emergent (SAFER) Dentistry

Effect of Silver Diamine Fluoride on Caries Arrest and Prevention

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