Cost‐effectiveness analysis of atraumatic restorative treatment to manage early childhood caries: microsimulation modelling

Tonmukayakul, Utsana; Forrest, Helen; Arrow, Peter

doi:10.1111/adj.12857

Cited by 3 publications

(2 citation statements)

References 24 publications

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“…The least cost-effective program among the five alternative interventions was APF-Gel program, which recorded the highest incremental cost (ZAR1825) per averted DMFT compared to the baseline intervention, “do nothing” and had the lowest NMB, ZAR1.6 billion. The findings are consistent with previous studies which have shown that ART [ 64 ] and fissure sealants [ 65 ] are cost-effective interventions in caries prevention. Findings from Chile show that the use of APF-Gel in caries prevention was less cost-effective compared to other interventions such as supervised tooth brushing programs [ 33 ].…”

Section: Discussionsupporting

confidence: 93%

Cost-effectiveness of dental caries prevention strategies in South African schools

Boachie,

Molete,

Hofman

et al. 2023

BMC Oral Health

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Background In South Africa, an estimated 85% of the population relies on the public sector for oral health services. With poor infrastructure and inadequate personnel, over 80% of children with dental caries remain untreated. To reduce this burden of disease, one key goal is to promote good oral health and address oral diseases through prevention, screening, and treatment among children. While all policies have been proven to be effective in the control and prevention of dental caries, it is unclear which of those strategies provide value for money. This study evaluated five caries preventative strategies in terms of the cost and benefits among South African school children. Methods The study uses a hypothetical South African population of school aged learners aged 5–15. The context and insights of the strategies utilized at the schools were informed by data from both grey and published literature. Using Markov modeling techniques, we conducted a cost-effectiveness analysis of Acidulated Phosphate Fluoride (APF) application, atraumatic restorative treatment (ART), sugar-reduction and fissure sealants. Markov model was used to depict the movement of a hypothetical patient cohort between different health states over time. We assessed both health outcomes and costs of various interventions. The health outcome metric was measured as the number of Decayed, Missing, Filled Tooth (DMFT). The net monetary benefit was then used to determine which intervention was most cost-effective. Results The results showed that school-based caries prevention strategies are cost-effective compared to the status quo of doing nothing. The average cost per learner over the 10-year period ranged from ZAR4380 to approx. ZAR7300 for the interventions considered. The total costs (including screening) associated with the interventions and health outcome (DMFT averted) were: sugar reduction (ZAR91,380, DFMT: 63,762), APF-Gel (ZAR54 million, DMFT: 42,010), tooth brushing (ZAR72.8 million, DMFT: 74,018), fissure sealant (ZAR44.63 million, DMFT: 100,024), and ART (ZAR45 million, DMFT: 144,035). The net monetary benefits achieved for APF-Gel, sugar reduction, tooth brushing, fissure sealant and ART programs were ZAR1.56, ZAR2.45, ZAR2.78, ZAR3.81, and ZAR5.55 billion, respectively. Conclusion Based on the net monetary benefit, ART, fissure sealant and sugar-reduction appear to be the most cost-effective strategies for preventing caries in South Africa. In a resource-scarce setting such as South Africa, where there is no fluoridation of drinking water, this analysis can inform decisions about service packages for oral health.

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Section: Discussionsupporting

confidence: 93%

Cost-effectiveness of dental caries prevention strategies in South African schools

Boachie,

Molete,

Hofman

et al. 2023

BMC Oral Health

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“…14 Also, children who were recommended a DGA and managed using the ART/HT approach in a primary care setting (non-DGA) improved in their COHRQoL after treatment and the approach was found to be cost-effective. 15,16 This study tested a combined ART and HT (ART/HT) model of care against the standard care to treat children with ECC living in remote Aboriginal communities in WA for its effectiveness. 17 It was expected that because the model of care required minimal equipment and materials it could be used to deliver dental services using portable equipment, and in locations where traditional services could not be readily delivered.…”

Section: Introductionmentioning

confidence: 99%

Atraumatic restorative treatments and oral health‐related quality of life and dental anxiety in Australian Aboriginal children: A cluster‐randomized trial

Arrow

Piggott

Carter

et al. 2021

Comm Dent Oral Epid

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Objectives:The management of early childhood caries is challenging and the impacts of its treatment on child oral health-related quality of life (COHRQoL) and dental anxiety among Australian Aboriginal children is relatively unknown. The aim of the study was to compare the impact on COHRQoL and dental anxiety after approximately 12 months among Aboriginal children treated for early childhood caries (ECC) using the Atraumatic Restorative Treatment and the Hall Technique (ART/HT: test) or standard care (control).Methods: Consenting Aboriginal communities in the North-West of Western Australia were randomized into early (test) or delayed (control) intervention for the management of ECC. Children and parents/carers completed a questionnaire at baseline and at follow-up. The questionnaire sought information on COHRQoL using the proxyreported Early Childhood Oral Health Impact Scale (ECOHIS) and the self-reported Caries Impacts and Experiences Questionnaire for Children (CARIES-QC). The test group was provided with the ART/HT care at baseline while the control group was advised to seek care through the usual care options available within the community. At follow-up, both groups were offered care using the ART/HT approach. Changes in the mean scores from baseline to follow-up within groups were evaluated using appropriate paired (t-test, Wilcoxon paired test), and between groups with unpaired tests (ttest). Multivariate regression analysis after multiple imputations of missing data used generalized estimating equation (GEE) controlling for clustering within communities.Results: Twenty-five communities and 338 children (mean age = 3.6 years, sd 1.7) participated in the study (test = 177). One child was excluded from the analysis because of a missing questionnaire and clinical data at baseline and follow-up. At baseline, test group children were older (test = 3.8 years, 95% CI 3.6-4.1;control = 3.3 years, 95% CI 3.1-3.6) and had higher caries experience (test dmft = 4.4, 95% CI 3.8-5.0;control dmft = 3.1, 95% CI 2.5-3.7), but there was no significant difference in COHRQoL or

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Cost-Effectiveness of Treatment Decisions for Early Childhood Caries in Infants and Toddlers: A Systematic Review

Wolf,

Campus

2023

Medicina

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Background and Objectives: Early childhood caries (ECC) is a multifactorial, biofilm-mediated, sugar-related, dynamic disease of primary dental hard tissues occurring in varying degrees of severity in infants and toddlers. Untreated ECC may lead to pain, infections, and severe systemic complications. The aim of this study was to systematically review and evaluate the scientific evidence on the cost-effectiveness of treatment decisions in ECC in infants and toddlers. Materials and Methods: Observational epidemiological studies, i.e., cohort studies, case–control studies, and randomized controlled trials, reporting cost-effectiveness of treatment decisions in ECC in infants and toddlers were included in the systematic review following the PRISMA guidelines. Using an ad hoc search with search terms or keywords (MeSH), electronic databases Embase, MEDLINE via PubMed, Scopus, and gray literature were searched. Results: The search identified 494 articles, of which 446 remained after removing duplicates. A total of 417 articles were excluded after title and abstract evaluation; 29 full-text articles were screened for eligibility, and five articles were discarded. Twenty-four full-text articles were included in the systematic review, assigning 17 to prevention and seven to restoration. Results were heterogeneous; comparability of included studies is difficult because of the different methodologies used. Conflicting efficacies were demonstrated for different interventions implemented, and cost-effectiveness data were documented. Conclusions: Socioeconomic, cultural, and ethnic differences must be considered when comparing conditions in terms of cost-effectiveness. A paradigm shift from surgical towards preventive treatment decisions can be observed. Cost-effectiveness studies on therapies for ECC in infants and toddlers are needed to identify the best practice approach and the most cost-effective therapy decisions.

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Cost‐effectiveness analysis of atraumatic restorative treatment to manage early childhood caries: microsimulation modelling

Cited by 3 publications

References 24 publications

Cost-effectiveness of dental caries prevention strategies in South African schools

Cost-effectiveness of dental caries prevention strategies in South African schools

Atraumatic restorative treatments and oral health‐related quality of life and dental anxiety in Australian Aboriginal children: A cluster‐randomized trial

Cost-Effectiveness of Treatment Decisions for Early Childhood Caries in Infants and Toddlers: A Systematic Review

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