Cost‐effectiveness analysis of silver diamine fluoride to divert dental general anaesthesia compared to standard care

Abstract

Background The aim is to perform a model‐based cost‐effectiveness analysis of a silver diamine fluoride (SDF) protocol intervention to divert dental general anaesthesia (DGA) among Victorian children aged 2–10 years. Methods Data inputs were based on an Australian single‐cohort 2017/18 study. Intervention costs for standard care were derived from two subgroups of children: (1) children who received standard care without DGA, and (2) children who received standard care with DGA. Two scenarios were modelled due to limited post‐follow‐up data: (1) children receiving SDF had standard care without DGA (base‐case scenario), and (2) children receiving SDF did not receive standard care without DGA (alternative scenario). A simple decision‐tree model with probabilistic sensitivity analysis (PSA) estimated the incremental costs per diverted DGA. Results The probability of children requiring specialist referral and offered SDF, but the primary carer opted for DGA is 0.124 (SD 0.034), and the probability of children requiring DGA in standard care is 0.346 (SD 0.036). For both the base‐case and alternative scenario, the incremental cost‐effectiveness ratio outcome is dominant and their cost‐effectiveness being either 74.8% or 100% respectively. Conclusions The SDF protocol intervention is cost‐effective dental caries management option for young children where referral for DGA is considered. © 2022 Australian Dental Association.

Professionally applied fluorides for preventing and arresting dental caries in low‐ and middle‐income countries: Systematic review

“…Even though the evidence generated from the current review is of low certainty, the global literature on topical fluoride interventions have demonstrated significant clinical benefits, leading to better health outcomes and reduced costs compared with standard care practices [60–62]. However, the present review specifically focused on LMICs.…”

Prioritizing population oral health through public policy in Australia: the Victorian experience

“…For example, clinical leadership by the American Academy of Pediatrics has enabled the delivery of fluoride varnish application by non-dental professionals since 2008 ( Hanlon, 2010 ) in the USA under the Medicaid program for young children. Non-invasive cost-effective interventions such as the application of fluoride varnish and silver fluoride (Nguyen et al, 2020 , 2022 ) are opportunities for broader implementation and delivered by non-dental professionals. In Victoria, the same intervention could be implemented through the Victorian Maternal and Child Health Service, which is a responsibility of local government authorities for program delivery.…”

“…Historically, dental caries has largely been the focus of prevention efforts for oral diseases due to their highest prevalence. The prevalence of periodontitis is significantly less than dental caries but has larger disease burden measured in years lived with disability, which reinforces urgent prevention is required targeting periodontitis ( Nguyen et al , 2022 ). Future analyses that broaden the search terms to include other oral diseases such as periodontal disease and head and neck cancer, and establishing oral health outcomes surveillance systems for LGAs would be important to monitor the impact of VPHWPs and the MPHWPs.…”

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

“…Studies were classified chronologically according to their country of study conduct, number of study participants, location (e.g., practice/clinic) of study conduct, age of study participants, and study quality assessment. Furthermore, included studies were classified into two main groups of prevention according to their primary outcome [18,[27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] and restoration [42][43][44][45][46][47][48] with different subgroups divided at prevention (outreach/education/education, sealing, fluoride varnish, and silver diamine fluoride (SDF) and atraumatic restorative treatment (ART) as well as restoration (filling and crown). For ease of synthesis and clarity, the results were summarized in tables.…”