Cost‐effectiveness of a disease management program for early childhood caries

Samnaliev, Mihail; Wijeratne, Rashmi; Kwon, Eun-Hae; Ohiomoba, Henry; Ng, Man Wai

doi:10.1111/jphd.12067

Cited by 29 publications

(31 citation statements)

References 14 publications

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“…Among its recommendations are the control of a cariogenic diet, adopting routine measures of oral hygiene from the eruption of the first tooth and the use of fluoride. This approach is very efficient in preventing ECC in public health services and decreasing the cost of treatment in children younger than 5 years . Our results suggest that the preventive programme may have a positive impact beyond early childhood, improving oral health up to adulthood.…”

Section: Discussionmentioning

confidence: 68%

Influence of a preschool preventive dental programme on caries prevalence, oral care and secretory immunity to Streptococcus mutans in young adults

Aida

Ramos

Seixas

et al. 2017

Int J Dental Hygiene

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Section: Discussionmentioning

confidence: 68%

Influence of a preschool preventive dental programme on caries prevalence, oral care and secretory immunity to Streptococcus mutans in young adults

Aida

Ramos

Seixas

et al. 2017

Int J Dental Hygiene

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“…Vermaire et al (2014) and Samnaliev et al (2015) came to similar conclusions in their analyses, in that treatments aimed at caries prevention increased the cost of providing treatment and that the opportunity cost of these treatments is dependent on the payers' willingness-to-pay [30,31]. Our results differ from other studies in which the HT, which was a component of our B + P intervention, was reported to be more effective and less costly [11,12] when compared to conventional and preventive based strategies.…”

Section: Discussionmentioning

confidence: 80%

Cost-effectiveness of child caries management: a randomised controlled trial (FiCTION trial)

et al. 2020

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Background: A three-arm parallel group, randomised controlled trial set in general dental practices in England, Scotland, and Wales was undertaken to evaluate three strategies to manage dental caries in primary teeth. Children, with at least one primary molar with caries into dentine, were randomised to receive Conventional with best practice prevention (C + P), Biological with best practice prevention (B + P), or best practice Prevention Alone (PA). Methods: Data on costs were collected via case report forms completed by clinical staff at every visit. The coprimary outcomes were incidence of, and number of episodes of, dental pain and/or infection avoided. The three strategies were ranked in order of mean cost and a more costly strategy was compared with a less costly strategy in terms of incremental cost-effectiveness. Costs and outcomes were discounted at 3.5%. Results: A total of 1144 children were randomised with data on 1058 children (C + P n = 352, B + P n = 352, PA n = 354) used in the analysis. On average, it costs £230 to manage dental caries in primary teeth over a period of up to 36 months. Managing children in PA was, on average, £19 (97.5% CI:-£18 to £55) less costly than managing those in B + P. In terms of effectiveness, on average, there were fewer incidences of, (− 0.06; 97.5% CI: − 0.14 to 0.02) and fewer episodes of dental pain and/or infection (− 0.14; 97.5% CI: − 0.29 to 0.71) in B + P compared to PA. C + P was unlikely to be considered cost-effective, as it was more costly and less effective than B + P. Conclusions: The mean cost of a child avoiding any dental pain and/or infection (incidence) was £330 and the mean cost per episode of dental pain and/or infection avoided was £130. At these thresholds B + P has the highest probability of being considered cost-effective. Over the willingness to pay thresholds considered, the probability of B + P being considered cost-effective never exceeded 75%. Trial registration: The trial was prospectively registered with the ISRCTN (reference number ISRCTN77044005) on the 26th January 2009 and East of Scotland Research Ethics Committee provided ethical approved (REC reference: 12/ES/0047).

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“…Our results may support the use of chronic disease management for severe ECC (Edelstein and Ng 2015). Programs at large children’s hospitals have successfully implemented CDM programs that integrate personal goal setting and fluoride varnish application to reduce dental GA use and expenditures (Ng et al 2014; Samnaliev et al 2015). Physicians or pediatricians may have a place in the CDM framework as a practitioner who applies frequent primary prevention techniques to teeth as they are erupting.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Physician Oral Health Services on Dental Use and Expenditures under General Anesthesia

Meyer

Wang

Steiner

et al. 2019

JDR Clinical & Translational Research

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Background: Despite early evidence touting the effectiveness of physician-provided oral health services (POHS), recent evidence suggests these services might have little impact on caries-related outcomes in children. General anesthesia (GA) is often used to treat early childhood caries and may be considered the most extreme utilization outcome. We sought to assess the impact of POHS utilization on dental GA utilization and expenditures. Methods: We used the Medicaid claims of a birth cohort of children born in 2008 in North Carolina ( N = 32,558) to determine the impact of POHS on dental utilization and expenditures under GA for individual children. Children were followed until their eighth birthday. We analyzed the association of the number of prior POHS visits with visit-specific outcomes of dental treatment under GA using population-averaged models fit with generalized estimating equations with exchangeable working correlation structure. Results: Children with 2 or more previous POHS visits had reduced odds of GA (odds ratio [OR] = 0.93; confidence interval [CI], 0.87–0.99; P = 0.029) and expenditures ($114; CI,−$152.61 to −$75.19; P < 0.001) compared to those without physician-provided oral health visits, adjusting for age, sex, race/ethnicity, and geographic residence. Dental expenditures did not differ between POHS and non-POHS subjects at non-GA visits. Conclusions: POHS decreased the odds of having dental GA treatment and dental expenditures at GA visits. The role of physicians in oral health care can reduce the impact on the most severe outcome—treatment under general anesthesia. Knowledge Transfer Statement: The results of this study have important financial implications for state Medicaid programs and disease management programs trying to mitigate the costs of treating early childhood caries under general anesthesia. Children who receive physician oral health care are less likely to use and more likely to save money on general anesthesia to complete dental treatment.

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Cost‐effectiveness of a disease management program for early childhood caries

Abstract: The DM program appears cost-effective and has the potential to reduce health care costs. Our results justify a multicenter trial to evaluate the DM program on a larger scale.

Cited by 29 publications

References 14 publications

Influence of a preschool preventive dental programme on caries prevalence, oral care and secretory immunity to Streptococcus mutans in young adults

Influence of a preschool preventive dental programme on caries prevalence, oral care and secretory immunity to Streptococcus mutans in young adults

Cost-effectiveness of child caries management: a randomised controlled trial (FiCTION trial)

The Effect of Physician Oral Health Services on Dental Use and Expenditures under General Anesthesia

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