Economic evaluation of dental sealants: A systematic literature review

Akinlotan, Marvellous A.; Chen, Bradley; Fontanilla, Tiana; Chen, Annie; Fan, Victoria Y.

doi:10.1111/cdoe.12326

Cited by 26 publications

(25 citation statements)

References 35 publications

(94 reference statements)

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“…Utility was calculated using quality-adjusted tooth years (QATY) [30–33]. QATY is a measure of dental health analogous to quality-adjusted life-year, that provides an outcome measure which could be compared across treatments and across clinical problems.…”

Section: Methodsmentioning

confidence: 99%

The cost-utility of school-based first permanent molar sealants programs: a Markov model

et al. 2019

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BackgroundEvidence of the cost-effectiveness of school-based first permanent molar sealants programs is not yet fully conclusive. The aim of this study was to determine the incremental cost-utility ratio (ICUR) of school-based prevention programs for the application of sealants in molars of schoolchildren compared with non-intervention.MethodsA cost-utility analysis based on a Markov model was carried out using probability distribution. The utility was measured in quality-adjusted tooth years (QATY). The assessment was carried out from the public payer’s perspective with a six-year time horizon. Costs and benefits were discounted at 3% per year. Only direct costs were evaluated, expressed in Chilean pesos (CLP) at 7th May at 2019 values (exchange rate USD = CLP 681.09). Univariate deterministic sensitivity analysis and probabilistic analysis were carried out.ResultsAfter a six-year follow up, the cost of sealing all first permanent molars was found to be higher than non-intervention, with a mean cost difference of USD 1.28 (CLP 875) per molar treated. The “seal all” strategy was more effective than non-intervention, generating 0.2 quality-adjusted tooth years more than non-intervention. The ICUR of the “seal all” strategy compared to non-intervention was USD 6.48 (CLP 4,412) per quality-adjusted tooth years. The sensitivity analysis showed that the increase in caries was the variable which most influenced the ICUR.ConclusionsA school-based sealant program is a cost-effective measure in populations with a high prevalence of caries.

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Section: Methodsmentioning

confidence: 99%

The cost-utility of school-based first permanent molar sealants programs: a Markov model

et al. 2019

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“…Thus, the prevention and treatment of caries in the pits and fissures of occlusal surfaces are of primary concern in children and adolescents [Carvalho et al, 1989[Carvalho et al, , 2016. Besides standard preventive methods such as toothbrushing with fluoridated toothpaste, additional in-office fluoride varnish applications and preventive sealants are effective but costly [Ahovuo-Saloranta et al, 2016, 2017Akinlotan et al, 2018] . Thus, they should be adjusted to the caries risk of the individual or the respective group/population [Schwendicke et al, 2018;Slayton et al, 2018].…”

Section: Occlusal Caries In Permanent Posterior Teethmentioning

confidence: 99%

How to Intervene in the Caries Process in Children: A Joint ORCA and EFCD Expert Delphi Consensus Statement

et al. 2020

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This paper provides recommendations for dentists for the treatment of dental caries in children, with an emphasis on early childhood caries (ECC), primary teeth, and occlusal surfaces in permanent teeth. A consensus workshop followed by an e-Delphi consensus process was conducted with an expert panel nominated by the European Organization for Caries Research (ORCA) and European Federation of Conservative Dentistry (EFCD)/German Association of Conservative Dentistry (DGZ) boards. Based on 3 systematic reviews and a nonsystematic literature search, recommendations were developed. The caries decline has led to a more polarized disease distribution in children and adolescents along social gradients which should be taken into account when managing the caries process at all levels, such as the individual, the group, or a population. The control or reduction of caries activity is the basis for successful caries management. In children, caries management requires adequate daily oral hygiene and fluoride application via toothpaste, ensured by caregivers, and especially for ECC prevention an emphasis on sugar intake reduction is needed. These noninvasive interventions are also suitable to arrest or control initial or even cavitated dentine caries lesions in the absence of irreversible pulpitis. Fluoride varnish or silver diammine fluoride can be added as supplementary agents. In pits and fissures, composite resin materials can be used as preventive sealants and for defect-oriented minimally invasive restorations. In primary molars, preformed metal crowns are more successful than multisurface fillings, especially in caries-active patients. With persisting high caries activity, multiple lesions, and limited cooperation, caries control should consist of robust measures with high success rates, even including extraction in selected cases. This applies especially to treatments performed under general anesthesia.

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“…This model framework was then adapted to reflect 1) characteristics of the population under treatment in a single comprehensive SCPP and 2) how a comprehensive SCPP may affect caries differently from SSPs. Given the variation in economic evaluation methods used to evaluate SSPs alone, especially in health outcome measures (Akinlotan et al 2018), using comparable methods and underlying assumptions from a prior model does the following: 1) increases the transparency of a potentially complicated economic evaluation and 2) succinctly clarifies any differences in how programs being compared are implemented and how this may affect estimates of cost and oral health outcomes.…”

Section: Overviewmentioning

confidence: 99%

“…As a concrete example of point 1, SCPPs can provide comprehensive care by incorporating multiple caries prevention treatments on multiple teeth. This is in contrast to the focused treatment currently delivered by and recommended for SSPs for 1Ms only (Griffin et al 2016;Griffin et al 2017;Akinlotan et al 2018). Although the impact on health outcomes and costs is unknown (Community Preventive Services Task Force 2016), prior work hypothesized that comprehensive SCPPs implementing primary and secondary prevention for all teeth may offer significant clinical and cost benefits (Niederman et al 2017).…”

Section: Introductionmentioning

confidence: 99%

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

Huang

Ruff

Niederman

2019

JDR Clinical & Translational Research

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Introduction: Current economic evaluations of school-based caries prevention programs (SCPPs) do not compare multiple types of SCPPs against each other and do not consider teeth beyond permanent first molars. Objectives: To assess the cost-effectiveness of a comprehensive SCPP relative to an SCPP focused on delivering sealants for permanent first molars only and to a default of no SCPP. Based on a societal perspective, a simulation model was used that compared the health and cost impacts on 1) permanent first molars only and 2) all posterior teeth. Methods: To calibrate the model, we used data from CariedAway, a comprehensive SCPP that used glass ionomer to prevent and arrest active decay among children. We then evaluated the incremental cost-effectiveness of implementing 3 alternate school-based approaches (comprehensive, sealant only, and no program) on only first molars and all posterior teeth. Probabilistic, 1-, and 2-way sensitivity analyses are included for robustness. Cost-effectiveness is assessed with a threshold of $54,639 per averted disability-adjusted life year (DALY). Results: We first compared the 3 programs under the assumption of treating only first molars. This assessment indicated that CariedAway was less cost-effective than school-based sealant programs (SSPs): the resulting incremental cost-effectiveness ratio (ICER) for CariedAway versus SSPs was $283,455 per averted DALY. However, when the model was extended to include CariedAway’s treatment of all posterior teeth, CariedAway was not only cost-effective but also cost-saving relative to SSPs (ICER, –$943,460.88 per averted DALY; net cost, –$261.45) and no SCPP (ICER, –$400,645.52 per averted DALY; net cost, –$239.77). Conclusions: This study finds that economic evaluations assessing only cost and health impacts on permanent first molars may underestimate the cost-effectiveness of comprehensive SCPPs 1) preventing and arresting decay and 2) treating all teeth. Hence, there is an urgent need for economic evaluations of SCPPs to assess cost and health impacts across teeth beyond only permanent first molars. Knowledge Transfer Statement: The results of this study can be used by policy makers to understand how to evaluate economic evaluations of school-based caries prevention programs and what factors to consider when deciding on what types of programs to implement.

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Economic evaluation of dental sealants: A systematic literature review

Cited by 26 publications

References 35 publications

The cost-utility of school-based first permanent molar sealants programs: a Markov model

The cost-utility of school-based first permanent molar sealants programs: a Markov model

How to Intervene in the Caries Process in Children: A Joint ORCA and EFCD Expert Delphi Consensus Statement

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

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