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

Gerardo Espinoza-Espinoza,Gilda Corsini,Carlos Zaror,Rubén Rojas,Rodrigo Mariño

doi:10.1186/s12903-019-0990-3

Gerardo Espinoza-Espinoza, Gilda Corsini + Show 3 more

Open Access

https://doi.org/10.1186/s12903-019-0990-3

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Abstract

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.

Highlights

Evidence of the cost-effectiveness of school-based first permanent molar sealants programs is not yet fully conclusive
The teeth most susceptible to dental caries are the first permanent molars (FPM), due to their occlusal anatomy which favors the retention of bacterial plaque, their position in the arch, which prevents adequate oral hygiene, and the immaturity of the teeth at the time of eruption [1]
The evidence provided by economic evaluation regarding sealant treatment at a school-based prevention program, is as of yet inconclusive [9]

Summary

Introduction

Evidence of the cost-effectiveness of school-based first permanent molar sealants programs is not yet fully conclusive. One way of preventing pit and fissure dental caries in first permanent molars, is by applying resin-based sealants [2, 3]. These have proven to be highly effective, Knowledge of the effectiveness and safety of any given intervention by itself, is not enough to decide on its implementation. Economic evaluations are an important factor for the implementation of any preventive program. The evidence provided by economic evaluation regarding sealant treatment at a school-based prevention program, is as of yet inconclusive [9].

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