Quiñonez Rocio B, Stearns Sally C, Talekar Bhavna S, Rozier R Gary, Downs Stephen M
Department of Pediatric Dentistry, School of Dentistry, University of North Carolina at Chapel Hill, NC 27599, USA.
Arch Pediatr Adolesc Med. 2006 Feb;160(2):164-70. doi: 10.1001/archpedi.160.2.164.
To examine the cost-effectiveness of fluoride varnish application by medical providers when implemented within a well-child periodicity schedule for Medicaid-enrolled children.
Cost-effectiveness was analyzed using published probabilities and costs. Input parameters included the effectiveness of fluoride varnish (35.4%) applied according to the well-child periodicity schedule up to 3 years of age at $16.00 per application, annual caries increment (14%), age-specific dental care usage rates (0.2% at 9 months to 19% at 42 months), and age-related nonhospital treatment costs ($292.00-$503.00) and hospital treatment costs ($2191.00-$2940.00). Sensitivity analysis was conducted to assess the effects for varying input parameters.
Well-child visits during primary care.
Children aged 9 to 42 months.
Application of universal fluoride varnish (fluoride varnish-all) at 9, 18, 24, and 36 months vs no intervention (fluoride varnish-none) was compared.
Cost per month without cavities and treatment averted during the first 42 months of life from a Medicaid payer's perspective.
Fluoride varnish improved clinical outcomes by 1.52 cavity-free months but at a cost of $7.18 for each cavity-free month gained per child and $203 for each treatment averted. Considerable uncertainty existed for some parameters. Fluoride varnish was cost saving when dental services and nonhospital treatment costs were 1.5 to 2 times greater, respectively, than our base case estimate.
Based on these assumptions, fluoride varnish use in the medical setting is effective in reducing early childhood caries in low-income populations but is not cost saving in the first 42 months of life. Potential total cost reductions with varying parameters suggest that evaluations using a longitudinal cohort are needed.
研究医疗服务提供者在为参加医疗补助计划的儿童进行健康儿童定期体检时应用氟化物涂膜的成本效益。
利用已发表的概率和成本分析成本效益。输入参数包括按照健康儿童定期体检计划在3岁前应用氟化物涂膜的有效性（35.4%），每次应用成本为16美元，每年龋齿增量（14%），特定年龄的牙科护理使用率（9个月时为0.2%至42个月时为19%），以及与年龄相关的非住院治疗成本（292美元至503美元）和住院治疗成本（2191美元至2940美元）。进行敏感性分析以评估不同输入参数的影响。
初级保健中的健康儿童就诊。
9至42个月大的儿童。
比较在9、18、24和36个月时应用通用氟化物涂膜（全氟化物涂膜）与不进行干预（无氟化物涂膜）的情况。
从医疗补助支付者的角度来看，在生命的前42个月中每月无龋齿的成本以及避免的治疗。
氟化物涂膜使临床结果改善了1.52个无龋月，但每个儿童每增加一个无龋月的成本为7.18美元，每次避免治疗的成本为203美元。一些参数存在相当大的不确定性。当牙科服务和非住院治疗成本分别比我们的基础病例估计高1.5至2倍时，氟化物涂膜具有成本节约效果。
基于这些假设，在医疗环境中使用氟化物涂膜可有效降低低收入人群的幼儿龋齿，但在生命的前42个月中不具有成本节约效果。不同参数下潜在的总成本降低表明需要使用纵向队列进行评估。
