Bhuridej Patita, Kuthy Raymond A, Flach Stephen D, Heller Keith E, Dawson Deborah V, Kanellis Michael J, Damiano Peter C
Department of Community Dentistry, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand.
J Public Health Dent. 2007 Fall;67(4):191-8. doi: 10.1111/j.1752-7325.2007.00025.x.
Dental sealants, by their ability to prevent caries and maintain teeth in better health, have some inherent utility to individuals, programs, or society. This study assessed the 4-year incremental cost utility of sealing first permanent molars of 6-year-old Iowa Medicaid enrollees from a societal perspective and identified the group of teeth or children in whom sealants are most cost effective.
Dental services for first permanent molars were assessed using claims and encounter data for a group of continuously enrolled Medicaid enrollees who turned 6 between 1996 and 1999. Previously published utilities were used to weight the different health states. The weighted sum of outcomes [Quality-Adjusted Tooth-Years (QATYs)] was the measure of effectiveness. Costs and QATYs were discounted to the time of the child's sixth birthday.
For all first molars, the cost of treatment associated with sealed teeth was higher but the utility was also slightly higher over the 4-year period. The relative incremental cost per 0.19 QATY ratio [changing the health state from a restored tooth (utility= 0.81) to a nonrestored tooth (utility = 1)] by sealing the molar ranged from $36.7 to $83.5 per 0.19 QATY. The incremental cost/QATY ratio was lower for sealing lower utilizers and for mandibular versus maxillary molars.
Sealants improved overall utility of first permanent molars after 4 years. The 4-year cost/QATY ratio of sealing the first permanent molar varied by arch and type of utilizers. Sealing first permanent molars in lower dental utilizers is the most cost-effective approach for prioritizing limited resources.
牙科密封剂因其预防龋齿和保持牙齿更健康的能力，对个人、项目或社会具有一些内在效用。本研究从社会角度评估了为爱荷华州医疗补助计划中6岁参保儿童的第一恒磨牙进行窝沟封闭的4年增量成本效用，并确定了窝沟封闭最具成本效益的牙齿组或儿童群体。
利用1996年至1999年间满6岁的一组连续参保医疗补助计划者的理赔和就诊数据，评估第一恒磨牙的牙科服务。使用先前发表的效用值对不同健康状态进行加权。结果的加权总和[质量调整牙年（QATY）]是有效性的衡量指标。成本和QATY被折现到儿童6岁生日时。
对于所有第一磨牙，在4年期间，与已封闭牙齿相关的治疗成本较高，但效用也略高。通过封闭磨牙将健康状态从修复牙（效用 = 0.81）转变为未修复牙（效用 = 1），每0.19 QATY的相对增量成本比率为每0.19 QATY 36.7美元至83.5美元。对于使用率较低的人群以及下颌磨牙与上颌磨牙，增量成本/QATY比率较低。
4年后，窝沟封闭提高了第一恒磨牙的总体效用。封闭第一恒磨牙的4年成本/QATY比率因牙弓和使用者类型而异。为有限资源确定优先顺序时，为牙科使用率较低者的第一恒磨牙进行窝沟封闭是最具成本效益的方法。
