Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
Section of Decision Sciences, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
J Public Health Dent. 2018 Mar;78(2):118-126. doi: 10.1111/jphd.12246. Epub 2017 Aug 18.
Evidence supports two methods for preventing dental caries lesions in children: pit and fissure sealants (PFS) and fluoride varnishes (FV). The aim of this study was to compare the cost-effectiveness of these two strategies in preventing dental caries lesions on the occlusal surface of the first permanent molar in children.
A Markov model was used to simulate the progression of dental caries on the occlusal surface of the first permanent molar in a hypothetical cohort of children over a 9-year period. Transition probabilities were extracted from the published literature and costs were calculated from a payer's perspective. Two scenarios were evaluated based on the probability of replacing a failed PFS. Sensitivity analysis was performed to test the robustness of the model.
Over the 9-year study period PFS were less expensive and more effective than FV in preventing occlusal dental caries lesions. For the base case scenario the probability of replacing a failed PFS was 100 percent and the Incremental Cost-Effectiveness Ratio (ICER) for PFS was $156.87 per first episode of caries lesion averted. For the second scenario, the probability of replacing a failed PFS was lowered to 50 percent. Here, the ICER dropped to $113.00 per first episode of caries lesion averted and remained the dominant strategy.
PFS should be the preferred method for the prevention of dental caries lesion on the occlusal surface of the first permanent molar, especially in children who are at high risk and have barriers of access to dental care.
有证据表明，有两种方法可预防儿童龋齿病变：窝沟封闭（PFS）和氟化物涂料（FV）。本研究旨在比较这两种策略在预防儿童第一恒磨牙咬合面龋齿病变方面的成本效益。
采用马尔可夫模型模拟了在 9 年期间内，儿童第一恒磨牙咬合面龋齿病变的进展情况。转移概率取自已发表的文献，成本则从支付者的角度进行计算。根据 PFS 失效的替换概率，评估了两种方案。采用敏感性分析对模型的稳健性进行了检验。
在 9 年的研究期间，PFS 在预防咬合面龋齿病变方面比 FV 更便宜且更有效。对于基础情况，100%的 PFS 失效概率，PFS 的增量成本效益比（ICER）为每例龋齿病变预防的 156.87 美元。在第二种情况下，将 PFS 失效的替换概率降低至 50%。此时，ICER 降至每例龋齿病变预防的 113.00 美元，仍然是优势策略。
PFS 应该是预防第一恒磨牙咬合面龋齿病变的首选方法，尤其是在那些高风险且难以获得牙科保健的儿童中。
