J Am Dent Assoc. 2021 Oct;152(10):832-841.e4. doi: 10.1016/j.adaj.2021.05.005.
In this study, the authors examine the cost-effectiveness of light-polymerized resin-based fluoride sealants on primary molars in high caries risk children younger than 6 years.
The authors examined the cost-effectiveness of pit-and-fissure sealant (PFS) treatment on primary molars by comparing sealed and unsealed molars treated in the outpatient clinic or operating room. Using 1,884 primary molars followed over a 5-year period, the authors used a mixed-effects regression model to estimate the probability of caries development. They used restricted means to estimate years free of caries for carious molars. They used a decision tree to address uncertainty due to PFS treatment failure, predict the expected value associated with each strategy, and estimate the incremental cost-effectiveness ratio using a 3% discount rate to adjust future cost and outcomes to present value.
Over 5 years, the cost of care was $90 for unsealed molars and $75 for sealed molars. Unsealed molars remained caries free for 4.32 years compared with 4.85 years in sealed molars. The cost-effectiveness of PFS treatment was dominant, leading to a savings of $25 for each caries-free year gained and overall savings of $742 million for the United States dental health system over a 5-year period.
PFS treatment is associated with cost savings and a delay in caries development and should be considered in children with high caries risk.
Policy makers should consider reimbursement of PFS treatment on primary molars in high caries risk children.
本研究旨在评估对 6 岁以下高龋风险儿童的乳磨牙进行光固化树脂型氟化物窝沟封闭的成本效益。
通过比较在门诊或手术室接受窝沟封闭和未封闭治疗的乳磨牙，本研究评估了窝沟封闭术对乳磨牙的成本效益。研究使用了 1884 颗随访 5 年的乳磨牙，采用混合效应回归模型估计龋齿发生的概率。使用受限均值估计龋齿牙的无龋年数。使用决策树处理窝沟封闭术治疗失败的不确定性，预测每种策略的预期值，并使用 3%的贴现率估算增量成本效益比，以调整未来成本和结果的现值。
5 年内，未封闭乳磨牙的治疗费用为 90 美元，封闭乳磨牙的治疗费用为 75 美元。与未封闭的乳磨牙相比，封闭的乳磨牙在 5 年内保持无龋的时间为 4.32 年。窝沟封闭术的成本效益占主导地位，每获得 1 年无龋，就节省 25 美元，5 年内美国牙科保健系统整体节省 7.42 亿美元。
窝沟封闭术与成本节约和龋齿发展延迟相关，应考虑在高龋风险儿童中使用。
决策者应考虑为高龋风险儿童的乳磨牙窝沟封闭术提供报销。
