Economic Modeling of Sealing Primary Molars Using a “Value of Information” Approach

• Published in: Journal of dental research Vol. 93; no. 9; pp. 876 - 881
• Main Authors: Ney, J.P., van der Goes, D.N., Chi, D.L.
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01-09-2014; SAGE PUBLICATIONS, INC
• Subjects: Age; Child, Preschool; Children; Children & youth; Computer Simulation; Cost analysis; Cost control; Cost Savings; Cost-Benefit Analysis; Costs and Cost Analysis; Dental care; Dental caries; Dental Caries - economics; Dental Caries - prevention & control; Dental health; Dental Restoration, Permanent - economics; Dental sealants; Enrollments; Expected values; Fluorides; Humans; Iowa; Low income groups; Medicaid; Medicare - economics; Models, Economic; Molar - drug effects; Molars; Monte Carlo simulation; Pediatrics; Pit and Fissure Sealants - economics; Population; Public health; Research Reports; Sealing compounds; Standard of Care - economics; Teeth; Time Factors; Tooth Extraction - economics; Tooth, Deciduous - drug effects; United States; United States; Iowa; United States > US; cost-effectiveness; expected value of perfect information; health policy; sealants; Medicaid; health economics
• ISSN: 0022-0345; 1544-0591
• DOI: 10.1177/0022034514544299

The objective was to evaluate 2 primary molar sealant strategies for publicly insured children using an “expected value of perfect information” (EVPI) approach. We converted a 10,000-observation tooth-level cost-effectiveness simulation model comparing 2 primary molar sealant strategies – always seal (AS) and standard care (SC) – with a 1,250-observation child-level model. Costs per child per restoration or extraction averted were estimated. Opportunity losses under the AS strategy were determined for children for whom SC was the optimal choice. We determined the EVPI by multiplying mean opportunity losses by the projected incident population of publicly insured 3-year-olds in the US over 10 years with costs discounted at 2%. All analyses were conducted under assumptions of high and low intrachild correlations between at-risk teeth. The AS strategy cost $43.68 over SC (95% CI: −$5.50, $92.86) per child per restoration or extraction averted under the high intrachild correlation assumption and $15.54 (95% CI $7.86, $23.20) under the low intrachild correlation. Under high intrachild correlation, mean opportunity losses were $80.28 (95% CI: $76.39, $84.17) per child, and AS was the optimal strategy in 31% of children. Under low correlation, mean opportunity losses were $14.61 (95% CI: $12.20, $17.68) and AS was the optimal strategy in 87% of children. The EVPI was calculated at $530,813,740 and $96,578,389 (for high and low intrachild correlation, respectively), for a projected total incident population of 8,059,712 children. On average, always sealing primary molars is more effective than standard care, but widespread implementation of this preventive approach among publicly insured children would result in large opportunity losses. Additional research is needed to identify the subgroups of publicly insured children who would benefit the most from this effective and potentially cost-saving public health intervention.