Comparing the costs of three sealant delivery strategies.
We analyzed the cost-effectiveness of 3 sealant delivery strategies: Seal all (SA), seal children assessed to be at risk by screening (TARGET), and seal none (SN). We assumed a nine-year analytic horizon, a 3% discount rate, and zero screening costs. Estimates for sealant costs ($27.00) and restoration costs ($73.77), annual caries increment (0.0624 surfaces), sealant failure rate (20% in yr 1 and 3% thereafter), annual amalgam failure rate (4.6%), and sensitivity (0.635) and specificity (0.795) of screening were obtained from published studies. Under baseline assumptions, TARGET dominated (cost less and reduced caries) SA and SN. If annual caries increment exceeded 0.095 surfaces, SA dominated TARGET, and if increment exceeded 0.05 surfaces, TARGET dominated SN. If sealant costs decreased to $6.00 (reported cost for school programs), TARGET dominated SN for caries increments exceeding 0.007 surfaces, and SA dominated TARGET for caries increments exceeding 0.034 surfaces.
Centers for Disease Control and Prevention/Division of Oral Health/Surveillance, Investigations and Research Branch, 4770 Buford Highway, MSF10, Chamblee, GA 30341, USA. sigl@cdc.gov
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Griffin
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Griffin
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Gooch
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Barker
D002648:Child; D003362:Cost-Benefit Analysis; D004245:DMF Index; D003695:Delivery of Health Care / Q000191:economics; D003723:Dental Amalgam / Q000191:economics; D003731:Dental Caries / Q000191:economics / Q000517:prevention & control; D003733:Dental Caries Susceptibility; D019232:Dental Restoration Failure / Q000191:economics; D003793:Dental Restoration, Permanent / Q000191:economics; D016527:Drug Costs; D005500:Follow-Up Studies; D006801:Humans; D008403:Mass Screening / Q000191:economics; D018803:Models, Economic; D010895:Pit and Fissure Sealants / Q000191:economics* / Q000627:therapeutic use; D018570:Risk Assessment; D012571:School Dentistry / Q000191:economics; D012680:Sensitivity and Specificity; D014481:United States
D010895:Pit and Fissure Sealants; D003723:Dental Amalgam