title: Simulating cost-effectiveness of fluoride varnish during well-child visits for Medicaid-enrolled children.
abstract: OBJECTIVE
  To examine the cost-effectiveness of fluoride varnish application by medical providers when implemented within a well-child periodicity schedule for Medicaid-enrolled children.
  
  
  METHODS
  Cost-effectiveness was analyzed using published probabilities and costs. Input parameters included the effectiveness of fluoride varnish (35.4%) applied according to the well-child periodicity schedule up to 3 years of age at $16.00 per application, annual caries increment (14%), age-specific dental care usage rates (0.2% at 9 months to 19% at 42 months), and age-related nonhospital treatment costs ($292.00-$503.00) and hospital treatment costs ($2191.00-$2940.00). Sensitivity analysis was conducted to assess the effects for varying input parameters.
  
  
  METHODS
  Well-child visits during primary care.
  
  
  METHODS
  Children aged 9 to 42 months.
  
  
  METHODS
  Application of universal fluoride varnish (fluoride varnish-all) at 9, 18, 24, and 36 months vs no intervention (fluoride varnish-none) was compared.
  
  
  METHODS
  Cost per month without cavities and treatment averted during the first 42 months of life from a Medicaid payer's perspective.
  
  
  RESULTS
  Fluoride varnish improved clinical outcomes by 1.52 cavity-free months but at a cost of $7.18 for each cavity-free month gained per child and $203 for each treatment averted. Considerable uncertainty existed for some parameters. Fluoride varnish was cost saving when dental services and nonhospital treatment costs were 1.5 to 2 times greater, respectively, than our base case estimate.
  
  
  CONCLUSIONS
  Based on these assumptions, fluoride varnish use in the medical setting is effective in reducing early childhood caries in low-income populations but is not cost saving in the first 42 months of life. Potential total cost reductions with varying parameters suggest that evaluations using a longitudinal cohort are needed.
authors.affiliation: Department of Pediatric Dentistry, School of Dentistry, University of North Carolina at Chapel Hill, NC 27599, USA. quinoner@dentistry.unc.edu
authors.forename: Rocio B
authors.initials: RB
authors.lastname: Quiñonez
authors.forename: Sally C
authors.initials: SC
authors.lastname: Stearns
authors.forename: Bhavna S
authors.initials: BS
authors.lastname: Talekar
authors.forename: R Gary
authors.initials: RG
authors.lastname: Rozier
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Downs
mesh_terms: D002327:Cariostatic Agents / Q000191:economics* / Q000627:therapeutic use*; D002662:Child Health Services; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D003731:Dental Caries / Q000191:economics* / Q000517:prevention & control*; D005460:Fluorides, Topical / Q000191:economics* / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D008484:Medicaid; D014481:United States
chemical_list: D002327:Cariostatic Agents; D005460:Fluorides, Topical