Four-year cost-utility analyses of sealed and nonsealed first permanent molars in Iowa Medicaid-enrolled children.
OBJECTIVE
Dental sealants, by their ability to prevent caries and maintain teeth in better health, have some inherent utility to individuals, programs, or society. This study assessed the 4-year incremental cost utility of sealing first permanent molars of 6-year-old Iowa Medicaid enrollees from a societal perspective and identified the group of teeth or children in whom sealants are most cost effective.


METHODS
Dental services for first permanent molars were assessed using claims and encounter data for a group of continuously enrolled Medicaid enrollees who turned 6 between 1996 and 1999. Previously published utilities were used to weight the different health states. The weighted sum of outcomes [Quality-Adjusted Tooth-Years (QATYs)] was the measure of effectiveness. Costs and QATYs were discounted to the time of the child's sixth birthday.


RESULTS
For all first molars, the cost of treatment associated with sealed teeth was higher but the utility was also slightly higher over the 4-year period. The relative incremental cost per 0.19 QATY ratio [changing the health state from a restored tooth (utility= 0.81) to a nonrestored tooth (utility = 1)] by sealing the molar ranged from $36.7 to $83.5 per 0.19 QATY. The incremental cost/QATY ratio was lower for sealing lower utilizers and for mandibular versus maxillary molars.


CONCLUSIONS
Sealants improved overall utility of first permanent molars after 4 years. The 4-year cost/QATY ratio of sealing the first permanent molar varied by arch and type of utilizers. Sealing first permanent molars in lower dental utilizers is the most cost-effective approach for prioritizing limited resources.
Bhuridej
Patita
P
Department of Community Dentistry, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand.
Kuthy
Raymond A
RA
Flach
Stephen D
SD
Heller
Keith E
KE
Dawson
Deborah V
DV
Kanellis
Michael J
MJ
Damiano
Peter C
PC
D002648:Child; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D019140:Dental Care for Children / Q000191:economics*; D003731:Dental Caries / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D003753:Dental Health Surveys; D003793:Dental Restoration, Permanent / Q000191:economics*; D019229:Dentition, Permanent; D005260:Female; D006801:Humans; D007345:Insurance Claim Review; D007484:Iowa / Q000453:epidemiology; D008297:Male; D008484:Medicaid / Q000191:economics; D008963:Molar; D017063:Outcome Assessment, Health Care; D010895:Pit and Fissure Sealants / Q000191:economics* / Q000627:therapeutic use; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods
D010895:Pit and Fissure Sealants