Modeling the long-term cost-effectiveness of the caries management system in an Australian population.
OBJECTIVE
The Monitor Practice Program demonstrated that regular monitoring and noninvasive management of dental caries is effective in reducing the incremental DMFT (decayed, missing, and filled teeth) in patients, within the construct of a 3-year randomized clinical trial. This analysis evaluates the long-term cost-effectiveness of the preventive approach underpinning the Caries Management System, used in the general practice setting and modeled to the Australian population.


METHODS
An individual patient-simulation Markov model was developed to compare the long-term costs and outcomes of the Caries Management System versus standard dental care in a hypothetical sample representative of the Australian population. Eight Markov submodels were developed, representing eight molar teeth (excluding wisdom teeth), each consisting of 11 health states simulating the incidence and progression of dental caries, and future interventions such as fillings and crowns. Transition probabilities and costs assigned to health states were based on claims data from the second largest private health insurer in Australia. The economic evaluation was performed from the Australian private dental practitioner perspective. The incremental cost per DMFT avoided was calculated at three time points: 2 years, 3 years, and lifetime. Univariate sensitivity analysis was conducted to test the robustness of the results.


RESULTS
The incremental cost per DMFT avoided at 2 years, 3 years, and lifetime was estimated to be $1287.07, $1148.91, and $1795.06, respectively.


CONCLUSIONS
The analysis suggests that the Caries Management System is most cost-effective in patients with a high risk of dental caries.
Warren
Emma
E
Health Economist, HERA Consulting Australia, Balmain, NSW, Australia. emma@heraconsulting.com.au
Pollicino
Christine
C
Curtis
Bradley
B
Evans
Wendell
W
Sbaraini
Alexandra
A
Schwarz
Eli
E
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D003729:Dental Care / Q000191:economics* / Q000379:methods / Q000458:organization & administration; D003731:Dental Caries / Q000191:economics* / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D017059:Models, Econometric; D018570:Risk Assessment; D055815:Young Adult