title: Cost-effectiveness of pit-and-fissure sealants on primary molars in Medicaid-enrolled children.
abstract: OBJECTIVE
  We compared the incremental cost-effectiveness of 2 primary molar sealant strategies-always seal and never seal-with standard care for Medicaid-enrolled children.
  
  
  METHODS
  We used Iowa Medicaid claims data (2008-2011), developed a tooth-level Markov model for 10 000 teeth, and compared costs, treatment avoided, and incremental cost per treatment avoided for the 2 sealant strategies with standard care.
  
  
  RESULTS
  In 10 000 simulated teeth, standard care cost $214 510, always seal cost $232 141, and never seal cost $186 010. Relative to standard care, always seal reduced the number of restorations to 340 from 2389, whereas never seal increased restorations to 2853. Compared with standard care, always seal cost $8.12 per restoration avoided (95% confidence interval [CI] = $4.10, $12.26; P ≤ .001). Compared with never seal, standard care cost $65.62 per restoration avoided (95% CI = $52.99, $78.26; P ≤ .001).
  
  
  CONCLUSIONS
  Relative to standard care, always sealing primary molars is more costly but reduces subsequent dental treatment. Never sealing costs less but leads to more treatment. State Medicaid programs that do not currently reimburse dentists for primary molar sealants should consider reimbursement for primary molar sealant procedures as a population-based strategy to prevent tooth decay and reduce later treatment needs in vulnerable young children.
authors.affiliation: Donald L. Chi is with the Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle. David N. van der Goes is with the Department of Economics, College of Arts and Sciences and the Robert Wood Johnson Foundation Center for Health Policy, University of New Mexico, Albuquerque. John P. Ney is with the Department of Neurology, School of Medicine, University of Washington.
authors.forename: Donald L
authors.initials: DL
authors.lastname: Chi
authors.forename: David N
authors.initials: DN
authors.lastname: van der Goes
authors.forename: John P
authors.initials: JP
authors.lastname: Ney
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D003362:Cost-Benefit Analysis; D016208:Databases, Factual; D019140:Dental Care for Children / Q000191:economics; D006801:Humans; D007349:Insurance, Health, Reimbursement; D007484:Iowa; D008390:Markov Chains; D008484:Medicaid / Q000191:economics; D008963:Molar; D010895:Pit and Fissure Sealants / Q000191:economics* / Q000627:therapeutic use; D014094:Tooth, Deciduous; D014481:United States
chemical_list: D010895:Pit and Fissure Sealants