title: Cost-effectiveness of a disease management program for early childhood caries.
abstract: OBJECTIVE
  To assess the cost-effectiveness of a pilot disease management (DM) program aimed at preventing early childhood caries among children younger than 5 years.
  
  
  METHODS
  The DM program was implemented in the Boston Children's Hospital-based dental practice in 2008. Health care costs were obtained from the hospital finance department and non-health care costs were estimated through a parent survey. The measure of effectiveness was avoided hospital-based visits for restorative treatment or extractions. Incremental costs (2011 US$) and effectiveness were estimated from a health care system, societal, and public payer perspectives over 3, 6, and 12 months, by comparing DM participants (n = 395) to a historical comparison group (n = 123) using generalized linear models. Bootstrapping and other sensitivity analyses were used to incorporate uncertainty in the analyses.
  
  
  RESULTS
  The DM program was associated with a reduction in societal costs of $20 (p = 0.85), $215 (p = 0.24), and $669 (p < 0.01) per patient and a reduction in the number of hospital-based visits for restorative treatment or extractions by 0.44 (p < 0.01), 0.42 (p < 0.01), and 0.45 (p < 0.01) per patient over 3, 6, and 12 months, respectively. The probability of it being less costly and more effective was 61.5 percent, 81.9 percent, and 98.6 percent over 3, 6, and 12 months, respectively. Consistent results were observed from a health care system and public payer perspectives.
  
  
  CONCLUSIONS
  The DM program appears cost-effective and has the potential to reduce health care costs. Our results justify a multicenter trial to evaluate the DM program on a larger scale.
authors.affiliation: Clinical Research Center, Boston Children's Hospital, Boston, MA, USA.
authors.forename: Mihail
authors.initials: M
authors.lastname: Samnaliev
authors.forename: Rashmi
authors.initials: R
authors.lastname: Wijeratne
authors.forename: Eunhae Grace
authors.initials: EG
authors.lastname: Kwon
authors.forename: Henry
authors.initials: H
authors.lastname: Ohiomoba
authors.forename: Man Wai
authors.initials: MW
authors.lastname: Ng
mesh_terms: D001900:Boston; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D003731:Dental Caries / Q000628:therapy*; D019468:Disease Management; D005260:Female; D006801:Humans; D008297:Male; D010865:Pilot Projects; D011336:Probability
keywords: cost; cost-effectiveness; disease management; early childhood caries; prevention