title: Economic modeling of sealing primary molars using a "value of information" approach.
abstract: The objective was to evaluate 2 primary molar sealant strategies for publicly insured children using an "expected value of perfect information" (EVPI) approach. We converted a 10,000-observation tooth-level cost-effectiveness simulation model comparing 2 primary molar sealant strategies - always seal (AS) and standard care (SC) - with a 1,250-observation child-level model. Costs per child per restoration or extraction averted were estimated. Opportunity losses under the AS strategy were determined for children for whom SC was the optimal choice. We determined the EVPI by multiplying mean opportunity losses by the projected incident population of publicly insured 3-year-olds in the US over 10 years with costs discounted at 2%. All analyses were conducted under assumptions of high and low intrachild correlations between at-risk teeth. The AS strategy cost $43.68 over SC (95% CI: -$5.50, $92.86) per child per restoration or extraction averted under the high intrachild correlation assumption and $15.54 (95% CI $7.86, $23.20) under the low intrachild correlation. Under high intrachild correlation, mean opportunity losses were $80.28 (95% CI: $76.39, $84.17) per child, and AS was the optimal strategy in 31% of children. Under low correlation, mean opportunity losses were $14.61 (95% CI: $12.20, $17.68) and AS was the optimal strategy in 87% of children. The EVPI was calculated at $530,813,740 and $96,578,389 (for high and low intrachild correlation, respectively), for a projected total incident population of 8,059,712 children. On average, always sealing primary molars is more effective than standard care, but widespread implementation of this preventive approach among publicly insured children would result in large opportunity losses. Additional research is needed to identify the subgroups of publicly insured children who would benefit the most from this effective and potentially cost-saving public health intervention.
authors: University of Washington, Department of Neurology, Box 359455, Seattle, WA 98195, USA.
authors: J P
authors: JP
authors: Ney
authors: University of New Mexico, Department of Economics, 1915 Roma Ave. NE 1019, Albuquerque, NM 87131, USA.
authors: D N
authors: DN
authors: van der Goes
authors: University of Washington, Department of Oral Health Sciences, Box 357475, Seattle, WA 98195, USA dchi@uw.edu.
authors: D L
authors: DL
authors: Chi
mesh_terms: D002675:Child, Preschool; D003198:Computer Simulation; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D003731:Dental Caries / Q000191:economics* / Q000517:prevention & control; D003793:Dental Restoration, Permanent / Q000191:economics; D006801:Humans; D007484:Iowa; D006278:Medicare / Q000191:economics; D018803:Models, Economic; D008963:Molar / Q000187:drug effects*; D010895:Pit and Fissure Sealants / Q000191:economics*; D059039:Standard of Care / Q000191:economics; D013997:Time Factors; D014081:Tooth Extraction / Q000191:economics; D014094:Tooth, Deciduous / Q000187:drug effects*; D014481:United States
chemical_list: D010895:Pit and Fissure Sealants
keywords: Medicaid; cost-effectiveness; expected value of perfect information; health economics; health policy; sealants