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Simulating Cost-effectiveness of Fluoride Varnish During Well-Child Visits for Medicaid-Enrolled Children
Rocio B. Quiñonez, DMD, MS, MPH;
Sally C. Stearns, PhD;
Bhavna S. Talekar, BDS, MPH;
R. Gary Rozier, DDS, MPH;
Stephen M. Downs, MD, MPH
Arch Pediatr Adolesc Med. 2006;160:164-170.
Objective To examine the cost-effectiveness of fluoride varnish application by medical providers when implemented within a well-child periodicity schedule for Medicaid-enrolled children.
Design Cost-effectiveness was analyzed using published probabilities and costs. Input parameters included the effectiveness of fluoride varnish (35.4%) applied according to the well-child periodicity schedule up to 3 years of age at $16.00 per application, annual caries increment (14%), age-specific dental care usage rates (0.2% at 9 months to 19% at 42 months), and age-related nonhospital treatment costs ($292.00-$503.00) and hospital treatment costs ($2191.00-$2940.00). Sensitivity analysis was conducted to assess the effects for varying input parameters.
Setting Well-child visits during primary care.
Participants Children aged 9 to 42 months.
Intervention Application of universal fluoride varnish (fluoride varnish—all) at 9, 18, 24, and 36 months vs no intervention (fluoride varnish—none) was compared.
Main Outcome Measures Cost per month without cavities and treatment averted during the first 42 months of life from a Medicaid payer's perspective.
Results Fluoride varnish improved clinical outcomes by 1.52 cavity-free months but at a cost of $7.18 for each cavity-free month gained per child and $203 for each treatment averted. Considerable uncertainty existed for some parameters. Fluoride varnish was cost saving when dental services and nonhospital treatment costs were 1.5 to 2 times greater, respectively, than our base case estimate.
Conclusions Based on these assumptions, fluoride varnish use in the medical setting is effective in reducing early childhood caries in low-income populations but is not cost saving in the first 42 months of life. Potential total cost reductions with varying parameters suggest that evaluations using a longitudinal cohort are needed.
Author Affiliations: Department of Pediatric Dentistry, School of Dentistry (Dr Quiñonez), Department of Health Policy and Administration, School of Public Health (Drs Stearns and Rozier and Talekar), and University of North Carolina at Chapel Hill; and Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis (Dr Downs).
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