Clinical and economic analysis of caries prevention programs by mathematic modeling

Relevance. Underestimating the importance of economic analysis is the barrier to the implementation of caries
prevention programs.

The aim is to study with use of mathematic modeling method the clinical and economic effectiveness of dental caries prevention programs provided for schoolchildren.

Materials and methods. The method of mathematic modeling was used to evaluate the clinical and economic efficiency of the caries prevention programs (educational, fissure sealing, fluoride varnish). The cost of prevention program implementation and the expenses for caries treatment without prevention were calculated according to the rate of Volgograd territorial mandatory medical insurance Fund for 2018 year. The differences between the caries prevention program’s cost and the expenses needed for the treatment of “prevented caries” were considered as saving.

Results. It was revealed that the Educational Dental Program for the first grade schoolchildren has short duration (2 years) of clinical-economic efficiency. The Continuous Educational Dental Program applied for 6 years by dental hygienists or dentists led to saving (per 100 children) of 99.5-115.0 or 84.0-99.6 thousand roubles respectively. The economic effect of The First Permanent Molar Fissure Sealing Program was revealed after 2 years only when The Program was implemented by dental hygienists. After 6 years of working with this Program the saving were 181.3 or 146.2 thousand roubles per 100 children depending on who implemented the Program, dental hygienists or dentists. The cost of Fluoride Varnish Program implementation was higher than the treatment of “prevented caries”. However, the number of “prevented caries” after fluoride varnish application is higher than after the implementation of the Educational Dental Programs. Moreover, fluoride varnish, in contrast to fissure sealing, prevents caries of smooth surfaces of permanent teeth.

Conclusions. The method of mathematic modeling can be used for the development of the caries prevention programs in various regions considering the availability of personnel and financial resources, and for evaluation of the clinical and economic effectiveness of preventive programs implementation.

1. N. J. Kassebaum, A. G. C. Smith, E. Bernabé, T. D. Fleming, A. E. Reynolds, T. Vos, C. J. L. Murray, W. Marcenes. Global, regional, and national prevalence, incidence, and disability-adjusted life years for oral conditions for 195 countries, 1990-2015: a systematic analysis for the global burden of diseases, injuries, and risk factors. J Dent Res. 2017;96(4):380-387. https://doi.org/10.1177/0022034517693566.

2. M. Radnaabaatar, Y. E. Kim, D. S. Go, Y. Jung, J. Jung, S. J. Yoon. Burden of dental caries and periodontal disease in South Korea: an analysis using the National Health Insurance Claims Database. Community Dent Oral Epidemiol. 2019;47(6):513-519. https://doi.org/10.1111/cdoe.12493.

3. J. Vergnes, M. Mazevet. Oral diseases: a global public health challenge. Lancet. 2020;Jul;18;395(10219):186. https://doi.org/10.1016/S0140-6736(19)33015-6.

4. P. Phantumvanit, Y. Makino, H. Ogawa et al. WHO global consultation on public health intervention against early childhood caries. Community Dent Oral Epidemiol. 2018;46(3):280-287. https://doi.org/10.1111/cdoe.12362.

5. S. Jepsen, J. Blanco, W. Buchalla et al. Prevention and control of dental caries and periodontal diseases at individual and population level: consensus report of group 3 of joint EFP/ORCA workshop on the boundaries between caries and periodontal diseases. J Clin Periodontol. 2017;44(Suppl.18):S85-S93. https://doi.org/10.1111/jcpe.12687.

6. Preventing oral disease. FDI policy statement. 2016. Poznan. Poland. https://www.fdiworlddental.org/resources/policy-statements-and-resolutions/preventing-oral-diseases.

7. C. H. Bersell. Access to oral health care: a national crisis and call for reform. J Dent Hyg. 2017.Feb;91(1):6-14. https://pubmed.ncbi.nlm.nih.gov/29118145/.

8. H. Harnagea, Y. Couturier, R. Shrivastava, F. Girard, L. Lamothe, C. P. Bedos, E. Emami. Barriers and facilitators in the integration of oral health into primary care: a scoping review. BMJ Open. 2017;7(9):e016078. https://doi.org/10.1136/bmjopen-2017-016078.

9. M. E. Manrikyan. Ways to optimize the prevention program of dental diseases in Armenia. Tavricheskiy Mediko-Biologicheskiy Vestnik. 2013;16.1.3(61):119-122. (In Russ.). https://elibrary.ru/item.asp?id=22833441.

10. M. Helgeson. Economic models for prevention: making a system work for patients. BMC Oral Health. 2015;15(Suppl):S11. https://doi.org/10.1186/1472-6831-15-S1-S11.

11. N. Fraihat, S. Madae'en, Z. Bencze, A. Herczeg, O. Varga. Clinical effectiveness and cost-effectiveness of oral-health promotion in dental caries prevention among children: systematic review and meta-analysis. Int J Environ Res Public Health. 2019;Jul;25;16(15):2668. https://doi.org/10.3390/ijerph16152668.

12. Y. Anopa, D. Conway. Exploring the cost-effectiveness of child dental caries prevention programmes. Are we comparing apples and oranges? Evid Based Dent. 2020;Mar;21(1):5-7. https://doi.org/10.1038/s41432-020-0085-7.

13. M. Anderson, T. Davidson, G. Dahllöf, M. Grindefjord. Economic evaluation of an expanded caries-preventive program targeting toddlers in high-risk areas in Sweden. Acta Odontol Scand. 2019;May;77(4):303-309. https://doi.org/10.1080/00016357.2018.1548709.

14. E. Kay, L. Owen, M. Taylor, L. Claxton, L. Sheppard. The use of costutility analysis for the evaluation of caries prevention: an exploratory case study of two community-based public health interventions in a high-risk population in the UK. Community Dent Health. 2018;Mar1;35(1):30-36. https://doi.org/10.1922/CDH_4115Owen07.

15. R. Palacio, J. Shen, L. Vale, C. R. Vernazza. Assessing the costeffectiveness of a fluoride varnish programme in Chile: The use of a decision analytic model in dentistry. Community Dent Oral Epidemiol. 2019;Jun;47(3):217-224. https://doi.org/10.1111/cdoe.12447.

16. E. E. Maslak, N. A. Lunyova. The results of carrying out the Educational Program in Oral Health for Volgograd schoolchildren. Pediatric dentistry and dental prophylaxis. 2002;3-4:42-44. (In Russ.). https://www.elibrary.ru/item.asp?id=24111196.

17. N. Lunyova, E. Maslak, S. Derevyanchenko, M. Yanovskaya, V. Shkarin, S. Stavskaya. The effect of different models of oral health educational programs on adolescents. Int J Paediatr Dent. 2011;21(1):147. https://onlinelibrary.wiley.com/doi/epdf/10.1111/j.1365-263X.2011.01138.x.

18. E. E. Maslak. Dental caries prevalence and the recent trends in caries prevention. Medical alphabet. 2015;1(1):28-31. (In Russ.). https://www.elibrary.ru/item.asp?id=22985079.

19. E. E. Maslak, N. V. Kuyumdzhidi, E. V. Alatortseva, A. V. Karaseva Effectiveness of glassionomer cement fissure sealing in primary and permanent teeth in children. Volgograd Journal of Medical Research. 2012;3(35):34-37. (In Russ.). https://www.elibrary.ru/item.asp?id=22910059.

20. V. C. Marinho, H. V. Worthington, T. Walsh et al. Fluoride varnishes for preventing dental caries in children and adolescents. Cochrane Database Syst Rev. 2013;Jul11;(7):CD002279. https://doi.org/10.1002/14651858.CD002279.pub2.

21. D. Richards. Oral diseases affect some 3.9 billion people. Evid Based Dent. 2013;14(2):35. https://doi.org/10.1038/sj.ebd.6400925.

22. E. E. Maslak, L. F. Onishchenko, T. G. Khmizova, E. A. Ogonyan, E. V. Gomenyuk. Dental caries and the level of dental service in Volgograd twelve-year-old children (1981–2015). Volgograd Journal of Medical Research. 2016;3(51):15-18. (In Russ.). https://www.elibrary.ru/item.asp?id=27249176.

23. E. E. Maslak, T. G. Khmizova, V. V. Abramova, M. G. Ponomarenko. Retrospective evaluation of caries experience in permanent teeth in children aged from 7 to 17 years. Pediatric dentistry and dental prophylaxis. 2017;4(63):32-36. (In Russ.). https://www.elibrary.ru/item.asp?id=32389348.

24. N. A. Luneva, E. E. Maslak. Long-term results of oral health educational program in primary schoolchildren. Pediatric dentistry and dental prophylaxis. 2007;4(23):59-62. (In Russ.). https://www.elibrary.ru/item.asp?id=9904847.

25. G. Espinoza-Espinoza, G. Corsini, R. Rojas, R. Mariño, C. Zaror. The cost-utility of school-based first permanent molar sealants programs: a Markov model. BMC Oral Health. 2019;Dec;30;19(1):293. https://doi.org/10.1186/s12903-019-0990-3.

26. T. M. Nguyen, U. Tonmukayakul, E. Warren, S. Cartwright, D. Liew. A Markov cost-effective analysis of biannual fluoride varnish for preventing dental caries in permanent teeth over a 70-year time horizon. Health Promot J Austr. 2020;Apr;27;31(2):177-183. https://doi.org/10.1002/hpja.283.

27. F. Li, P. Jiang, F. Yu et al. Comparison between fissure sealant and fluoride varnish on caries prevention for first permanent molars: a systematic review and meta-analysis. Sci Rep. 2020;Feb13;10(1):2578. https://doi.org/10.1038/s41598-020-59564-5.

28. E. P. Tagliaferro, D. S. Marinho, C. C. Pereira, V. Pardi, G. M. Ambrosano, C. Meneghim Mde, A. C. Pereira. Cost-effectiveness analysis of preventive methods for occlusal surface according to caries risk: results of a controlled clinical trial. Cad Saude Publica. 2013;Nov;29.Suppl1:S121-30. [In Portuguese]. https://doi.org/10.1590/0102-311x00021613.