To improve oral health disparities and outcomes among US children impacted by dental caries, there is a need to understand the cost-effectiveness of a targeted, risk-based versus universal-based approach for caries prevention. Health and economic outcomes were simulated in a cohort of 50,000 US children aged 1–18 years, comparing current practice (CP) to risk-based-prevention (RBP) and prevention-for-all (PFA) strategies using healthcare sector and limited societal perspectives. Prevention included bia nnual oral health exams and fluoride varnish application, and one-time dental sealant placement. The primary outcome is the cost-effectiveness ratio (ICER), defined as the additional cost per quality-adjusted life year (QALY) gained when comparing each strategy to the next least costly one. For RBP compared to CP, the ICER was US$83,000/QALY from the healthcare sector perspective; for PFA compared to RBP the ICER was US$154,000/QALY. Using a limited societal perspective that includes caregiver time spent attending dental or medical setting visits, RBP compared to CP yielded a ratio of $119,000/QALY and PFA compared to RBP was $235,000/QALY. Results were most sensitive to changes in the probability of pain from an episode of dental caries, costs for prevention and restoration, and the loss in health-related quality of life due to dental caries pain. Scenario analyses evaluating a reduced intensity of prevention services yielded lower ICERs. Using a risk-based approach that identifies and targets children at increased risk for dental caries to guide the delivery of prevention services represents an economic value similar to other pediatric prevention programs.

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美国儿童人群龋齿预防策略的成本效益分析

为了改善受龋齿影响的美国儿童的口腔健康差异和结果，有必要了解有针对性的、基于风险的与基于普遍的龋齿预防方法的成本效益。对 50,000 名 1-18 岁美国儿童的健康和经济结果进行了模拟，将当前实践 (CP) 与使用医疗保健部门和有限社会资源的基于风险的预防 (RBP) 和全民预防 (PFA) 策略进行比较观点。预防措施包括每年两次的口腔健康检查和氟化物清漆的涂敷以及一次性牙科密封剂的放置。主要结果是成本效益比（ICER），定义为将每种策略与下一个成本最低的策略进行比较时获得的每个质量调整生命年（QALY）的额外成本。从医疗保健行业的角度来看，RBP 与 CP 相比，ICER 为 83,000 美元/QALY；与 RBP 相比，PFA 的 ICER 为 154,000 美元/QALY。从有限的社会角度来看，包括护理人员花在牙科或医疗机构就诊上的时间，RBP 与 CP 相比，产生的比率为 119,000 美元/QALY，PFA 与 RBP 相比，产生的比率为 235,000 美元/QALY。结果对龋齿发作引起的疼痛概率的变化、预防和修复的成本以及龋齿疼痛导致的健康相关生活质量的损失最为敏感。评估预防服务强度降低的情景分析得出较低的 ICER。使用基于风险的方法来识别和针对龋齿风险较高的儿童来指导预防服务的提供，具有与其他儿科预防计划类似的经济价值。