Cost-minimization Analysis Of ART Sealant Placement In Preventing Pit And Fissure Caries In Young Permanent Molars

ObjectiveTo investigate cost-effectiveness performance of two sealing methods(using resin or glass ionomer sealing material)in preventing pit and fissure caries in permanent first molars in grade 1 or 2 primary school students.MethodsTwo primary schools in Zhengzhou City of Henan Province were selected and screened.The two schools were randomly assigned into group 1 and group 2.In group 1,resin sealant was provided,and in group 2,ART sealant,i.e.glass ionomer material was used for the sealing with the aid of the atraumatic restorative treatment(ART)technique,was provided.Eligible students were recruited with parental consent after screening oral examination taken in the school.Eligible molars in their mouth then received different sealant application according to the group allocation of the students.A short questionnaire on their oral health habit was performed to each student at baseline.Retention of the sealant and molar status were checked after 18 months.The cost of performing different sealing methods in the two groups were recorded.Appropriate method of cost and effectiveness analysis was then conducted based on the follow-up effectiveness results of the two methods.ResultsA total of 329 children(mean age of 8.1 years and 49.5% boys)with 1128 permanent first molars were recruited.A subtotal of 126 children with 453 first permanent molars were allocated to group 1 and the rest(203 children with 675 molars)to group 2.There was no statistically significant difference between the two groups of students in gender distribution,tooth brushing habit,candy snacking habit,dental treatment experience and the baseline status of the permanent first molars(P>0.05).Significant differences existed in their age distribution and fluoride toothpaste awareness at baseline(P<0.05).After 18 months,109(86.5%)children with 392(86.5%)molars were examined in group 1 and 192(94.6%)children with 643(95.3%)molars were examined in group 2.Chi-square test showed no statistically significant difference between the two groups in sealant falling(6.4% V.S 9.9%,P=0.067)and dental caries occurrence(27.5% V.S 28.6%,P =0.894).Logistic regression analysis was performed enrolling various possible confounding factors on dental caries occurrence.The results showed no statistically significant difference in dental caries occurrence rate between the two groups(P=0.067).Cost-minimization analysis(CMA)was used to evaluate the cost-effectiveness performance of the two methods.The results showed that the average cost of sealing one tooth in group 1 was 26.17 yuan(RMB)and in group 2 was 22.38 yuan.Results of one-way sensitivity analysis showed that the main affecting parameter on the cost was the longevity of the equipment or instrument used in sealant application.Probability sensitivity analysis by conducting Monte Carlo simulations(1000 times)indicated that the cost of resin sealant application was higher than that of ART sealant application in most(79.6%)of the times.ConclusionsART sealant had similar effectiveness in preventing pit and fissure caries in young permanent molars as compared with the traditional resin sealant application.ART sealant was more cost-effective in this school setting program and in most of the simulations.Take a combined consideration of the cost-effectiveness performance,ART sealant would be more appropriate than resin sealant to use in dental public health project or for large-scale promotion or application,especially for less developed rural areas.