Economic Evaluation Of Caries Prevention Project Of School-Age Children In Anhui Province

Objectives: To build a Markov model of dental caries among school-age children,and to evaluate the economic significance of caries prevention project for school-age children in Anhui Province by cost-effectiveness analysis,so as to provide decision-making basis for further implementation and promotion of caries prevention project for school-age children.Methods: According to the natural course of dental caries of children aged 7-12 years,a dynamic decision-making Markov model was established.The three parameters of the model,such as transition probability among different states,dental caries treatment cost and dental caries number,came from the fourth national oral epidemiological survey and published literature,and the intervention cost parameters came from the comprehensive intervention project data of children’s oral diseases in Anhui Province.Taking the number of dental caries as the effect index,the cost and effect of 5 years(7-12 years old)after pit and fissure sealant intervention were simulated from the perspective of health system and the whole society,and the incremental cost-effectiveness ratio of pit and fissure sealant group compared with non-pit and fissure sealant group was calculated to evaluate the cost-effectiveness significance of intervention projects.Sensitivity analysis is used to discuss the influence of key parameters in the model on the stability of the research results.Through budget impact analysis,the influence of gradually expanding the coverage of pit and fissure closure in different stages on the annual government budget is estimated.Results:(1)Compared with non-pit and fissure sealant group,children in pit and fissure sealant group can avoid 2.08 dental caries per capita within 5 years.(2)From the perspective of health system,it costs 160.86 yuan(ICER=160.86 yuan/caries avoided)for pit and fissure sealant compared with the group without pit and fissure sealant.From the perspective of the whole society,it costs 133.30 yuan(ICER=133.30 yuan/avoiding one dental caries)for pit and fissure sealant;Both of them are lower than the direct medical cost of one dental caries(293.17 yuan).(3)Single factor sensitivity analysis shows that the top three parameters that have great influence on the stability of the model from the perspective of health system are caries rate,per capita intervention cost and direct medical cost in the non-pit and fissure sealant group.The top three parameters with great influence from the perspective of the whole society are indirect cost,caries rate and caries treatment rate in the non-pit and fissure sealant group.(4)Budget impact analysis shows that the government needs to invest an additional33.0333 million yuan on the basis of financial subsidies in 2017 in order to achieve the target of 28% closed coverage rate of school-age children.Discussion and suggestions:(1)The intervention project of pit and fissure sealant for school-age children in Anhui Province is a preventive strategy with cost-economic significance.(2)To further strengthen oral health education in the process of carrying out intervention projects,and build an integrated health management mode of "hospital-community-school-family".(3)Gradually expand the coverage of pit and fissure sealant for school-age children and promote the concept of caries management in the whole life cycle.(4)Strengthen the epidemiological monitoring of children’s caries in Anhui Province,use big data to track,monitor,update and publish shared information on caries prevalence and prevention in time,and promote the economic evaluation of caries intervention projects.(5)Gradually improve the dental caries prevention service technology to ensure the prevention and treatment effect of children’s dental caries.