Assessing costs and savings associated with interventions implemented to reduce early childhood caries

Background

Rates of tooth decay are significantly higher among young children from lower income households and of some racial/ethnic backgrounds.

Purpose

To describe a methodology developed to assess intervention costs, potential cost savings associated with reductions in early childhood caries (ECC), and the financial sustainability of two interventions aimed at reducing ECC in populations with documented health disparities.

Methods and Results

Intervention personnel cost data are collected using personnel logs and time-motion studies. Common cost measures for training, health promotion materials, dental supplies, and administrative overhead are defined. The model accounts for costs from both provider and societal perspectives, and includes costs associated with participant time and travel. Data on clinical outcomes, dental and medical service utilization, and biases related to parent-reported utilization data will be used to estimate program savings. Second-order Monte Carlo probabilistic sensitivity analyses will be used to test the influence of cost and other estimates on outcomes. Outcome measures include cost and net cost per child served and per carious lesion averted. The methodology allows for outcomes to be measured using intervention-specific data and data that remove variability across interventions (e.g., number of participants, geographic variation in prices) so that outcomes may be compared across interventions.

Discussion

Through use of a standardized method for evaluating costs and savings, it will be possible to assess and compare the financial feasibility and sustainability of the oral health interventions. The addition of cost outcomes to those related to clinical effectiveness, appropriateness, and acceptability strengthen evaluations of oral health interventions.