JDR clinical and translational research · 2026
Cost-Effectiveness of Sealant Placement on Molars in Young Adults in the United States.
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Scherrer C R, Naavaal S, Lin M, Wei L, Griffin S O
Аннотация
INTRODUCTION: Untreated caries can diminish quality of life and decrease productivity. About 20% of young adults aged 20 to 34 y have untreated caries, with adults living in lower-income households bearing the greatest burden. Teeth most affected with caries are molars. About 57% of molar caries occurring over 4 y could be prevented with dental sealants. At present, insurance typically covers sealants only for children and adolescents.
OBJECTIVE: This study estimates the incremental cost-effectiveness (ie, net cost per averted disability-adjusted life-year; DALY) of sealing compared with not sealing all eligible molars in US adults aged 21 to 25 y from the societal and Medicaid (household income ≤138% of federal poverty level) perspectives.
METHODS: We used a discrete event simulation model that assumed sealants lost effectiveness after 48 mo. The model followed 1,000 molars over 84 mo (additional 36 mo captures sequelae of outcomes incurred in first 48 mo) with 1,000 replications. Transition probabilities and other input data were derived from published studies and nationally representative surveys. We used deterministic sensitivity analysis to identify parameters with the most influence on cost-effectiveness estimates.
RESULTS: Providing sealants reduced treatment costs by about 50% from both perspectives. Net cost per averted DALY overall was $37,053 (95% confidence interval [CI]: $36,062, $38,045) from the societal perspective and $13,079 (95% CI: $12,665, $13,493) from the Medicaid perspective. The parameter with the most influence on findings overall was the annual probability a sound, unsealed molar developed caries: the incremental cost-effectiveness equaled $25,030 and $60,650 when this parameter varied by ±20% from its baseline value.
CONCLUSION: Providing dental sealants to young adults could reduce dental caries and provide good value. The net cost per averted DALY aligns with that for other preventive interventions recommended by the US Preventive Services Task Force.Knowledge Transfer Statement:Dental insurance typically does not cover dental sealants for young adults. This age group has a high prevalence of untreated decay, primarily located in the molars. Our discrete simulation model comparing sealing to not sealing molars in young adults indicated sealing may provide good value; the incremental cost-effectiveness ratio (net cost per averted disability life-year) was in line with those for preventive interventions typically mandated to be provided with no copay.
OBJECTIVE: This study estimates the incremental cost-effectiveness (ie, net cost per averted disability-adjusted life-year; DALY) of sealing compared with not sealing all eligible molars in US adults aged 21 to 25 y from the societal and Medicaid (household income ≤138% of federal poverty level) perspectives.
METHODS: We used a discrete event simulation model that assumed sealants lost effectiveness after 48 mo. The model followed 1,000 molars over 84 mo (additional 36 mo captures sequelae of outcomes incurred in first 48 mo) with 1,000 replications. Transition probabilities and other input data were derived from published studies and nationally representative surveys. We used deterministic sensitivity analysis to identify parameters with the most influence on cost-effectiveness estimates.
RESULTS: Providing sealants reduced treatment costs by about 50% from both perspectives. Net cost per averted DALY overall was $37,053 (95% confidence interval [CI]: $36,062, $38,045) from the societal perspective and $13,079 (95% CI: $12,665, $13,493) from the Medicaid perspective. The parameter with the most influence on findings overall was the annual probability a sound, unsealed molar developed caries: the incremental cost-effectiveness equaled $25,030 and $60,650 when this parameter varied by ±20% from its baseline value.
CONCLUSION: Providing dental sealants to young adults could reduce dental caries and provide good value. The net cost per averted DALY aligns with that for other preventive interventions recommended by the US Preventive Services Task Force.Knowledge Transfer Statement:Dental insurance typically does not cover dental sealants for young adults. This age group has a high prevalence of untreated decay, primarily located in the molars. Our discrete simulation model comparing sealing to not sealing molars in young adults indicated sealing may provide good value; the incremental cost-effectiveness ratio (net cost per averted disability life-year) was in line with those for preventive interventions typically mandated to be provided with no copay.