Journal of health economics and outcomes research · 2026
Managing High-Risk Root Caries with Silver Diamine Fluoride Application: A Markov Simulation Study.
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Kim Young S, Yoo Ji W, Tabrizi Maryam, Ryu Jae-In, Kim Yonsu, Chong Maria Teresa, Han Dong-Hun, Won Jong Ho, Kim Yoohwan, Ioanitoaia-Chaudhry Iulia, Rosenberg Mark J, Loo Marcia, Lee Claire S, Penna Anderson
Аннотация
BACKGROUND: Dental caries are common oral health conditions among Medicaid beneficiaries. Silver diamine fluoride (SDF) has been applied to manage dental caries.
OBJECTIVES: To evaluate the cost-effectiveness of SDF application for managing high-risk root caries within the context of Medicaid, a Markov simulation model was adopted from a healthcare system perspective.
METHODS: A 45-year-old subject with 21 residual teeth was simulated for 19 years. Twice-yearly 38% SDF application on the tooth surface at risk for caries was compared with 5% sodium fluoride (NaF) varnish in terms of effectiveness and cost. Tooth-years free of extraction were set as the effect.
RESULTS: Compared with 5% NaF varnish, 38% SDF application was cost-effective, with a difference of 6.34 extraction-free tooth-years and an additional cost of 7798 ( i n c r e m e n t a l c o s t - o f - e f f e c t i v e n e s s r a t i o , 1229 per extraction-free tooth-year gained; incremental net monetary benefit, $309 355). One-way sensitivity analyses on SDF and NaF costs confirmed cost-effectiveness of SDF application over NaF varnish.
CONCLUSIONS: An integrated orosystemic care model is underscored to disseminate the benefits of SDF application as the Medicaid payment system shifts from fee-for-service to managed care. Semiannual 38% SDF application might reduce and delay tooth extraction due to root caries in statewide dental provider shortage areas, particularly "dental deserts," where Medicaid-accepting dentists are not available.
OBJECTIVES: To evaluate the cost-effectiveness of SDF application for managing high-risk root caries within the context of Medicaid, a Markov simulation model was adopted from a healthcare system perspective.
METHODS: A 45-year-old subject with 21 residual teeth was simulated for 19 years. Twice-yearly 38% SDF application on the tooth surface at risk for caries was compared with 5% sodium fluoride (NaF) varnish in terms of effectiveness and cost. Tooth-years free of extraction were set as the effect.
RESULTS: Compared with 5% NaF varnish, 38% SDF application was cost-effective, with a difference of 6.34 extraction-free tooth-years and an additional cost of 7798 ( i n c r e m e n t a l c o s t - o f - e f f e c t i v e n e s s r a t i o , 1229 per extraction-free tooth-year gained; incremental net monetary benefit, $309 355). One-way sensitivity analyses on SDF and NaF costs confirmed cost-effectiveness of SDF application over NaF varnish.
CONCLUSIONS: An integrated orosystemic care model is underscored to disseminate the benefits of SDF application as the Medicaid payment system shifts from fee-for-service to managed care. Semiannual 38% SDF application might reduce and delay tooth extraction due to root caries in statewide dental provider shortage areas, particularly "dental deserts," where Medicaid-accepting dentists are not available.