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Framework for fiscal impact analysis of managing initial caries lesions with noninvasive therapies.
- Source :
-
Journal of the American Dental Association (1939) [J Am Dent Assoc] 2023 Oct; Vol. 154 (10), pp. 897-909.e6. - Publication Year :
- 2023
-
Abstract
- Background: Evidence-based noninvasive caries therapies for initial caries lesions are available in the United States. Fundamental differences between noninvasive therapies and the traditional surgical dental approach warrant a study of the financial scalability.<br />Methods: The financial costs and benefits of fee-for-service clinics and payors were compared across 11 scenarios simulating the treatment of 1,000 initial caries lesions during a 3-year period. The scenarios included varying combinations of noninvasive therapies (that is, silver diamine fluoride, self-assembling peptide P <subscript>11</subscript> -4, and glass ionomer therapeutic sealants), no treatment, and various rates of 1- through 3-surface restorations to an estimated 2022 practice model. We used a decision tree microsimulation model for deterministic and probabilistic sensitivity analyses. We derived assumptions from an initial lesion and noninvasive therapy-focused cohort study with operations data from 16 sites accepting Medicaid in Alabama as a case study and clinical data from all 92 sites.<br />Results: In comparison with the 2022 practice model assumed for this study, scenarios that produce mutually beneficial results for payors' savings and clinics' net profits and profit margins include self-assembling peptide P <subscript>11</subscript> -4, silver diamine fluoride on nonesthetic surfaces, and a mix of 3 noninvasive therapies. When considering the limited resources of chair and clinician time, the same scenarios, as well as silver diamine fluoride with restorations, emerged with substantially higher clinic net profit.<br />Conclusions: Hypothetical scenarios that include noninvasive therapies and minimize restorations achieve improved outcomes for all parties.<br />Practical Implications: Payors and clinicians should explore and implement noninvasive caries therapies to improve oral health for all. This study was registered at ClinicalTrials.gov. The registration number is NCT04933331.<br /> (Copyright © 2023 American Dental Association. Published by Elsevier Inc. All rights reserved.)
Details
- Language :
- English
- ISSN :
- 1943-4723
- Volume :
- 154
- Issue :
- 10
- Database :
- MEDLINE
- Journal :
- Journal of the American Dental Association (1939)
- Publication Type :
- Academic Journal
- Accession number :
- 37770132
- Full Text :
- https://doi.org/10.1016/j.adaj.2023.07.007