Pit-and-fissure sealants on primary molars are a cost savings

Background. In this study, the authors examine the cost-effectiveness of light-polymerized resin based fluoride sealants on primary molars in high caries risk children younger than 6 years. Methods. The authors examined the cost-effectiveness of pit-and -fissure sealant (PFS) treatment on primary molars by comparing sealed and unsealed molars treated in the outpatient clinic or operating room. Using 1,884 primary molars followed over a 5-year period, the authors used a mixed-effects regression model to estimate the probability of caries development. They used restricted means to estimate years free of caries for carious molars. They used a decision tree to address uncertainty due to PFS treatment failure, predict the expected value associated with each strategy, and estimate the incremental cost-effectiveness ratio using a 3% discount rate to adjust future cost and outcomes to present value. Results. Over 5 years, the cost of care was $90 for unsealed molars and $75 for sealed molars. Unsealed molars remained caries free for 4.32 years compared with 4.85 years in sealed molars. The cost-effectiveness of PFS treatment was dominant, leading to a savings of $25 for each caries-free year gained and overall savings of $742 million for the United States dental health system over a 5-year period. Conclusions. PFS treatment is associated with cost savings and a delay in caries development and should be considered in children with high caries risk. Practical Implications. Policy makers should consider reimbursement of PFS treatment on primary molars in high caries risk children.