Cost-Effectiveness of Preventive Oral Health Services in Pediatric Medical Offices

Objective: To estimate the cost-effectiveness of a preventive oral health program (Into the Mouths of Babes [IMB]) among young Medicaid enrollees from the perspective of the North Carolina (NC) Medicaid program.

Method: This observational cohort study used longitudinal administrative data for children up to 6 years old enrolled in NC Medicaid from 2000-06. Regression analyses provided estimates of the effect of IMB on monthly Medicaid payments and health outcomes (the number of dental caries-related treatments and hospitalization). We calculated Incremental Cost-Effectiveness Ratios to measure the additional payments per caries-related treatment or hospitalization averted for children with 4-6 IMB visits versus no IMB visits. We used bootstrapping to estimate the probability that the IMB program is cost-effective at varying willingness to pay thresholds. Analyses were conducted on the full sample as well as a propensity score matched sample to control for selection bias.

Result: Compared to children with no IMB visits, children with 4-6 IMB visits received fewer caries-related treatments, had lower Medicaid dental payments, and had a lower probability of hospitalization per month. Having 4-6 IMB visits relative to no IMB visits (at a cost of $56 per IMB visit for screening, counseling, and fluoride varnish) led to a cumulative reduction in dental payments of $230.65 from investing $247.20 in IMB visits. The IMB program has a 42% likelihood of being cost saving and a 95% likelihood of being cost-effective when paying approximately $2,000 per hospitalization averted.

Conclusion: IMB visits in medical offices for children up to 3 years of age lead to reductions in Medicaid payments for caries-related treatments in children through 6 years of age.  On average, payments for IMB visits exceed the reduction in payments, but the additional costs can be weighed against other costs such as pain and work loss involved with dental treatments in hospital or office settings.