Sot. Sri. Med. Vol. 36, No. II, pp. 1483-1493, 1993 Printed in Great Britain 0277-9536!93 $6.00 + 0.00 Pergamon Press Ltd A RETROSPECTIVE ANALYSIS OF THE COST-EFFECTIVENESS OF DENTAL SEALANTS IN A CHILDREN’S HEALTH CENTER* JANE A. WEINTRAUB,’ SALLY C. STEARNS,’BRIAN A. BURT,’ EUCENIO BELTRAN’ and STEPHEN A. EKLUND’ ‘The University of North Carolina, School of Public Health, Department of Health Policy and Administration; Campus Box 7400, Chapel Hill, NC 27599-7400, U.S.‘A., 2The University of Michigan, School of Public Health, Program in Dental Public Health, Ann Arbor, MI 48109, U.S.A. and ‘Centers for Disease Control, Division of Oral Health, 1600 Clifton Road, MS F-IO, Atlanta, GA 30333, U.S.A. Abstract-A retrospective patient record analysis was conducted to study the cost-effectiveness of dental sealants placed under routine, unrestricted practice condition in a fluoridated community. The 26 dentists who provided care at the clinic over the period of the study used their own clinical judgement to determine sealant placement or alternative treatment. Dental services for 275 patients at a children’s dental clinic for low-income families were evaluated. All children had at least 3 years between their first and last dental visit (mean = 5.8 years). A lifetable analysis was conducted to compare the probability of survival (restoration-free tooth years) and costs incurred to first molars of children who did not receive sealants, received any sealants, or received sealants on all first molars. Among the children with sealants, comparisons were also made between sealed and unsealed teeth in children who did and did not have a first molar restoration prior to sealant placement. Costs included the cost of sealants and restorative treatments for these teeth over time. Depending on the conditions under which sealants were placed, cost-savings or improving cost-effectiveness with time were found. A strategy of identifying children with prior restorations and sealing the remaining molars showed cost-savings within 4-6 years. For other comparisons, incremental cost-effectiveness ratios became more favorable over time. Key words-pit and fissure sealants, prevention, cost-effectiveness analysis, dental caries, health economics INTRODUCTION Widespread adoption of dental sealants has been slow because of lack of consumer and provider awareness, the relative absence of third party reim- bursement, and uncertainty about the cost-effective- ness of the procedure [l, 21. Although many studies and reports have addressed the effectiveness of sealants [3] and the costs of sealants [4,5], the cost- effectiveness of sealants has not been adequately resolved. Factors that affect the cost-effectiveness of sealants have been described by Mitchell and Murray [6], and Houpt and Shey [7]. These factors include: the caries prevalence of the community; the type and costs of the equipment, materials, and operator; the longevity of sealants and amalgams; the selection of patients and teeth to be sealed; and the use of other preventive methods. Results from theoretical studies [8,9], demonstration programs [lo], and longitudinal studies with attrition rates resulting in small sample sizes [ll] have various limitations. Study results are dependent on the assumptions made, the clinical conditions of use, or the characteristics of the partici- pants. For example, Niessen and Douglass’ [8] theor- etical study made assumptions about caries *This paper was presented, in part, at the 1989 AADR meeting in San Francisco. increment, the type of personnel applying sealant, sealant retention rates, the age of the children receiv- ing sealant and the number of occlusal surfaces sealed per child. These assumptions may or may not reflect actual circumstances. Clinical trials and demon- stration programs have control over certain variables such as patient and tooth selection, but do not reflect the variety of conditions and philosophies that exist in practice. In studies in Minnesota [ 11, 121 and New York [ 131,different study designs and conditions were used, and different conclusions were drawn. At the lo-year follow-up Simonsen [12] compared 12 matched pairs of patients, half initially with sealants on all four permanent first molars and half without sealants. The sealant group had all four first molars sealed at baseline. It was not reported why the control group of patients at the same health center had not received sealants. This study found application of sealants to lead to fewer restorations and a reduction in total costs compared to not using sealants. In contrast, the 4-year community clinical trial conducted in fluori- dated Rochester, New York included 292 partici- pants who had sealants placed on one side of their mouths on occlusal surfaces that were sound or had incipient carious lesions, and restorative treatment provided as needed on the other side. Caries rates were lower but costs were higher for the teeth receiv- SSM ,611 I-” 1483