Longitudinal Clinical Outcomes and Cost- Effectiveness Evaluation of a Comprehensive School- Based Dental Prevention Program – ForsythKids

We aimed to evaluate longitudinal clinical outcomes and cost-effectiveness of a comprehensive school-based caries prevention program, ForsythKids. In collaboration with the Massachusetts Department of Health, we solicited all principals and nurses from Massachusetts’s elementary schools in which greater than 50% of students received free or reduced meals, to participate. Dentists were calibrated at baseline and hygienists trained to deliver standardized dental care. Dentists clinically examined children following guidelines provided by the National Institute of Dental and Craniofacial Research. We assessed trends in the proportion of sound surfaces (PrSS) and teeth (PrST) remaining sound over subjects' number of visits in the program. We fit multivariable linear regression models with visit number as a predictor, adjusting for age, baseline untreated decay, gender, and previous dental care and accounting for the repeated measures by subject by using a generalized estimating equations (GEE) approach. We stratified models on the presence of untreated decay at baseline. For cost-effectiveness analysis, an individual micro-simulation decision-analytic model was implemented to assess the cost-effectiveness of the ForsythKids program over 6 years in terms of cost per quality-adjusted life-year (QALY) and cost per sound tooth year. Analyses were conducted from a societal perspective. On average, the proportion of sound surfaces remaining sound ranged from 95% to 99%, depending on type of dentition, baseline untreated decay, and type of surface. Further, the per- visit trend was almost flat (0.07% to 1%) in PrST and PrSS. Regarding cost analysis, the annual cost per child in the ForsythKids program was $520. In terms of cost per QALY, over a six-year time horizon, implementing the ForsythKids program led to an ICER of $40,454 per QALY. Moreover, in terms of cost per sound tooth year, an ICER of $1,095 per sound tooth year was estimated. In summary, while the results may be subject to attrition or selection bias, they are consistent with a protective effect of school-based comprehensive caries prevention programs. Further, the ForsythKids program appears to be a good value for money in terms of cost per QALY and cost per sound tooth year