Cost-effectiveness of preventive oral health care in medical offices for young Medicaid enrollees

Abstract

Objective: To estimate the cost-effectiveness of a medical office-based preventive oral health program in North Carolina called Into the Mouths of Babes (IMB).

Design: Observational study using Medicaid claims data (2000-2006).

Setting: Medical staff delivered IMB services in medical offices, and dentists provided dental services in offices or hospitals.

Participants: A total of 209 285 children enrolled in Medicaid at age 6 months.

Interventions: Into the Mouths of Babes visits included screening, parental counseling, topical fluoride application, and referral to dentists, if needed. The cost-effectiveness analysis used the Medicaid program perspective and a propensity score-matched sample with regression analysis to compare children with 4 or more vs 0 IMB visits.

Main outcome measures: Dental treatments and Medicaid payments for children up to age 6 years enabled assessment of the likelihood of whether IMB was cost-saving and, if not, the additional payments per hospital episode avoided.

Results: Into the Mouths of Babes is 32% likely to be cost-saving, with discounting of benefits and payments. On average, IMB visits cost $11 more than reduced dental treatment payments per person. The program almost breaks even if future benefits from prevention are not discounted, and it would be cost-saving with certainty if IMB services could be provided at $34 instead of $55 per visit. The program is cost-effective with 95% certainty if Medicaid is willing to pay $2331 per hospital episode avoided.

Conclusions: Into the Mouths of Babes improves dental health for additional payments that can be weighed against unmeasured hospitalization costs.

Figure 1

The Effect of ≥4 IMB Visits on the Probability of Dental Services: By Treatment Location with 95% CI for Pr(Hospital Use)

Figure 2

2A: Incremental Cost-Effectiveness Plane (Bootstrap Estimates from Propensity Score Sample with Discounting) 2B: Cost Effectiveness Acceptability Curve (Cost per Hospital Episode Avoided for Dental caries) Propensity Score Sample with Discounting