A Simulation Model for Designing Effective Interventions in Early Childhood Caries
A Simulation Model for Designing Effective Interventions in Early Childhood Caries
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DOI：
10.5888/pcd9.110219
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发表时间：
2012-03-01
影响因子：
5.5
通讯作者：
Anselmo, Theresa
中科院分区：
文献类型：
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作者：
Hirsch, Gary B.;Edelstein, Burton L.;Anselmo, Theresa
简介儿童早期龋齿 (ECC)（6 岁以下儿童中的蛀牙）非常普遍且后果严重，影响着近一半的美国 5 岁儿童，尽管这种情况是高度可预防的。人们已经探索了各种干预措施来限制导致蛀牙的龋齿活动，但人们对这些干预措施的长期影响和成本知之甚少。我们开发了一个系统动力学模型，以确定哪些干预措施（单独或组合）可以对减少出生至 5 岁儿童群体的龋齿经历和成本产生最大效果。方法系统动力学是一种计算机模拟技术，可帮助政策制定者为其人群选择最合适的干预措施。这项针对科罗拉多州学龄前儿童的研究模拟了 6 类 ECC 干预措施——使用氟化物、限制致龋细菌从母亲传播给儿童、直接对儿童使用木糖醇、临床治疗、动机访谈以及这些措施的组合——以比较其相对效果和成本。结果该模型预计 10 年干预成本为 600 万美元至 2.45 亿美元，蛀牙患病率相对基线降低为从零到 79.1%。针对最小儿童的干预措施需要多花 2 到 4 年的时间才能影响整个学龄前儿童群体，但最终会在减少 ECC 方面发挥更大的效益；针对最高风险儿童的干预措施可提供最大的投资回报，而针对 ECC 自然史的几个阶段的综合干预措施则具有最大的减少蛀牙的潜力。有些干预措施节省的牙齿修复费用比其成本还要多；所有这些都大大降低了维修成本。结论通过使用与任何地理区域相关的数据，该系统模型可以为政策制定者提供信息，以最大限度地提高公共卫生和临床护理投资的回报。
IntroductionEarly childhood caries (ECC) - tooth decay among children younger than 6 years - is prevalent and consequential, affecting nearly half of US 5-year-olds, despite being highly preventable. Various interventions have been explored to limit caries activity leading to cavities, but little is known about the long-term effects and costs of these interventions. We developed a system dynamics model to determine which interventions, singly and in combination, could have the greatest effect in reducing caries experience and cost in a population of children aged birth to 5 years.MethodsSystem dynamics is a computer simulation technique useful to policy makers in choosing the most appropriate interventions for their populations. This study of Colorado preschool children models 6 categories of ECC intervention - applying fluorides, limiting cariogenic bacterial transmission from mothers to children, using xylitol directly with children, clinical treatment, motivational interviewing, and combinations of these - to compare their relative effect and cost.ResultsThe model projects 10-year intervention costs ranging from $6 million to $245 million and relative reductions in cavity prevalence ranging from none to 79.1% from the baseline. Interventions targeting the youngest children take 2 to 4 years longer to affect the entire population of preschool-age children but ultimately exert a greater benefit in reducing ECC; interventions targeting the highest-risk children provide the greatest return on investment, and combined interventions that target ECC at several stages of its natural history have the greatest potential for cavity reduction. Some interventions save more in dental repair than their cost; all produce substantial reductions in repair cost.ConclusionBy using data relevant to any geographic area, this system model can provide policy makers with information to maximize the return on public health and clinical care investments.