Cost-effectiveness of preventive oral health care in medical offices for young Medicaid enrollees.
Cost-effectiveness of preventive oral health care in medical offices for young Medicaid enrollees.
复制标题
年轻医疗补助招待会在医疗办公室预防性口腔保健的成本效益。
DOI：
10.1001/archpediatrics.2012.797
复制
发表时间：
2012-10
影响因子：
--
通讯作者：
Quiñonez RB
中科院分区：
文献类型：
--
作者：
Stearns SC;Rozier RG;Kranz AM;Pahel BT;Quiñonez RB
龋齿是学龄前儿童中最常见的可预防慢性疾病。儿科初级保健机构提供了提供预防性口腔健康的替代场所。这项研究评估了北卡罗来纳州基于医疗办公室的预防性口腔健康计划的成本效益（“进入宝贝的嘴里”，IMB）。使用医疗补助索赔的观察性研究（2000-2006 年）。医务人员在医疗办公室提供 IMB 服务。牙医在办公室或医院提供牙科服务。 209,285 名 6 个月大的儿童参加了医疗补助计划。 IMB 就诊包括筛查、家长咨询、局部氟化物应用以及在需要时转介给牙医。成本效益分析使用医疗补助计划视角和倾向评分匹配样本与回归分析来比较 IMB 就诊次数≥4 次和 0 次的儿童。 6 岁以下儿童的牙科治疗和医疗补助付款可以评估 IMB 是否可以节省成本，如果不能，则可以避免每次住院的额外付款。 IMB 有 32% 的可能性通过福利和付款折扣来节省成本。平均而言，每人 IMB 就诊费用比减少的牙科治疗费用高出 11 美元。如果未来预防带来的好处不打折扣，该计划几乎可以实现收支平衡，如果 IMB 服务的价格可以从每次就诊 55 美元改为 34 美元，那么肯定会节省成本。如果 Medicaid 愿意为避免每次住院发作支付 2331 美元，则该计划具有 95% 的确定性，具有成本效益。 IMB 改善牙齿健康需要额外支付费用，这些费用可以与未衡量的住院费用进行权衡。
Dental caries is the most common preventable chronic disease among preschool children. The pediatric primary care setting provides an alternative site to deliver preventive oral health. This study estimates the cost-effectiveness of a medical office-based preventive oral health program in North Carolina (“Into the Mouths of Babes,” IMB). Observational study using Medicaid claims (2000–2006). Medical staff delivered IMB services in medical offices. Dentists provided dental services in offices or hospitals. 209,285 Medicaid enrolled children at age 6 months. IMB 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 versus 0 IMB visits. Dental treatments and Medicaid payments for children up to age 6 enabled assessment of the likelihood that IMB was cost-saving and, if not, the additional payments per hospital episode avoided. IMB 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 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. IMB improves dental health for additional payments that can be weighed against unmeasured hospitalization costs.