Threshold analysis of reimbursing physicians for the application of fluoride varnish in young children
Threshold analysis of reimbursing physicians for the application of fluoride varnish in young children
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DOI：
10.1111/jphd.12026
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发表时间：
2013-09-01
影响因子：
2.3
通讯作者：
Swigonski, Nancy L.
中科院分区：
文献类型：
--
作者：
Hendrix, Kristin S.;Downs, Stephen M.;Swigonski, Nancy L.
大多数州医疗补助计划报销医生提供氟化物清漆，然而唯一公布的成本效益研究并没有显示成本节约。我们的目标是将特定州的索赔数据应用到现有的已发布模型中，以快速、低成本地估计政策考虑的成本节约，从而更好地为决策提供信息——具体来说，评估印第安纳州医疗补助儿童恢复性服务率是否达到了产生成本节约的门槛。方法采用Quinonez等人2006年建立的模型进行阈值分析。通过简单的计算，将印第安纳州医疗补助计划的数据与公布的模型相一致。儿童接受龋齿治疗的季度可能性是按年计算的。牙齿发生空化损伤的概率乘以使用修复服务的概率。最后，将考虑到空化的恢复性服务比率乘以1.5，以达到节省费用的临界值。从印第安纳州医疗补助计划中推断的恢复性服务利用率与这些阈值进行了比较。结果1-2岁儿童的恢复性服务使用率为2.6%，低于5.8%的成本节约门槛。然而，对于3-5岁的儿童，恢复性服务的使用率为23.3%，超过了14.5%的门槛，这表明节省了成本。将公布的模型与各州具体数据相结合，我们能够快速、廉价地证明，印第安纳州36个月及以上儿童的恢复性服务利用率足够高，医生从9个月大开始定期给儿童使用氟化物清漆，可以在3年内节省医疗补助资金。
ObjectiveMost state Medicaid programs reimburse physicians for providing fluoride varnish, yet the only published studies of cost-effectiveness do not show cost-savings. Our objective is to apply state-specific claims data to an existing published model to quickly and inexpensively estimate the cost-savings of a policy consideration to better inform decisions - specifically, to assess whether Indiana Medicaid children's restorative service rates met the threshold to generate cost-savings.MethodsThreshold analysis was based on the 2006 model by Quinonez etal. Simple calculations were used to align the Indiana Medicaid data with the published model. Quarterly likelihoods that a child would receive treatment for caries were annualized. The probability of a tooth developing a cavitated lesion was multiplied by the probability of using restorative services. Finally, this rate of restorative services given cavitation was multiplied by 1.5 to generate the threshold to attain cost-savings. Restorative services utilization rates, extrapolated from available Indiana Medicaid claims, were compared with these thresholds.ResultsFor children 1-2 years old, restorative services utilization was 2.6 percent, which was below the 5.8 percent threshold for cost-savings. However, for children 3-5 years of age, restorative services utilization was 23.3 percent, exceeding the 14.5 percent threshold that suggests cost-savings.ConclusionsCombining a published model with state-specific data, we were able to quickly and inexpensively demonstrate that restorative service utilization rates for children 36 months and older in Indiana are high enough that fluoride varnish regularly applied by physicians to children starting at 9 months of age could save Medicaid funds over a 3-year horizon.