|Equation||(# individuals treated) x (Q: % patients who avoid tooth decay with treatment solely because of program) x (# QALY increase) x ($ QALY)|
|Explanation||This metric estimates the impact of resin sealants on future health, estimated in terms of quality-adjusted life years (QALY). Sealants are plastic films applied to the biting surfaces of molars to prevent decay. This analysis focuses on the effect of resin sealants compared to no treatment.
Number of patients: Reported by program.
Q: Percentage of patients who avoid tooth decay with treatment: [0.19 general population; 0.31 Latinx individuals; 0.32 Low-income individuals]. This is estimated using the following formula:
In this formula, ES is the effect size [0.973] indicating the reduction in tooth decay due to program (WSIPP, 2014). The base percentage is the share of patients receiving care solely because of the program, which we approximate based on the estimate that 74 percent of Minnesota adults age 18 and older report having had at least one past year dental visit. (Minnesota Department of Health, n.d.). If program targets Latinx individuals, we approximate the rate of use of dental service using the Crozier (2011) estimate of the percent of Latinx Individuals who lack dental insurance [45%]. For low-income population, bout 35% of Medicaid enrollees report receiving oral care (MN Department of Health, 2017)
QALY increase: [0.2]. This estimate of the value of stopping dental pain is based on an average of QALY values found in the literature for chronic oral pain and its control [0.39] (Thomsen, Gundgaard, Sorenson, Sjogren & Eriksen, 2000; Schmeir, Palmer, Flood & Gourlay, 2002). We discount the average from these studies by 50% since not every person will develop tooth decay even without sealants and not all tooth decay results in chronic pain.
$ value per QALY: [$50,000]
Benefits are then discounted to present value based on the average age of participation to life expectancy.
|References||Minnesota Department of Health (n.d.) Quick Facts: Oral health in Minnesota. Retrieved from http://www.health.state.mn.us/divs/healthimprovement/data/quick-facts/oralhealth.html
Minnesota Department of Health (2017). Retrieved from: https://data.web.health.state.mn.us/service-use-medicaid
Schmeir, J., Palmer, C., Flood, E. & Gourlay, G. (2002). Utility assessment of opioid treatment for pain. Pain Medicine, 3(3), 218-230.
Thomsen, A., Gundgaard, J., Sorenson, J., Sjogren, P. & Eriksen, J. (2000). Cost-effectiveness of multidisciplinary treatment of patients with chronic non-malignant pain. Copenhagen, Denmark: Multidisciplinary Pain Centre, Danish National Hospital. Retrieved from https://www.researchgate.net/scientific-contributions/5872408_Annemarie_Bondegaard_Thomsen
Crozier, S. (2011, November). Insights gained in Hispanic survey. ADA News. American Dental Association. Retrieved January 25, 2011.