Financial Impact of SDF, Curodont, and GI sealants for Managing Initial Caries Lesions: Clinic and Payor Perspective

Abstract

Introduction: Evidence-based noninvasive caries therapies for initial caries lesions recently became available in the United States. Fundamental differences between noninvasive therapies and the traditional surgical dental approach warrant study of the financial scalability. Methods: The financial costs and benefits to fee-for-service clinicians and payors were compared across eleven scenarios simulating the treatment of 1,000 initial lesions over a three-year period. The scenarios included varying combinations of noninvasive therapies (silver diamine fluoride (SDF), Curodont Repair Fluoride Plus, and glass ionomer sealants), no treatment, and various rates of one to three surface restorations to an estimated current practice model. We used a decision tree microsimulation model for deterministic and probabilistic sensitivity analyses. We derived assumptions from an initial lesion and noninvasive therapy-focused cohort study with operations data from 16 sites accepting Medicaid in Alabama as a case study and clinical data from all 92 sites. Results: In comparison to the current practice model, scenarios that produce mutually beneficial results for payors in terms of cost savings and clinics in terms of net profit and profit margin include: Curodont, SDF on non-cosmetic surfaces, and a mix of three noninvasive therapies. When considering the limited resources of chair and clinician time, the same scenarios as well as SDF with restorations emerged with vastly higher profit margins. Conclusion: Scenarios that include noninvasive therapies and minimize restorations achieve the balance of improving outcomes for all parties. Reaping these benefits requires payors to appropriately reimburse and clinics to adopt the noninvasive therapy procedures.

Competing Interest Statement

All authors were funded by CareQuest Innovation Partners to conduct this evaluation. CareQuest Innovation Partners has a financial relationship with vVARDIS to assess and support the U.S. deployment of Curodont Repair Fluoride Plus (CRFP). The goal of the partnership is to ensure access for historically marginalized populations (e.g., Medicaid beneficiaries). Dr. Keeper has been paid honoraria for teaching continuing education courses on various noninvasive caries therapies by Elevate Oral Care and GC America, and practices pediatric dentistry.

Funding Statement

All authors were funded by CareQuest Innovation Partners to conduct this evaluation.

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

ELMO is a change management study focusing on diagnosis and non-invasive management of initial lesions across ninety-two Advantage Dental+ clinics in eight states (WCG IRB#: 1295572; clinicaltrials.gov ID: NCT04933331).

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

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I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.

Yes

Data Availability

All data produced in the present study are available upon reasonable request to the authors.

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