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

IntroductionEvidence-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. MethodsThe financial costs and benefits to fee-for-service clinics 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), SAP P11-4, 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. ResultsIn comparison to the current practice model, scenarios that produce mutually beneficial results for payors savings and clinics net profit and profit margin include: SAP P11-4, 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 substantially higher clinic net profit. ConclusionScenarios that include noninvasive therapies and minimize restorations achieve the balance of improving outcomes for all parties. Practical implicationsPayors should appropriately reimburse and clinics should adopt noninvasive caries therapies to improve oral health for all.