Supplementary Material for: Cost-effectiveness of pit and fissure sealing at schools for caries prevention in China: A Markov modeling analysis

The World Health Organization states that the application of pit and fissure sealants (PFS) is an effective way to prevent dental caries. Estimates of potential health and economic impacts of PFS upon school-age children provide crucial evidence to support the extension of PFS coverage to all target populations. The China Children's Oral Disease Comprehensive Intervention Project was launched in 2009 to provide free oral health examinations, PFS application, and oral health education for children aged seven to nine years. However, the national-level health and economic impacts of the program are unclear. To provide higher-quality evidence at the national level in China, we developed a multi-perspective, multi-state Markov model to estimate the cost and effect of PFS application to prevent dental caries. The total cost of the PFS project was 2.087 billion CNY, which can prevent 16.06 million PFMs from caries lesions. Compared with no intervention, PFS application was cost-effective from payer and society perspectives (BCR=1.22 from the payer’s perspective, BCR=1.91 from the societal perspective). The incremental cost-effectiveness ratio (ICER) from both perspectives was negative (-61.46 CNY from the payer's perspective, and -125.75 CNY from the societal perspective), indicating that PFS was cost-effective and cost-saving. Expanding the coverage of PFS application in school can be a more cost-effective strategy for caries prevention in China.

世界卫生组织（World Health Organization）指出，窝沟封闭剂（pit and fissure sealants, PFS）的应用是预防龋齿（dental caries）的有效手段。对学龄儿童实施窝沟封闭剂的潜在健康与经济影响评估，可为将其覆盖范围拓展至所有目标人群提供关键佐证。中国儿童口腔疾病综合干预项目（China Children's Oral Disease Comprehensive Intervention Project）于2009年启动，旨在为7至9岁儿童提供免费口腔健康检查、窝沟封闭服务及口腔健康教育。但目前该项目在全国层面的健康与经济影响仍不明确。为在中国全国层面获取更高质量的研究证据，本研究构建了多视角、多状态马尔可夫模型（Markov model），以评估窝沟封闭剂预防龋齿的成本与效果。该窝沟封闭项目的总成本达20.87亿元人民币，可避免1606万颗第一恒磨牙（permanent first molars, PFMs）发生龋损。与未实施干预的情况相比，从支付方与社会视角出发，窝沟封闭服务均具备成本效益：支付方视角下的效益成本比（Benefit-Cost Ratio, BCR）为1.22，社会视角下为1.91。两种视角下的增量成本效果比（incremental cost-effectiveness ratio, ICER）均为负值（支付方视角下为-61.46元人民币，社会视角下为-125.75元人民币），这表明窝沟封闭服务不仅具有成本效益，还可节约医疗成本。扩大学校内窝沟封闭服务的覆盖范围，或将成为中国龋齿预防领域更具成本效益的公共卫生策略。