Clinical Effectiveness and Cost-Effectiveness of Oral-Health Promotion in Dental Caries Prevention among Children: Systematic Review and Meta-Analysis

Nadine Fraihat, Saba Madae'en, Zsuzsa Bencze, Adrienn Herczeg, Orsolya Varga, Nadine Fraihat, Saba Madae'en, Zsuzsa Bencze, Adrienn Herczeg, Orsolya Varga

Abstract

The objective of this study was to evaluate the clinical effectiveness and cost-effectiveness of oral-health promotion programs (OHPPs) aiming to improve children's knowledge of favorable oral health behavior to lower decayed/-missing/-filled teeth (DMFT) while reducing the financial cost on health institutions. An electronic search was performed in seven databases. Studies were restricted to human interventions published in English. The search study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, and the risk of bias was assessed based on the Drummonds Checklist. A total of 1072 references were found. Among these, 19 full texts were included. Most studies had a strong quality. The overall pooled impact of OHPPs estimates children suffering from DMFT/S to have 81% lower odds of participating in OHPP (95% CI 61-90%, I2: 98.3%, p = 0). Furthermore, the program was shown to be effective at lowering the cost in 97 out of 100 OHPPs (95% CI 89-99%, I2: 99%, p = 0). Three subgroups analyses (age groups, study countries, studies of the last five years) were performed to evaluate the influence modification on the pooled effect. A comprehensive analysis of the OHPPs confirmed a reduction effect on child DMFT, hence, lowering the financial burden of dental-care treatment on health institutions.

Keywords: Decayed Missing Filled Teeth (DMFT); Incremental Cost Effectiveness Ratio (ICER); Oral Health Promotion Programs (OHPP); cost-effectiveness analysis (CEA).

Conflict of interest statement

All authors declare that they have no conflict of interests.

Figures

Figure A1
Figure A1
STATA do-files for analysis of Figure 2. “metan DMFTintervention NIntervention, DMFTcontrol Ncontrol, label (namevar = Author, yearvar = year) random or”.
Figure A2
Figure A2
STATA do-file for analysis of Figure 3. “metan DMFTintervention Costintervetion DMFTcontrol Costcontrol, label (namevar = Author, yearvar = year) random or”.
Figure A3
Figure A3
STATA do-file for analysis of Figure 4. “metan DMFTintervention NIntervention DMFTcontrol Ncontrol, label (namevar = Author, yearvar = year) by (age) random or”.
Figure A4
Figure A4
STATA do-file for analysis Figure 5. “metan DMFTintervention Costintervetion DMFTcontrol Costcontrol, label (namevar = Author, yearvar = year) by (age) random or”.
Figure A5
Figure A5
STATA do-files for analysis of Figure 6. “metan DMFTintervention Costintervetion, DMFTcontrol Costcontrol, label (namevar = Author, yearvar = year) by (One less than 2015 two 2015 onwards) random or”.
Figure A6
Figure A6
STATA do-files for analysis of Figure 7. “metan DMFTintervention Costintervetion, DMFTcontrol Costcontrol label (namevar = Author, yearvar = year) by (Country) random or”.
Figure 1
Figure 1
Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) flow diagram for the inclusion of studies.
Figure 2
Figure 2
Forest plots of Decayed Missing Filled Teeth (DMFT)/S by the participating children.
Figure 3
Figure 3
Forest plot of incremental cost-effectiveness per DMFT/S.
Figure 4
Figure 4
Forest plot of DMFT/S by children age group: 1 as (Age > 6) and 2 as (Age ≤ 6).
Figure 5
Figure 5
Forest plot of the incremental cost-effectiveness of the intervention and the control groups by the age groups: 1 as (Age > 6) and 2 as (Age ≤ 6).
Figure 6
Figure 6
Forest plot for the difference in the DMFT of the intervention group compared to the control group regarding the study years.
Figure 7
Figure 7
Forest plot for the difference in the DMFT/S of the intervention group compared to the control group by study countries.
Figure 8
Figure 8
Eggers regression test to test hypothesis 1.
Figure 9
Figure 9
Eggers regression test to test hypothesis 2.
Figure 10
Figure 10
Funnel Plot represented from the eight pooled trial and model-based economic-evaluation studies of Oral Health Promotion Programs (OHPPs), with log-odds ratios displayed on the horizontal axis and the standard error of the log-odds ratios displayed on the vertical axis.

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