{
  "abstract": "Although the association of visual inspection and radiographic examination is the diagnostic strategy for detecting caries lesions in children recommended in many clinical guidelines, recent findings from a randomized clinical trial (CARDEC-1) showed that radiographs have a small impact on treatment decisions compared to visual inspection alone. Moreover, this diagnostic strategy can result in more false positives and overdiagnosis. However, the economic impact of detecting caries lesions using only the visual inspection compared to the association with the radiographic method has not yet been assessed. Therefore, we aimed to investigate whether conducting visual inspection alone as a diagnostic strategy for caries detection in children is an efficient manner to allocate resources compared to the recommended association of visual inspection + radiographic examination. Briefly, in CARDEC-1, 252 children (3 – 6 years old) were diagnosed and subsequently treated according to the allocated diagnostic strategy: visual + radiographic (RAD) or only visual inspection (VIS). The primary outcome was the number of new operative interventions after 2 years. For the present study, we designed two economic evaluations based on the main trial, considering a societal perspective and a 24-month time horizon. Two endpoints were considered as effects: the number of new operative interventions and the number of false positives. The resources for diagnosis and subsequent appointments for dental treatment were recorded. Costs were estimated in Brazilian Real (BR$) and converted to International Dollars ($) (ppp=2.413 in 2022). The incremental (Δ) costs and effects were calculated between VIS and RAD examination figures. Monte Carlo simulations (x10,000) were conducted to consider possible uncertainties. The net monetary benefit (NMB) and probability of being cost-effective (pCE) were calculated at a $50-ceiling ratio (Brazilian willingness-to-pay – WTP - for prevention in children). The ΔEffects were multiplied to (-1) as the effects were converted into positive values to facilitate the interpretations. Acceptability curves were plotted to check pCE for different WTP thresholds. We found that the VIS saved approximately $63 (ΔCost=$ -62.73; 95% CI: -64.35 to -61.17) compared to the RAD strategy. It also reduced the number of new operative interventions (ΔEffect1= -0.30; 95%CI: -0.28 to -0.33) and avoided false positives (ΔEffect2=-0.49; 95%CI: -0.50 to -0.46). At a $50 ceiling ratio, the VIS diagnostic strategy presented 96.0% (95%CI: 95.5 to 96.3) of being cost-effective to substitute RAD when FP was considered as effects, and 91.2% (95% CI: 90.56 to 91.68) when the new interventions were the endpoint. The NMB varied from 47.4 (95%CI:45.0 to 49.9) to 86.71 (85.20 to 88.21) for these two health effects, respectively. In the acceptability curves, considering the FP, the probability of being cost-effective could still be higher if the WTP was increased to $170. Therefore, we can conclude that recommending visual inspection alone as a diagnostic strategy for detecting caries in children is an efficient method of allocating resources compared to performing the association of visual and radiographic methods. This effect is probably due to reduced false positives and overdiagnosis occurrence compared to the association of methods.",
  "authors": [
    {
      "affiliations": [
        "School of Dentistry, University of São Paulo, São Paulo, Brazil",
        "Radboudumc, Nijmegen, Netherlands"
      ],
      "name": "Fausto Medeiros Mendes"
    },
    {
      "affiliations": [
        "School of Dentistry, University of São Paulo, São Paulo, Brazil"
      ],
      "name": "Laura Regina Pontes"
    },
    {
      "affiliations": [
        "School of Dentistry, University of São Paulo, São Paulo, Brazil"
      ],
      "name": "Lucas Gabriel Rodrigues"
    },
    {
      "affiliations": [
        "School of Dentistry, University of São Paulo, São Paulo, Brazil"
      ],
      "name": "Mariana Minatel Braga"
    }
  ],
  "title": "046 Could a simplified diagnostic strategy for detecting caries in children be cost-effective? Findings from trial-based economic evaluations",
  "uid": "d8aed534-332e-5c51-b7b1-69e4e7dacbda"
}