Despite considerable efforts to reduce oral health disparities, poor oral health and quality of dental care continue to disproportionately affect minority and publicly insured children. Decision analytic models and causal inference methods provide important insights into how to best address these problems, according to Sung Eun Choi. Choi, an assistant professor at the Harvard School of Dental Medicine, presented her work on these issues at a recent CHDS seminar.
Choi first discussed her work with CHDS affiliate Ye Shen and CHDS faculty Davene Wright that uses a microsimulation model to evaluate the cost-effectiveness of dental workforce expansion through the National Health Service Corps (NHSC) program. By linking NHANES restricted-use geographic data with county-level dentist supply and dental health professional shortage areas (HPSAs), her work simulated a nationally representative sample of US children residing in dental HPSAs to estimate differences in changes in dental caries incidence, number of decayed teeth, QALYs, and costs associated with increased NHSC funding for dental professionals. The researchers found that expanding NHSC funding by 5% to 30% reduced dental caries and accrued QALY gains and cost savings over a 10-year time horizon.
Choi then described work that uses a target trial emulation framework to estimate the causal effect of adhering to two dental care quality measures (process-based measures for dental sealants and fluoride varnishes, respectively) on children’s risk of dental caries using electronic dental records. Choi demonstrated the presence of substantial confounding as children at moderate-to-high risk of caries are more likely to use dental services. She applied matching methods to obtain covariate balance which resulted in estimates in the expected direction. The causal estimates were similar comparing an Instrumental-variable-match design to exact matching on treatment status.
Learn more: Read the publication, Cost-effectiveness of Dental Workforce Expansion Through the National Health Service Corps and Its Association With Oral Health Outcomes Among US Children
Learn more: Resource Pack: Model Calibration and Validation