The primary goal of this project is to improve oral health care delivery and reduce health inequities by conducting robust economic evaluations to support decision-making by policymakers and stakeholders. To achieve this goal, the proposed study has three primary objectives, which are to evaluate how variation in program design of school-based caries prevention programs (SCPPs) and prior use of dental care impacts (1) oral health outcomes, (2) use and spending within Medicaid, and (3) the overall cost-effectiveness and budget impact of SCPPs. This will be done using a novel data linkage between oral health outcomes data from a pragmatic clinical trial of two multi-site SCPPs and New York Medicaid claims data. Prior systematic reviews of SCPPs have found significant variation in SCPP program design and implementation. As a result, the proposed study is critical to identify cost-effective SCPP program designs in real-world settings. In support of this research, Dr. Shulamite S. Huang is applying for a K-25 award. Dr. Huang, a health economist specializing in the study of the dental market at New York University College of Dentistry, is establishing herself as a young investigator in economic evaluations of dental interventions and oral health services research. This award will allow Dr. Huang to integrate her background and experience in health economics and policy evaluation with additional training in clinical research methods and evaluation of clinical interventions, and work towards reducing health disparities and improving health care delivery and quality.
In Aim 1, Dr. Huang will determine the impact of SCPPs on oral health outcomes, after accounting for prior dental care use. As part of this aim, Dr. Huang will link oral health outcomes data from a pragmatic clinical trial comparing two different SCPP program designs to New York Medicaid/CHIP claims data at the individual level.
In Aim 2, Dr. Huang will evaluate the impact of SCPPs on utilization and spending on care for dental conditions for children enrolled in Medicaid/CHIP.
In Aim 3, Dr. Huang will evaluate the cost-effectiveness and budget impact of different SCPP program designs relative to a no-SCPP scenario. This research will launch Dr. Huang?s career in oral health services research, which aims to combine mathematical modeling with large dataset analyses to study the impact of changes in dental care delivery and payment on large populations. This work will be in the form of an R01 grant application prior to the completion of the K-award. Dr. Huang has assembled a mentoring team comprised of a primary mentor, Dr. Heather Gold, an expert in population health research and economic evaluations of clinical & behavioral interventions and Associate Professor at NYU Langone Health and School of Medicine; and one co-mentor, Dr. Richard Niederman, a dentist and Professor and Chair of the Department of Epidemiology and Health Promotion at NYU College of Dentistry, who conducts the SCPP pragmatic clinical trial providing data for this study.
This project addresses the need to conduct robust economic evaluations of school-based caries prevention programs (SCPPs) in order to support decision-making by public health officials, policymakers, and other stakeholders to improve oral health equity. This study will compare two different multi-site SCPPs to assess how program design affects oral health outcomes and spending on care related to dental conditions. This research will inform policymakers and stakeholders on whether to implement SCPPs and what SCPP program designs are most cost-effective, as well as set new standards for data collection for economic evaluation of SCPPs and dental interventions more broadly.
