{"version":"sf-mnc-dental-prevention-cea-v1","reviewedAt":"2026-09-07","organization":"Mission Neighborhood Centers","program":"Proposed targeted child dental-prevention course","confidence":"very-low","denominator":"10 incremental QALYs","formula":"10 * costPerCourse / ((controlRisk - controlRisk/(controlToTreatmentOddsRatio*(1-controlRisk)+controlRisk)) * transferRetention * additionality * untreatedCycles * painProbability * painQalyLossPerCycle)","scope":"Proposed MNC dental navigation plus a licensed clinical partner for otherwise-unreached initially caries-free children. MNC varnish delivery is not verified. Not an estimate of preschool or all family services.","scenarios":[{"name":"Favorable positive","costPerCourse":100,"controlRisk":0.5,"controlToTreatmentOddsRatio":3.77,"transferRetention":1,"additionality":0.75,"untreatedCycles":1,"painProbability":0.48,"painQalyLossPerCycle":0.0112},{"name":"Central analyst estimate","costPerCourse":250,"controlRisk":0.4,"controlToTreatmentOddsRatio":3.77,"transferRetention":0.5,"additionality":0.5,"untreatedCycles":0.5,"painProbability":0.24,"painQalyLossPerCycle":0.0085},{"name":"Unfavorable positive","costPerCourse":500,"controlRisk":0.2,"controlToTreatmentOddsRatio":1.88,"transferRetention":0.25,"additionality":0.25,"untreatedCycles":0.25,"painProbability":0.14,"painQalyLossPerCycle":0.0049}],"judgments":[{"key":"costPerCourse","label":"Donor course budget","basis":"Assumed nominal $250 with existing clinical infrastructure. Four historical $20.88 Medicaid application fees (~$84) are only a reimbursement reference; the remainder allows navigation, scheduling and delivery overhead. Not a local quote or complete dental-treatment budget."},{"key":"controlRisk","label":"Untreated incident-caries risk","basis":"Assumed 40% over the proposed two-year course, not MNC data. Trial endpoint was person-level cavitated decay or filled surfaces at last follow-up, not uniform two-year pain incidence."},{"key":"controlToTreatmentOddsRatio","label":"Control / assigned-treatment odds","basis":"SF randomized trial assigned twice-yearly varnish: OR3.77 (95%CI1.88–7.58). Invert odds correctly; not a risk ratio. Protocol error caused fewer active applications; no upward adjustment using nonrandom actual-dose comparisons."},{"key":"transferRetention","label":"Incremental effect retention","basis":"50% judgment for current population, service and baseline-prevention differences. MNC already provides toothbrushing; a different trial found no extra varnish benefit on top of supervised brushing."},{"key":"additionality","label":"New donor-financed access","basis":"50% judgment for actual additional access beyond Head Start, Medi-Cal and existing dental homes. Missing recorded care does not prove an eligible unfunded child."},{"key":"untreatedCycles","label":"Equivalent untreated mouth-level cycles","basis":"Central 0.5 six-month cycles per prevented incident-case child: an explicit provisional judgment giving only partial credit because the incidence endpoint includes promptly treated/filled lesions. Captures clinical-state compatibility and untreated duration, not extra efficacy. Range0–1 emphasized; no local measurement."},{"key":"painProbability","label":"Pain given compatible untreated disease","basis":"External Janusz model0.24 for moderate caries; extensive0.48 favorable. Not all new caries is painful. Combined literature/expert inputs, not the SF trial's measured health effect."},{"key":"painQalyLossPerCycle","label":"Pain loss per six-month cycle","basis":"Janusz2024 model0.0085 QALY per six-month cycle (0.0049–0.0112). Already time-integrated: do not multiply by0.5years again. Not a direct trial utility measurement."}],"nullBoundary":"No new completed prevention, no additional benefit beyond existing brushing/care, or zero untreated painful disease yields no finite positive price. Positive scenarios are subjective stress tests, not confidence bounds; harm is not assigned a positive price.","fundingRoom":{"verifiedUsd":null,"status":"unverified","nextEvidence":"Licensed delivery partner, otherwise-unreached eligible children, completed applications, caries and untreated-pain follow-up, full navigation costs and reimbursement/public-funding reconciliation."},"excluded":["Education, school readiness, earnings and IQ","Caregiver health or lifetime benefits","Avoided dental costs as donor cash returns","Multiple lesions counted as separate people or repeated QALY gains"],"sources":[{"publisher":"Mission Neighborhood Centers","title":"Head Start / Early Head Start Annual Report2023–2024","url":"https://mncsf.org/wp-content/uploads/2025/03/Annual-Report-2023-2024.pdf","published":"FY2023–2024; website March2025","retrieved":"2026-09-07","sourceType":"Local toothbrushing and dental navigation; not verified varnish delivery or causal health"},{"publisher":"Weintraub et al., Journal of Dental Research","title":"Fluoride varnish efficacy in preventing early childhood caries","url":"https://pubmed.ncbi.nlm.nih.gov/16434737/","published":"2006-02","retrieved":"2026-09-07","sourceType":"Primary SF randomized trial; assigned-treatment odds, attrition and protocol deviation"},{"publisher":"Janusz et al.","title":"US childhood dental economic model, author manuscript","url":"https://scholarworks.indianapolis.iu.edu/server/api/core/bitstreams/6a3540ba-d542-4344-b6f8-545ee32f3519/content","published":"2024","retrieved":"2026-09-07","sourceType":"External reimbursement and expert/literature pain-QALY model inputs"},{"publisher":"Effenberger et al.","title":"Fluoride varnish added to supervised toothbrushing randomized trial","url":"https://static1.squarespace.com/static/5d91c9f2c5b70a65bf3064dc/t/617a45583ebd5b1034afc63a/1635403097180/effenberger-2021.pdf","published":"2021","retrieved":"2026-09-07","sourceType":"Primary South African cluster trial; no significant additive caries benefit, different population"}],"evaluatedScenarios":[{"name":"Favorable positive","costPerCourse":100,"controlRisk":0.5,"controlToTreatmentOddsRatio":3.77,"transferRetention":1,"additionality":0.75,"untreatedCycles":1,"painProbability":0.48,"painQalyLossPerCycle":0.0112,"treatedRisk":0.20964360587002098,"riskDifference":0.29035639412997905,"qalysPerCourse":0.0011707169811320754,"costPerTenQalys":854177.4110366169,"additionalQalys":1.1707169811320755},{"name":"Central analyst estimate","costPerCourse":250,"controlRisk":0.4,"controlToTreatmentOddsRatio":3.77,"transferRetention":0.5,"additionality":0.5,"untreatedCycles":0.5,"painProbability":0.24,"painQalyLossPerCycle":0.0085,"treatedRisk":0.15026296018031557,"riskDifference":0.24973703981968445,"qalysPerCourse":0.00006368294515401953,"costPerTenQalys":39256978.36294566,"additionalQalys":0.025473178061607815},{"name":"Unfavorable positive","costPerCourse":500,"controlRisk":0.2,"controlToTreatmentOddsRatio":1.88,"transferRetention":0.25,"additionality":0.25,"untreatedCycles":0.25,"painProbability":0.14,"painQalyLossPerCycle":0.0049,"treatedRisk":0.11737089201877936,"riskDifference":0.08262910798122065,"qalysPerCourse":8.85680751173709e-7,"costPerTenQalys":5645375033.130135,"additionalQalys":0.0001771361502347418}]}