Health and Economic Impact of a Large-Scale School-Based Pit and Fissure Sealant Program in Dongguan, China: A Real-World Program Evaluation.

Objectives: To evaluate the effectiveness and economic impact of a large-scale school-based pit and fissure sealant program in Dongguan, China. Methods: A secondary analysis of deduplicated program data from 9343 students across 20 schools was conducted, comparing sealed and unsealed groups. School-clustered Poisson and linear probability models were used to estimate associations with caries prevalence and incidence, adjusting for sex, grade, town, and baseline oral conditions. An economic evaluation was performed using project cost data with follow-up to March 31, 2021. The base-case analysis adopted a societal perspective with 5% annual discounting. Results: Compared with unsealed students, the sealed group had lower caries prevalence (adjusted risk ratio [RR] = 0.82; 95% confidence interval [CI]: 0.73-0.92) and lower incident caries (adjusted RR = 0.60; 95% CI: 0.52-0.70). A total of 485,608 teeth were sealed, corresponding to 38,633 prevented carious teeth. The total program cost was 33.99 million yuan, with discounted treatment savings of 115.74 million yuan, yielding a benefit-cost ratio of 3.40. The net cost per prevented carious tooth was -2459.91 yuan, indicating cost savings. In a conservative sensitivity analysis assuming filling-only treatment, the program was no longer cost-saving. Conclusions: The Dongguan school-based sealant program was associated with reduced caries risk and demonstrated a favorable economic return under base-case assumptions. These findings support the use of school-based sealant programs as an effective and potentially cost-saving strategy for caries prevention in children.