• pit and fissure sealants;
  • cost-effectiveness;
  • decision support techniques;
  • Markov chains;
  • public health practice;
  • private practice


Objectives: No cost-effectiveness evaluation of pit and fissure sealants has ever been carried out in Quebec. The objective of this study was to simulate a publicly funded program of pit and fissure administration, either in the public or private sectors, and compare these hypothetical situations with the current one, i.e., a publicly funded, school-based selective program.

Methods: A Markov model was developed using a virtual population of 8-year-old children that was monitored over a time span of 10 years. The incremental cost per child without decay was computed.

Results: The current situation and a publicly funded program in the public sector were more cost-effective than the other option: a universal, publicly funded, private practice. However, the most cost-effective option varied, depending on the incidence of decay and the proportion of children identified as being at high-risk for decay.

Conclusion: By implementing a school-based program of universal pit and fissure sealant application, access to preventive dental care could be improved at an equivalent cost-effectiveness to the current one.