{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T16:59:48Z","timestamp":1780678788397,"version":"3.54.1"},"reference-count":38,"publisher":"S. Karger AG","license":[{"start":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T00:00:00Z","timestamp":1774569600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T00:00:00Z","timestamp":1774569600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Caries Res"],"abstract":"<jats:p>Introduction: Early childhood caries (ECC) affects one in four Dutch 5-year olds and disproportionately impacts children from lower socioeconomic backgrounds. The Toddler Oral Health Intervention (TOHI) integrates oral health promotion into well-baby clinics, aiming to prevent ECC from the eruption of the first tooth. This study evaluates the cost-effectiveness of TOHI compared to care as usual (CAU) from a societal perspective, using caries reduction and quality-adjusted life years (QALYs) as outcomes. Methods: A trial-based economic evaluation was conducted alongside a pragmatic randomized controlled trial with approximately 3\u20133.5 years of follow-up (n = 353). Costs (intervention delivery, dental healthcare, parental travel, and productivity losses) were combined with clinical and utility outcomes to calculate incremental cost-effectiveness ratios (ICERs). Missing and skewed data were handled using multiple imputation and bootstrapping, respectively. Analyses were adjusted for maternal socioeconomic position. Results: TOHI reduced cavitated caries lesions (ICDAS \u22653) by 0.93 lesions per child at an incremental cost of EUR 93, resulting in an ICER of EUR 100 per lesion prevented compared to CAU. The probability of cost-effectiveness exceeded 80% at a willingness-to-pay (WTP) threshold of EUR 250 per lesion. TOHI also yielded a QALY gain of 0.01 per child, with an ICER of EUR 6,262 per QALY gained. The probability of cost-effectiveness for QALYs exceeded 80% at a WTP threshold of EUR 20,000 per QALY and increased to approximately 85% at EUR 40,000 per QALY. Sensitivity analyses supported the findings\u2019 robustness. Conclusion: TOHI is a more costly, yet also more effective strategy for reducing ECC and improving quality of life within the Dutch well-baby clinic system. With a low upfront investment and ICER and a moderate to high probability of cost-effectiveness at a EUR 20,000 per QALY threshold, TOHI seems to represent good value for money. Future research should assess long-term cost-effectiveness, broader healthcare impacts, and scalability across healthcare settings.<\/jats:p>","DOI":"10.1159\/000551783","type":"journal-article","created":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T17:00:44Z","timestamp":1774630844000},"page":"1-15","source":"Crossref","is-referenced-by-count":0,"title":["Cost-Effectiveness of the Toddler Oral Health Intervention in Dutch Well-Baby Clinics: A Trial-Based Economic Evaluation"],"prefix":"10.1159","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-4276-525X","authenticated-orcid":false,"given":"Denise","family":"Leusink","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6815-5162","authenticated-orcid":false,"given":"Peggy C.J.M.","family":"van Spreuwel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geert J.M.G.","family":"van der 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Loveren","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katarina","family":"Jerkovi\u0107-\u0106osi\u0107","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"127","published-online":{"date-parts":[[2026,3,27]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1177\/0022034517693566"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.5177\/ntvt.2019.07\/08.19049"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1111\/ipd.12783"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1111\/ipd.12484"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1111\/cdoe.12597"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1111\/cdoe.12863"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1007\/s12508-020-00288-2"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.2196\/39683"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1159\/000545116"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1186\/s12903-019-0825-2"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1016\/j.jval.2020.04.1823"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1136\/bmj-2021-067975"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2016.04.050"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.1159\/000088180"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.1159\/000358342"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.1111\/cdoe.12578"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.1111\/bjhp.12294"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0528.2009.00514.x"},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.1186\/1477-7525-5-6"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.1111\/cdoe.12025"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.1007\/s10198-022-01542-x"},{"key":"ref22","doi-asserted-by":"publisher","DOI":"10.1002\/sim.4067"},{"key":"ref23","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0528.2010.00580.x"},{"key":"ref24","doi-asserted-by":"publisher","DOI":"10.1186\/s12903-015-0021-y"},{"key":"ref25","doi-asserted-by":"publisher","DOI":"10.1002\/hec.843"},{"key":"ref26","doi-asserted-by":"publisher","DOI":"10.1007\/s40273-023-01301-7"},{"key":"ref27","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwq260"},{"key":"ref28","doi-asserted-by":"publisher","DOI":"10.1016\/j.healthpol.2018.04.001"},{"key":"ref29","doi-asserted-by":"publisher","DOI":"10.1007\/s40273-014-0136-z"},{"key":"ref30","doi-asserted-by":"publisher","DOI":"10.1177\/0022034515573272"},{"key":"ref31","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph16152668"},{"key":"ref32","doi-asserted-by":"publisher","DOI":"10.1159\/000356859"},{"key":"ref33","doi-asserted-by":"publisher","DOI":"10.1002\/hec.4603"},{"key":"ref34","doi-asserted-by":"publisher","DOI":"10.1111\/cdoe.12917"},{"key":"ref35","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0187477"},{"key":"ref36","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0299470"},{"key":"ref37","doi-asserted-by":"publisher","DOI":"10.1001\/archpedi.160.2.164"},{"key":"ref38","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2014.301869"}],"container-title":["Caries 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