Predictive validity and cost-effectiveness analysis of two caries risk assessment tools for preschool children

Background This study compared the predictive validity and cost-effectiveness of Cariostat and a reduced Cariogram model for caries risk screening in preschoolers, to guide community-based prevention programs. Methods A longitudinal study was conducted among 156 children (aged 3–4 years) recruited from two randomly selected kindergartens. Baseline assessments included oral examinations, caregiver questionnaires, and caries-risk stratification using Cariostat and the reduced Cariogram. After 12 months, follow-up examinations recorded caries incidence. Predictive performance was analyzed using sensitivity, specificity, and area under the receiver operating characteristic curve (AUC). Cost-effectiveness ratios (CER) and incremental cost-effectiveness ratio (ICER) were calculated per correctly identified moderate-to-high-risk child. Results Among 147 children completing follow-up, 43.54% developed new caries (mean dmft increment: 1.41 ± 0.21). The reduced Cariogram showed higher sensitivity (90.24% vs. 73.17%) but similar specificity (43.08% vs. 44.62%) and AUC (0.71 vs. 0.69) compared to Cariostat. The cost per correctly screened high-risk child was 6-fold lower for the reduced Cariogram (¥14.41 vs. ¥82.68), with a negative ICER favoring Cariogram. Conclusion The reduced Cariogram outperformed Cariostat in sensitivity and cost-effectiveness for community caries screening, despite modest specificity. Its lower cost and simpler implementation support use in resource-limited settings.