Cost-effectiveness models for dental caries prevention programmes among Chilean schoolchildren

Community Dent Health. 2012 Dec;29(4):302-8.

Abstract

Aim: This study aims to estimate the cost-effectiveness from a societal perspective of seven dental caries prevention programmes among schoolchildren in Chile: three community-based programmes: water-fluoridation, salt-fluoridation and dental sealants; and four school-based programmes: milk-fluoridation; fluoridated mouthrinses (FMR); APF-Gel, and supervised toothbrushing with fluoride toothpaste.

Methods: Standard cost-effectiveness analysis methods were used. The costs associated with implementing and operating each programme, using a societal perspective, were identified and estimated. The comparator was non-intervention. Health outcomes were measured as dental caries averted over a 6-year period. Costs were estimated as direct treatment costs, programmes costs and costs of productivity losses as a result of each dental caries prevention programme. Incremental cost-effectiveness ratios were calculated for each programme. Sensitivity analyses were conducted over key parameters.

Results: Primary cost-effectiveness analysis (discounted) indicated that four programmes showed net social savings by the DMFT averted. These savings encompassed a range of values per diseased tooth averted; US$16.21 (salt-fluoridation), US$14.89 (community water fluoridation); US$14.78 (milk fluoridation); and US$8.63 (FMR). Individual programmes using an APF-Gel application, dental sealants, and supervised tooth brushing using fluoridated toothpaste, represent costs for the society per diseased tooth averted of US$21.30, US$11.56 and US$8.55, respectively.

Conclusion: Based on cost required to prevent one carious tooth among schoolchildren, salt fluoridation was the most cost-effective, with APF-Gel ranking as least cost-effective. Findings confirm that most community/school-based dental caries interventions are cost-effective uses of society's financial resources. The models used are conservative and likely to underestimate the real benefits of each intervention.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acidulated Phosphate Fluoride / therapeutic use
  • Animals
  • Cariostatic Agents / administration & dosage
  • Cariostatic Agents / therapeutic use
  • Child
  • Chile
  • Community Dentistry / economics
  • Cost Savings
  • Cost of Illness
  • Cost-Benefit Analysis
  • DMF Index
  • Dental Caries / economics
  • Dental Caries / prevention & control*
  • Efficiency
  • Fluoridation / economics
  • Fluorides / administration & dosage
  • Fluorides / therapeutic use
  • Health Care Costs
  • Health Promotion / economics*
  • Humans
  • Milk
  • Models, Economic
  • Mouthwashes / therapeutic use
  • Outcome Assessment, Health Care / economics
  • Pit and Fissure Sealants / therapeutic use
  • Preventive Dentistry / economics
  • Process Assessment, Health Care / economics
  • School Dentistry / economics
  • Sodium Chloride, Dietary / administration & dosage
  • Toothbrushing / methods
  • Toothpastes / therapeutic use

Substances

  • Cariostatic Agents
  • Mouthwashes
  • Pit and Fissure Sealants
  • Sodium Chloride, Dietary
  • Toothpastes
  • Acidulated Phosphate Fluoride
  • Fluorides