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

• Published in: Community dental health Vol. 29; no. 4; p. 302
• Main Authors: Mariño, R, Fajardo, J, Morgan, M
• Format: Journal Article
• Language: English
• Published: England 01.12.2012
• Subjects: Acidulated Phosphate Fluoride - therapeutic use; Animals; Cariostatic Agents - administration & dosage; Cariostatic Agents - therapeutic use; Child; Chile; Community Dentistry - economics; Cost of Illness; Cost Savings; Cost-Benefit Analysis; Dental Caries - economics; Dental Caries - prevention & control; DMF Index; 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; Chile
• ISSN: 0265-539X
• DOI: 10.1922/CDH_2893Marino07

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. 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. 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. 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.