Economic Evaluation of public health interventions to reduce caries in children at high risk

Objectives: This study assessed the cost effectiveness of preventive oral health interventions to reduce caries in children . To date there are no published economic evaluations of the cost effectiveness of dental disease prevention
Methods: A decision analytic model was developed in which five key parameters could be varied . The model examined the costs and potential quality of life benefits associated with delivering fluoride varnish and toothbrushing schemes to 5 and 12 year old children in the UK . Reductions in caries risk were derived from published data. Baseline risk of caries for 5 and 12 year olds in the most deprived quintile (by Index of Multiple Deprivation) were obtained from national survey data. In order to address uncertainties around the key parameters, the model examined a range of alternative values for QALY loss associated with tooth decay/extraction and the costs of treatment.
Results: For 5 year old children in the most deprived quintile, if all extractions are carried out under GA, the QALY loss is high (0.007) and the cost of treatment is £225, then spending up to £46 per child on toothbrushing or up to £62 per child on fluoride varnish can be considered cost effective at the NICE threshold of £20,000 per QALY. If QALY loss is low (0.002)and cost of treatment is £175, supervised brushing is still cost effective up to £27 per child and fluoride varnish up to £37 per child. For 12 year olds, for interventions that reduce caries risk by 11% and if GA extractions are common (80%) a spend of up to £23 per child is justifiable on the basis of £20,000 per QALY. If however a relative risk reduction of 39% can be achieved, spending of up to £81 per child is justifiable. If 50% of extractions are carried out under GA, QALY loss is low (0.002) and treatment costs low,(£175) spending more than £9 per child would not be considered cost effective.
Conclusions: The analysis is limited by the need to make assumptions where data is absent. However, this model shows that for children at high risk of disease, supervised brushing and fluoride varnish schemes are cost effective public health interventions in terms of benefit to quality of life. The challenges of undertaking sound economic evaluation of oral health research will be demonstrated and discussed.