Economic Evaluation of dental caries prevention programs among Chilean schoolchildren

Methods: Standard cost-effectiveness analysis methods were used. The costs associated with implementing and operating each program, using a societal perspective, were identified and measured. The comparator was the status-quo. Health outcomes were measured as dental caries averted over a 6-year period. Clinical effectiveness data for the different programs were taken from published data. Costs were measured as direct treatment costs, programs costs and costs of productivity losses as a result of dental treatments. All costs were estimated in 2008 prices. Incremental cost-effectiveness ratios were calculated. Two hypothetical populations were used in the analyses. The first comprised 80,000 12-year olds living in a large city (water-fluoridation). For the school-based programs,the population was a rural community consisting of 6,000 children aged 12-years old. Sensitivity analyses were conducted over a range of values for key parameters.

Results: The cost-effectiveness ratio of each program resulted in a net societal saving per diseased tooth averted of: US$23.22 with community water fluoridation; US$31.34 with milk fluoridation; US$7.33 with APF-Gel; US$6.87 with FMR; and US$5.87 with supervised toothbrushing, when compared to a non-intervention group.

Conclusion: Findings confirm that community/school-based dental caries interventions are highly cost-effective and an efficient use of society's financial resources. Based on cost required to prevent one carious tooth, milk-fluoridation was the most cost-effective, with supervised toothbrushing ranking as least cost-effective. The models used here were conservative and likely to underestimate the real benefits of each intervention, which also last for longer timeframes than the analysis.