Cost‐effectiveness and estimated net monetary benefits of a fluoride varnish application program during well‐child visits by 9‐ to 30‐month‐old children in three areas of Thailand

Abstract

Objectives To evaluate the cost‐effectiveness and estimated net monetary benefits of a fluoride varnish application program during well‐child visits in young children in three Thai provinces. Costs and benefits from both the provider and patients are presented. Methods Cost‐effectiveness and estimated net monetary benefit analysis of one to five visits for fluoride varnish application using a retro‐prospective cohort study design. Cost and outcomes were estimated using dental personnel survey data, hospital procurement data and guardian survey. The primary outcomes were decayed (treatment needed), missing due to caries and filled teeth (dmft). Results From the provider's perspective, one to three visits for fluoride varnish application decreased dmft and saved costs compared to no visits, one visit and two visit strategies (ICER = −468.36, −424.40 and −65.72, respectively). These strategies also showed an estimated net monetary benefit of 430.89, 216.44 and 7.23 THB, respectively. From the patient's perspective, the estimated net monetary benefits were positive for up to three visits (383.24, 212.45 and 45.82 THB, respectively); however, the incremental cost‐effectiveness ratios were no different with these strategies (ICER = −416.56). The one and two visit strategies had a very high chance of showing cost saving in the probabilistic sensitivity analysis (97.1% and 95.5%, respectively). Conclusions The one to three visits fluoride varnish application program during well‐child visits appears to be cost‐effective with estimated net benefit interventions for dental caries prevention. These findings suggest that children between 9 and 30 months old should attend at least three visits of the fluoride varnish application program during well‐child visits.

Cost-Effectiveness of Treatment Decisions for Early Childhood Caries in Infants and Toddlers: A Systematic Review

“…While the articles [34,49] were about similar results, the articles [43,48] represented the baseline study [43] and the follow-up study with final clinical trial results [48]. Of the 24 articles included in the systematic review, 17 articles could be classified as prevention [18,[27][28][29][30][31][32][33][34][35][36][37][38][39][40][41]49]. Seven studies were classified as restoration [42][43][44][45][46][47][48].…”

“…All included studies were published in the last decade [18,. Most of the included articles (12 studies) and thus half of the articles were published in the last 3 years from 2020 to 2023 [18,[33][34][35][36][37][38][39][40][41]48,49].…”

“…Studies were classified chronologically according to their country of study conduct, number of study participants, location (e.g., practice/clinic) of study conduct, age of study participants, and study quality assessment. Furthermore, included studies were classified into two main groups of prevention according to their primary outcome [18,[27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] and restoration [42][43][44][45][46][47][48] with different subgroups divided at prevention (outreach/education/education, sealing, fluoride varnish, and silver diamine fluoride (SDF) and atraumatic restorative treatment (ART) as well as restoration (filling and crown). For ease of synthesis and clarity, the results were summarized in tables.…”

“…The included studies were a total of seven retrospective cohort studies [27,31,33,37,39,41,42], one uncontrolled [29], one cohort study [23], and randomized controlled trials [18,28,30,32,[34][35][36]38,40,[43][44][45][46][47][48][49] (Table 1). The summaries of the selected studies are presented in Table 2.…”

“…Most studies were conducted in the United Kingdom of Great Britain and Northern Ireland [28,29,31,34,35,47,49], the United States [27,28,37,42], and Brazil [32,43,46,48]. Sixteen studies were conducted in public health facilities or schools [18,[27][28][29][30][31][32]35,36,38,40,41,43,44,48,49], one study in a specialized dental practice [42], one study in a day care center [46], four studies in general or private dental practices [33,34,45,47], one study in an outpatient clinic or operating room [37], and one study that examined dental services only [46]. Of the included studies, a total of 14 were considered "good" [27,28,31,32,35,36,40,41,…”