Cost‐effectiveness of caries‐preventive fluoride varnish applications in clinic settings among patients of low, moderate and high risk

Abstract

Objectives: The total body of evidence finds fluoride varnish effective to prevent caries. However, most trials were conducted in high-risk populations, with more recent trials on low-risk groups finding a lower efficacy. We aimed to assess the cost-effectiveness of fluoride varnish application in clinic setting in populations with different caries risk.Methods: A mixed public-private-payer perspective in the context of German health care was performed using a lifetime Markov model. Effectiveness data were derived from an update of the most recent systematic Cochrane review and synthesized in three different risk groups according to control group caries increment via randomeffects meta-analysis. Varnish was assumed to be applied twice yearly between age 6 and 18 years. Teeth with carious defects would be treated restoratively and could experience further follow-up treatments. Costs were deduced from German fee item catalogues. Monte Carlo microsimulations were used for to analyse lifetime treatment costs and caries increment (Euro/Decayed, Missing, Filled Teeth (DMFT)).

A Markov cost‐effective analysis of biannual fluoride varnish for preventing dental caries in permanent teeth over a 70‐year time horizon

“…Our findings were consistent with a study that showed biannual fluoride varnish applications are more expensive and more effective than current practice . Other studies have shown that the intervention is cost‐saving for children under 6 years .…”

“…This chance for moving between health states is known as transitional probabilities, which were adapted from previous studies . Consistent with the relevant literature, the incidence of dental caries was assumed to be constant . Transition probabilities for subjects aged 76‐85 years was extrapolated as for individuals aged 75.…”

Cost-effectiveness of managing cavitated primary molar caries lesions: A randomized trial in Germany

“…Costs may be much lower if NRCC follow-up was to be provided in kindergartens or schools, or by dental therapists or other, less costly providers. This is notable, as cost-effectiveness for dental interventions may be very different when provided in surgery versus in other settings [17]. However, even if we halved the regular costs (by assuming re-instruction costs…”

Assessing the cost‐effectiveness of a fluoride varnish programme in Chile: The use of a decision analytic model in dentistry

“…A further German study using a lifetime Markov model to estimate caries increment in DMFT, considered FV application for both adolescent and adult populations and showed that the application of FV in a clinical setting is unlikely to be cost‐effective in low‐risk populations. However, the Schwendicke study used data from a birth cohort study from New Zealand which is of less relevance to this context.…”