The economic value of Quebec’s water fluoridation program

Tchouaket, Éric; Brousselle, Astrid; Fansi, Alvine Kamdeu; Dionne, Pierre; Bertrand, Élise; Fortin, Christian

doi:10.1007/s10389-013-0578-3

Cited by 24 publications

(31 citation statements)

References 20 publications

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“…The cost-effectiveness of water fluoridation has been recently assessed in Canada 97 and Australia, 98 and both studies suggested significant cost savings can be made as a result of water fluoridation, especially if a large population is covered by a scheme. We have a poor understanding of the cost-effectiveness of this public health intervention for the UK.…”

Section: A 2003 Cochrane Reviewmentioning

confidence: 99%

A randomised controlled trial to measure the effects and costs of a dental caries prevention regime for young children attending primary care dental services: the Northern Ireland Caries Prevention In Practice (NIC-PIP) trial

Tickle

O’Neill

Donaldson

et al. 2016

Health Technol Assess

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BackgroundDental caries is the most common disease of childhood. The NHS guidelines promote preventative care in dental practices, particularly for young children. However, the cost-effectiveness of this policy has not been established.ObjectiveTo measure the effects and costs of a composite fluoride intervention designed to prevent caries in young children attending dental services.DesignThe study was a two-arm, parallel-group, randomised controlled trial, with an allocation ratio of 1 : 1. Randomisation was by clinical trials unit, using randomised permuted blocks. Children/families were not blinded; however, outcome assessment was blinded to group assessment.SettingThe study took place in 22 NHS dental practices in Northern Ireland, UK.ParticipantsThe study participants were children aged 2–3 years, who were caries free at baseline.InterventionsThe intervention was composite in nature, comprising a varnish containing 22,600 parts per million (p.p.m.) fluoride, a toothbrush and a 50-ml tube of toothpaste containing 1450 p.p.m. fluoride; plus standardised, evidence-based prevention advice provided at 6-monthly intervals over 3 years. The control group received the prevention advice alone.Main outcome measuresThe primary outcome measure was conversion from caries-free to caries-active states. Secondary outcome measures were the number of decayed, missing or filled tooth surfaces in primary dentition (dmfs) in caries-active children, the number of episodes of pain, the number of extracted teeth and the costs of care. Adverse reactions (ARs) were recorded.ResultsA total of 1248 children (624 randomised to each group) were recruited and 1096 (549 in the intervention group and 547 in the control group) were included in the final analyses. A total of 87% of the intervention children and 85% of control children attended every 6-month visit (p = 0.77). In total, 187 (34%) children in the intervention group converted to caries active, compared with 213 (39%) in the control group [odds ratio (OR) 0.81, 95% confidence interval (CI) 0.64 to 1.04;p = 0.11]. The mean number of tooth surfaces affected by caries was 7.2 in the intervention group, compared with 9.6 in the control group (p = 0.007). There was no significant difference in the number of episodes of pain between groups (p = 0.81). However, 164 out of the total of 400 (41%) children who converted to caries active reported toothache, compared with 62 out of 696 (9%) caries-free children (OR 7.1 95% CI 5.1 to 9.9;p < 0.001). There was no statistically significant difference in the number of teeth extracted in caries-active children (p = 0.95). Ten children in the intervention group had ARs of a minor nature. The average direct dental care cost was £155.74 for the intervention group and £48.21 for the control group over 3 years (p < 0.05). The mean cost per carious surface avoided over the 3 years was estimated at £251.00.LimitationsThe usual limitations of a trial such as generalisability and understanding the underlying reasons for the outcomes apply. There is no mean willingness-to-pay threshold available to enable assessment of value for money.ConclusionsA statistically significant effect could not be demonstrated for the primary outcome. Once caries develop, pain is likely. There was a statistically significant difference in dmfs in caries-active children in favour of the intervention. Although adequately powered, the effect size of the intervention was small and of questionable clinical and economic benefit.Future workFuture work should assess the caries prevention effects of interventions to reduce sugar consumption at the population and individual levels. Interventions designed to arrest the disease once it is established need to be developed and tested in practice.Trial registrationCurrent Controlled Trials ISRCTN36180119 and EudraCT 2009-010725-39.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 20, No. 71. See the NIHR Journals Library website for further project information.

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Section: A 2003 Cochrane Reviewmentioning

confidence: 99%

A randomised controlled trial to measure the effects and costs of a dental caries prevention regime for young children attending primary care dental services: the Northern Ireland Caries Prevention In Practice (NIC-PIP) trial

Tickle

O’Neill

Donaldson

et al. 2016

Health Technol Assess

View full text Add to dashboard Cite

show abstract

“…The final ten studies were composed of nine peer-reviewed journal articles 5, 9–16 plus a report 17 . Geographically, six of the studies were from the U.S. 5, 9–11, 15, 17 , with the rest from Australia 13, 14 , Canada 16 , and New Zealand 12 .…”

Section: Evidence Synthesismentioning

confidence: 99%

“…Geographically, six of the studies were from the U.S. 5, 9–11, 15, 17 , with the rest from Australia 13, 14 , Canada 16 , and New Zealand 12 . Six papers 9, 11–14, 16 provided cost and benefit information, two 13, 14 of which also conducted cost-effectiveness analysis using DALY. The remaining four papers 5, 10, 15, 17 provided only benefit information and used regression models to analyze the change in treatment cost or dental claims with the presence of CWF.…”

Section: Evidence Synthesismentioning

confidence: 99%

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Economic Evaluation of Community Water Fluoridation

Tao¹,

Chattopadhyay²

2016

American Journal of Preventive Medicine

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Context: A recently updated Community Guide systematic review of the effectiveness of community water fluoridation (CWF) still found strong evidence that CWF reduced dental caries across populations. Although CWF was found to have saved money in a 2002 Community Guide review, the conclusion was based on studies before year 1995. Given the update to the effectiveness review and changes in the economic environment, re-examination of the benefit and cost of CWF is necessary. Evidence acquisition: Using methods developed for Community Guide economic reviews, 564 potentially relevant papers were identified within a search period from January 1995 to November 2013. Ten studies were included in the current review, with four covering CWF benefits only and another six providing both cost and benefit information. Additionally, two of the six studies analyzed the cost-effectiveness of CWF. The economic review was conducted in 2014. Evidence synthesis: For all four benefit–only studies, which used regression analysis, dental costs in various forms were lower in communities with water fluoridation. For the remaining six studies, per capita annual intervention cost ranged from $0.11 to $4.89 in 2013 U.S dollars. Variation in cost was caused mainly by community population size, with decreasing per capita cost associated with increasing community population. Per capita annual benefit in the six studies ranged from $5.45 to $139.78. Variation in benefit was mainly due to the numbers and types of benefit components included in the benefit calculation. Benefit–cost ratios ranged from 1.12:1 to 135:1, and these ratios were positively associated with community population size. Conclusions: Recent evidence continues to indicate that the economic benefit of community water fluoridation exceeds the intervention cost. Further, the benefit–cost ratio increases with the community population size.

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“…[123] A modelling study on CWF in South Africa also reported that benefits of CWF would exceed costs. [124] At least since the year 2000, there appear to be no published studies in the peer-reviewed literature that show that CWF is not costeffective (i.e., in communities over 1000 people and where the water is not naturally fluoridated).…”

Section: Health Inequalities and Cost Effectivenessmentioning

confidence: 99%

Water fluoridation: It really is this simple

2017

Br Dent J

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(RSNZ), and the Ministry of Health, to review the scientific evidence for and against the efficacy and safety of fluoridation of public water supplies. After discussion between the parties, it was agreed that the Office of the PMCSA and the RSNZ would establish a panel to undertake a review. This review would adhere strictly to the scientific issues of safety and efficacy (or otherwise), but take into account the various concerns that have been raised in the public domain about the science and safety of fluoride. It would not consider the ethical and philosophical issues that have surrounded fluoridation and influenced legal proceedings lately. The Prime Minister gave his consent for the Office of the PMCSA to be involved and funding was provided by Councils through your office and by the Ministry of Health.We are pleased to advise the report is being delivered on the timetable agreed. ProcessGiven this is inevitably an issue that arouses passions and argument, we summarise in some detail the process used.As this was the first formal scientific review conducted jointly between the Office of PMCSA and the Royal Society a memorandum of understanding for the process was developed and has been followed.The essence of the process was that the PMCSA appointed an experienced literature researcher to undertake the primary research and literature reviews. Following an initial scoping that included an extensive reading of the literature (informal, grey and peer reviewed) on the subject, a draft table of contents was agreed between the PMCSA and the President of the RSNZ. The RSNZ then appointed a panel of appropriate experts across the relevant disciplines that was approved by the PMCSA.A member of civil society with expertise in local body issues, Ms Kerry Prendergast, was invited to be an observer to the panel and to be included in the discussions and drafting to be sure that it met local body needs. The scientific writer then produced an early partial draft of the report that was presented to a meeting of the expert panel, and their input was sought both as to framing and interpretation of the literature. The panel paid particular attention to the claims that fluoride had adverse effects on brain development, on the risks of cancer, musculoskeletal and hormonal disorders -being the major areas where claims about potential harms have been made. Over the following weeks, the panel members joined in an iterative process with the scientific writer to develop the report. In its advanced form all the members of the panel, together with the PMCSA and the President of the RSNZ, agreed via email exchange on the final wording of the report and its executive summary. In this form it was sent out for international peer review by appropriate scientific experts in Australia, UK and Ireland. Following their suggestions (which were minor and did not affect the panel's conclusions), the report and executive summary were returned to the panel for comment. Findings and recommendationsThe report and its executive summary are very clear i...

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The economic value of Quebec’s water fluoridation program

Cited by 24 publications

References 20 publications

A randomised controlled trial to measure the effects and costs of a dental caries prevention regime for young children attending primary care dental services: the Northern Ireland Caries Prevention In Practice (NIC-PIP) trial

A randomised controlled trial to measure the effects and costs of a dental caries prevention regime for young children attending primary care dental services: the Northern Ireland Caries Prevention In Practice (NIC-PIP) trial

Economic Evaluation of Community Water Fluoridation

Water fluoridation: It really is this simple

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