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

Abstract

Objectives This study illustrates the use of a decision analytic model (DAM) to evaluate whether fluoride varnish application (FV) increases the proportion of caries‐free children in the Chilean preschool population, at an acceptable cost. Methods Different FV interventions were compared with an oral health counselling‐only intervention. The FV interventions were tested (with and without screening) every 6 months over 2 years, in either a preschool setting or during a well‐child programme appointment in a primary care setting. A Markov model was developed to simulate the FV performance. The model was populated with data obtained from Chilean epidemiologic studies, a systematic review and a costing study. The counselling‐only intervention was compared with FV interventions to estimate the incremental cost per child. As there was uncertainty in terms of precise parameter values both probabilistic and deterministic sensitivity analyses were performed. Results Delivery of FV in a primary care setting without screening was the most effective and the least costly intervention. Compared with counselling‐only intervention, this intervention increased the prevalence of caries‐free children in the population by 3.7%, with an extra cost (in March 2015) of £3 per caries‐free child. The results were sensitive to the starting age of FV application; increasing age would reduce the cost‐effectiveness of the FV intervention. Furthermore, cost‐effectiveness improves if some equipment such as an oral hygiene kit was not used and if less costly but qualified staff applied FV rather than dentists. Conclusions This analysis allowed the comparison of the performance of FV in realistic scenarios incorporating important aspects of health and education policies. The application of FV in a primary care setting was the most cost‐effective strategy. The work demonstrated that both the methodology and results are useful for decision‐makers.

Cost-effectiveness of caries preventive interventions – a systematic review

“…Of the 26 included studies, ten were economic evaluations directly based on empirical studies [19][20][21][22][23][24][25][26][27][28] and the other 16 were modelling studies [29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44]. In nine studies, the target population comprised pre-school children up to five years of age [19,22,25,26,31,32,35,36,38]. Twelve studies were analyses of interventions for schoolchildren aged from 6 to 15 years [20,21,23,24,[27][28][29][30]33,35,40,41].…”

“…A majority (n ¼ 18) of the included studies analysed fluoride varnish [19][20][21][22][23][24][25][26][27][28]30,35,[37][38][39][40][41]44], sometimes as a consequence of a risk-based program [21,23,25,26,28,44], while four studies analysed fissure sealants [29][30][31]33]. One study analysed the frequency of dental check-ups [32] and two studies [34,42] analysed the adoption of a tax on beverages containing sugar.…”

Community interventions and strategies for caries control in Latin American and Caribbean countries

“…65 APF gels and fluoride varnishes represent a professional approach to fluoride delivery, and studies reporting their use in LACC did so in the context of specific populations only and not in a clinical environment. School-based programs incorporating APF gel application as a complementary approach for mouth-rinses have been reported in Brazil 18 and Peru, 30 while the use of fluoride varnishes as a desirable preventive public health measure targeting high-caries-risk populations living in remote and rural areas without access to fluoridated salt or water have been reported in Brazil, 36 Chile, 37 and El Salvador. 39 Although fluoride varnishes may represent a feasible public health program for this specific population, the associated costs make them a less-suitable approach in comparison to the alternatives.…”

“…Although our searches identified many publications examining soluble fluoride content in commercial dentifrices used by the population, this review only included the four studies that were carried out in LACC (Brazil, Chile, Peru, and Uruguay). The remaining relevant studies included in this report focused on the use of fluoride varnishes in Brazil, 36 Chile, 37 Dominican Republic, 38 and El Salvador, 39 and on the use of a combination of fluoride mouth-rinses and APF gels in Brazil 18,35 and Peru 30 . Some publications were more comprehensive and documented several strategies for fluoride use within the same country, such as in Chile, 17 Cuba, 16 Brazil, 18 Colombia, 29 Haiti, 19 and Peru, 30 or reported one or more strategies adopted in several LACC.…”

Color evaluation of white spot lesions treated with resin infiltration after water or grape juice storage

“…Its first clinical sign is the presence of opaque white spot lesions, which consist of non-cavitated subsurface lesions that can be treated conservatively using preventive approaches 3 . Among these approaches, the application of fluoride in the form of solution, gel or varnish are the most common in dental clinics, since it is cost accessible and easy to use 4 . In addition, the introduction of resinous materials to seal pits and grooves and to infiltrate white spot lesions brought the advantage of being an immediate treatment.…”