Cost-Effectiveness through the Dental-Health FRAMM Guideline for Caries Prevention among 12- to 15-Year-Olds in Sweden

Abstract

Since 2008, FRAMM has been a guideline for caries prevention for all 3- to 15-year-olds in the Västra Götaland Region in Sweden and a predominant part is school-based fluoride varnish applications for all 12- to 15-year-olds. The aims were to evaluate dental health-economic data among 12- to 15-year-olds, based on the approximal caries prevalence at the age of 12, and to evaluate cost-effectiveness. Caries data for 13,490 adolescents born in 1993 who did not take part and 11,321 adolescents born in 1998 who followed this guideline were extracted from dental records. Those with no dentin and/or enamel caries lesions and/or fillings on the approximal surfaces were pooled into the “low” subgroup, those with 1–3 into the “moderate” subgroup and those with ≥4 into the “high” subgroup. The results revealed that the low subgroup had a low approximal caries increment compared with the moderate and high subgroups during the 4-year study period. In all groups, there were statistically significant differences between those who took part in the guideline and those who did not. The analysis of cost-effectiveness revealed the lowest incremental cost-effectiveness ratio (ICER) for the high subgroup for decayed and/or filled approximal surfaces (DFSa) and approximal enamel lesions together and the highest ICER for the low subgroup for DFSa alone. To conclude, the FRAMM Guideline reduced the caries increment for adolescents with low, moderate and high approximal caries prevalence. The subgroup with the most favourable cost-effectiveness comprised those with a high caries prevalence at the age of 12.

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].…”

A scoping review of cost‐effectiveness analyses of school‐based interventions for caries

“…A total of 738 articles were initially identified and reviewed and 15 met the inclusion criteria 16‐30 . Figure S1 outlines the results of the search process 31 …”

“…Table 1 summarized the key characteristics of the 15 included studies. Nearly 80% of the studies assessed the cost‐effectiveness of interventions based on topical fluoride therapy and fissure sealants at school premises 16‐18,21,23‐25,27,29,30 . Only two studies reported preference‐based health outcomes, 19,28 while all but one 16 reported an Incremental Cost‐Effectiveness Ratio (ICER).…”

“…Further, a patient‐centred comprehensive preventive programme was found to be more effective, but costlier than standard care in Finland, 2009 20 . One study reported that school‐based caries preventive programme was cost‐effective for the high‐risk group under lower threshold 17 and it was cost‐effective in all groups if a higher threshold was adapted 28 . More details of the included studies are in Supplementary material .…”

“…All studies identified and reported on background and objectives, comparators, time horizon, analytical methods, study parameters. However, an explanation of some of the key components of the study design including, setting and location, study perspective, discount rate, currency, price and date conversion, choice of model and characterizing uncertainty and heterogeneity were excluded in some studies 16‐18,21,23,24,27 …”