Issues in the economic evaluation of community water fluoridation

Abstract

Community water fluoridation has long been recognized as an effective public health intervention in the prevention of dental caries. The recently documented secular decline in dental caries, however, presents for policy makers the challenge of appropriately allocating limited health care resources between a variety of health care programs. Appropriate economic assessment of these alternatives becomes critical for rational distribution of such resources. Cost‐benefit and cost‐effectiveness analyses are techniques that, when used correctly, can guide policy makers facing such decisions. This paper reviews and critiques the published literature assessing the cost effectiveness and cost benefit of community water fluoridation using criteria developed for economic evaluation. Eight papers met the criteria for inclusion in the present study. In general, the articles failed to incorporate the declining prevalence of dental caries into their analyses and to fully document costs associated with water fluoridation. Treatment savings from dental care averted secondary to water fluoridation were not appropriately incorporated into the cost‐effectiveness analyses, thereby overestimating the marginal cost associated with fluoridation. Specification of outcome measures to assess the consequences of water fluoridation failed to incorporate the dynamic nature of dental disease. Suggestions for improving the generalizability and usefulness of future cost‐benefit and cost‐effectiveness analyses are made.

Reviews of evidence on interventions to prevent dental caries, oral and pharyngeal cancers, and sports-related craniofacial injuries1 1The names and affiliations of the Task Force members are listed at the beginning of this supplement, and at www.thecommunityguide.org.

“…Our systematic search for economic information identified 27 candidate studies (see Appendix A). 39,46, Of these,18 were excluded for the following reasons: they (1) were not primary studies (10 studies 39,52,60,63,65,70,71,73,75,76 ); (2) did not report sufficient cost data (6 studies [55][56][57]62,63,69 ); (3) compared costs between low fluoride and optimal fluoride exposure groups without controlling for confounding factors (1 study 54 ); or (4) reported the cost of removing fluoride from water with extremely high levels of natural fluoride (1 study 74 ). The remaining 9 studies were considered qualifying studies from which we present the following summary findings.…”

Economic evaluations in water-fluoridation: a scoping review

“…Thirty-four articles were selected for full text review. Of these, five were excluded due to being cost studies [18][19][20][21][22]; two due to being review articles [23,24]; two did not have comparators [25,26] and two articles were in French [27,28]. In addition, three articles were identified by hand search and other online sources.…”

An Update on Oral Hygiene Products and Techniques

“…An increase in applied force from 0.6 to 5.0 N led to a 47% decrease in plaque deposition in patients with fixed appliances. 11 However, it was previously thought that brushing orthodontic fixed appliance brackets with a powered brush might be too aggressive,…”