How effective and cost-effective is water fluoridation for adults and adolescents? The LOTUS 10-year retrospective cohort study

IF 1.8 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Community dentistry and oral epidemiology Pub Date : 2024-01-08 DOI:10.1111/cdoe.12930

Deborah Moore, Blessing Nyakutsikwa, Thomas Allen, Emily Lam, Stephen Birch, Martin Tickle, Iain A. Pretty, Tanya Walsh

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Abstract

Objective

To pragmatically assess the clinical and cost-effectiveness of water fluoridation for preventing dental treatment and improving oral health in a contemporary population of adults and adolescents, using a natural experiment design.

Methods

A 10-year retrospective cohort study (2010–2020) using routinely collected NHS dental treatment claims data. Participants were patients aged 12 years and over, attending NHS primary dental care services in England (17.8 million patients). Using recorded residential locations, individuals exposed to drinking water with an optimal fluoride concentration (≥0.7 mg F/L) were matched to non-exposed individuals using propensity scores. Number of NHS invasive dental treatments, DMFT and missing teeth were compared between groups using negative binomial regression. Total NHS dental treatment costs and cost per invasive dental treatment avoided were calculated.

Results

Matching resulted in an analytical sample of 6.4 million patients. Predicted mean number of invasive NHS dental treatments (restorations ‘fillings’/extractions) was 3% lower in the optimally fluoridated group (5.4) than the non-optimally fluoridated group (5.6) (IRR 0.969, 95% CI 0.967, 0.971). Predicted mean DMFT was 2% lower in the optimally fluoridated group (IRR 0.984, 95% CI 0.983, 0.985). There was no difference in the predicted mean number of missing teeth per person (IRR 1.001, 95% CI 0.999, 1.003) and no compelling evidence that water fluoridation reduced social inequalities in dental health. Optimal water fluoridation in England 2010–2020 was estimated to cost £10.30 per person (excludes initial set-up costs). NHS dental treatment costs for optimally fluoridated patients 2010–2020 were 5.5% lower, by £22.26 per person (95% CI -£21.43, −£23.09).

Conclusions

Receipt of optimal water fluoridation 2010–2020 resulted in very small positive health effects which may not be meaningful for individuals. Existing fluoridation programmes in England produced a positive return on investment between 2010 and 2020 due to slightly lower NHS dental care utilization. This return should be evaluated against the projected costs and lifespan of any proposed capital investment in water fluoridation, including new programmes.

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成人和青少年使用氟化水的效果和成本效益如何？LOTUS 10 年回顾性队列研究。

目的采用自然实验设计，务实地评估氟化水在预防牙科治疗和改善当代成人和青少年口腔健康方面的临床和成本效益：一项为期 10 年的回顾性队列研究（2010-2020 年），使用的是常规收集的英国国家医疗服务体系牙科治疗索赔数据。参与者为年龄在 12 岁及以上、在英格兰国家医疗服务体系初级牙科保健服务机构就诊的患者（1780 万名患者）。根据记录的居住地点，采用倾向得分法将接触最佳氟化物浓度（≥0.7 毫克/升）饮用水的人与未接触氟化物的人进行匹配。采用负二项回归法比较不同组间的 NHS 侵入性牙科治疗次数、DMFT 和缺牙情况。计算了 NHS 牙科治疗总成本和每次避免侵入性牙科治疗的成本：结果：通过匹配得到了 640 万患者的分析样本。最佳氟化组（5.4）的NHS侵入性牙科治疗（修复 "补牙"/拔牙）预测平均次数比非最佳氟化组（5.6）低3%（IRR为0.969，95% CI为0.967，0.971）。最佳加氟组的预测平均 DMFT 低 2%（IRR 为 0.984，95% CI 为 0.983，0.985）。预测的人均缺牙数量没有差异（IRR 1.001，95% CI 0.999，1.003），也没有令人信服的证据表明氟化水减少了牙齿健康方面的社会不平等。据估计，英格兰 2010-2020 年的最佳水氟化费用为每人 10.30 英镑（不包括初始设置费用）。2010-2020年经过最佳氟化处理的患者的NHS牙科治疗费用降低了5.5%，每人降低了22.26英镑（95% CI为-21.43英镑，-23.09英镑）：结论：2010-2020 年接受最佳水氟化处理对健康的积极影响非常小，对个人而言可能意义不大。英格兰现有的氟化计划在 2010-2020 年间产生了积极的投资回报，原因是国民保健服务系统（NHS）牙科保健的使用率略有下降。应根据任何拟议的水氟化资本投资（包括新计划）的预计成本和寿命对这一回报进行评估。

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来源期刊

Community dentistry and oral epidemiology 医学-公共卫生、环境卫生与职业卫生

CiteScore

4.40

自引率

8.70%

发文量

审稿时长

6 months

期刊介绍： The aim of Community Dentistry and Oral Epidemiology is to serve as a forum for scientifically based information in community dentistry, with the intention of continually expanding the knowledge base in the field. The scope is therefore broad, ranging from original studies in epidemiology, behavioral sciences related to dentistry, and health services research through to methodological reports in program planning, implementation and evaluation. Reports dealing with people of all age groups are welcome. The journal encourages manuscripts which present methodologically detailed scientific research findings from original data collection or analysis of existing databases. Preference is given to new findings. Confirmations of previous findings can be of value, but the journal seeks to avoid needless repetition. It also encourages thoughtful, provocative commentaries on subjects ranging from research methods to public policies. Purely descriptive reports are not encouraged, nor are behavioral science reports with only marginal application to dentistry. The journal is published bimonthly.