Economic evaluation of a water fluoridation scheme in Cumbria, UK

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

Community dentistry and oral epidemiology Pub Date : 2024-03-25 DOI:10.1111/cdoe.12958

William Whittaker, Michaela Goodwin, Saima Bashir, Matt Sutton, Richard Emsley, Michael P. Kelly, Martin Tickle, Tanya Walsh, Iain A. Pretty

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引用次数: 0

Abstract

Objectives

The addition of fluoride to community drinking water supplies has been a long-standing public health intervention to improve dental health. However, the evidence of cost-effectiveness in the UK currently lacks a contemporary focus, being limited to a period with higher incidence of caries. A water fluoridation scheme in West Cumbria, United Kingdom, provided a unique opportunity to study the contemporary impact of water fluoridation. This study evaluates the cost-effectiveness of water fluoridation over a 5–6 years follow-up period in two distinct cohorts: children exposed to water fluoridation in utero and those exposed from the age of 5.

Methods

Cost-effectiveness was summarized employing incremental cost-effectiveness ratios (ICER, cost per quality adjusted life year (QALY) gained). Costs included those from the National Health Service (NHS) and local authority perspective, encompassing capital and running costs of water fluoridation, as well as NHS dental activity. The measure of health benefit was the QALY, with utility determined using the Child Health Utility 9-Dimension questionnaire. To account for uncertainty, estimates of net cost and outcomes were bootstrapped (10 000 bootstraps) to generate cost-effectiveness acceptability curves and sensitivity analysis performed with alternative specifications.

Results

There were 306 participants in the birth cohort (189 and 117 in the non-fluoridated and fluoridated groups, respectively) and 271 in the older school cohort (159 and 112, respectively). In both cohorts, there was evidence of small gains in QALYs for the fluoridated group compared to the non-fluoridated group and reductions in NHS dental service cost that exceeded the cost of fluoridation. For both cohorts and across all sensitivity analyses, there were high probabilities (>62%) of water fluoridation being cost-effective with a willingness to pay threshold of £20 000 per QALY.

Conclusions

This analysis provides current economic evidence that water fluoridation is likely to be cost-effective. The findings contribute valuable contemporary evidence in support of the economic viability of water fluoridation scheme.

Abstract Image

查看原文本刊更多论文

英国坎布里亚郡氟化水计划的经济评估。

目的：在社区饮用水中添加氟化物是一项由来已久的改善牙齿健康的公共卫生干预措施。然而，目前在英国，有关成本效益的证据缺乏当代重点，仅限于龋齿发病率较高的时期。英国西坎布里亚郡的水氟化计划为研究水氟化的当代影响提供了一个独特的机会。这项研究评估了氟化水在 5-6 年跟踪期内的成本效益，对象是两个不同的群体：在子宫内接触氟化水的儿童和从 5 岁开始接触氟化水的儿童：成本效益采用增量成本效益比（ICER，每质量调整生命年（QALY）获得的成本）进行总结。成本包括国家医疗服务体系（NHS）和地方当局的成本，包括氟化水的资本成本和运行成本，以及国家医疗服务体系的牙科活动成本。健康效益的衡量标准是 "QALY"，使用儿童健康效用 9 维度问卷确定效用。为了考虑不确定性，对净成本和结果的估计值进行了自举（10 000 次自举），以生成成本效益可接受性曲线，并采用其他规格进行了敏感性分析：出生队列中有 306 人（无氟组和有氟组分别有 189 人和 117 人），年龄较大的学校队列中有 271 人（分别有 159 人和 112 人）。在这两个队列中，都有证据表明，与无氟组相比，有氟组在质量调整生命年（QALYs）方面的收益较小，而且国家医疗服务体系（NHS）牙科服务成本的降低幅度超过了加氟的成本。对于两个队列和所有敏感性分析，在每QALY20,000英镑的支付意愿阈值下，水氟化具有成本效益的概率很高（>62%）：这项分析提供了当前的经济学证据，证明水氟化很可能具有成本效益。研究结果为支持水氟化计划的经济可行性提供了宝贵的现代证据。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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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.