Economic evaluation of fluoride varnish application in Iranian schools

Document Type : Original Article

Authors

1 Department of Health Management and Economics, School of Public Health, Urmia University of Medical Sciences, Urmia, Iran

2 Professor, Reproductive Health Research Center AND Department of Public Health, School of Public Health, Urmia University of Medical Sciences, Urmia, Iran

3 Dentist, Deputy of Health, Urmia University of Medical Sciences, Urmia, Iran

4 Assistant Professor, Department of Public Health, School of Public Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran

5 Assistant Professor, Department of Health Economics and Management, School of Public Health, Urmia University of Medical Sciences, Urmia, Iran

6 Associate Professor, Department of Health Economics and Management, School of Public Health, Urmia University of Medical Sciences, Urmia, Iran

Abstract

BACKGROUND AND AIM: Dental caries is still one of the most common chronic diseases among children, although it can be prevented through early and regular professional services. This study aimed to analyze cost-effectiveness of fluoride varnish therapy intervention to develop and implement appropriate strategies in order to reduce incidence of tooth decay.
METHODS: This study modelled the cost-effectiveness of fluoride varnish therapy plan to prevent dental caries in elementary students with age range between 7-12 years, in Urmia, northwestern Iran. All costs and benefits were measured from a provider perspective in order to obtain the cost-effectiveness analysis (CEA). We estimated the direct medical costs of fluoride varnish in a school-based setting and compared this to the benefits of reducing the incidence of dental caries, as measured by the disability-adjusted life year (DALY) index. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist was used to report this economic evaluation.
RESULTS: Based on the DALY index, the incremental cost-effectiveness ratio (ICER) was obtained $200.02 per DALY averted. According to the threshold defined by World Health Organization (WHO), fluoride varnish therapy intervention in this study is cost-effective. The results of this research were not sensitive to the desired parameters based on the results of one-way sensitivity analysis.
CONCLUSION: This study recommends fluoride varnish therapy intervention because of reducing caries, improving quality of life (QOL), and financial saving for families in the long term. The results of this study can also help health policy makers and managers to make decisions about allocating resources to prevent dental diseases.

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Main Subjects


  1. Petersen PE. The World Oral Health Report 2003: continuous improvement of oral health in the 21st century-the approach of the WHO Global Oral Health Programme. Community Dent Oral Epidemiol 2003; 31(Suppl 1): 3-23.
  2. Dye BA. The global burden of oral disease: Research and public health significance. J Dent Res 2017; 96(4): 361-3.
  3. Vos T, Abajobir AA, Abate KH, Abbafati C, Abbas KM, Abd-Allah F, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: A systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017; 390(10100): 1211-59.
  4. Organisation for Economic Co-operation and Development (OECD). Health at a Glance 2013 [Online]. [cited 2013]; Available from: URL: https://www.oecd.org/els/health-systems/Health-at-a-Glance-2013.pdf
  5. Organisation for Economic Co-operation and Development (OECD). Health at a Glance [Online]. [cited 2018]; Available from: URL: https://www.oecd-ilibrary.org/social-issues-migration-health/health-at-a-glance-2017_health_glance-2017-en
  6. Righolt AJ, Jevdjevic M, Marcenes W, Listl S. Global-, regional-, and country-level economic impacts of dental diseases in 2015. J Dent Res 2018; 97(5): 501-7.
  7. Eaton K. The state oforal health in Europe [Online]. [cited 2017]; Available from: URL: http://www.oralhealthplatform.eu/our-work/the-state-of-oral-health-in-europe
  8. Kassebaum NJ, Smith AGC, Bernabe E, Fleming TD, Reynolds AE, Vos T, et al. Global, regional, and national prevalence, incidence, and disability-adjusted life years for oral conditions for 195 countries, 1990-2015: A systematic analysis for the global burden of diseases, injuries, and risk factors. J Dent Res 2017; 96(4): 380-7.
  9. Gill M. Book review: The challenge of oral disease: A call for global action. Br Dent J 2016; 221(11): 687.

10. Dehghani M, Omrani R, Zamanian Z, Hashemi H. Determination of DMFT index among 7-11 year-old students and its relation with? Uoride in Shiraz drinking water in Iran. Pak J Med Sci 2013; 29(1 Suppl): 373-7.

11. Hamissi J. Prevalence of dental caries among preschool children in Qazvin, Iran: School screening programs. J Int Oral Health 2015.

12. Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: A systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380(9859): 2163-96.

13. Lalloo R, Kroon J, Tut O, Kularatna S, Jamieson LM, Wallace V, et al. Effectiveness, cost-effectiveness and cost-benefit of a single annual professional intervention for the prevention of childhood dental caries in a remote rural Indigenous community. BMC Oral Health 2015; 15: 99.

14. Kohn WG, Maas WR, Malvitz DM, Presson SM, Shaddix KK. Recommendations for using fluoride to prevent and control dental caries in the United States. Centers for Disease Control and Prevention. MMWR Recomm Rep 2001; 50(RR-14): 1-42.

15. Holm AK. Effect of fluoride varnish (Duraphat) in preschool children. Community Dent Oral Epidemiol 1979; 7(5): 241-5.

16. Marinho VC, Higgins JP, Logan S, Sheiham A. Topical fluoride (toothpastes, mouthrinses, gels or varnishes) for preventing dental caries in children and adolescents. Cochrane Database Syst Rev 2003; (4): CD002782.

17. Brown M. Transitions of care. In: Helton MR, Daaleman TP, Editors. Chronic illness care. Berlin, Germany: Springer International Publishing; 2018. p. 369-73.

18. Ogunseitan OA. Certification in public health (CPH) Q&A exam review. Berlin, Germany: Springer Publishing Company; 2020.

19. Neidell M, Shearer B, Lamster IB. Cost-effectiveness analysis of dental sealants versus fluoride varnish in a school-based setting. Caries Res 2016; 50(Suppl 1): 78-82.

20. Fyfe C, Borman B, Scott G, Birks S. A cost effectiveness analysis of community water fluoridation in New Zealand. N Z Med J 2015; 128(1427): 38-46.

21. Schwendicke F, Splieth CH, Thomson WM, Reda S, Stolpe M, Foster PL. Cost-effectiveness of caries-preventive fluoride varnish applications in clinic settings among patients of low, moderate and high risk. Community Dent Oral Epidemiol 2018; 46(1): 8-16.

22. Chestnutt IG, Hutchings S, Playle R, Morgan-Trimmer S, Fitzsimmons D, Aawar N, et al. Seal or Varnish? A randomised controlled trial to determine the relative cost and effectiveness of pit and fissure sealant and fluoride varnish in preventing dental decay. Health Technol Assess 2017; 21(21): 1-256.

23. World Health Organization. Health statistics and information systems [Online]. [cited 2021]; Available from: URL: https://www.who.int/healthinfo/bodgbd2002revised/en

24. Institute for Health Metrics and Evaluation. Global health data exchange [Online]. [cited 2021]; Available from: URL: http://ghdx.healthdata.org

25. Drummond M, Torrance GW. Methods for the economic evaluation of health care programmes. Oxford, UK: Oxford University Press; 2015.

26. Marseille E, Larson B, Kazi DS, Kahn JG, Rosen S. Thresholds for the cost-effectiveness of interventions: alternative approaches. Bull World Health Organ 2015; 93(2): 118-24.

27. International Monetary Fund. GDP per capita, current prices [Online]. [cited 2021]; Available from: URL: https://www.imf.org/external/datamapper/NGDPDPC@WEO/OEMDC/ADVEC/WEOWORLD%22

28. O'Neill C, Worthington HV, Donaldson M, Birch S, Noble S, Killough S, et al. Cost-effectiveness of caries prevention in practice: A randomized controlled trial. J Dent Res 2017; 96(8): 875-80.

29. Skold UM, Petersson LG, Birkhed D, Norlund A. Cost-analysis of school-based fluoride varnish and fluoride rinsing programs. Acta Odontol Scand 2008; 66(5): 286-92.