A cost-effectiveness analysis of community water fluoridation for schoolchildren.

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dc.contributor.authorCronin, Jodi
dc.contributor.authorMoore, Stephen
dc.contributor.authorHarding, Máiréad
dc.contributor.authorWhelton, Helen
dc.contributor.authorWoods, Noel
dc.contributor.funderHealth Research Boarden
dc.date.accessioned2022-06-14T13:33:49Z
dc.date.available2022-06-14T13:33:49Z
dc.date.issued2021-03-25
dc.date.updated2022-06-14T03:13:43Z
dc.description.abstractBackground: Community water fluoridation (CWF), the controlled addition of fluoride to the water supply for the prevention of dental caries (tooth decay), is considered a safe and effective public health intervention. The Republic of Ireland (Ireland) is the only country in Europe with a legislative mandate for the fluoridation of the public water supply, a key component of its oral health policy. However, more recently, there has been an increase in public concern around the relevance of the intervention given the current environment of multiple fluoride sources and a reported increase in the prevalence of enamel fluorosis. The aim of this economic analysis is to provide evidence to inform policy decisions on whether the continued public investment in community water fluoridation remains justified under these altered circumstances. Methods: Following traditional methods of economic evaluation and using epidemiological data from a representative sample of 5-, 8-, and 12-year-old schoolchildren, this cost-effectiveness analysis, conducted from the health-payer perspective, compared the incremental costs and consequences associated with the CWF intervention to no intervention for schoolchildren living in Ireland in 2017. A probabilistic model was developed to simulate the potential lifetime treatment savings associated with the schoolchildren’s exposure to the intervention for one year. Results: In 2017, approximately 71% of people living in Ireland had access to a publicly provided fluoridated water supply at an average per capita cost to the state of €2.15. The total cost of CWF provision to 5-, 8-, and 12-year-old schoolchildren (n = 148,910) was estimated at €320,664, and the incremental cost per decayed, missing, or filled tooth (d3vcmft/D3vcMFT) prevented was calculated at €14.09. The potential annual lifetime treatment savings associated with caries prevented for this cohort was estimated at €2.95 million. When the potential treatment savings were included in the analysis, the incremental cost per d3vcmft/D3vcMFT prevented was -€115.67, representing a cost-saving to the health-payer and a positive return on investment. The results of the analysis were robust to both deterministic and probability sensitivity analyses. Conclusion: Despite current access to numerous fluoride sources and a reported increase in the prevalence of enamel fluorosis, CWF remains a cost-effective public health intervention for Irish schoolchildren.en
dc.description.sponsorshipHealth Research Board, Ireland (grant CARG (Collaborative Applied Research Grant)/2012/34, which also included the FACCT (Fluoride and Caring for Children’s Teeth) Study)en
dc.description.statusPeer revieweden
dc.description.versionPublished Versionen
dc.format.mimetypeapplication/pdfen
dc.identifier.citationCronin, J., Moore, S., Harding, M., Whelton, H. and Woods, N. (2021) 'A cost-effectiveness analysis of community water fluoridation for schoolchildren', BMC Oral Health 21, 158 (12 pp). doi: 10.1186/s12903-021-01490-7en
dc.identifier.doi10.1186/s12903-021-01490-7en
dc.identifier.endpage12en
dc.identifier.issn1472-6831
dc.identifier.issued158en
dc.identifier.journaltitleBMC Oral Healthen
dc.identifier.startpage1en
dc.identifier.urihttps://hdl.handle.net/10468/13298
dc.identifier.volume21en
dc.language.isoenen
dc.publisherSpringeren
dc.relation.urihttps://bmcoralhealth.biomedcentral.com/articles/10.1186/s12903-021-01490-7
dc.rights© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/publicdomain/zero/1.0/ The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.en
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en
dc.subjectCost-effectiveness analysisen
dc.subjectEconomic evaluationen
dc.subjectCommunity water fluoridationen
dc.subjectPreventive dentistryen
dc.subjectPublic health dentistryen
dc.titleA cost-effectiveness analysis of community water fluoridation for schoolchildren.en
dc.typeArticle (peer-reviewed)en
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