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Economic Evaluation of the Protecting Teeth @ 3 Randomized Controlled Trial
Y Anopa1,2, L M D Macpherson1, A D McMahon1
1College of Medical, Veterinary and Life Sciences, Glasgow Dental School, University of Glasgow, Glasgow, UK.
JDR Clinical and Translational Research
|April 20, 2022
Summary
Adding fluoride varnish (FV) to nursery school oral health programs did not prove cost-effective. This economic evaluation suggests reviewing the targeted FV component for better resource allocation in child dental public health.
Area of Science:
- Public Health & Health Services Research
- Dental Public Health
- Health Economics
Background:
- Child oral health interventions are crucial for preventing dental caries in early life.
- The Childsmile program in Scotland provides a multicomponent oral health intervention in nurseries.
- The additional preventive value of routine fluoride varnish (FV) application alongside existing programs requires economic evaluation.
Purpose of the Study:
- To conduct an economic evaluation alongside the Protecting Teeth @ 3 (PT@3) randomized controlled trial.
- To compare the cost-utility of adding 6-monthly fluoride varnish (FV) applications in nurseries versus treatment as usual (TAU).
- To determine the cost-effectiveness of the additional FV intervention from a National Health Service perspective.
Main Methods:
- A within-trial cost-utility analysis (CUA) was performed.
- Health outcomes measured in Quality-Adjusted Life Years (QALYs) over a 2-year follow-up.
- Sensitivity analyses and incremental cost-utility ratios were calculated using national reference costs and a 1.5% discount rate.
Main Results:
- The mean incremental cost per child for the FV arm was £68.37, with no statistically significant difference in QALYs (-0.004).
- The probability of the FV intervention being cost-effective at the UK threshold of £20,000 was only 11.3%.
- Data from 534 participants (265 FV, 269 TAU) were analyzed.
Conclusions:
- The additional application of fluoride varnish in nurseries, beyond the existing Childsmile program components, is not cost-effective at current UK thresholds.
- The universal nursery toothbrushing component of Childsmile has proven clinical and economic value.
- A review of the targeted nursery fluoride varnish component is recommended due to its low probability of cost-effectiveness.
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