title: Cost-effectiveness models for dental caries prevention programmes among Chilean schoolchildren.
abstract: OBJECTIVE
  This study aims to estimate the cost-effectiveness from a societal perspective of seven dental caries prevention programmes among schoolchildren in Chile: three community-based programmes: water-fluoridation, salt-fluoridation and dental sealants; and four school-based programmes: milk-fluoridation; fluoridated mouthrinses (FMR); APF-Gel, and supervised toothbrushing with fluoride toothpaste.
  
  
  METHODS
  Standard cost-effectiveness analysis methods were used. The costs associated with implementing and operating each programme, using a societal perspective, were identified and estimated. The comparator was non-intervention. Health outcomes were measured as dental caries averted over a 6-year period. Costs were estimated as direct treatment costs, programmes costs and costs of productivity losses as a result of each dental caries prevention programme. Incremental cost-effectiveness ratios were calculated for each programme. Sensitivity analyses were conducted over key parameters.
  
  
  RESULTS
  Primary cost-effectiveness analysis (discounted) indicated that four programmes showed net social savings by the DMFT averted. These savings encompassed a range of values per diseased tooth averted; US$16.21 (salt-fluoridation), US$14.89 (community water fluoridation); US$14.78 (milk fluoridation); and US$8.63 (FMR). Individual programmes using an APF-Gel application, dental sealants, and supervised tooth brushing using fluoridated toothpaste, represent costs for the society per diseased tooth averted of US$21.30, US$11.56 and US$8.55, respectively.
  
  
  CONCLUSIONS
  Based on cost required to prevent one carious tooth among schoolchildren, salt fluoridation was the most cost-effective, with APF-Gel ranking as least cost-effective. Findings confirm that most community/school-based dental caries interventions are cost-effective uses of society's financial resources. The models used are conservative and likely to underestimate the real benefits of each intervention.
authors.affiliation: Oral Health Cooperative Research Centre, University of Melbourne, Melbourne, Victoria, Australia. rmarino@unimelb.edu.au
authors.forename: R
authors.initials: R
authors.lastname: Mariño
authors.forename: J
authors.initials: J
authors.lastname: Fajardo
authors.forename: M
authors.initials: M
authors.lastname: Morgan
mesh_terms: D000149:Acidulated Phosphate Fluoride / Q000627:therapeutic use; D000818:Animals; D002327:Cariostatic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D002648:Child; D002677:Chile; D003149:Community Dentistry / Q000191:economics; D017046:Cost Savings; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D004245:DMF Index; D003731:Dental Caries / Q000191:economics / Q000517:prevention & control*; D004526:Efficiency; D005457:Fluoridation / Q000191:economics; D005459:Fluorides / Q000008:administration & dosage / Q000627:therapeutic use; D017048:Health Care Costs; D006293:Health Promotion / Q000191:economics*; D006801:Humans; D008892:Milk; D018803:Models, Economic; D009067:Mouthwashes / Q000627:therapeutic use; D017063:Outcome Assessment, Health Care / Q000191:economics; D010895:Pit and Fissure Sealants / Q000627:therapeutic use; D011313:Preventive Dentistry / Q000191:economics; D017064:Process Assessment, Health Care / Q000191:economics; D012571:School Dentistry / Q000191:economics; D017673:Sodium Chloride, Dietary / Q000008:administration & dosage; D014099:Toothbrushing / Q000379:methods; D014100:Toothpastes / Q000627:therapeutic use
chemical_list: D002327:Cariostatic Agents; D009067:Mouthwashes; D010895:Pit and Fissure Sealants; D017673:Sodium Chloride, Dietary; D014100:Toothpastes; D000149:Acidulated Phosphate Fluoride; D005459:Fluorides