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Moimaz SAS, Santos LFPD, Saliba TA, Saliba NA, Saliba O. Health surveillance: public water supply fluoridation in 40 municipalities of São Paulo, Brazil. CIENCIA & SAUDE COLETIVA 2020; 25:2653-2662. [PMID: 32667548 DOI: 10.1590/1413-81232020257.03972018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 10/03/2018] [Indexed: 11/22/2022] Open
Abstract
Since fluoridation of water is an established public health measure for the prevention of dental caries and considering that monitoring of the method is crucial to its success, this study aimed to analyze the results of the analysis of the fluorine content of public water supply of 40 municipalities in the state of São Paulo, from November 2004 to December 2016. Samples were analyzed monthly using the potentiometric method. Of the 32,488 samples, 50.94% contained fluoride levels within the recommended range. In 2004, it was verified that 21 cities (52.50%) had mean levels within the recommended parameter, increasing to 32 cities (80.00%) in 2016. It was observed that 15 municipalities that initially had levels of fluoride below 0.55 mgF/L in their water supply adjusted to adequate levels during the project. In the first year of the study, 47.76% of the samples had values in the recommended range, which increased to 58.22% in 2016. Most of the municipalities adjusted the levels of fluoride in their waters over the years, evidencing the performance of heterocontrol programs as important strategies that assist in the monitoring of the method and have significant participation in the control of the water quality supplied to the population.
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Affiliation(s)
- Suzely Adas Saliba Moimaz
- Departamento de Odontologia Infantil e Social, Faculdade de Odontologia de Araçatuba, Universidade Estadual Paulista. R. José Bonifácio 1193, Vila Mendonça. 16015-050 Araçatuba SP Brasil.
| | - Luis Felipe Pupim Dos Santos
- Departamento de Odontologia Infantil e Social, Faculdade de Odontologia de Araçatuba, Universidade Estadual Paulista. R. José Bonifácio 1193, Vila Mendonça. 16015-050 Araçatuba SP Brasil.
| | - Tânia Adas Saliba
- Departamento de Odontologia Infantil e Social, Faculdade de Odontologia de Araçatuba, Universidade Estadual Paulista. R. José Bonifácio 1193, Vila Mendonça. 16015-050 Araçatuba SP Brasil.
| | - Nemre Adas Saliba
- Departamento de Odontologia Infantil e Social, Faculdade de Odontologia de Araçatuba, Universidade Estadual Paulista. R. José Bonifácio 1193, Vila Mendonça. 16015-050 Araçatuba SP Brasil.
| | - Orlando Saliba
- Departamento de Odontologia Infantil e Social, Faculdade de Odontologia de Araçatuba, Universidade Estadual Paulista. R. José Bonifácio 1193, Vila Mendonça. 16015-050 Araçatuba SP Brasil.
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Mariño R, Zaror C. Economic evaluations in water-fluoridation: a scoping review. BMC Oral Health 2020; 20:115. [PMID: 32299417 PMCID: PMC7164347 DOI: 10.1186/s12903-020-01100-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 03/31/2020] [Indexed: 12/11/2022] Open
Abstract
Background Community water fluoridation (CWF) is considered one of the 10 greatest public health achievements of the twentieth century and has been a cornerstone strategies for the prevention and control of dental caries in many countries. However, for decision-makers the effectiveness and safety of any given intervention is not always sufficient to decide on the best option. Economic evaluations (EE) provide key information that managers weigh, alongside other evidence. This study reviews the relevant literature on EE in CWF. Methods A systematic database search up to August 2019 was carried out using MEDLINE, EMBASE, Cochrane Library, LILACS, Paediatric Economic Database Evaluation and National Health Service Economic Evaluation Database. The review included full economic evaluations on CWF programs, written in English, Spanish or Portuguese. The selection process and data extraction were carried out by two researchers independently. A qualitative synthesis of the results was performed. Results Of 498 identified articles, 24 studies met the inclusion criteria; 11 corresponded to cost-benefit analysis; nine were cost-effectiveness analyses; and four cost-utility studies. Two cost-utility studies used Disability-Adjusted Life Years,, one used Quality-Adjusted Tooth Years, and another Quality-Adjusted Life Years. EEs were conducted in eight countries. All studies concluded that water fluoridation was a cost-effective strategy when it was compared with non-fluoridated communities, independently of the perspective, time horizon or discount rate applied. Four studies adopted a lifetime time horizon. The outcome measures included caries averted (n = 14) and savings cost of dental treatment (n = 4). Most of the studies reported a caries reduction effects between 25 and 40%. Conclusion Findings indicated that CWF represents an appropriate use of communities’ resources, using a range of economic evaluation methods and in different locations. These findings provide evidence to decision-makers which they could use as an aid to deciding on resource allocation.
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Affiliation(s)
- Rodrigo Mariño
- Melbourne Dental School, University of Melbourne, Melbourne, Australia
| | - Carlos Zaror
- Department of Pediatric Dentistry and Orthodontics; Faculty of Dentistry, Universidad de La Frontera, Manuel Montt #112, Temuco, Chile. .,Center for Research in Epidemiology, Economics and Oral Public Health (CIEESPO), Faculty of Dentistry, Universidad de La Frontera, Temuco, Chile.
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O'Connell J, Rockell J, Ouellet J, Tomar SL, Maas W. Costs And Savings Associated With Community Water Fluoridation In The United States. Health Aff (Millwood) 2018; 35:2224-2232. [PMID: 27920310 DOI: 10.1377/hlthaff.2016.0881] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The most comprehensive study of US community water fluoridation program benefits and costs was published in 2001. This study provides updated estimates using an economic model that includes recent data on program costs, dental caries increments, and dental treatments. In 2013 more than 211 million people had access to fluoridated water through community water systems serving 1,000 or more people. Savings associated with dental caries averted in 2013 as a result of fluoridation were estimated to be $32.19 per capita for this population. Based on 2013 estimated costs ($324 million), net savings (savings minus costs) from fluoridation systems were estimated to be $6,469 million and the estimated return on investment, 20.0. While communities should assess their specific costs for continuing or implementing a fluoridation program, these updated findings indicate that program savings are likely to exceed costs.
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Affiliation(s)
- Joan O'Connell
- Joan O'Connell is an associate professor in the Department of Community and Behavioral Health at the Colorado School of Public Health, in Aurora
| | - Jennifer Rockell
- Jennifer Rockell is a research associate in the Department of Community and Behavioral Health at the Colorado School of Public Health
| | - Judith Ouellet
- Judith Ouellet is a senior professional research assistant in the Division of Health Care Policy and Research at the University of Colorado Denver School of Medicine, in Aurora
| | - Scott L Tomar
- Scott L. Tomar is a professor in the Department of Community Dentistry and Behavioral Science at the College of Dentistry, University of Florida, in Gainesville
| | - William Maas
- William Maas is a dental consultant at William Maas, LLC, in Rockville, Maryland
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Ran T, Chattopadhyay SK. Economic Evaluation of Community Water Fluoridation: A Community Guide Systematic Review. Am J Prev Med 2016; 50:790-796. [PMID: 26776927 PMCID: PMC6171335 DOI: 10.1016/j.amepre.2015.10.014] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 10/20/2015] [Accepted: 10/20/2015] [Indexed: 11/19/2022]
Abstract
CONTEXT A recently updated Community Guide systematic review of the effectiveness of community water fluoridation once again found evidence that it reduces dental caries. Although community water fluoridation was found to save money in a 2002 Community Guide systematic review, the conclusion was based on studies conducted before 1995. Given the update to the effectiveness review, re-examination of the benefit and cost of community water fluoridation is necessary. EVIDENCE ACQUISITION Using methods developed for Community Guide economic reviews, 564 studies were identified within a search period from January 1995 to November 2013. Ten studies were included in the current review, with four covering community fluoridation benefits only and another six providing both cost and benefit information. Additionally, two of the six studies analyzed the cost effectiveness of community water fluoridation. All currencies were converted to 2013 dollars. EVIDENCE SYNTHESIS The analysis was conducted in 2014. The benefit-only studies used regression analysis, showing that different measures of dental costs were always lower in communities with water fluoridation. For the six cost-benefit studies, per capita annual intervention cost ranged from $0.11 to $4.92 for communities with at least 1,000 population, and per capita annual benefit ranged from $5.49 to $93.19. Benefit-cost ratios ranged from 1.12:1 to 135:1, and these ratios were positively associated with community population size. CONCLUSIONS Recent evidence continues to indicate that the economic benefit of community water fluoridation exceeds the intervention cost. Further, the benefit-cost ratio increases with the community population size.
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Affiliation(s)
- Tao Ran
- Community Guide Branch, Division of Public Health Information Dissemination, CDC, Atlanta, Georgia.
| | - Sajal K Chattopadhyay
- Community Guide Branch, Division of Public Health Information Dissemination, CDC, Atlanta, Georgia
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Wildman CF, Gandhi DH, Kavanaugh MC. Iodine Addition to Drinking Water for Perchlorate Mitigation: Engineering Feasibility. ACTA ACUST UNITED AC 2015. [DOI: 10.5942/jawwa.2015.107.0067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Ko L, Thiessen KM. A critique of recent economic evaluations of community water fluoridation. INTERNATIONAL JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HEALTH 2014; 21:91-120. [PMID: 25471729 PMCID: PMC4457131 DOI: 10.1179/2049396714y.0000000093] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although community water fluoridation (CWF) results in a range of potential contaminant exposures, little attention has been given to many of the possible impacts. A central argument for CWF is its cost-effectiveness. The U.S. Government states that $1 spent on CWF saves $38 in dental treatment costs. OBJECTIVE To examine the reported cost-effectiveness of CWF. METHODS Methods and underlying data from the primary U.S. economic evaluation of CWF are analyzed and corrected calculations are described. Other recent economic evaluations are also examined. RESULTS Recent economic evaluations of CWF contain defective estimations of both costs and benefits. Incorrect handling of dental treatment costs and flawed estimates of effectiveness lead to overestimated benefits. The real-world costs to water treatment plants and communities are not reflected. CONCLUSIONS Minimal correction reduced the savings to $3 per person per year (PPPY) for a best-case scenario, but this savings is eliminated by the estimated cost of treating dental fluorosis.
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Tchouaket E, Brousselle A, Fansi A, Dionne PA, Bertrand E, Fortin C. The economic value of Quebec's water fluoridation program. ZEITSCHRIFT FUR GESUNDHEITSWISSENSCHAFTEN = JOURNAL OF PUBLIC HEALTH 2013; 21:523-533. [PMID: 24293810 PMCID: PMC3837190 DOI: 10.1007/s10389-013-0578-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2013] [Accepted: 05/31/2013] [Indexed: 11/07/2022]
Abstract
AIM Dental caries is a major public health problem worldwide, with very significant deleterious consequences for many people. The available data are alarming in Canada and the province of Quebec. The water fluoridation program has been shown to be the most effective means of preventing caries and reducing oral health inequalities. This article analyzes the cost-effectiveness of Quebec's water fluoridation program to provide decision-makers with economic information for assessing its usefulness. METHODS An approach adapted from economic evaluation was used to: (1) build a logic model for Quebec's water fluoridation program; (2) determine its implementation cost; and (3) analyze its cost-effectiveness. Documentary analysis was used to build the logic model. Program cost was calculated using data from 13 municipalities that adopted fluoridation between 2002 and 2010 and two that received only infrastructure grants. Other sources were used to collect demographic data and calculate costs for caries treatment including costs associated with travel and lost productivity. RESULTS The analyses showed the water fluoridation program was cost-effective even with a conservatively estimated 1 % reduction in dental caries. The benefit-cost ratio indicated that, at an expected average effectiveness of 30 % caries reduction, one dollar invested in the program saved $71.05-$82.83 per Quebec's inhabitant in dental costs (in 2010) or more than $560 million for the State and taxpayers. CONCLUSION The results showed that the drinking-water fluoridation program produced substantial savings. Public health decision-makers could develop economic arguments to support wide deployment of this population-based intervention whose efficacy and safety have been demonstrated and acknowledged.
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Affiliation(s)
- Eric Tchouaket
- Department of Nursing, Université du Québec en Outaouais (UQO), Saint-Jérôme Campus, Saint-Joseph Street, Room J-3204, Saint-Jérôme, Quebec Canada J7Z 0B7
| | - Astrid Brousselle
- Community Health Sciences Department, Canada Research Chair in Evaluation and Health System Improvement, Longueuil, Canada
| | - Alvine Fansi
- Institut National d’Excellence en Santé et Services Sociaux du Québec, Montreal, Canada
| | | | - Elise Bertrand
- Public Health Directorate for the Laurentides Region, Laurentides, Canada
| | - Christian Fortin
- Ministry of Health and Social Services of Quebec, Québec, Canada
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Kroon J, van Wyk PJ. A model to determine the economic viability of water fluoridation. J Public Health Dent 2012; 72:327-33. [PMID: 22554069 DOI: 10.1111/j.1752-7325.2012.00342.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES In view of concerns expressed by South African local authorities the aim of this study was to develop a model to determine whether water fluoridation is economically viable to reduce dental caries in South Africa. METHODS Microsoft Excel software was used to develop a model to determine economic viability of water fluoridation for 17 water providers from all nine South African provinces. Input variables for this model relate to chemical cost, labor cost, maintenance cost of infrastructure, opportunity cost, and capital depreciation. The following output variables were calculated to evaluate the cost of water fluoridation: per capita cost per year, cost-effectiveness and cost-benefit. In this model it is assumed that the introduction of community water fluoridation can reduce caries prevalence by an additional 15 percent and that the savings in cost of treatment will be equal to the average fee for a two surface restoration. RESULTS Water providers included in the study serve 53.5 percent of the total population of South Africa. For all providers combined chemical cost contributes 64.5 percent to the total cost, per capita cost per year was $0.36, cost-effectiveness was calculated as $11.41 and cost-benefit of the implementation of water fluoridation was 0.34. CONCLUSIONS This model confirmed that water fluoridation is an economically viable option to prevent dental caries in South African communities, as well as conclusions over the last 10 years that water fluoridation leads to significant cost savings and remains a cost-effective measure for reducing dental caries, even when the caries-preventive effectiveness is modest.
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Affiliation(s)
- Jeroen Kroon
- School of Dentistry and Oral Health / Population and Social Health Research Programme, Griffith Health Institute, Griffith University, Gold Coast, Queensland, Australia.
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Kroon J, Van Wyk PJ. A retrospective view on the viability of water fluoridation in South Africa to prevent dental caries. Community Dent Oral Epidemiol 2012; 40:441-50. [DOI: 10.1111/j.1600-0528.2012.00681.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Revised: 01/24/2012] [Accepted: 02/08/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Jeroen Kroon
- School of Dentistry and Oral Health / Population and Social Health Research Programme; Griffith Health Institute; Griffith University; Australia
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Esfandiari S, Jamal N, Feine J. Community-specific, preventive oral health policies: preventive measures on dental caries. JOURNAL OF INVESTIGATIVE AND CLINICAL DENTISTRY 2010; 1:2-7. [PMID: 25427180 DOI: 10.1111/j.2041-1626.2010.00006.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
In all health fields, limited infrastructure and resources hinder the provision of basic services to low-income populations. Subsequently, oral health is often neglected, as over 90% of caries remains untreated in developing communities. In order to deliver the most cost-effective prevention methods, public health officials must assess each available strategy on an individual community basis. In this paper, examples from oral health will demonstrate the importance of community-specific determinants in the formation of preventive public health policies. These determinants include economical, cultural, social, and political elements that can assist policy makers in generating effective functional public health policies.
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Tianviwat S, Chongsuvivatwong V, Birch S. Estimating unit costs for dental service delivery in institutional and community-based settings in southern Thailand. Asia Pac J Public Health 2008; 21:84-93. [PMID: 19124339 DOI: 10.1177/1010539508327246] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In this cross-sectional study, the cost of different dental services was estimated and the unit costs of dental services for schoolchildren were compared between 2 settings: hospital-based and community-based mobile dental clinics. Heads of all departments in a selected community hospital were invited to attend 2 workshops to collect relevant data. Unit costs of different dental services varied from 41 to 2693 baht, with services falling into 4 unit cost groups: very high, high, moderate, and low. The very-high-unit-cost services included rehabilitative dental services. The high-unit-cost services covered removal of an impacted tooth, root canal treatment, and tooth-color fillings. The moderate-unit-cost group included a wide range of other dental services, with screening and oral hygiene instruction in community-based dental clinics falling into the low-unit-cost group. Generally, services provided in the community-based mobile clinic had lower unit costs than the same services provided in the hospital dental clinic.
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Affiliation(s)
- Sukanya Tianviwat
- Prince of Songkla University, Faculty of Dentistry, Songkhla, Thailand.
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Frias AC, Narvai PC, Araújo MED, Zilbovicius C, Antunes JLF. Custo da fluoretação das águas de abastecimento público, estudo de caso Município de São Paulo, Brasil, período de 1985-2003. CAD SAUDE PUBLICA 2006; 22:1237-46. [PMID: 16751963 DOI: 10.1590/s0102-311x2006000600013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
O objetivo do artigo é estimar o custo da fluoretação das águas de abastecimento público no Município de São Paulo no período de 1985-2003. Para o cálculo da composição de custos da fluoretação das águas levou-se em conta os seguintes custos: (a) capital inicial de instalação; (b) produto químico (ácido fluorsilícico); (c) operacionalização do sistema (manutenção do sistema, energia elétrica e recursos humanos); e (d) controle dos teores de flúor. A ação do flúor mostrou-se efetiva, pois para a idade de 12 anos observou-se redução de 73% na experiência de cárie dentária, sendo que em 1986 a média do índice CPO-D era de 6,47 (6,12-6,82) e em 2002 foi de 1,75 (1,48-2,92). Nesta idade-índice 40% das crianças apresentaram CPO-D = 0 em 2002. O custo médio per capita/ano na Cidade de São Paulo foi de R$ 0,08 (US$ 0,03) em 2003. O custo acumulado em 18 anos de implantação do sistema de fluoretação foi de R$ 1,44 (US$ 0,97) per capita.
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Truman BI, Gooch BF, Sulemana I, Gift HC, Horowitz AM, Evans CA, Griffin SO, Carande-Kulis VG. Reviews of evidence on interventions to prevent dental caries, oral and pharyngeal cancers, and sports-related craniofacial injuries. Am J Prev Med 2002; 23:21-54. [PMID: 12091093 DOI: 10.1016/s0749-3797(02)00449-x] [Citation(s) in RCA: 119] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This report presents the results of systematic reviews of effectiveness, applicability, other positive and negative effects, economic evaluations, and barriers to use of selected population-based interventions intended to prevent or control dental caries, oral and pharyngeal cancers, and sports-related craniofacial injuries. The related systematic reviews are linked by a common conceptual approach. These reviews form the basis of recommendations by the Task Force on Community Preventive Services (the Task Force) about the use of these selected interventions. The Task Force recommendations are presented in this supplement.
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Affiliation(s)
- Benedict I Truman
- Office of the Director, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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Abstract
OBJECTIVE The purpose of this research was to assess the local cost savings resulting from community water fluoridation, given current exposure levels to other fluoride sources. METHODS Adopting a societal perspective and using a discount rate of 4 percent, we compared the annual per person cost of fluoridation with the cost of averted disease and productivity losses. The latter was the product of annual dental caries increment in nonfluoridated communities, fluoridation effectiveness, and the discounted lifetime cost of treating a carious tooth surface. We obtained or imputed all parameters from published studies and national surveys. We conducted one-way and three-way sensitivity analyses. RESULTS With base-case assumptions, the annual per person cost savings resulting from fluoridation ranged from $15.95 in very small communities to $18.62 in large communities. Fluoridation was still cost saving for communities of any size if we allowed increment, effectiveness, or the discount rate to take on their worst-case values, individually. For simultaneous variation of variables, fluoridation was cost saving for all but very small communities. There, fluoridation was cost saving if the reduction in carious surfaces attributable to one year of fluoridation was at least 0.046. CONCLUSION On the basis of the most current data available on the effectiveness and cost of fluoridation, caries increment, and the cost and longevity of dental restorations, we find that water fluoridation offers significant cost savings.
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Affiliation(s)
- S O Griffin
- Centers for Disease Control and Prevention, Division of Oral Health, Surveillance, Investigations and Research Branch, 4770 Buford Highway, MSF10, Chamblee, GA 30341, USA.
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