Abstract
BackgroundCommunity 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.MethodsFollowing 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.ResultsIn 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.ConclusionDespite 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.
Highlights
Community water fluoridation (CWF), the controlled addition of fluoride to the water supply for the prevention of dental caries, is considered a safe and effective public health intervention
One recommendation, redefining the optimal level of fluoride in drinking water from 0.8–1.0 mg/L to 0.6–0.8 mg/L with a target value of 0.7 mg/L, was implemented in 2007. Another consequence of the review was the formation of the Irish Expert Body on Fluorides and Health, who commissioned an independent audit of the CWF process in Ireland [20]. It is within this context that we evaluate the economic evidence to inform policy decisions around the continuation of CWF as a national oral health policy
The primary aim of FACCT was a valuation of health outcomes in schoolchildren following the reduction in the level of fluoride in the public water supply (PWS) [31]. This cost-effectiveness analysis, guided by methodologies applied in previous analyses [21,22,23,24, 30, 32], and using epidemiological data from a representative sample of 5, 8, and 12-year-old schoolchildren collected in FACCT [31], compared the incremental costs and consequences associated with exposure to the CWF intervention compared to no CWF exposure for this cohort living in Ireland in 2017
Summary
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. 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. The human, psychological and financial implications of this largely preventable disease are substantial [4]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
