Cost-effectiveness and estimated net monetary benefits of a fluoride varnish application program during well-child visits by 9- to 30-month-old children in three areas of Thailand.

Abstract

To evaluate the cost-effectiveness and estimated net monetary benefits of a fluoride varnish application program during well-child visits in young children in three Thai provinces. Costs and benefits from both the provider and patients are presented. Cost-effectiveness and estimated net monetary benefit analysis of one to five visits for fluoride varnish application using a retro-prospective cohort study design. Cost and outcomes were estimated using dental personnel survey data, hospital procurement data and guardian survey. The primary outcomes were decayed (treatment needed), missing due to caries and filled teeth (dmft). From the provider's perspective, one to three visits for fluoride varnish application decreased dmft and saved costs compared to no visits, one visit and two visit strategies (ICER=-468.36, -424.40 and -65.72, respectively). These strategies also showed an estimated net monetary benefit of 430.89, 216.44 and 7.23 THB, respectively. From the patient's perspective, the estimated net monetary benefits were positive for up to three visits (383.24, 212.45 and 45.82 THB, respectively); however, the incremental cost-effectiveness ratios were no different with these strategies (ICER=-416.56). The one and two visit strategies had a very high chance of showing cost saving in the probabilistic sensitivity analysis (97.1% and 95.5%, respectively). The one to three visits fluoride varnish application program during well-child visits appears to be cost-effective with estimated net benefit interventions for dental caries prevention. These findings suggest that children between 9 and 30 months old should attend at least three visits of the fluoride varnish application program during well-child visits.