PIH7 - A Cost-Benefit Analysis of A Kindergarten-Based Fluoride Varnish Program Among 3-Year Old Children: Some Preliminary Results

Abstract

We aimed to evaluate the cost-effectiveness of a kindergarten-based fluoride varnish (FV) program for caries prevention among 3-year old children. The program was part of a larger public health project from 2015-2017 to improve oral health of pre-school children in Shanghai, China. Specifically, from January 2016, FV (50 mg/ml Sodium Fluoride, Duraphat, Colgate-Palmolive, USA) was applied every 6 months to all primary teeth of every 3-year old child (with parental/guardian’s consent) in all public kindergartens in Shanghai. A cost-benefit analysis was conducted from the perspective of the municipal healthcare system to compare with a historic cohort before the program launched. The effectiveness outcomes (proportion of children having caries, mean number of decayed, missing, or filled teeth surfaces (dmfs)) were measured at end of 2017 as part of a routine yearly dental screening from a representative sample of all 5-year old children attending public kindergartens in Shanghai. The mean cumulative cost of the program over the 3-year implementation was calculated for one FV application. Cost-benefit ratio (CBR) was estimated by using treatment cost per carious surface for monetary valuation of effectiveness. The prevalence of caries among 5-year old children in Shanghai was 62.82% in 2017, 2.36 percent points lower than that in 2015. The mean dmfs was 2.64 in 2017 vs 3.14 in 2015. Incremental cost-effectiveness ratios (ICERs) were CNY 2833 per child remaining caries free, and CNY 134 per carious surface avoided. Given that the mean treatment cost was estimated at CNY 127 per carious surface, the CBR was 0.95. The sensitivity analysis indicated that CBR would reach 1.0 if the mean dmfs was improved to 2.61, or the cost per FV application was cut by 5%. With a high CBR, the program seemed to be value for money. Further analysis was warranted to evaluate uncertainties.