The Cost-effctiveness Analysis Of Topical Fluoride Application Program For Pre-school Children Over Two Years

Objective:To compare the preventive effect of these two fluoride containing materials on caries increment in primary teeth,and the direct and indirect costs incurred in this two-year program.To estimate the cost-effectiveness of these two method so that to provide reference for choosing appropriate approach to caries prevention for preschool children.Method: A randomized controlled trial was conducted.There were1384 preschool children aged 3 to 4 from 3 districts of Chongqing urban area included.They were randomly allocated into three groups: the fluoride foam intervention group,the fluoride varnish intervention group,and the control group.For the intervention groups,topical fluoridation intervention activity and OHI were carried out semi-annually.The control group was only given the OHI(oral hygiene instruction)given semi-annually.Follow up examination was conducted after two years.The costs incurred in the two intervention activities should be collected regularly.All data were double entered by Epidata.Statistical analysis was performed by SPSS 17.0,thus to compare the increment of dental caries of each group and to estimate the cost-effectiveness.Result: There were 518 children(276 in the fluoride foam group and242 in the fluoride varnish group)participated in topical fluorideapplication over two consecutive years.The loss-of-follow-up rate was37.1% and 41.7% for the fluoride foam group and the fluoride varnish group,respectively.In the fluoride foam group,the incidence of dental caries was 19.2%,dmft increased by 693,dmfs increased by 2032,the mean of dmft increased by 2.5,and the mean of dmfs increased by 7.2.In the fluoride varnish group,the incidence of dental caries was 16.5%,dmft increased by 518,dmfs increased by 1499,the mean of dmft increased by2.1,and the mean of dmfs increased by 6.2;in the control group,incidence of dental caries was 27.5%,dmft increased by 1276,dmfs increased by3244,the mean of dmft increased by 3.4,and the mean of dmfs increased by 8.7.There was no statistically significant difference among different intervention groups(the fluoride foam group andthe fluoride varnish group)(p>0.05).Comparing with the control group,both fluoride varnish and fluoride foam had good preventive effect on the occurrence of dental caries in preschool children,and there were significant differences in the incidence of dental caries,the increment of the mean of dmft,and the increment of the mean of dmfts(p<0.05).Costs incurred in this two-year program were ?38202.9 and ?23130.4for the fluoride varnish group and the fluoride foam group,respectively.For the fluoride varnish,costs of labor,material and working-operation were ?15038,?11446 and ?11718.9 respectively;for the fluoride foam group,the corresponding costs were ? 5263.3,? 8236,and ?9631.1,respectively.The main influencing factor was the time cost of the labor cost.The number of preventable carious teeth per child per year(the reduction of the increment of the mean dmft compared with the control group)was1.3 and 0.9,respectively;the cost-effectiveness ratio(the cost for a child toprevent a carious tooth per year)was ?121.4and ?93.2,respectively;the lowest cost-benefit ratio was 2.1 and 3.1,respectively.Conclusion: Both fluoride varnish and fluoride foam have good preventive effect on dental caries,and both of them have a comparable overall effect on preventing dental caries(p > 0.05).Fluoride foam is more suitable to be popularized widely because it has lower cost-effectiveness ratio,higher cost-benefit ratio,lower susceptibility to technology,and fewer requirements for operating environment.