Birch S
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
Community Dent Health. 1990 Mar;7(1):3-10.
The effectiveness of water fluoridation as a means of reducing the prevalence of dental caries is well established in the dental literature. The case for water fluoridation however rests on the size of this reduction and the benefits that could be produced by using the same resources in other oral health or dental care programmes. In this paper the cost-effectiveness of water fluoridation is analysed for communities of different sizes and with differing oral health levels. Using the traditional model of economic evaluation, data from recent epidemiological studies, and a number of simplifying assumptions, it is shown that the cost per unit health benefit produced from water fluoridation varies by a factor of four according to the existing level of caries prevalence. Furthermore this is likely to be a conservative estimate of the differential impact given the nature of the assumptions. Marked differences in cost-effectiveness are also found for communities of different sizes suggesting that important economies of scale occur in water fluoridation projects. As a consequence cost effectiveness estimates of water fluoridation projects should be assessed on their own merits to ensure that scarce health care resources are used efficiently, i.e. in a way which maximises the impact these resources have on population health status.
在牙科文献中，水氟化作为降低龋齿患病率的一种手段，其有效性已得到充分证实。然而，水氟化的合理性取决于龋齿患病率降低的幅度，以及将相同资源用于其他口腔健康或牙科护理项目可能产生的益处。本文分析了不同规模和不同口腔健康水平社区的水氟化成本效益。利用传统的经济评估模型、近期流行病学研究的数据以及一些简化假设，结果表明，根据现有龋齿患病率水平，水氟化产生的单位健康效益成本相差四倍。此外，鉴于假设的性质，这可能是对差异影响的保守估计。不同规模社区的成本效益也存在显著差异，这表明水氟化项目存在重要的规模经济。因此，水氟化项目的成本效益估计应根据其自身优点进行评估，以确保稀缺的医疗资源得到有效利用，即以最大限度地提高这些资源对人群健康状况影响的方式使用。
