College of Medical, Veterinary and Life Sciences, Glasgow Dental School, University of Glasgow, Glasgow, UK.
Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
JDR Clin Trans Res. 2023 Jul;8(3):207-214. doi: 10.1177/23800844221090444. Epub 2022 Apr 20.
An economic evaluation (EE) was conducted alongside a randomized controlled trial (the Protecting Teeth @ 3 Study [PT@3]), exploring the additional preventive value of fluoride varnish (FV) application at 6-monthly intervals in nursery schools compared to treatment as usual (TAU) in the same nurseries. TAU represented a multicomponent national child oral health improvement intervention, the Childsmile program, apart from nursery FV.
The EE was a within-trial cost-utility analysis (CUA) comparing the FV and TAU groups. The CUA was conducted from a National Health Service perspective and followed relevant methods guidance. Within-trial costs included intervention costs and health care resource use costs. Health outcomes were expressed in quality-adjusted life years (QALYs) accrued over the 2-y follow-up period. The Child Health Utility 9 Dimensions questionnaire was used to obtain utility scores. National reference costs were used, a discount rate of 1.5% for public health interventions was adopted, multiple imputation methods for missing data were employed, sensitivity analyses were conducted, and incremental cost-utility ratios were calculated.
Data from 534 participants from the 2014-2015 PT@3 intake were used in the EE analyses, = 265 (50%) in the FV arm and = 269 (50%) in the TAU arm. Mean incremental cost per child in the FV arm was £68.37 ( = 0.382; 95% confidence interval [CI], -£18.04 to £143.82). Mean incremental QALY was -0.004 ( = 0.636; 95% CI, -0.016 to 0.007). The probability that the FV intervention was cost-effective at the UK £20,000 threshold was 11.3%.
The results indicate that applying FV in nurseries in addition to TAU (all other components of Childsmile, apart from nursery FV) would not be deemed cost-effective given current UK thresholds. In view of previously proven clinical effectiveness and economic worthiness of the universal nursery toothbrushing component of Childsmile, continuation of the additional, targeted nursery FV component in its pre-COVID-19 form should be reviewed given its low probability of cost-effectiveness.
The results of this study can be used by child oral health policy makers and dental public health professionals. They can form part of the evidence to inform the Scottish, UK, and international guidance on community-based child oral health promotion programs.
本研究开展了一项经济评价（EE），同时进行了一项随机对照试验（Protecting Teeth@3 研究 [PT@3]），旨在比较氟保护漆（FV）每 6 个月在幼儿园应用与幼儿园常规治疗（TAU）相比，对儿童口腔健康的额外预防价值。TAU 代表了国家儿童口腔健康改善干预措施——儿童微笑计划（Childsmile）的一个多组分方案，除了幼儿园 FV 以外还包括常规治疗。
EE 是一项在试验内的成本效用分析（CUA），比较了 FV 组和 TAU 组。CUA 从国家卫生服务的角度出发，并遵循相关的方法指南。在试验内成本包括干预成本和医疗保健资源使用成本。健康结果以 2 年随访期间获得的质量调整生命年（QALY）表示。采用儿童健康效用 9 维度问卷来获取效用评分。使用国家参考成本，公共卫生干预措施的贴现率为 1.5%，采用多重插补方法处理缺失数据，进行敏感性分析，并计算增量成本效用比。
来自 2014-2015 年 PT@3 入组的 534 名参与者的数据用于 EE 分析，其中 FV 组有 265 名（50%），TAU 组有 269 名（50%）。FV 组每名儿童的平均增量成本为 68.37 英镑（ = 0.382；95%置信区间 [CI]，-18.04 英镑至 143.82 英镑）。平均增量 QALY 为 -0.004（ = 0.636；95% CI，-0.016 至 0.007）。FV 干预措施在英国 20000 英镑阈值下具有成本效益的概率为 11.3%。
结果表明，鉴于目前英国的阈值，在幼儿园内除了 TAU（儿童微笑计划中的所有其他组成部分，除了幼儿园 FV 以外）应用 FV 不会被认为具有成本效益。鉴于儿童微笑计划中的普遍幼儿园刷牙这一组成部分已被证明具有临床有效性和经济价值，应考虑在其具有低成本效益概率的情况下，对其进行审查，因为该计划中额外的、有针对性的幼儿园 FV 部分可能不再具有成本效益。
本研究的结果可被儿童口腔健康政策制定者和牙科公共卫生专业人员使用。它们可以作为苏格兰、英国和国际社区为基础的儿童口腔健康促进计划指南的一部分证据。
