Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Department of Pediatric Dentistry, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand.
Community Dent Oral Epidemiol. 2023 Jun;51(3):512-518. doi: 10.1111/cdoe.12769. Epub 2022 Jul 14.
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.
评估在泰国三个省份的幼儿常规保健就诊期间，氟化物涂料应用项目的成本效益和估计的净货币效益。本研究从提供者和患者两个角度呈现了成本和效益。
采用回顾性前瞻性队列研究设计，对氟化物涂料应用的一至五次就诊的成本效益和估计的净货币效益进行分析。使用牙科人员调查数据、医院采购数据和监护人调查来估计成本和结果。主要结果是龋齿（需要治疗）、因龋齿导致缺失的牙齿和已填充的牙齿（dmft）。
从提供者的角度来看，与不就诊、就诊一次和就诊两次的策略相比，氟化物涂料应用一至三次就诊可降低 dmft 并节省成本（ICER 分别为-468.36、-424.40 和-65.72）。这些策略还显示出估计的净货币效益分别为 430.89、216.44 和 7.23 泰铢。从患者的角度来看，最多三次就诊的估计净货币效益为正（分别为 383.24、212.45 和 45.82 泰铢）；然而，这些策略的增量成本效益比没有差异（ICER 为-416.56）。在概率敏感性分析中，一至两次就诊策略具有很高的成本节约可能性（分别为 97.1%和 95.5%）。
在常规保健就诊期间，氟化物涂料应用一至三次的方案在预防龋齿方面具有成本效益和估计的净效益干预。这些发现表明，9 至 30 个月大的儿童在常规保健就诊期间应至少接受三次氟化物涂料应用方案的就诊。
