Lamloum Demetrio, Dettori Marco, Cagetti Maria Grazia, Arghittu Antonella, Castiglia Paolo, Campus Guglielmo
Department of Restorative, Paediatric and Preventive Dentistry, University of Bern, Bern, Switzerland.
Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy.
Caries Res. 2025 Apr 1:1-9. doi: 10.1159/000545300.
Despite efforts to reduce sugar consumption, Italy continues to experience high levels of caries, particularly among 12-year-old children. The introduction of a sugar tax is one strategy that gained traction as a mean of curbing excessive sugar intake. This study aimed to assess the potential impact of a sugar tax on reducing caries prevalence through the analysis of two scenarios: a hypothetical implementation of the tax in 2008 (Scen1), compared against actual 2017 data, and a projection of the effects of the planned 2025 tax extending to 2034 (Scen2).
The evaluation utilizes a Markov model to evaluate the health and economic outcomes of a 20% ad valorem tax on sugar-sweetened beverages. Outcomes included the caries experience, as DMFT index and QALYs (Quality-Adjusted Life Year/s), direct dental costs, and indirect costs as forgone earnings due to care, assuming a 100% pass-through to consumers. A 3% annual discount rate was applied to all costs. Sub-analysis also included geographical macro-areas of Italy (North-West, North-East, Centre, South, Islands), based on main socioeconomic determinants. A probabilistic sensitivity analysis, involving a Monte Carlo simulation with 1,000 iterations, was conducted to assess the robustness of the model, generating estimates of mean values and 95% uncertainty intervals.
In Scen1, the simulation suggested that a 20% ad valorem tax would have resulted in a 0.05 reduction of the DMFT, yielded a cost saving of EUR 18.5 million, and EUR 24,520 per QALY gained. The projected 2025-2034 implementation estimated to decrease the DMFT by 0.07, save EUR 38.6 million, and EUR 31,933 per QALY gained. Significant benefits were observed in southern Italy, an area with higher caries rates and lower dental care utilization, where the impact was pronounced in both scenarios.
Integrating a sugar tax into a broader public health strategy can significantly reduce caries and healthcare costs, especially in disadvantaged settings. These findings highlight the need for policymakers to pair sugar taxes with additional preventive measures for optimal public health outcomes.
尽管人们努力减少糖的摄入量，但意大利的龋齿发病率仍然很高，尤其是在12岁儿童中。引入糖税是作为遏制过量糖摄入的一种手段而受到关注的策略之一。本研究旨在通过分析两种情景来评估糖税对降低龋齿患病率的潜在影响：一是假设在2008年实施糖税（情景1），并与2017年的实际数据进行比较；二是预测计划在2025年实施并延续至2034年的糖税的效果（情景2）。
该评估采用马尔可夫模型来评估对含糖饮料征收20%从价税的健康和经济结果。结果包括龋齿经历（以DMFT指数和质量调整生命年/QALY表示）、直接牙科费用以及因护理导致的收入损失等间接费用，假设税率100%转嫁给消费者。对所有成本应用3%的年贴现率。子分析还包括基于主要社会经济决定因素的意大利地理宏观区域（西北、东北、中部、南部、岛屿）。进行了概率敏感性分析，涉及1000次迭代的蒙特卡罗模拟，以评估模型的稳健性，生成均值估计和95%的不确定性区间。
在情景1中，模拟表明20%的从价税将使DMFT降低0.05，节省成本1850万欧元，每获得一个QALY节省24520欧元。预计2025 - 2034年实施糖税将使DMFT降低0.07，节省成本3860万欧元，每获得一个QALY节省31933欧元。在意大利南部观察到显著益处，该地区龋齿率较高且牙科护理利用率较低，在两种情景下影响都很明显。
将糖税纳入更广泛的公共卫生战略可以显著降低龋齿率和医疗成本，特别是在弱势地区。这些发现凸显了政策制定者将糖税与其他预防措施相结合以实现最佳公共卫生结果的必要性。
