Caries Res 2017;51:231-239
Abstract
Application of fluoride gel/varnish (FG/FV) reduces
caries increments but generates costs. Avoiding restorative treatments
by preventing caries might compensate for these costs. We assessed the
cost-effectiveness of dentists applying FG/FV in office and the expected
value of perfect information (EVPI). EVPI analyses estimate the
economic value of having perfect knowledge, assisting research resource
allocation. A mixed public-private-payer perspective in Germany was
adopted. A population of 12-year-olds was followed over their lifetime,
with caries increments modelled using wide intervals to reflect the
uncertainty of caries risk. Biannual application of FV/FG until age 18
years was compared to no fluoride application. Effectiveness parameters
and their uncertainty were derived from systematic reviews. The health
outcome was caries increment (decayed, missing, or filled teeth; DMFT).
Cost calculations were based on fee catalogs or microcosting, including
costs for individual-prophylactic fluoridation and, for FG, an
individualized tray, plus material costs. Microsimulations, sensitivity,
and EVPI analyses were performed. On average and applied to a largely
low-risk population, no application of fluoride was least costly but
also least effective (EUR 230; 11 DMFT). FV was more costly and
effective (EUR 357; 7 DMFT). FG was less effective than FV and also more
costly when using individualized trays. FV was the best choice for
payers willing to invest EUR 39 or more per avoided DMFT. This
cost-effectiveness will differ in different settings/countries or if
FG/FV is applied by other care professionals. The EVPI was mainly driven
by the individual's caries risk, as FV/FG were significantly more
cost-effective in high-risk populations than in low-risk ones. Future
studies should focus on caries risk prediction.
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