Economic Evaluation of Dental Sealant and Fluoride Mouthrinsing Program in Two Non-Fluoridated Regions of Victoria

Purpose: This study assessed the cost-effectiveness of a 3 year school-based dental sealant and fluoride mouthrinsing (DS and FMR) program in 2 non-fluoridated regions in Victoria, Australia. Methods: The primary analysis was based on a community intervention in 5 schools comparing an intervention group receiving the DS and a weekly FMR, and a non-intervention group. The study measured mean differences in DMFS increments between study groups. Results: The mean discounted DMFS gain between study groups was 1.22 DMFS over 3 years. The incremental cost-effectiveness ratio between intervention to control groups varied between a net saving of $7.00 to a cost of $35.60 per DMFS gained. The results were sensitive to assumptions on program effectiveness, dental examination rates, and baseline DMFS of students. The program became more cost-effective with each successive year. Extrapolation of results of the 3-year intervention to the wider non-fluoridated community over a 10 year time frame resulted in a benefit- to-cost ratio above unity, regardless of assumptions used for either program cost or effectiveness. Conclusions: The introduction of such a preventive program in non-fluoridated regions of Victoria will represent an efficient use of community resources. Policy issues that need consideration are whether to target adolescents with a history of high dental disease experience, and whether dentists or auxiliaries are to be used. There is a need for a systematic evaluation (including an economic evaluation component) of dental prevention and treatment programs in Victoria.