A cost-effectiveness analysis of fluoride varnish application in preventing Root caries in elderly persons: a Markov simulation study.

BACKGROUND: Root caries are prevalent issues that affect dental health, particularly among elderly individuals with exposed root surfaces. Fluoride therapy has shown effectiveness in preventing root caries, but limited studies have addressed its cost-effectiveness in elderly persons population. This study aimed to evaluate the cost-effectiveness of a fluoride treatment program for preventing root caries in elderly persons within the context of Chinese public healthcare. METHODS: A Markov simulation model was adopted for the cost-effectiveness analysis in a hypothetical scenario from a healthcare system perspective. A 60-year-old subject with 23 teeth was simulated for 20 years. A 5% sodium fluoride varnish treatment was compared with no preventive intervention in terms of effectiveness and cost. Tooth years free of root caries were set as the effect. Transition probabilities were estimated from the data of a community-based cohort and published studies, and costs were based on documents published by the government. The incremental cost-effectiveness ratio (ICER) was calculated to evaluate cost-effectiveness. Univariate and probabilistic sensitivity analyses were performed to evaluate the influence of data uncertainty. RESULTS: Fluoride treatment was more effective (with a difference of 10.20 root caries-free tooth years) but also more costly (with a difference of ¥1636.22). The ICER was ¥160.35 per root caries-free tooth year gained. One-way sensitivity analysis showed that the risk ratio of root caries in the fluoride treatment group influenced the result most. In the probabilistic sensitivity analysis, fluoride treatment was cost-effective in 70.5% of the simulated cases. CONCLUSIONS: Regular 5% sodium fluoride varnish application was cost-effective for preventing root caries in the elderly persons in most scenarios with the consideration of data uncertainty, but to a limited extent. Improved public dental health awareness may reduce the incremental cost and make the intervention more cost-effective. Overall, the study shed light on the economic viability and impact of such preventive interventions, providing a scientific basis for dental care policies and healthcare resource allocation.

Comparison of 18F-sodium fluoride PET/CT, 18F-fluorocholine PET/CT and diffusion-weighted MRI for the detection of bone metastases in recurrent prostate cancer: a cost-effectiveness analysis in France.

BACKGROUND: The diagnostic performance of 18F-sodium fluoride positron emission tomography/computed tomography (PET/CT) (NaF), 18F-fluorocholine PET/CT (FCH) and diffusion-weighted whole-body magnetic resonance imaging (DW-MRI) in detecting bone metastases in prostate cancer (PCa) patients with first biochemical recurrence (BCR) has already been published, but their cost-effectiveness in this indication have never been compared. METHODS: We performed trial-based and model-based economic evaluations. In the trial, PCa patients with first BCR after previous definitive treatment were prospectively included. Imaging readings were performed both on-site by local specialists and centrally by experts. The economic evaluation extrapolated the diagnostic performances of the imaging techniques using a combination of a decision tree and Markov model based on the natural history of PCa. The health states were non-metastatic and metastatic BCR, non-metastatic and metastatic castration-resistant prostate cancer and death. The state-transition probabilities and utilities associated with each health state were derived from the literature. Real costs were extracted from the National Cost Study of hospital costs and the social health insurance cost schedule. RESULTS: There was no significant difference in diagnostic performance among the 3 imaging modalities in detecting bone metastases. FCH was the most cost-effective imaging modality above a threshold incremental cost-effectiveness ratio of 3000€/QALY when imaging was interpreted by local specialists and 9000€/QALY when imaging was interpreted by experts. CONCLUSIONS: FCH had a better incremental effect on QALY, independent of imaging reading and should be preferred for detecting bone metastases in patients with biochemical recurrence of prostate cancer. TRIAL REGISTRATION: NCT01501630. Registered 29 December 2011.

Cost-analysis of school-based fluoride varnish and fluoride rinsing programs.

OBJECTIVE: From a dental care perspective, we analyze whether the prevention of approximal caries by fluoride varnish treatment (FVT) or by fluoride mouth rinsing (FMR) could contain costs in an extended period of follow-up after the end of school-based prevention programs. MATERIAL AND METHODS: It is assumed in a model that, after 3 years of prevention with either FVT or FMR according to published studies, the "natural course" of approximal caries progression would follow for 5 consecutive years, as described in a Swedish longitudinal study. The outcome and costs of FVT, FMR and controls were modelled from years 4 to 8. RESULTS: The FVT program had a better outcome in reducing approximal caries than FMR, and costs were lower. The FVT was expected to result in cost containment compared to controls 3 years after the end of the preventive FVT program. The ratio benefits to costs were 1.8: 1 for FVT and 0.9: 1 for FMR. CONCLUSIONS: Prevention of approximal caries by FVT may result in cost containment, at a benefit cost ratio of 1.8: 1, given that the program can be administered at school.

Cost effectiveness of ibandronate for the prevention of fractures in inflammatory bowel disease-related osteoporosis: cost-utility analysis using a Markov model.

BACKGROUND: Osteoporosis is a frequent complication in patients with inflammatory bowel disease. Recent studies have shown bisphosphonates to considerably reduce fracture risk in patients with osteoporosis, and preventing fractures with bisphosphonates has been reported to be cost effective in older populations. However, no studies of the cost effectiveness of these agents in preventing fractures in patients with inflammatory bowel disease are available. OBJECTIVE: To investigate the cost effectiveness of the bisphosphonate ibandronate combined with calcium/colecalciferol ('ibandronate') in patients with osteopenia or osteoporosis due to inflammatory bowel disease in Germany. Treatment strategies used for comparison were sodium fluoride combined with calcium/colecalciferol ('fluoride') and calcium/colecalciferol ('calcium') alone. STUDY DESIGN AND METHODS: A cost-utility analysis was conducted using data from a randomized controlled trial (RCT). Changes in bone mineral density (BMD) were adjusted and predicted for a standardized population receiving each respective treatment. A Markov model was developed, with probabilities of transition to fracture states consisting of BMD-dependent and -independent components. The BMD-dependent component was assessed using predicted change in BMD from the RCT. The independent component captured differences in bone quality and micro-architecture resulting from prevalent fractures or treatment with anti-resorptive drugs. The analysis was conducted for a population with a mean age of the RCT patients (women aged 36 years, men aged 38 years) with osteopenia (T-score about -2.0 at baseline), a population of the same age with osteoporosis (T-score of -3.0 at baseline) and for an older population (both sexes aged 65 years) with osteoporosis (T-score of -3.0). Outcomes were measured as costs per QALY gained from a societal perspective. The treatment duration in the RCT was 42 months. A 5-year period was assumed to follow, during which the treatment effects linearly declined to 0. The simulation time was 10 years. Prices for medication and treatment were presented as year 2004 values; costs and effects were discounted at 5%. To test the robustness of the results, univariate and probabilistic sensitivity analyses (Monte Carlo simulation) were conducted. RESULTS: The calcium strategy dominated the fluoride strategy. When the ibandronate strategy was compared with the calcium strategy, the base-case cost-effectiveness ratios (costs per QALY gained) were between euro 407 375 for an older female population with osteoporosis and euro 6 516 345 for a younger female population with osteopenia. Univariate sensitivity analyses resulted in variations between 4% of base-case results and dominance of calcium. In Monte Carlo simulations, conducted for the various populations, the probability of an ICER of ibandronate below euro 50 000 per QALY was never greater than 20.2%. CONCLUSION: The ibandronate strategy is unlikely to be considered cost effective by decision makers in men or women with characteristics of those in the target population of the RCT, or in older populations with osteoporosis.

Treatment and posttreatment effects of fluoride mouthrinsing after 17 years.

OBJECTIVES: This study assessed the treatment and posttreatment effects of a school-based, fluoride mouthrinse regimen. METHODS: Children in a nonfluoridated community in Japan participated in a daily rinse program using a 0.05 percent NaF solution in nursery and primary schools, and a weekly rinse with 0.2 percent NaF in junior high school. Students were examined at least annually for dental caries and dental treatment was provided in a public dental clinic through the ninth grade. Incipient carious lesions with no cavitation were not restored. RESULTS: The percent of children in grades one through nine (6-14 years of age) with caries-free permanent teeth increased from 13.4 percent in 1974 to 73.0 percent in 1991, while the mean DMFT decreased by 86 percent during this period. For 12-year-olds, mean DMFT scores declined to about one tooth per child after 1982. For adults 20 years of age, there was a 64 percent difference in DMFS between the treatment group who started the rinse regimen at 4 years of age and continued for 11 years, and the controls who lived in different districts and did not participate in a fluoride rinse regimen. CONCLUSIONS: Children who began rinsing at 4 or 5 years of age benefited the most from the program. The program was inexpensive, simple to implement and well accepted by families and teachers. The conservative treatment policy in the public clinic likely contributed to the benefits derived by participants.

The status of fluoride mouthrinse programmes in Japan: a national survey.

The purpose of this investigation was to determine the current status of fluoride mouthrinse programmes throughout Japan. Data collection and analysis took place in 1992. The focus of this study was on schools that were participating in the rinse programme at the time of the survey. Questionnaires were sent by mail to 49 dentist-members of the Association for the Promotion of Fluoride Use in Japan. These members gathered information from the schools and, when necessary, also from local government offices. Starting with a single prefecture in 1970, the rinse programme increased to 32 out of 47 prefectures by 1992. The total number of schools using fluoride mouthrinse was 1,183 (nursery schools and kindergartens 48 per cent, primary schools 46 per cent, and secondary schools 6 per cent). In nursery schools and kindergartens, 60 per cent of the participating schools adopted the daily method using 0.05 per cent NaF solution. In primary and secondary schools, 78 per cent adopted the weekly method using 0.2 per cent NaF solution. The costs for the rinse regimen were paid for by public funds of the prefectural and municipal governments in 71 per cent of the schools. Fifty-four per cent of the schools which first initiated the rinse programmes in their districts identified dentists and dental associations as the most influential in programme acceptance and implementation. Although the number of fluoride rinse programmes is increasing, it is still modest. These results suggest that cooperation between dental organisations, dental schools and prefectural governments can play very important roles in implementing school based rinse programmes.

Intensive fluoride varnish program in Swedish adolescents: economic assessment of a 7-year follow-up study on proximal caries incidence.

The aim of this study was to assess the long-term effect after 7 years of an intensive fluoride varnish program in the age interval 11-14 compared to a standard biannual fluoride varnish program. Special reference was made to factors explaining the individual variance in caries incidence between 11-14 and 11-17 years as well as the net benefit of the intensified fluoride varnish program. Two caries measures, one unweighted (DFS0) and one weighted (DFS1), were used. Besides three caries measures D1-D3 were used to distinguish different grades of decay where D1 is enamel lesion and D3 dentinal lesion. The results show statistically significant differences for the age interval 11-17 years according to mean values of DFS0, DFS1 and D1. Regression analyses for caries incidence in the time interval 11-14 gives only explanation (i.e. significant estimated coefficient value) for caries prevalence at 11 years of age irrespective of caries measure, but in the age interval 11-17 years regression analysis also gives explanation for the variable father's education and the fluoride preventive measures in the age interval 11-14. The cost/benefit analysis shows net total costs of 3,880 SEK and net total benefits of 5,000 SEK over a time span of 10 years discounted to 1982 using an annual discount rate of 5%.