Economic evaluation of the protecting teeth @ 3 randomised controlled trial

Anopa, Y., Macpherson, L. M. D. , McMahon, A. D. , Wright, W., Conway, D. I. and McIntosh, E. (2022) Economic evaluation of the protecting teeth @ 3 randomised controlled trial. JDR Clinical and Translational Research, (doi: 10.1177/23800844221090444) (PMID:35442091) (Early Online Publication)

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Abstract

Introduction: An economic evaluation (EE) was conducted alongside a randomised controlled trial (the Protecting Teeth @ 3 Study; PT@3), exploring the additional preventive value of fluoride varnish (FV) application at six-monthly intervals in nursery schools compared to treatment as usual (TAU) in the same nurseries. TAU represented a multi- component national child oral health improvement intervention – the Childsmile programme, apart from nursery FV. Methods: The EE was a within-trial cost-utility analysis (CUA) comparing the FV and TAU groups. The CUA was conducted from a National Health Service perspective and followed relevant methods guidance. Within-trial costs included intervention costs and health care resource use costs. Health outcomes were expressed in quality-adjusted life years (QALYs) accrued over the two-year follow-up period. The CHU9D questionnaire was used to obtain utility scores. National reference costs were used, a discount rate of 1.5% for public health interventions was adopted, multiple imputation methods for missing data were employed, sensitivity analyses were conducted, and incremental cost-utility ratios calculated. Results: Data from 534 participants from the 2014/15 PT@3 intake were used in the EE analyses, n=265 (50%) in the FV and n=269 (50%) in the TAU arm. Mean incremental cost per child in the FV was £68.37 (p=0.382; 95% confidence interval: -£18.04, £143.82). Mean incremental QALY was -0.004 (p=0.636; 95% confidence interval: -0.016, 0.007). The probability that the FV intervention was cost-effective at the UK’s £20,000 threshold was 11.3%. Conclusion: The results indicate that applying FV in nurseries in addition to TAU (all other components of Childsmile, apart from nursery FV) would not be deemed cost-effective given current UK thresholds. In view of previously proven clinical effectiveness and economic worthiness of the universal nursery toothbrushing component of Childsmile, continuation of the additional, targeted nursery FV component in its pre-COVID-19 form, should be reviewed given its low probability of cost-effectiveness.

Item Type:Articles
Additional Information:This study was funded as part of the Childsmile program evaluation, which is, in turn, funded by the Scottish Government Population Health Directorate. Y. Anopa’s post was funded by the Scottish Government Population Health Directorate, as part of the Childsmile program evaluation.
Status:Early Online Publication
Refereed:Yes
Glasgow Author(s) Enlighten ID:Wright, Mr William and McIntosh, Professor Emma and Macpherson, Professor Lorna and McMahon, Dr Alex and Conway, Professor David and Anopa, Ms Yulia
Authors: Anopa, Y., Macpherson, L. M. D., McMahon, A. D., Wright, W., Conway, D. I., and McIntosh, E.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Health Economics and Health Technology Assessment
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Dental School
Journal Name:JDR Clinical and Translational Research
Publisher:SAGE Publications
ISSN:2380-0844
ISSN (Online):2380-0852
Published Online:20 April 2022
Copyright Holders:Copyright © 2022 International Association for Dental Research and American Association for Dental, Oral, and Craniofacial Research
First Published:First published in JDR Clinical and Translational Research 2022
Publisher Policy:Reproduced in accordance with the publisher copyright policy

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