Cost-effectiveness analysis of fluoride varnish for preventing dental caries in Iraqi schoolchildren: A cluster-randomized controlled trial

This study aimed to evaluate the cost-effectiveness of fluoride varnish application on the occurrence of dental caries in permanent teeth among 8-10-year-old children in Iraq. : The effectiveness and cost were determined from a cluster randomized controlled trial in 372 schoolchildren, 186 in each group. At the beginning of the study, subjects in the intervention group received oral health education (OHE) and a single dose of 5 % sodium fluoride varnish for all teeth surfaces, while the control group only received oral health education. In this study, the economic analysis was considered from the public payer perspective, only the direct costs were considered which included human resources and supplies of varnish application. Incremental cost-effectiveness ratios (ICERs) were calculated to provide an estimate of the mean cost per additional unit of outcome. An independent t-test was used to compare the mean scores of caries increment between the two groups. The study participants consisted of 372 children with no significant difference in baseline characteristics between the intervention and control groups. The DMFS and DMFT increments at the six-month follow-up for the intervention group were 0.2 and 0.1, respectively, while for the control group were 0.8 and 0.5, respectively. The average cost per child in the intervention group was $4.00 and $1.70 for the control group. The ICER was 0.28 for preventing each tooth from being filled in the intervention group. School-based oral health programs that include fluoride varnish application with OHE were slightly more costly but cost-effective in dental caries prevention compared with OHE alone.