Caries prevention in Chile : an epidemiological, econometric, and economic evaluation

Abstract

In order to increase the proportion of caries-free preschool children, the Chilean Ministry of Health (MINSAL) proposed a fluoride varnish (FV) intervention program in the preschool setting. This thesis compares the costs and effects of such a proposal with alternative FV interventions in different socioeconomic scenarios. A combinatory selection process was performed to define new FV interventions, for example, in the primary care setting during a well-child check-up. Epidemiological and econometric analyses were conducted and then used as data input into decision analytic models. Cost values, from a costing study, and the relative effectiveness of FV, obtained from a systematic review, were used as well. Several Markov cycle decision models were created to simulate the performance of FV intervention over 2 years. The cost-effectiveness of the different interventions was compared and an incremental cost-effectiveness ratio (ICER) was estimated. The robustness of such estimations was tested using one-way deterministic sensitivity analyses and a Monte-Carlo simulation. All FV interventions resulted in a small increase in the number of caries-free children. In the baseline scenario, FV application in the primary care setting without screening was more effective and less costly than the other interventions; this intervention increased the caries-free population by 3.7% at an extra cost of CLP 7,620 per child with an ICER of CLP 130,849 compared with counselling-only intervention. Increasing the starting age of FV application raised the incremental cost-effectiveness ratio. The ICER decreased when other health professionals, rather than dentists, provided the FV applications. This thesis illustrates the simulation of the performance of FV in realistic scenarios incorporating important aspects of health and education policies. Also, this study demonstrates that MINSAL’s proposal was not the least effective but was unequivocally the more costly intervention by far. The methodology and results of this thesis can be useful for both policy- and decision-makers.