Water Fluoridation - Economics

Economics

Fluoridation costs an estimated $1 per person-year on the average (range: $0.24–$10.63; all costs in this paragraph are for the U.S. and are in 2012 dollars, inflation-adjusted from earlier estimates). Larger water systems have lower per capita cost, and the cost is also affected by the number of fluoride injection points in the water system, the type of feeder and monitoring equipment, the fluoride chemical and its transportation and storage, and water plant personnel expertise. In affluent countries the cost of salt fluoridation is also negligible; developing countries may find it prohibitively expensive to import the fluoride additive. By comparison, fluoride toothpaste costs an estimated $8–$17 per person-year, with the incremental cost being zero for people who already brush their teeth for other reasons; and dental cleaning and application of fluoride varnish or gel costs an estimated $92 per person-year. Assuming the worst case, with the lowest estimated effectiveness and highest estimated operating costs for small cities, fluoridation costs an estimated $15–$24 per saved tooth-decay surface, which is lower than the estimated $91 to restore the surface and the estimated $153 average discounted lifetime cost of the decayed surface, which includes the cost to maintain the restored tooth surface. It is not known how much is spent in industrial countries to treat dental fluorosis, which is mostly due to fluoride from swallowed toothpaste.

Although a 1989 workshop on cost-effectiveness of cavity prevention concluded that water fluoridation is one of the few public health measures that save more money than they cost, little high-quality research has been done on the cost-effectiveness and solid data are scarce. Dental sealants are cost-effective only when applied to high-risk children and teeth. A 2002 U.S. review estimated that on average, sealing first permanent molars saves costs when they are decaying faster than 0.47 surfaces per person-year whereas water fluoridation saves costs when total decay incidence exceeds 0.06 surfaces per person-year. In the U.S., water fluoridation is more cost-effective than other methods to reduce tooth decay in children, and a 2008 review concluded that water fluoridation is the best tool for combating cavities in many countries, particularly among socially disadvantaged groups.

U.S. data from 1974–1992 indicate that when water fluoridation is introduced into a community, there are significant decreases in the number of employees per dental firm and the number of dental firms. The data suggest that some dentists respond to the demand shock by moving to non-fluoridated areas and by retraining as specialists.