Studies such as this are periodically published in certain journals in an attempt to convince readers that communal water fluoridation is cost-effective. The study sounds convincing. But hidden inside are certain assumptions that drive the conclusions. In the end, the study ends up showing what it has already assumed from the start. But the major weaknesses are quite easily to understand. People, adults and children, are not statistical categories. When grouped into artificial statistical categories with assumed health outcomes and assumed costs just about any claim could be “proven” cost effective on paper.
Tchouaket E, Brousselle A, Fansi A, Dionne PA, Bertrand E, Fortin C. The economic value of Quebec’s water fluoridation program. Journal of Public Health (09431853); Dec2013, Vol. 21 Issue 6, p523-533
Aim: Dental caries is a major public health problem worldwide, with very significant deleterious consequences for many people. The available data are alarming in Canada and the province of Quebec. The water fluoridation program has been shown to be the most effective means of preventing caries and reducing oral health inequalities. This article analyzes the cost-effectiveness of Quebec’s water fluoridation program to provide decision-makers with economic information for assessing its usefulness.
Methods: An approach adapted from economic evaluation was used to: (1) build a logic model for Quebec’s water fluoridation program; (2) determine its implementation cost; and (3) analyze its cost-effectiveness. Documentary analysis was used to build the logic model. Program cost was calculated using data from 13 municipalities that adopted fluoridation between 2002 and 2010 and two that received only infrastructure grants. Other sources were used to collect demographic data and calculate costs for caries treatment including costs associated with travel and lost productivity.
Results: The analyses showed the water fluoridation program was cost-effective even with a conservatively estimated 1 % reduction in dental caries. The benefit-cost ratio indicated that, at an expected average effectiveness of 30 % caries reduction, one dollar invested in the program saved $71.05–$82.83 per Quebec’s inhabitant in dental costs (in 2010) or more than $560 million for the State and taxpayers.
Conclusion: The results showed that the drinking-water fluoridation program produced substantial savings. Public health decision-makers could develop economic arguments to support wide deployment of this population-based intervention whose efficacy and safety have been demonstrated and acknowledged.