An assessment of the cost effectiveness of a postal toothpaste programme to prevent caries among five-year-old children in the North West of England

Objective: To assess the cost effectiveness of a postal toothpaste programme to prevent caries in 5-year-old children in the north west of England. Participants: Birth cohorts of children aged 12 months were recruited from high caries risk populations in nine health districts. Design: The results of a randomised controlled trial to measure the effects of a postal toothpaste programme are used and related to the costs of running a similar programme. Children in the trial received free toothpaste on four occasions a year and a toothbrush once a year for four years from age 12 months to 5 years. When aged 5-6 years children were examined by trained, calibrated examiners using BASCD standards. Those who received toothpaste containing 1450 ppm F were found to have a significantly lower mean dmft than those who had not. The costs that would be incurred by a public dental service running such a postal toothpaste programme are identified, measured and related to the likely health improvement that could be achieved. Main outcome measures: The cost per tooth saved and the cost per child saved from caries experience and extraction experience. Results: The estimated cost per tooth saved from carious attack was £80.83 and the cost per child of preventing caries experience was £424.38 and avoiding any extractions was £679.01. Analysis resulted in an overestimation of costs and underestimation of benefits. Conclusion: The programme achieved a significant caries reduction in children who received the 1450 ppm F toothpaste and the costs are now available to those considering provision of treatment services in areas where children are at high caries risk.