Cost-Benefit Analysis of Water Fluoridation in England.

Objectives: Although community water fluoridation (CWF) is a safe and effective public health intervention, CWF schemes currently serve less than 10% of the population in England. Recent legislative changes have nonetheless demonstrated a commitment by policymakers to expand CWF to interested authorities. Economic analyses can play an important part in helping to inform the decision-making process. Yet it is important that these consider all costs alongside the benefits, both health and non-health. The objective of this research was to determine the costs and benefits of a CWF scheme in England.
Methods: A Markov model was constructed to calculate the costs and benefits of a CWF scheme. As part of this process a contingent valuation exercise was undertaken to elicit participants’ willingness to pay (WTP) to avoid four different dental health states - signs of decay with no filling required, decay with filling required, root canal treatment, and a single tooth extraction.
Results: Base-case assumptions show CWF to be cost-beneficial with a 100% probability of being an optimal public health intervention. This is driven, in part, by responses to the contingent valuation exercise which showed that avoiding having a tooth in various states of decay is highly valued by participants. Sensitivity analyses including reduced CWF effectiveness and lengthened time to treatment re-intervention also show CWF to be cost-beneficial.
Conclusions: Water fluoridation is cost-beneficial. This finding provides economic grounds for the expansion of CWF schemes in England. The results provide relevant and timely information for local policymaker’s keen to promote a public health policy intervention whose effectiveness and safety have been scientifically demonstrated over the course of more than half a century, but which has not been implemented on a large scale in England.