上海市幼儿园3岁儿童乳牙涂氟防龋项目的卫生经济学评价  

An economic evaluation of a kindergarten-based fluoride varnish program for deciduous teeth among 3-year-old children in Shanghai

作　　者：王薇 陈英耀[1] 曹新明 陈栋 WANG Wei;CHEN Ying-yao;CAO Xin-ming;CHEN Dong(School of public health,Fudan University,National Health Commission Key Lab of Health Technology Assessment (Fudan University),Shanghai 200032,China;Shanghai Stomatological Hospital,Shanghai 200001,China)

机构地区：[1]复旦大学公共卫生学院,国家卫生健康委员会卫生技术评估重点实验室(复旦大学),上海200032 [2]上海市口腔病防治院,上海200001

出　　处：《中国卫生资源》2019年第3期204-208,共5页Chinese Health Resources

基　　金：上海市卫生和计划生育委员会科研基金(201540281);上海市级医院适宜技术联合开发推广应用项目(SHDC2012216)

摘　　要：目的评估在幼儿园开展乳牙涂氟项目对预防3岁儿童龋齿的成本效益,为推动该项目建立长效机制提供决策支持。方法2016年1月—2017年12月,(经家长/监护人同意)每6个月在上海市所有公立幼儿园对每位3岁在园儿童的所有乳牙施用1次涂氟处理。从卫生系统的角度进行成本效益分析,并与项目启动前的历史队列进行比较。2017年底测量有效性结果,即患龋儿童的比例及龋齿、缺失或填充牙齿表面的平均数量(龋均值),作为例行年度牙科筛查的一部分,该筛查采用上海市所有公立幼儿园5岁儿童的代表性样本。根据该项目实施3年的累计成本来估算1次涂氟应用的平均成本。估算成本效益比,通过使用每颗龋齿表面的治疗成本来估算干预有效性的货币价值。结果2017年上海市5岁儿童龋齿患病率为62.82%,比2015年降低了2.36个百分点。2017年龋均值为2.64,而2015年为3.14。增量成本效果比为每预防1个学龄前儿童患上龋齿需花费2833元,而每预防1颗龋齿的发生需花费134元。平均治疗成本估计为每颗龋齿表面127元,成本效益比为0.95。参数敏感性分析表明,如果龋均值降低到2.61,或者每次涂氟应用的成本降低5%,成本效益比将达到1.00,即投入与产出平衡。结论从卫生系统的角度看,基于较高的成本效益比,该项目是具有成本效益潜力的。Objective To evaluate the cost-effectiveness of a kindergarten-based fluoride varnish(FV)program for deciduous long-term teeth caries prevention among 3-year-old children.Methods From January 2016 to December 2017,FV was applied every 6 months to all primary teeth of every 3-year-old child(with parental/guardian’s consent)in all public kindergartens in Shanghai.A cost-benefit analysis was conducted from the perspective of healthcare system,and data were compared with that from a historic cohort.The effectiveness outcomes[proportion of children with caries,and mean number of decayed,missing,or filled teeth surfaces(dmfs)]were measured at end of 2017 as part of a routine annual dental screening from a representative sample of all 5-year-old children attending public kindergartens in Shanghai.Cumulative cost of the program over the 3-year implementation was used to calculate the mean cost for one FV application.Cost-benefit ratio(CBR)was estimated by using treatment cost per carious surface for monetary valuation of effectiveness.Results The prevalence rate of caries among 5-year-old children in Shanghai was 62.82%in 2017,2.36 percent points lower than that in 2015.The mean dmfs was 2.64 in 2017 vs.3.14 in 2015.Incremental cost-effectiveness ratios(ICERs)were CNY 2 833 per child remaining caries free,and CNY 134 per caries avoided.Given that the mean treatment cost was estimated at CNY 127 per carious surface,the CBR was 0.95.The sensitivity analysis indicated that CBR would reach 1.0 if the mean dmfs was improved to 2.61,or the cost per FV application was cut by 5%.Conclusion With a high CBR,the program seemes to be valuable from the perspective of healthcare system.

关 键 词：龋齿 预防 乳牙涂氟 幼儿 幼儿园 成本效益分析 卫生经济学评价 上海市 

分 类 号：R1-9[医药卫生—公共卫生与预防医学] R788.1