Fluoridation: New research confirms it is cost effective – yet again

Yet again a cost-benefit analysis shows community water fluoridation to save far more than it costs.

A new study has found, once again, that community water fluoridation (CWF) saves more than it costs. Carrying on from the previous most comprehensive study in 2001 this new study is based on updated costs of CWF and the averted lifetime costs of dental treatment in the United States.

It estimates savings from averted tooth decay in 2013  as a result of CWF to be about $32 per capita. The estimated costs of CWF in 2013 was $324 million. The net saving (savings minus costs) from CWF was estimated to be $6,469 million.

The estimated return on investment (annual net saving/annual costs), averaged across all sizes of water systems, was 20.

The study is published in this paper:

O’Connell, J., Rockell, J., Ouellet, J., Tomar, S. L., & Maas, W. (2016). Costs And Savings Associated With Community Water Fluoridation In The United States. Health Affairs, 35(12), 2224–2232.

These figures strongly show that further savings could be achieved by extending CWF in the USA. the authors say:

“During 2013 more than seventy-eight million people had access to a public water system that served 1,000 or more people that did not fluoridate the water. Our findings suggest that if those water systems had implemented fluoridation, an additional $2.5 billion might have been saved as a result of reductions in caries.”

This study found large saving from CWF despite using a lower estimate of tooth decay present when  there is no fluoridation than used by some other studies. The present study relied on estimations of decayed and filled teeth, rather than the more sensitive measure of decay and filled tooth surfaces.

The authors also investigated the robustness of their conclusion by estimating the return on investment for different figures of reduced tooth decay due to CWF. This varied from 16.5 when CWF effectiveness was assumed to be 20% (less effective than the estimated 25%) to 23.7 when  CWF was assumed to be 30% (more effective than the estimated 25%).

Of course, anti-fluoridation propagandists will rubbish this study – just as they have every other study which does not support their message. And their message will be the same they have used to attack every other high-quality cost-effectiveness study of CWF. They will claim it is biased because it does not include consideration of adverse effects of CWF. In particular, costs related to dental fluorosis.

In recent years their argument relies strongly on the flawed work of Ko & Thiessen (2014) – A critique of recent economic evaluations of community water fluoridation. This is flawed because it includes the cost of treatment fo moderate and severe forms of dental fluorosis.  This is despite acknowledging in their discussion that CWF is not responsible for any moderate or severe forms of dental fluorosis. I have discussed this further in Alternative reality of anti-fluoride “science”.

Mind you, I still expect anti-fluoride commenters here to the Ko and Thiessen study at me.

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