Public health ROI: Fluoridation prevents tooth decay and saves a ton of money [The Pump Handle]

As 2016 comes to a close — and 2017 looms with enormous uncertainty — let’s end the year with some encouraging public health news. This time it’s a study on one of the 10 great public health achievements of the 20^th century: fluoridation.

Published this month in Health Affairs, the study is an update on a 2001 study that marked the most comprehensive examination to date of community water fluoridation benefits and costs. This new study found that in 2013, more than 211 million American residents had access to fluoridated drinking water. That fluoridation was associated with the prevention of dental cavities that would have otherwise cost $6,792 million, or $32.19 per capita, in treatment and lost productivity. The cost of providing fluoridated drinking water in 2013 was $324 million, which means the net savings of fluoridation when compared to the costs of tooth decay is a whopping $6,469 million. Talk about a serious public health return on investment.

But wait, there’s more. When breaking down the savings by population size, the study found net savings ranged from $247 million for fluoridated water systems that served 1,000-4,999 people to $3,693 million for systems servings 100,000 people or more. When researchers assumed that fluoridation reduced tooth decay by 20 percent, the return on investment was 16.5; when they assumed a tooth decay reduction of 30 percent, the return on investment was 23.7. And in fact, even when researchers considered the capital costs of drinking water fluoridation, such as construction, as well as the depreciation of such costs, they still found a return on investment of nearly 20.

Study authors Joan O’Connell, Jennifer Rockell, Judith Ouellet, Scott Tomar and William Maas write:

Families, communities, government, health care payers and providers, and private organizations continually evaluate opportunities to improve health outcomes, accounting for the benefits and costs of doing so. The World Health Organization classifies interventions as cost-effective if costs per disability-adjusted life-year (DALY) avoided are less than three times the per capita national annual gross domestic product and highly cost-effective if costs per DALY are less than that value. In other words, cost-effective interventions need not save money. Not only is community water fluoridation effective at reducing caries, it has been found to save money in this and other recent studies. Furthermore, (community water fluoridation programs) might also reduce oral health disparities within communities.

According to the Centers for Disease Control and Prevention, fluoridated drinking water prevents cavities by up to 25 percent in children and adults, though childhood cavities continue to be one of the most common chronic diseases affecting kids. First begun in 1945, fluoridated water reached nearly 75 percent of the U.S. population as of 2014. The nation’s Healthy People 2020 goal is to bring fluoridated water to 79.6 percent of Americans living on public water systems.

“The fact that the United States has not yet met the Healthy People 2020 goal that 79.6 percent of the population served by community water systems have optimally fluoridated water is an indication that public health understanding of water fluoridation and its benefits merits further study,” the Health Affairs study authors wrote. “This study provides updated information on (community water fluoridation programs) costs and savings that could increase such understanding.”

To request a full copy of the fluoridation study, visit Health Affairs.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for 15 years.