{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T18:03:48Z","timestamp":1788977028324,"version":"build-2803163510"},"reference-count":41,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2024,3,25]],"date-time":"2024-03-25T00:00:00Z","timestamp":1711324800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2024,3,25]],"date-time":"2024-03-25T00:00:00Z","timestamp":1711324800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Comm Dent Oral Epid"],"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The addition of fluoride to community drinking water supplies has been a long\u2010standing public health intervention to improve dental health. However, the evidence of cost\u2010effectiveness in the UK currently lacks a contemporary focus, being limited to a period with higher incidence of caries. A water fluoridation scheme in West Cumbria, United Kingdom, provided a unique opportunity to study the contemporary impact of water fluoridation. This study evaluates the cost\u2010effectiveness of water fluoridation over a 5\u20136\u2009years follow\u2010up period in two distinct cohorts: children exposed to water fluoridation in utero and those exposed from the age of 5.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Cost\u2010effectiveness was summarized employing incremental cost\u2010effectiveness ratios (ICER, cost per quality adjusted life year (QALY) gained). Costs included those from the National Health Service (NHS) and local authority perspective, encompassing capital and running costs of water fluoridation, as well as NHS dental activity. The measure of health benefit was the QALY, with utility determined using the Child Health Utility 9\u2010Dimension questionnaire. To account for uncertainty, estimates of net cost and outcomes were bootstrapped (10\u2009000 bootstraps) to generate cost\u2010effectiveness acceptability curves and sensitivity analysis performed with alternative specifications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>There were 306 participants in the birth cohort (189 and 117 in the non\u2010fluoridated and fluoridated groups, respectively) and 271 in the older school cohort (159 and 112, respectively). In both cohorts, there was evidence of small gains in QALYs for the fluoridated group compared to the non\u2010fluoridated group and reductions in NHS dental service cost that exceeded the cost of fluoridation. For both cohorts and across all sensitivity analyses, there were high probabilities (&gt;62%) of water fluoridation being cost\u2010effective with a willingness to pay threshold of \u00a320\u2009000 per QALY.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This analysis provides current economic evidence that water fluoridation is likely to be cost\u2010effective. The findings contribute valuable contemporary evidence in support of the economic viability of water fluoridation scheme.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/cdoe.12958","type":"journal-article","created":{"date-parts":[[2024,3,25]],"date-time":"2024-03-25T05:59:48Z","timestamp":1711346388000},"page":"601-612","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Economic evaluation of a water fluoridation scheme in Cumbria,\n                    <scp>UK<\/scp>"],"prefix":"10.1111","volume":"52","author":[{"given":"William","family":"Whittaker","sequence":"first","affiliation":[{"name":"Division of Population Health, Health Services Research and Primary Care University of Manchester  Manchester 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