应用决策树模型评价3~5岁儿童含氟涂料防龋的经济学效果

目的: 调查上海市周家渡街道3岁儿童龋病负担,并对2年涂氟防龋项目进行效果评价。方法: 采取整群抽样方法,选择周家渡社区3岁常住儿童1 010人,随机分为对照组和干预组,干预组连续涂氟2年,比较2组间患龋情况;同时在上海市口腔病防治院抽取同年龄、等比例样本量的龋病就诊儿童,了解该年龄阶段儿童不同龋蚀程度龋病的经济负担（含直接负担、间接负担和无形负担）。采用SPSS 16.0 软件包和决策树模型,分析涂氟干预措施的预防效果和成本,分析干预成本效果及增量成本的效果比。结果: 涂氟干预组儿童龋病发病率和患龋率分别为47.0%和58.3%,对照组为51.1%和67.6%,增量成本效果比为每预防1个儿童患上龋齿需花费153.76元。随着龋齿腐蚀深度增加,所需的间接负担和无形负担随之增大。结论: 从卫生系统角度看,通过涂氟降低龋病的单位成本较低,适合儿童群体龋病预防。

Economic effect evaluation of fluoride varnishes on 3-5 years old children based on decision tree model

PURPOSE: To analyze the burden of dental caries among 3-year-old children in Zhoujiadu community of Shanghai, and to evaluate the effect of a 2-year fluoride anti-caries project. METHODS: According to the method of cluster sampling,1010 3-year-old children in Zhoujiadu community were randomly divided into control group and intervention group. Children in the intervention group were continuously fluorinated for two years, then dental caries prevelence was evaluated and compared between the two groups. At the same time, the economic burden (including direct burden,indirect burden and intangible burden) of caries in different corrosion degree in the same age and equal proportion of sample size were studied. The preventive effect and cost of fluoride intervention were analyzed by decision tree model,and the cost-effectiveness and incremental cost-effectiveness ratio(ICER) of intervention were analyzed with SPSS 16.0 software package. RESULTS: The incidence and prevalence of dental caries in the intervention group were 47%, 58.3%, and 51.1%,67.6% in the control group.Incremental cost-effectiveness ratio(ICER) was CNY 153.76 per child remaining caries free. With the increase of the corrosion depth of dental caries,the indirect cost and intangible cost increased. CONCLUSIONS: From the perspective of healthcare system, the unit cost of reducing dental caries through fluoride application is low,which is suitable for prevention of dental caries in children.