106 American Dental Association Cost 68. Cost-effective and cost-saving?..................... 106 69. Practical?............................................................. 109 68. Is water fluoridation a cost-effective and cost-saving method of preventing tooth decay? Answer. Yes. When compared to the cost of other prevention programs, water fluoridation is the most cost- effective means of preventing tooth decay for both children and adults in the United States. A number of studies over the past 15 years have attempted to place a specific dollar value on the benefit of fluoridation. These studies, conducted in different years (and therefore using different dollar values), encompassing different communities/populations and different methodologies have two conclusions in common: 1) for systems that serve more than 1,000 people, the economic benefit of fluoridation exceeds the cost and 2) the benefit-cost ratios increased as the size of the populations increase largely due to economies of scale. Fact. The cost of community water fluoridation varies for each community depending on the following factors.1 1. Size of the community (population and water usage) 2. Number of fluoride injection points where fluoride additives will be added to the water system 3. Amount and type of equipment used to add and monitor fluoride additives 4. Amount and type of fluoride additive needed to reach the target fluoride level of 0.7 mg/L its price, cost of transportation and storage and 5. Expertise and preferences of personnel at the water plant. In 2016, a study2 led by researchers from the Colorado School of Public Health created a model of fluoridation program costs, savings, net savings and return on investment for the 2013 U.S. population with access to optimally fluoridated water systems that served 1,000 or more people. The researchers found that savings associated with individuals avoiding tooth decay in 2013 as a result of fluoridation were estimated at $6.8 billion, or $32.19 per person, for the more than 211 million people who had access to fluoridated water through community water systems serving more than 1,000 people that year. Based on the estimated cost of the systems to fluoridate ($324 million), the net savings from fluoridation was estimated at $6.5 billion and the estimated return on investment (ROI) averaged 20 to 1 across water systems of all sizes (from 1,000 to over 100,000 people with a ROI range of 15.5 to 26.2). However, it was noted that the cost per person to fluoridate can vary significantly among different sizes of communities based on a number of the factors outlined in the previous paragraph. Because of those variables, the researchers urged communities to inform their policy decisions by identifying their specific water system’s annual cost and comparing that cost to the annual estimated per person savings ($32.19) in averted treatment costs. The researchers noted that in 2013, while 211 million people had access to fluoridated water, more than 78 million people had access to a public water system that served 1,000 or more people that was not fluoridated. The study findings suggest that if those water systems had been fluoridated, an additional $2.5 billion could have been saved as a result of reductions in tooth decay.2 The economic benefits of fluoridation were also reconfirmed in a systematic review3 conducted in 2013 by the Community Preventive Services Task Force which sought to update their prior review conducted in 20024 which also found that fluoridation saved money. The 2013 review concluded that recent