{"text_format":"1","workbook":"xlsx","n_sheets":59,"sheets":["Control","Introduction","Guide","Model steps","Example","Disclaimer","Intervention","Intervention (2)","Population","Population (3)","Population (2)","Programme costs","Programme costs (2)","Resources","MENU1B5","MENU1B6","MENU1B7","MENU1B8","Resources (2)","Results tables","Results charts","MENU2B3","MENU2B4","MENU2B5","MENU2B6","MENU2B7","MENU2B8","MENU3B4","MENU3B5","MENU3B6","MENU3B7","MENU3B8","MENU4B1","MENU4B2","MENU4B3","MENU4B4","MENU4B5","MENU4B6","MENU4B7","MENU4B8","MENU5B1","MENU5B2","MENU5B3","MENU5B4","MENU5B5","MENU5B6","MENU5B7","MENU5B8","MENU6B1","MENU6B2","MENU6B3","MENU6B4","MENU6B5","MENU6B6","MENU6B7","MENU6B8","PDF","Calcs","Study data"],"not_rendered":{"charts":3,"images":3,"macros":1,"external_links":0,"defined_names":1,"comments":4,"pivot_tables":0},"unopened":[],"bounds":{"document_bytes":16777216,"sheet_cells":100000,"rows_first":2000,"rows_last":500,"rows_between":2000,"halvings":0,"cell_chars":16384,"cell_head_chars":4096},"cells_cut":0,"cells_raw":0,"read":"whole","date_system":"1900"}

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["Menu Text","Button Text/Sheet Names"]
["Inputs","Intervention","Population","Programme costs","Resources",".",".",".","."]
["Results","Results tables","Results charts",".",".",".",".",".","."]
["Intro","Background","Guide","Model steps",".",".",".",".","."]
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["Inputs","Intervention","Population","Programme costs","Resources","MENU1B5","MENU1B6","MENU1B7","MENU1B8"]
["Results","Results tables","Results charts","MENU2B3","MENU2B4","MENU2B5","MENU2B6","MENU2B7","MENU2B8"]
["Intro","Background","Guide","Model steps","MENU3B4","MENU3B5","MENU3B6","MENU3B7","MENU3B8"]
["MENU4","MENU4B1","MENU4B2","MENU4B3","MENU4B4","MENU4B5","MENU4B6","MENU4B7","MENU4B8"]
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{"sheet":"Introduction","index":1,"n_rows":2,"n_cols":4,"rows_kept":2,"cut":false,"hidden":false,"merged":[[1,3,4,11]]}
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[null,null,null,"Public Health England - Return on Investment of Oral Health Interventions"]

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[null,null,null,"How to use the tool"]
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[null,null,null,"Formatting:"]
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[null,null,null,"Dark grey background",null,"Indicates input cells for the user of the tool. These should be filled with local data."]
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[null,null,null,"Light grey background",null,"Indicates input cells containing default or suggested inputs. These may be changed should more relevant evidence become available."]
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[null,null,null,"Plain background",null,"Indicates a formula cell for model calculations. These are dependent upon other cells, and should not be changed."]
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[null,null,null,"Comments",null,"A red mark in the corner of a cell indicates a comment. To view the comment, hover the pointer over the cell. Comments often contain details of an inputs source or an assumption, or how a parameter was estimated."]
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[null,null,null,"Navigating around the model:"]
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[null,null,null,"The rectangular buttons along the left allow the user to toggle between each section of the tool (Introduction,  Set-up, and Results)"]
[null,null,null,"Within each section, the chevron buttons along the top can be used to switch between pages"]
[null,null,null,"For each input section, the user can toggle between viewing information about the evidence for that section, and the values used"]
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[null,null,null,"Sheets in this tool:",null,"Key inputs:"]
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[null,null,null,"Intervention",null,"Programme type"]
[null,null,null,"Population",null,"Programme size, local deprivation levels"]
[null,null,null,"Programme costs",null,"Costs of the programme, broken down by year"]
[null,null,null,"Resources",null,"Rates of absenteeism, cost of fillings and extraction"]
[null,null,null,"Results",null,"Displays the potential cost savings and return on investment"]

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[null,null,null,"Model calculation steps"]
[null,null,null,null,null,null,null,null,null,null,{"$f":"'Study data'!B33","v":"To view more information on how each step of the analysis has been calculated, please click on the relevant box, and details will provided to the right."}]
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[null,null,null,null,null,null,null,null,null,null,{"$f":"IF(Calcs!C4 = 0,\"\", CHOOSE(Calcs!C4,'Study data'!B34,'Study data'!B35,'Study data'!B36,'Study data'!B37,'Study data'!B38,'Study data'!B39,'Study data'!B40,'Study data'!B41,'Study data'!B42,'Study data'!B43,'Study data'!B44))","v":"Programme costs are entered by the user on the \"Programme costs\" page.\n\nFor water fluoridation the mean operating costs per child should be entered this has been prepopulated with the known average per head operating costs of schemes in England. No other costs including capital costs have been included.\n\nFor all other programmes the estimated or indicative costs should be entered for each year the programme will run. The costs should only be for one cohort: for example, a tooth brushing programme that runs for two years will have in any one year one cohort in the first year of the programme and one in the second year. In the model the number of children is one cohort and the costs are those relating to that one cohort.\n\nBoth of these methods result in a total cost of delivering the programme, for each year that a child is enrolled in it. \n\nProgramme costs that are incurred in the future (after Year 1) are discounted at a rate of 3.5% (UK Treasury). This reflects society's preference for costs to be experienced in the future rather than the present."}]

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{"sheet":"Disclaimer","index":5,"n_rows":0,"n_cols":0,"rows_kept":0,"cut":false,"hidden":false,"merged":[[1,3,2,11]]}

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[null,null,null,null,"View information about this page",null,null,"View inputs for this page"]
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[null,null,null,"Select programme",null,null,null,"Study information - Programme effectiveness"]
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[null,null,null,"Supervised toothbrushing",null,null,null,"Source study",null,null,{"$f":"CHOOSE(Calcs!$C$2,'Study data'!C5,'Study data'!C9,'Study data'!C13,'Study data'!C17,'Study data'!C21,'Study data'!C25)","v":"Macpherson (2013)"}]
[null,null,null,"Fluoride varnish"]
[null,null,null,"Water fluoridation",null,null,null,"Programme length",null,null,{"$f":"CHOOSE(Calcs!C2,'Study data'!D5,'Study data'!D9,'Study data'!D13,'Study data'!D17,'Study data'!D21,'Study data'!D25)","v":"2 years (at nursery)"}]
[null,null,null,"Provision of toothbrushes and paste by post",null,null,null,"Age at start of programme",null,null,{"$f":"CHOOSE(Calcs!C2,'Study data'!E5,'Study data'!E9,'Study data'!E13,'Study data'!E17,'Study data'!E21,'Study data'!E25)","v":"3-4 years (nursery-aged children)"}]
[null,null,null,"Provision of toothbrushes and paste by health visitors and post"]
[null,null,null,"Multi-component community promotion",null,null,null,"Preventive fraction",null,null,{"$f":"CHOOSE(Calcs!$C$2,'Study data'!H5,'Study data'!I9,'Study data'!J13,'Study data'!J17,'Study data'!J21,'Study data'!K25)","v":0.32352941176470595}]
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[null,null,null,null,"Supervised toothbrushing"]
[null,null,null,null,"Targeted supervised tooth brushing in schools or nurseries is recommended as an effective intervention by NICE PH55 and CBOH. This model has used the preventive fraction estimated from the Childsmile programme (Macpherson, 2013). This study was assessed as being of good quality by the NICE PH55 review (\"All or most of the NICE checklist criteria have been fulfilled; where they have not been fulfilled, the conclusions are very unlikely to alter\"). The mean dmft at 5 years of age before the programme was introduced was 3.06 (SD 3.76), and the mean dmft ten years after the programme was introduced was 2.07 (SD 3.16), resulting in a preventive fraction of 32%.\n\nThe Childsmile programme, which has been run throughout Scotland over the last decade, involves daily supervised tooth brushing in nurseries of 3 and 4 year old children and distribution by nurseries of fluoride toothpaste (at least 1000ppm) for use at home on 6 occasions. The Childsmile programme has also reported overall cost savings in Scotland (Anopa et al., 2015), with the largest reduction in estimated cost in the most deprived cohort of children.\n\nWhether this programme could have an impact on inequalities depends on a number of factors, including appropriate targeting of high-risk populations, as well as high rates of consent, compliance and retention. "]
[null,null,null,null,"Reference: Macpherson LM, Anopa Y, Conway DI et al. National supervised toothbrushing program and dental decay in Scotland.  J Dent Res.  2013;92(2):109-13. \nAvailable at: http://www.ncbi.nlm.nih.gov/pubmed/23264611"]
[]
[null,null,null,null,"Fluoride varnish"]
[null,null,null,null,"Targeted community fluoride varnish programmes are recommended by NICE PH55 and CBOH. Programmes centred on the applications of fluoride varnish in targeted community settings have strong evidence of effectiveness in preventing tooth decay. The model has used the preventive fraction based on the most recent systematic review (Marinho et al., 2013). This review updated the evidence from the first systematic review in 2002. The pooled prevented fraction was 37% (95% CI 24% to 51%; P < 0.0001).\n\nThe systematic review and meta-analysis included evidence from ten clinical trials combined to estimate the overall impact of fluoride varnish. The majority of trials included were of two year duration, had a biannual application frequency, and were in both community and dental settings. Some of the studies were carried out in populations which may not be representative of the UK population and there was considerable variation in outcomes across the studies. The review suggests a substantial caries inhibiting effect of fluoride varnish in both permanent and primary teeth; however, the quality of the evidence was assessed as moderate.\n\nEffectiveness and whether this programme could have an impact on inequalities depends on a number of factors, including appropriate targeting of high-risk populations, providing oral health improvement advice within the programme, as well as high rates of consent, compliance and retention over a two year period."]
[null,null,null,null,"Reference: Marinho VCC, Worthing HV, Walsh T, Clarkson JE. Fluoride varnishes for preventing dental caries in children and adolescents. Cochrane Database of Systematic Reviews 2013, Issue 7. Art. No,: CD002279. \nAvailable at:  http://www.ncbi.nlm.nih.gov/pubmed/23846772"]
[]
[null,null,null,null,"Water fluoridation"]
[null,null,null,null,"Community water fluoridation schemes are recommended by CBOH (PHE2014) and were not within the remit of the NICE PH55 review. The model has used the preventive fraction from the most recent systematic review of the effectiveness of water fluoridation (Cochrane 2015).\n\nThe systematic review and meta-analysis was undertaken by Cochrane. Insufficient evidence was found to determine whether fluoridation reduces differences in decay levels between deprived and affluent areas, though the review excluded more recent cross-sectional studies. There are a number of limitations with using the pooled analysis, namely that there was substantial variation across the studies, and the use of other sources of fluoride, including topical agents, was not taken into account. The pooled analysis indicates that the reduction in dmft is 1.81 (95% CI 1.31 to 2.31), translating to a 35% reduction in dmft.\n\nMany of the studies used to inform the Cochrane review were relatively old: of the 19 studies in the review, 70% were undertaken before 1975 with the most recent published in 1997. There were some concerns about the applicability of the findings. However, a recently-conducted study of the impact of water fluoridation in England (Health Monitoring Report for England 2014, PHE) supports the outcome of the Cochrane review, where a preventive fraction of 0.37 (95% CI 0.27 to 0.48) was estimated for 5 year olds.\n\nGiven that the approach targets geographic areas rather than specific population groups, it may be more difficult to target these kinds of programmes to benefit only children at high risk of disease, but the universal nature of the programme means that compliance is not an issue, in contrast with the other programmes."]
[null,null,null,null,"Reference: Iheozor-Ejiofor Z, Worthington HV, Walsh T, et al. Water fluoridation for the prevention of dental caries. Cochrane Database of Systematic Reviews 2015, Issue 6. \nAvailable at: http://www.ncbi.nlm.nih.gov/pubmed/26092033"]
[]
[null,null,null,null,"Provision of toothbrushes and paste by post"]
[null,null,null,null,"Provision of toothbrushes and paste by post is recommended by NICE PH55 and CBOH (PHE, 2014). The model has used the preventive fraction from Davies et al 2002. This study was assessed as being of good quality by the NICE PH55 review (\"some of the quality checklist criteria have been fulfilled; where they have not been fulfilled, or not adequately described, the conclusions are unlikely to alter\").\n\nDavies et al., 2002 assessed the impact on the level of caries in the deciduous dentition at 5-6 years of age by regularly supplying free fluoride toothpaste (1450ppm) to children via post. Children were initially aged 12 months, and living in deprived areas of the north west of England. Toothpaste containing 1450 ppmF and dental health literature was posted at three monthly intervals and a toothbrush annually to children until they were aged 5-6 years. The cost-effectiveness of the programme has also been established, with an estimated cost per child saved from caries experience as £424.38 (Davies et al., 2003).  The mean reduction in dmft estimated from this study was 16% (CI NR, p < 0.05).\n\nTo increase effectiveness programmes should consider targeting to those with highest levels of disease, length of programme, frequency of postal drops, the use of 1450ppm fluoride toothpaste, age of commencement and provision of oral health advice information. There are a number of methods by which families can be supplied with toothbrush and paste, however postal delivery is thought to be likely to minimise uptake issues, making the impact on inequalities more favourable. Further consideration could be given to innovative postal solutions, perhaps partnering with other delivery firms to reduce the costs of delivery."]
[null,null,null,null,"Reference: Davies GM, Worthington HV, Ellwood RP, Bentley EM, et al. A randomised controlled trial of the effectiveness of providing free fluoride toothpaste from the age of 12 months on reducing caries in 5-6 year old children. Community Dent Health. 2002 Sep;19(3):131-6. \nAvailable at: http://www.ncbi.nlm.nih.gov/pubmed/12269458"]
[]
[null,null,null,null,"Provision of toothbrushes and paste by health visitors and post"]
[null,null,null,null,"Provision of toothbrushes and paste by post and via health visitors is recommended by NICE PH55 and CBOH (PHE, 2014). The model has estimated the preventive fraction of this programme from Davies et al 2007. This study was assessed as being of high quality in the systematic review in which it was identified (Rogers 2011).\n\nHealth visitor mediated scheme: Davies et al., 2005 assessed the impact on the level of caries in the deciduous dentition at 5 years of age by using health visitors and a regular supply of free fluoride toothpaste to children. The programme consisted of a series of interventions from 8 to 32 months of age, including gift bags containing trainer cup and toothpaste 1450ppm, toothbrush and advice given to parents on attendance at designated clinics and children’s centres. Toothbrushes and paste are handed out by health visitors at regular child development checks as part of the Brushing for Life programme. Further paste and brushes posted to homes. The mean dmft at 5 years of age in the programme arm in the study was 2.23 (95% CI 1.84 to 2.62), and the mean dmft in the comparison arm was 3.72 (95% CI 3.23 to 4.21), resulting in a preventive fraction of 40% (p < 0.0001).\n\nTo increase effectiveness programmes should consider targeting to those with highest levels of disease, length of programme, frequency of postal drops, the use of 1450ppm fluoride toothpaste, age of commencement and provision of oral health advice information. There are a number of methods by which families can be supplied with toothbrush and paste. Engaging with health visitors is important to ensure support for the programme and the consistency of messages."]
[null,null,null,null,"Reference: Davies GM, Duxbury JT, Boothman NJ, Davies RM. Challenges associated with the evaluation of a dental health promotion programme in a deprived urban area. Community Dent Health. 2007 Jun;24(2):117-21.\nAvailable at: http://www.ncbi.nlm.nih.gov/pubmed/17615828"]
[]
[null,null,null,null,"Multi-component community promotion"]
[null,null,null,null,"Multi-component programmes are recommended by CBOH. Oral health promotion programmes delivered through multiple venues and providing interventions at a local policy, supporting environment and programme level may be associated with a reduced risk of dental decay. Many local authorities commission a combination of individual programmes similar to the programme outlined by Blair et al., (2006), from which the model has estimated the preventive fraction. This study was assessed as being of good quality by the NICE PH55 review (\"some of the quality checklist criteria have been fulfilled; where they have not been fulfilled, or not adequately described, the conclusions are unlikely to alter\").\n\nThis study assessed the impact of a programme targeting children under 5 attending breakfast clubs in schools and community centres in a severely deprived area of Glasgow. The programme incorporated a wide range of elements, including tooth brushing schemes (e.g. in nurseries), free toothbrush and fluoride toothpaste (1000ppm), opportunistic oral health promotion by a health visitor, the promotion of sugar free medicines in National Smile Week, snack and meal policies for schools, fruit promotion in nurseries and schools, baby bottle swap/cup provision, annual community fairs, oral health related competitions, child friendly dentist scheme, and parenting support baby club. The odds ratio for presence of tooth decay reported in the study was 0.66 (95% CI 0.57 to 0.77; p<0.0001), equivalent to a preventive fraction of 34%.\n\nThe multi-component nature of the programme and upstream policy interventions make it more likely to have an impact on inequalities."]
[null,null,null,null,"Reference: Blair Y, Macpherson L, McCall D et al. Dental health of 5-year-olds following community based oral health promotion in Glasgow, UK.  Int J Paediatr Dent.  2006;16(6):388-98\nAvailable at: http://www.ncbi.nlm.nih.gov/pubmed/17014536"]

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[null,null,null,null,"View information about this page",null,null,"View inputs for this page"]

{"sheet":"Population","index":8,"n_rows":54,"n_cols":11,"rows_kept":54,"cut":false,"hidden":false,"merged":[[27,7,27,9]]}
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[null,null,null,null,"View information about this page",null,null,"View inputs for this page"]
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[null,null,null,"Baseline prevalence of decay (at age 5)"]
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[null,null,null,"Please select an option to estimate dmft at age 5",null,null,null,"The mean dmft based on your selected option is:"]
[null,null,null,"Option 1 - Select local area (for universal programmes)",null,null,null,{"$f":"Calcs!E7","v":""}]
[null,null,null,"Option 2 - Input dmft for local area (for targeted programmes)"]
[null,null,null,"Option 3 - Quintile modelling based on the local dmft"]
[null,null,null,"Option 4 - Quintile modelling based on national average dmft"]
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[null,null,null,"Option 1 - select local area (for universal programmes)"]
[null,null,null,"Local area"]
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[null,null,null,"Option 2 - input for local area"]
[null,null,null,"Mean dmft (for targeted programmes)"]
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[null,null,null,"Option 3 - Quintile modelling based on the local dmft",null,null,"Most deprived",null,null,null,"Least deprived"]
[null,null,null,"IMD Quintile",null,null,1,2,3,4,5]
[null,null,null,"Proportion of children in each quintile (targeted area - user input)"]
[null,null,null,"Mean dmft per quintile (local area - user input)"]
[null,null,null,"Please ensure percentages add to 100%"]
[]
[null,null,null,"Option 4 - Quintile modelling based on national average dmft",null,null,"Most deprived",null,null,null,"Least deprived"]
[null,null,null,"IMD Quintile",null,null,1,2,3,4,5]
[null,null,null,"Proportion of children in each quintile (targeted area - user input)"]
[null,null,null,"Mean dmft per quintile (national)",null,null,1.35,0.99,0.7,0.54,0.39]
[null,null,null,"Please ensure percentages add to 100%"]
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[null,null,null,"Programme size"]
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[null,null,null,"Total number of children in programme (per cohort)"]

{"sheet":"Population (3)","index":9,"n_rows":11,"n_cols":8,"rows_kept":11,"cut":false,"hidden":false,"merged":[]}
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[null,null,null,null,"View information about this page",null,null,"View inputs for this page"]

{"sheet":"Population (2)","index":10,"n_rows":170,"n_cols":10,"rows_kept":170,"cut":false,"hidden":true,"merged":[]}
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[null,null,1,"Select an area","5-year-old population\n(mid 2014)","Examined","% of sample examined","Mean\nd3mft"]
[null,null,2,"England",673956,111500,63.1,0.83879000596589404,null,1]
[null,null,3,"East Midlands",55313,8944,64.099999999999994,0.89944186643620905]
[null,null,4,"     Derby",3554,272,60.1,1.30529484303969,null,{"$f":"IF(J11=1,\"\",VLOOKUP(J11,C10:H181,6))","v":""}]
[null,null,5,"     Derbyshire",8402,1461,59.7,0.68990926819099496]
[null,null,6,"     Leicester",4895,816,51.6,1.8712099748276401]
[null,null,7,"     Leicestershire",7437,1536,69.400000000000006,0.79306816093990895]
[null,null,8,"     Lincolnshire",7849,1605,74.7,0.70286781183379199]
[null,null,9,"     Northamptonshire",9500,1227,57,0.84032086873337497]
[null,null,10,"     Nottingham",3888,404,64,1.22834541911621]
[null,null,11,"     Nottinghamshire",9417,1413,66.900000000000006,0.60745096587439695]
[null,null,12,"     Rutland",371,210,81.900000000000006,0.73556859465391]
[null,null,13,"East of England",75327,15899,65.5,0.65644329754976505]
[null,null,14,"     Bedford ",2219,870,80.599999999999994,0.948406974203162]
[null,null,15,"     Cambridgeshire",7840,1308,67,0.54949727483834698]
[null,null,16,"     Central Bedfordshire",3464,1302,78.599999999999994,0.50038225029100203]
[null,null,17,"     Essex",17173,3710,61.4,0.48984180518756298]
[null,null,18,"     Hertfordshire",15539,4272,75.900000000000006,0.59541359118444803]
[null,null,19,"     Luton",3276,356,77.7,1.69483686776487]
[null,null,20,"     Norfolk",9620,1465,51.2,0.68793745049683597]
[null,null,21,"     Peterborough",2833,280,72.900000000000006,1.1426931436658401]
[null,null,22,"     Southend-on-Sea",2317,328,56.1,0.57252762035578397]
[null,null,23,"     Suffolk",8626,1731,53.1,0.66098437286949596]
[null,null,24,"     Thurrock",2420,277,73,0.59789429856888499]
[null,null,25,"London",115622,19490,61.1,1.0004807906797399]
[null,null,26,"     Barking and Dagenham",3842,302,42.1,1.2840920325734699]
[null,null,27,"     Barnet",5293,312,70,1.20652912635892]
[null,null,28,"     Bexley",3130,401,72.900000000000006,0.44314495659263398]
[null,null,29,"     Brent",4332,472,66.599999999999994,1.28224368338578]
[null,null,30,"     Bromley",4222,353,86.5,0.43468920380369303]
[null,null,31,"     Camden",2699,395,59.7,0.85291397665000801]
[null,null,32,"     Croydon",5586,410,65.400000000000006,0.85434438552195302]
[null,null,33,"     Ealing",4717,675,51.6,1.76814023518166]
[null,null,34,"     Enfield",4996,559,67,1.1512759306907601]
[null,null,35,"     Greenwich",4081,323,60.6,0.75751568570923999]
[null,null,36,"     Hackney (including City of London)",3532,1313,50.5,0.97443126540894498]
[null,null,37,"     Hammersmith and Fulham",2161,195,64.2,0.71067718418603698]
[null,null,38,"     Haringey",3396,645,68.8,1.18317552918156]
[null,null,39,"     Harrow",3264,413,64.3,1.3935245873167801]
[null,null,40,"     Havering",3044,260,49.4,0.66779969124705496]
[null,null,41,"     Hillingdon",4156,395,69.900000000000006,1.46155665334747]
[null,null,42,"     Hounslow",3785,900,68.599999999999994,1.0979229658177201]
[null,null,43,"     Islington",2274,582,57.5,0.86383456917900003]
[null,null,44,"     Kensington and Chelsea",1724,263,53.1,1.1132457959680799]
[null,null,45,"     Kingston upon Thames",2379,347,76,0.77948963876420796]
[null,null,46,"     Lambeth",3812,670,47.5,0.81989514543784003]
[null,null,47,"     Lewisham",4112,386,63.2,0.56367526714159499]
[null,null,48,"     Merton",2745,403,70.3,0.91964096540632101]
[null,null,49,"     Newham",4759,3156,63.7,1.24286918823084]
[null,null,50,"     Redbridge",4367,394,53.3,0.961652099161319]
[null,null,51,"     Richmond upon Thames",2845,389,69.3,0.47452742158031103]
[null,null,52,"     Southwark",3668,525,45.8,0.61846709211414297]
[null,null,53,"     Sutton",2699,708,69,0.56166417229971999]
[null,null,54,"     Tower Hamlets",3740,1672,59.9,1.26329113712495]
[null,null,55,"     Waltham Forest",3937,387,61.3,1.05740786236591]
[null,null,56,"     Wandsworth",3736,434,64.3,0.83517122348342199]
[null,null,57,"     Westminster",2546,851,65.400000000000006,1.17499174084457]
[null,null,58,"North East",29994,2796,58,0.95106022923734901]
[null,null,59,"     County Durham ",5657,235,67.3,1.0638087451794001]
[null,null,60,"     Darlington",1316,230,59.6,1.20601432583528]
[null,null,61,"     Gateshead",2450,175,61.3,0.652108995290967]
[null,null,62,"     Hartlepool",1157,233,51.8,0.39781134387875999]
[null,null,63,"     Middlesbrough",1783,265,50.9,1.66300185066831]
[null,null,64,"     Newcastle upon Tyne",3325,203,44.4,0.72602410648634896]
[null,null,65,"     North Tyneside",2373,236,68,0.53568103909067799]
[null,null,66,"     Northumberland",3271,290,65.900000000000006,0.73691225291607998]
[null,null,67,"     Redcar and Cleveland",1455,238,54.4,1.1096555680851501]
[null,null,68,"     South Tyneside",1685,205,58.7,0.702247542919884]
[null,null,69,"     Stockton-on-Tees",2479,255,55.6,0.94751604543984702]
[null,null,70,"     Sunderland",3043,231,67.599999999999994,1.51630922889139]
[null,null,71,"North West",86974,10126,65.099999999999994,1.28309755815098]
[null,null,72,"     Blackburn with Darwen",2227,254,70,2.4458405487083201]
[null,null,73,"     Blackpool",1648,179,60.3,1.82640325338371]
[null,null,74,"     Bolton",3780,261,68.7,1.6671554547745]
[null,null,75,"     Bury",2452,249,59.7,0.89555885787843403]
[null,null,76,"     Cheshire East",4220,273,72.900000000000006,0.77340933893948605]
[null,null,77,"     Cheshire West and Chester",3595,205,66.3,0.67403023913141002]
[null,null,78,"     Cumbria",5154,1785,72.099999999999994,1.1689554063462999]
[null,null,79,"     Halton",1639,212,59.4,0.92616727046257297]
[null,null,80,"     Knowsley",1790,318,45.4,1.22275600311389]
[null,null,81,"     Lancashire",14035,2666,77.900000000000006,1.17710131732773]
[null,null,82,"     Liverpool",5265,361,41.3,1.3577246287249001]
[null,null,83,"     Manchester",6926,307,62.1,1.3144691231588099]
[null,null,84,"     Oldham",3307,242,63.1,2.4624698748878702]
[null,null,85,"     Rochdale",2890,334,86.5,2.1272453180709601]
[null,null,86,"     Salford",3166,359,57.8,1.8383019289839699]
[null,null,87,"     Sefton",2919,337,53,0.632613306359879]
[null,null,88,"     St. Helens",2087,153,46.7,1.08988311005664]
[null,null,89,"     Stockport",3566,245,64.099999999999994,0.75212905026723698]
[null,null,90,"     Tameside",2810,440,64.2,1.1707129222885799]
[null,null,91,"     Trafford",3173,356,82.5,0.86308931390381904]
[null,null,92,"     Warrington",2588,135,47,0.85901320472417897]
[null,null,93,"     Wigan",3974,263,57.9,1.1242381191014399]
[null,null,94,"     Wirral",3763,192,57.1,1.1534275023834499]
[null,null,95,"South East",110508,17281,63,0.63230673200480103]
[null,null,96,"     Bracknell Forest",1740,264,63.5,0.76687824147386896]
[null,null,97,"     Brighton and Hove",2965,170,54.1,0.36516126147046701]
[null,null,98,"     Buckinghamshire",6926,1144,73.8,0.70515120198886405]
[null,null,99,"     East Sussex",5852,436,57.7,0.50500816188916198]
[null,null,100,"     Hampshire",15944,2316,51.2,0.45646514182162901]
[null,null,101,"     Isle of Wight",1315,490,75.400000000000006,0.82735149630216198]
[null,null,102,"     Kent",18657,3243,69.400000000000006,0.52744678058241001]
[null,null,103,"     Medway",3595,282,68.5,0.68104815444175704]
[null,null,104,"     Milton Keynes",4073,2274,61.1,0.64597200897000195]
[null,null,105,"     Oxfordshire",8080,1460,69.599999999999994,0.75481579653693498]
[null,null,106,"     Portsmouth",2663,859,78.3,0.57181192918405299]
[null,null,107,"     Reading",2293,295,67.099999999999994,0.94546315966808403]
[null,null,108,"     Slough",2522,301,65.5,1.77705272778435]
[null,null,109,"     Southampton",3015,1155,81.5,1.2572566325722001]
[null,null,110,"     Surrey (No data for Tandridge LA)",14919,1304,51.4,0.53796795097699501]
[null,null,111,"     West Berkshire",1978,241,63.2,0.733319238900634]
[null,null,112,"     West Sussex (No data for Adur LA)",9855,549,61,0.43023255698696999]
[null,null,113,"     Windsor and Maidenhead",1924,257,67.5,0.62627531411650506]
[null,null,114,"     Wokingham",2192,241,65.3,0.56142931625204795]
[null,null,115,"South West",61100,9135,72.5,0.66074131765818001]
[null,null,116,"     Bath and North East Somerset",1944,245,65.7,0.37068718000520501]
[null,null,117,"     Bournemouth",2106,257,81,0.94091386044859004]
[null,null,118,"     Bristol, City of",5574,277,59.9,1.12274430719208]
[null,null,119,"     Cornwall (including Isles of Scilly)",5797,764,70.7,0.69734279084567397]
[null,null,120,"     Devon",7856,2262,80,0.55978370234180996]
[null,null,121,"     Dorset",4161,639,76.3,0.63132773756517602]
[null,null,122,"     Gloucestershire",7019,1435,71.7,0.68538454711265395]
[null,null,123,"     North Somerset",2456,262,62.7,0.55401076151978801]
[null,null,124,"     Plymouth",2977,384,48.3,0.43591557275529003]
[null,null,125,"     Poole",1684,442,89.4,0.74629582448635001]
[null,null,126,"     Somerset",6065,1161,67.099999999999994,0.708515077303981]
[null,null,127,"     South Gloucestershire",3367,277,73.5,0.41062468495336402]
[null,null,128,"     Swindon",2831,247,67.8,0.78476428520300001]
[null,null,129,"     Torbay",1318,270,74.5,0.83371006640816203]
[null,null,130,"     Wiltshire",5945,213,66.900000000000006,0.43661434337871002]
[null,null,131,"West Midlands",72409,16272,62.5,0.72107633195667697]
[null,null,132,"     Birmingham",16671,451,53.9,0.82630371466333197]
[null,null,133,"     Coventry",4519,283,79.7,1.04042126015609]
[null,null,134,"     Dudley",3780,1667,59.1,0.46422668665350098]
[null,null,135,"     Herefordshire, County of",2014,295,79.099999999999994,1.42533415557072]
[null,null,136,"     Sandwell",4756,2568,62.4,0.67286348994538803]
[null,null,137,"     Shropshire",3176,194,54.4,0.80267564963723703]
[null,null,138,"     Solihull",2449,264,71.599999999999994,0.57023661432765504]
[null,null,139,"     Staffordshire",9575,1641,63.6,0.49826127323431202]
[null,null,140,"     Stoke-on-Trent",3223,297,69.900000000000006,1.2060693258652]
[null,null,141,"     Telford and Wrekin",2265,166,47.8,0.88175248655448901]
[null,null,142,"     Walsall",3792,1681,64.3,0.66965549502285104]
[null,null,143,"     Warwickshire",6445,1214,72.7,0.82312529722977701]
[null,null,144,"     Wolverhampton",3299,2089,64.400000000000006,1.0073709166277001]
[null,null,145,"     Worcestershire",6445,3462,59.5,0.64698142366273304]
[null,null,146,"Yorkshire and The Humber",66709,11557,57.4,1.01431382174288]
[null,null,147,"     Barnsley",2785,1652,60.4,1.0588654021584301]
[null,null,148,"     Bradford",8252,1069,48.4,1.50355786904666]
[null,null,149,"     Calderdale",2573,305,73.2,1.0849998270743699]
[null,null,150,"     Doncaster",4021,227,59.5,1.10871893223136]
[null,null,151,"     East Riding of Yorkshire",3474,207,72.400000000000006,0.60303705009741404]
[null,null,152,"     Kingston upon Hull, City of",3390,251,65.5,1.5501325671274899]
[null,null,153,"     Kirklees",5687,297,62.7,1.06870208738189]
[null,null,154,"     Leeds",9681,1225,51.6,1.1022611194779099]
[null,null,155,"     North East Lincolnshire",2000,997,56.8,1.06620138224482]
[null,null,156,"     North Lincolnshire",2127,888,49.5,0.52299529377240095]
[null,null,157,"     North Yorkshire",6405,1806,65.900000000000006,0.62504694140519801]
[null,null,158,"     Rotherham",3328,1795,58.9,1.0203141084774801]
[null,null,159,"     Sheffield",6820,402,68,1.1090171662428701]
[null,null,160,"     Wakefield",4027,201,29.1,1.6463995428662499]
[null,null,161,"     York",2139,235,57.5,0.53603250924905499]

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[null,null,null,null,null,"View information about this page",null,null,"View inputs for this page"]
[]
[]
[null,null,null,"Programme cost",null,"Year 1","Year 2","Year 3","Year 4","Year 5"]
[null,null,null,"Start-up cost",null,null,"-","-","-","-"]
[null,null,null,"Staff salaries"]
[null,null,null,"Staff training"]
[null,null,null,"Administration/office costs"]
[null,null,null,"Transport and travel"]
[null,null,null,"Consumables"]
[null,null,null,"Public consultation"]
[null,null,null,"Other"]
[null,null,null,"Other"]
[null,null,null,"Total cost*"]
[null,null,null,null,"*Please enter either the cost breakdown, or the total cost (i.e. it is not necessary to provide both, otherwise costs will be counted twice)"]
[null,null,null,null,"**If you wish to use the indicative costs provided below as a basis for estimating programme costs, multiple the cost per child by the number of children in your programme (entered in the Population sheet)."]
[]
[null,null,null,null,"Programme cost","Year 1","Year 2","Year 3","Year 4","Year 5"]
[null,null,null,null,"Operation cost per person",0.5,0.5,0.5,0.5,0.5]
[]
[null,null,null,null,"Indicative costs - Supervised tooth brushing "]
[]
[null,null,null,null,"Top line – cost per child\nThere has been shown to be some variation around the cost of delivering a supervised toothbrushing programme, with the annual cost per child expected to range between £17 and £35. \nThis variation is due to some programmes providing toothbrush and toothpaste packs for the children on a number of occasions to use at home in addition to the supervised toothbrushing.  The cost per child in the Childsmile programme is lower due to economies of scale due to the size of the programme. The annual cost per child of providing Childsmile is approximately £17 (2011, Anopa – inflated to 2016). Factors such as providing packs to take home, where packs are from, staffing costs (pay scale) and economies of scale will influence the overall cost."]
[null,null,null,null,"Recommendations\nNICE PH55 sets out the following recommendations for the implementation of a supervised toothbrushing programme: a designated lead is required at all establishments where they are run; access to advice from a dental professional if needed; and free toothbrush and fluoride toothpaste packs (one set to use on the premises and one set to take home). CBOH recommends that staff will require ongoing support in terms of training, cross infection control and consent issues. The programme requires teacher supervision which can be time-consuming; a potential alternative is using older peers or parent supervisors."]
[null,null,null,null,"Staffing and consumables within the school setting\nThe cost of an age-appropriate toothbrush, 100ml of toothpaste and an educational leaflet (purchasing a pack of 50 units via NHS Supply Chain) is currently between £27.20 and £33.60. This is equivalent to between 54p and 67p per pack."]
[null,null,null,null,"The cost of staffing such a scheme may depend on how it is structured and delivered. For example the designated lead may be a current member of staff, such as a teacher or teaching assistant working within core hours. If this is the case, it is likely that no additional staff costs will be incurred."]
[null,null,null,null,"Training\nIt is anticipated that the support and training required for people delivering the scheme (including the designated leads) will be the main cost incurred. This training may be provided by members of an existing community oral health team, or by an external supplier. There are a wide range of potential suppliers of local or online courses on oral health."]
[null,null,null,null,"Training may be needed for other frontline staff who work with groups at high risk of poor oral health. This is to ensure they can give advice on the importance of oral health and promote good practice. In one example provided in NICE Costing template for PH55, a 3.5 hour course for 20 delegates cost £15 per delegate. This included raising awareness of a range of oral health issues and equipping them to provide advice on good practice for oral health promotion."]
[null,null,null,null,"Example programmes\nOne local authority has developed a local supervised toothbrushing programme, targeting a number of special schools, day nurseries and playgroups (16 sites). Children are involved in the programme for the two years they attend nursery. Annual non-pay costs ranged from £9.12 per child in day nurseries (based on 355 children), £8.98 per child in playgroups (based on 60 children), and £12.59 per child (based on 75 children) in the special schools. The largest component of the non-pay costs were the toothbrushes, tooth paste, toiletry bags, gloves and parent packs. Project support was provided by a Band 5 worker (based on the midpoint of the Band 5 pay scale and includes 10% oncosts), allocating approximately 20% of their working hours to the implementation of this programme. The project worker trained staff at the nurseries (approximately two hours), with a further visit to support implementation. Audits were carried out twice per year to observe the supervised brushing. No toothbrush and toothpaste packs were provided for the children to take home. The overall annual cost per children was approximately £20."]
[null,null,null,null,"Another local authority has also implemented a supervised brushing programme for children in nursery schools. The total annual cost of providing this programme in 2014/2015 was £189,981, and the total number of children in that year was 4,417 (plus 812 in special schools) at 40 sites. This is equivalent to an annual cost per head of £36. This cost includes the initial and annual training for school staff, observation at each site twice a year for quality assurance, resources for the supervised toothbrushing at the schools and provision of toothbrush and toothpaste packs for the children to take home four times a year. The costs also include on-costs for the staff providing training."]
[null,null,null,null,"The cost of delivering the Childsmile programme on a national level in Scotland is also described in Anopa 2015. The largest cost component was staff salary, ranging from 49.1% to 90.4% of the total cost. Total annual costs ranged from £19,881 (under 600 children aged 3 to 4), to £399,650 (over 12,000 children aged 3 to 4). The mean cost per child was £17, and ranged from £4.76 (in one of the largest Health Boards) to £76.88 (in the smallest Health Board).  The organisation and delivery of the programme varied across the health boards, with some boards employing Band 2 (support) workers, and some boards employing senior oral health educators - this contributed to the large variation in cost per child."]
[]
[null,null,null,null,"Indicative costs - Fluoride varnish"]
[]
[null,null,null,null,"Top line – cost per child\nThe annual cost per child for providing a fluoride varnish programme is expected to be between £26 and £28."]
[null,null,null,null,"Recommendations\nNICE PH55 sets out a number of recommendations for the implementation of a fluoride varnish programme. Programmes should involve at least 2 applications of fluoride varnish per year, over a two year programme. This programme should also provide oral health improvement advice. This service could be provided by dental hygienists or specially trained dental nurses commissioned by the local authority. There may be a high cost due to need for clinical personnel. CBOH recommends that the use of skill mix may help to reduce costs (e.g. using dental nurses rather than dentists). The higher high cost of fluoride varnish community programmes are due to the use of clinical personnel. "]
[null,null,null,null,"Staffing and consumables\nThe entry level paygrade for a dental nurse in the NHS is Agenda for Change Band3. Senior dental nurses will be on Agenda for Change Band 5 or higher. NHS dental practices are independent businesses, which will set their pay rates for dental staff."]
[null,null,null,null,"The cost of the materials required for the application of fluoride varnish should be checked with the provider, but is expected to account for a relatively small proportion of the programme costs."]
[null,null,null,null,"Training\nTraining is needed for these staff to apply fluoride varnish in schools and provide oral health advice. The associated costs depend on the provider and can vary widely. One example provided in NICE Costing template for PH55, is that training in how to deliver fluoride varnish would cost £150 per delegate for a group of 15 delegates. The costs were primarily for the student workbooks, the venue and external speakers."]
[null,null,null,null,"Training may be needed for other frontline staff who work with groups at high risk of poor oral health. This is to ensure they can give advice on the importance of oral health and promote good practice. In one example provided in NICE Costing template for PH55, a 3.5 hour course for 20 delegates cost £15 per delegate. This included raising awareness of a range of oral health issues and equipping them to provide advice on good practice for oral health promotion."]
[null,null,null,null,"Example programmes\nOne local authority has implemented a fluoride varnish programme, treating 50 pupils in a session. The staff requirements are dental nurses applying the varnish, and a dentist. For each session, two nurses delivered varnish over three hours – with an hourly cost of £10 per nurse, this is approximately £60 per session for nurse time. It was estimated that, per year, the dentist cost per 200 pupils was £275. Materials required for the programme are fluoride varnish, and toothbrush and paste. The varnish cost is approximately £1.40 per head, per session, and provision of toothbrush and paste is £1.00 per head, per session. The annual administration cost was estimated to be £1.33 per head, and management fee is an additional 20% extra on the total running cost. The total cost of providing a fluoride varnish to 1,400 children in a year is approximately £38,000, with the cost per head per year being £27."]
[null,null,null,null,"Another local authority has also implemented a fluoride varnish programme for children aged between 2 and 4. The total annual cost of providing a fluoride varnish programme in 2014/2015 was £254,500, and the total number of applications in that year was 19,329. This is equivalent to £13.17 per application of fluoride varnish, or an annual cost per head of £26.34."]
[null,null,null,null,"The NICE Costing template for PH55 provides an example of the costs for one local authority delivering twice-yearly fluoride varnish to children aged between 3 and 10. The programme treated around 6,000 children in this age range a year. Fluoride, disposables and other clinical equipment accounted for around 8% of the total cost. The total programme cost was £169,000, and the costs per child were approximately £28 per child per year (see cost breakdown on NICE website)."]
[]
[null,null,null,null,"Indicative costs - Water fluoridation"]
[]
[null,null,null,null,"Top line – cost per child\nThe average annual cost per child of operating a water fluoridation programme is around 50p. This can vary with aspects of the water fluoridation scheme, such as the number of children served by individual fluoridation sites, and the costs can range from as low as 30p and as high as 80p per child per year."]
[null,null,null,null,"Recommendations\nThe Fluoridation toolkit published by Public Health England sets out the process for proposing and establishing a new fluoridation scheme."]
[null,null,null,null,"Overview\nWhere local authorities are looking to implement new schemes, there will also be a need to meet the costs for feasibility studies and public consultations. The capital and operating costs of an individual scheme will flow from fluoridation sites required. The size of population served by each of those sites will have a material effect on both capital and operating costs. At present, PHE meets the capital cost of schemes and recovers the operating costs from local authorities."]
[null,null,null,null,"Operating costs\nThe operating costs of an individual scheme will, as above, flow from the design of that scheme. Schemes where multiple fluoridation plants are needed in order to achieve a consistent level of fluoride will tend to be more expensive to operate than simpler designs where smaller numbers of plants serve larger populations, as less equipment and fewer staff are required."]
[null,null,null,null,"The operating costs for any given scheme may also vary from year to year dependent upon a number of factors, including the amount of (fluoridated) water supplied in that year, changes in unit cost of materials, particularly the fluoridation chemicals, and the operational status of the fluoridation plants, for example including time out of operation for maintenance."]
[null,null,null,null,"Example programme\nThe more people supplied with fluoridated water from a single fluoridation plant, the proportionally cheaper a scheme becomes. In April 2016, a Local Authority in the East of England reported an expected cost of 21p per person per year for a single plant serving around 140,000 people: (http://www.councillorsupport.bedford.gov.uk/documents/s32688/Item%205a%20Water%20Fluoridation%20Review%20-%20Committee%20report.pdf)"]
[]
[null,null,null,null,"Indicative costs - Provision of toothbrushes and paste by post"]
[]
[null,null,null,null,"Top line – cost per child\nThe cost per child per year of providing toothbrush and paste by post has been estimated as being between £8 (based on a delivery twice a year costing £4, scaled up to reflect deliveries 4 times a year) and £11 (based on deliveries 4 times a year)."]
[null,null,null,null,"Recommendations\nThe targeted provision of toothbrushes and paste is recommended by CBOH to be a good use of resources."]
[null,null,null,null,"Staffing and consumables\nThe cost of an age-appropriate toothbrush, 100ml of toothpaste and an educational leaflet (purchasing a pack of 50 units via NHS Supply Chain) is currently between £27.20 and £33.60. This is equivalent to between 54p and 67p per pack."]
[null,null,null,null,"There are a number of potential methods by which toothbrushes and paste can be delivered by post. The use of community distribution schemes such as Amazon or the milkman could also be explored. A parcel containing toothbrushing supplies for six months sent via second class post is currently £2.80 (2016). Other associated costs include the storage of the toothbrush packs."]
[null,null,null,null,"The staffing requirements for the implementation would be limited to the administration of the programme. It has been estimated that this would require one Band 2 worker for one day a week, per around 800 families. The NHS Agenda for Change provides staffing salaries for a range of health professionals. A Band 2 worker would have a salary midpoint of £16,372 in 2016/2017."]
[null,null,null,null,"Training\nMinimal training of staff is expected, given that there is no face-to-face contact with the children in the programme."]
[null,null,null,null,"Example programme\nA study by Davies 2003 established the costs (2003£) of providing toothpaste and toothbrushes to children four times a year, for four years. The overall total cost of delivering this programme over four years was £27.93 per child (£7 per year in 2003£, uplifted to £11 in 2016 costs). Labour costs were approximately £1.65 per child annually, and included the employment of a programme manager, an administrator and parcel packer. The annual cost of the product and its postal delivery was £4.40 per child (including four annual deliveries of four tubes of toothpaste and one toothbrush). The rental cost of the office and storage space was £2,500 per year."]
[null,null,null,null,"One local authority commissioned an agency to package and send out the toothbrush and toothpaste packs.  During 2014/15, packs of toothbrush, toothpaste and leaflet were sent out twice to approximately 9,500 children in the age cohorts: 3-9 months, 12-18 months and ages 3-10 years. The cost per child worked out at approx. £4. This included the cost of agency which stored the resources, sorted data of child names and addresses from database, packaging, labelling and posting of the packs. The cost also includes cost of toothbrushes and toothpaste which the local authority ordered, and the cost of a Band 7 worker who organised the leaflet content and on-costs."]
[]
[null,null,null,null,"Indicative costs - Provision of toothbrushes and paste by health visitor and post"]
[]
[null,null,null,null,"Top line – cost per child\nThere has been shown to be some variation around the cost of delivering a programme providing toothbrush and paste by health visitors, with the annual cost per child having been estimated as being between £2 and £7. The cost of providing toothbrush and paste by post is between £8 (based on deliveries twice a year costing £4, scaled up to reflect deliveries 4 times a year) and £11 (based on four deliveries). The overall cost per child for delivering toothbrush and paste via a combination of health visitors and post is therefore likely to be between £10 and £18 per child, per year."]
[null,null,null,null,"Recommendations\nThe targeted provision of toothbrushes and paste is recommended  by CBOH to be a good use of resources."]
[null,null,null,null,"Staffing and consumables\nHealth visitors usually start at Band 6 of the NHS Agenda for Change (AfC) Pay Rates. The NHS Agenda for Change provides staffing salaries for a range of health professionals many of health visitor delivered oral health interventions are commissioned through the healthy child programme and may therefore incur additional costs only for the resources for the oral health element. A dental nurse on Band 6 would have a salary midpoint of £30,357 in 2016/2017. Team managers and health visitor specialists can earn up to £41,373 on Band 7 of the NHS pay scale (2016/2017). This is not an additional cost to the programme, since health visitors are already part of the workforce."]
[null,null,null,null,"The cost of an age-appropriate toothbrush, 100ml of toothpaste and an educational leaflet (purchasing a pack of 50 units via NHS Supply Chain) is currently between £27.20 and £33.60. This is equivalent to between 54p and 67p per pack."]
[null,null,null,null,"There are a number of potential methods by which toothbrushes and paste can be delivered by post. The use of community distribution schemes such as Amazon or the milkman could also be explored. A parcel containing toothbrushing supplies for six months sent via second class post is currently £2.80 (2016)."]
[null,null,null,null,"The administration of the programme (including producing the packs) has been estimated to require one Band 2 worker for one day a week, per around 800 families. The NHS Agenda for Change provides staffing salaries for a range of health professionals. A Band 2 worker would have a salary midpoint of £16,372 in 2016/2017."]
[null,null,null,null,"Training\nIt is anticipated that the support and training required for health visitors delivering the scheme will be the main cost incurred. This training may be provided by members of an existing community oral health team, or by an external supplier. There are a wide range of potential suppliers of local or online courses on oral health."]
[null,null,null,null,"Training may be needed for other frontline staff who work with groups at high risk of poor oral health. This is to ensure they can give advice on the importance of oral health and promote good practice. In one example provided in NICE Costing template for PH55, a 3.5 hour course for 20 delegates cost £15 per delegate. This included raising awareness of a range of oral health issues and equipping them to provide advice on good practice for oral health promotion."]
[null,null,null,null,"Example programme\nA local authority has made some local adaptation to the Brushing for Life programme. Different packs are provided at different ages; these include a weaning pack that contains a free flow cup, toothpaste, brush and an educational leaflet, and a 12-24 month pack which includes toothbrush, paste and an information leaflet. Weaning packs are estimated at being £2.37 and the 12-24 month cost costs £1.29. These are distributed by health visitors. A Band 3 worker provided project support, and it was estimated that 10% of their working hours (approximately half a day a week) was allocated to the implementation of this programme. This is approximately equivalent to £1,997 a year in total (based on the salary mid-point of a Band 3 worker, plus 10% oncosts) The project worker managed the recording distribution of the packs to the health visitors which arrive at the children centres ready packed. The total annual cost of the programme for 11,079 children is therefore around £20,000 (£1.80 per child)."]
[null,null,null,null,"Another local authority has also implemented the Brushing for Life programme. The total annual cost of providing the programme in 2014/2015 was £51,780, and the total number of health visitor contacts in that year was 7,193. This is equivalent to an annual cost per child of £7.20."]
[]
[null,null,null,null,"Indicative costs - Multicomponent community promotion"]
[]
[null,null,null,null,"Top line\nAn indicative cost per child was unable to be estimated for this type of programme (although the user can still enter their own cost estimate if available). This is due to the fact that the nature of a multicomponent programme means that it often includes both universal (upstream) and targeted (downstream) programmes. A child may be included in more than one programme and there may be varied access to programmes across the population. "]
[null,null,null,null,"Multicomponent programmes will vary greatly across local authorities depending on which community interventions have been commissioned, as well as upstream actions such as local policy initiatives and healthy early year’s settings in the area. It is difficult to provide a total cost of all the separate components and the cost per child will vary depending on which of the programmes the child is included in."]
[null,null,null,null,"Recommendations\nLocal authorities may wish to implement a programme that encompasses a number of different approaches to improving the oral health of their population. Recommendations of the resources needed to run the programme will vary according to the elements that are to be included in the programme – please refer to each individual programme type included in this tool for further details."]
[null,null,null,null,"Staffing and consumables\nThe staffing and materials requirements of the programme would be determined by the combination of elements in the programme (i.e. provision of toothbrush and paste, education leaflets, etc). The NHS Agenda for Change provides staffing salaries for a range of health professionals. A dental nurse on Band 6 would have a salary midpoint of £30,357 in 2016/2017, and a Band 5 worker providing oral health promotion would have a salary midpoint of £24,801."]
[null,null,null,null,"Training \nIt is anticipated that the support and training required for those delivering the scheme will be the main cost incurred, and will depend on the elements of the programme being considered. This training may be provided by members of an existing community oral health team, or by an external supplier. There are a wide range of potential suppliers of local or online courses on oral health."]
[null,null,null,null,"Training may be needed for other frontline staff who work with groups at high risk of poor oral health. This is to ensure they can give advice on the importance of oral health and promote good practice. In one example provided in NICE Costing template for PH55, a 3.5 hour course for 20 delegates cost £15 per delegate. This included raising awareness of a range of oral health issues and equipping them to provide advice on good practice for oral health promotion."]
[null,null,null,null,"Example programme\nAn example programme has been introduced across a number of local authorities, involving promotion and educational resources designed to help adults and children improve their oral health. The four key themes are encouraging health eating and drinking, encouraging regular toothbrushing, encouraging the promotion of a healthy lifestyle, and visiting the dentist regularly. Sessions are provided at children centres. In the first year of programme implementation, each centre received 18 hours of NHS support, with this dropping to 12 hours in year 2 and 8 hours in year 3. Families access the children’s centres on a sessional basis, attending drop-in sessions that offer the support they need. "]
[null,null,null,null,"The total annual cost for running this programme was £21,852 in 2015/2016, based on 25 centres and 1,214 implementation hours. The number of children that access the centres will be variable – the number of children in the area under the age of 5 is approximately 25,000. As such, it is difficult to estimate a cost per child for the programme. There are supervised toothbrushing in some early years settings. Some of these settings are linked to a local dental practice with NHS England support to do this. Health visitors give out toothbrush and toothpaste packs, the frequency and timing of this varies between the local authorities. There is also cascade training through an e-learning resource for all early years settings staff. Oral health improvement is included in all children centre specifications."]

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[null,null,null,"Unit costs of treatment",null,null,null,null,"Expected future costs of a decayed tooth"]
[]
[null,null,null,"Secondary care"]
[null,null,null,"Cost of hospital tooth extraction",null,null,836,null,"Probability of treatment before teeth exfoliated naturally",null,null,0.16]
[null,null,null,"Primary care",null,null,null,null,"Probability that the treatment was extraction",null,null,0.74]
[null,null,null,"Cost of a UDA",null,null,25,null,"Probability that the treatment was a restoration",null,null,{"$f":"1-L19","v":0.26}]
[null,null,null,"Cost of tooth restoration",null,null,{"$f":"G20*2","v":50},null,"Expected cost of a decayed tooth",null,null,{"$f":"L18*(L19*G18 + L20*G21)","v":101.0624}]
[]
[null,null,null,"Dental disease resulting in school and work absence",null,null,null,null,"Extractions"]
[]
[null,null,null,"Proportion of children with decay missing school",null,null,0.26,null,"Proportion of extractions in secondary care",null,null,1]
[null,null,null,"School absence due to pain (days while waiting)",null,null,3.1]
[null,null,null,"School absence due to an extraction*",null,null,4,null,"Treatment patterns"]
[null,null,null,"School absence due to a filling",null,null,0.5,null,"Proportion of teeth with decay experience that are extracted (% mt of dmft)",null,null,0.10167299521115999]
[]
[null,null,null,"Proportion of carers who are employed",null,null,0.41,null,"Proportion of teeth with decay experience that are filled \n(the care index, or % ft of dmft)",null,null,0.120360292611407]
[null,null,null,"Average daily wage",null,null,{"$f":"467/5","v":93.4}]

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[null,null,null,"The results summarise the potential economic impact to local authorities and to the NHS by reducing levels of decay in the primary teeth. Included are the cost savings per child and for the population, and the return on investment of the selected programme.  The impact to the local economy includes the potential gained days at school and work through implementation of the programme. Benefits accrue in the analysis for the length of the effectiveness studies."]
[null,null,null,"Total cost savings are not often observed immediately, and so the time until the programme is estimated to break-even is also presented. Return on investment in this analysis incorporates elements of both the benefits to the NHS and to the local economy. Also presented on this page is the ratio of investment to cost savings, i.e. the potential cost savings per pound invested."]
[null,null,null,"However, the impact on the wider economy and on school readiness has been evaluated, with the number of days at school that have been gained due to avoided dental disease. No financial value has been assigned to the days gained at school, and it is likely that the economic benefit will be observed over a longer-term period. The number of days at work that have been gained by the carer as a result of improved school attendance has also been evaluated and translated to a potential gained cost."]
[null,null,null,{"$f":"Calcs!F130","v":"Please note that not all required inputs have been completed. Please enter information on dmft, programme size, programme costs to view results below."}]
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[null,null,null,"Gross cost savings in local economy","Per child","For population",null,"Child impact","Per child","For population"]
[null,null,null,"At five years",null,null,null,"At five years"]
[null,null,null,"Gained days at work (carer)",{"$f":"IF(Calcs!$G$125>0,\"\",Calcs!G107)","v":""},{"$f":"IF(Calcs!$G$125>0,\"\",Calcs!H107)","v":""},null,"Gained days at school",{"$f":"IF(Calcs!$G$125>0,\"\",Calcs!G106)","v":""},{"$f":"IF(Calcs!$G$125>0,\"\",Calcs!H106)","v":""}]
[null,null,null,"Savings due to days gained at work",{"$f":"IF(Calcs!$G$125>0,\"\",Calcs!C127)","v":""},{"$f":"IF(Calcs!$G$125>0,\"\",Calcs!D127)","v":""},null,"At ten years"]
[null,null,null,"At ten years",null,null,null,"Gained days at school",{"$f":"IF(Calcs!$G$125>0,\"\",Calcs!G110)","v":""},{"$f":"IF(Calcs!$G$125>0,\"\",Calcs!H110)","v":""}]
[null,null,null,"Gained days at work (carer)",{"$f":"IF(Calcs!$G$125>0,\"\",Calcs!G111)","v":""},{"$f":"IF(Calcs!$G$125>0,\"\",Calcs!H111)","v":""}]
[null,null,null,"Savings due to days gained at work",{"$f":"IF(Calcs!$G$125>0,\"\",Calcs!C129)","v":""},{"$f":"IF(Calcs!$G$125>0,\"\",Calcs!D129)","v":""}]
[]
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[null,null,null,"Gross cost savings to NHS","Per child","For population",null,"Return on investment"]
[null,null,null,"At five years",null,null,null,"At five years"]
[null,null,null,"Primary care",{"$f":"IF(Calcs!$G$125>0,\"\",Calcs!C106)","v":""},{"$f":"IF(Calcs!$G$125>0,\"\",Calcs!D106)","v":""},null,"Net ROI",null,{"$f":"IF(Calcs!$G$125>0,\"\",Calcs!C118)","v":""}]
[null,null,null,"Secondary care",{"$f":"IF(Calcs!$G$125>0,\"\",Calcs!C107)","v":""},{"$f":"IF(Calcs!$G$125>0,\"\",Calcs!D107)","v":""},null,"Ratio",null,{"$f":"IF(Calcs!$G$125>0,\"\",Calcs!C119)","v":""}]
[null,null,null,"Total",{"$f":"IF(Calcs!$G$125>0,\"\",Calcs!C108)","v":""},{"$f":"IF(Calcs!$G$125>0,\"\",Calcs!D108)","v":""},null,"At ten years"]
[null,null,null,"At ten years",null,null,null,"Net ROI",null,{"$f":"IF(Calcs!$G$125>0,\"\",Calcs!C121)","v":""}]
[null,null,null,"Primary care",{"$f":"IF(Calcs!$G$125>0,\"\",Calcs!C110)","v":""},{"$f":"IF(Calcs!$G$125>0,\"\",Calcs!D110)","v":""},null,"Ratio",null,{"$f":"IF(Calcs!$G$125>0,\"\",Calcs!C122)","v":""}]
[null,null,null,"Secondary care",{"$f":"IF(Calcs!$G$125>0,\"\",Calcs!C111)","v":""},{"$f":"IF(Calcs!$G$125>0,\"\",Calcs!D111)","v":""},null,"*includes cost to local economy and NHS"]
[null,null,null,"Total",{"$f":"IF(Calcs!$G$125>0,\"\",Calcs!C112)","v":""},{"$f":"IF(Calcs!$G$125>0,\"\",Calcs!D112)","v":""}]
[null,null,null,"*includes costs of restorations and extractions",null,null,null,"Break-even"]
[null,null,null,null,null,null,null,"Year in which programme breaks-even",null,{"$f":"IF(Calcs!$G$125>0,\"\", Calcs!AB69)","v":""}]
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[]
[]
[null,"Return on Investment of Oral Health Interventions"]
[]
[]
[]
[null,"The analysis focuses on programmes aimed at improving the oral health of young children and reducing the decay levels in 5 year olds. The programmes included in the tool are those that have the best available evidence of effectiveness in reducing tooth decay in pre-school children (CBOH)."]
[]
[]
[]
[null,"Programme:",null,{"$f":"Calcs!D2","v":"Supervised toothbrushing"}]
[]
[null,{"$f":"CHOOSE(Calcs!C2,Intervention!E25,Intervention!E29,Intervention!E33,Intervention!E37,Intervention!E41,Intervention!E47)","v":"Targeted supervised tooth brushing in schools or nurseries is recommended as an effective intervention by NICE PH55 and CBOH. This model has used the preventive fraction estimated from the Childsmile programme (Macpherson, 2013). This study was assessed as being of good quality by the NICE PH55 review (\"All or most of the NICE checklist criteria have been fulfilled; where they have not been fulfilled, the conclusions are very unlikely to alter\"). The mean dmft at 5 years of age before the programme was introduced was 3.06 (SD 3.76), and the mean dmft ten years after the programme was introduced was 2.07 (SD 3.16), resulting in a preventive fraction of 32%.\n\nThe Childsmile programme, which has been run throughout Scotland over the last decade, involves daily supervised tooth brushing in nurseries of 3 and 4 year old children and distribution by nurseries of fluoride toothpaste (at least 1000ppm) for use at home on 6 occasions. The Childsmile programme has also reported overall cost savings in Scotland (Anopa et al., 2015), with the largest reduction in estimated cost in the most deprived cohort of children.\n\nWhether this programme could have an impact on inequalities depends on a number of factors, including appropriate targeting of high-risk populations, as well as high rates of consent, compliance and retention. "}]
[]
[null,{"$f":"CHOOSE(Calcs!C2,Intervention!E26,Intervention!E30,Intervention!E34,Intervention!E38,Intervention!E42,Intervention!E48)","v":"Reference: Macpherson LM, Anopa Y, Conway DI et al. National supervised toothbrushing program and dental decay in Scotland.  J Dent Res.  2013;92(2):109-13. \nAvailable at: http://www.ncbi.nlm.nih.gov/pubmed/23264611"}]
[]
[]
[]
[null,"Your population"]
[]
[null,{"$f":"Population!D54","v":"Total number of children in programme (per cohort)"},null,null,null,null,null,{"$f":"Population!G54","v":0}]
[null,"Mean dmft of 5 year olds in your area",null,null,null,null,null,{"$f":"Calcs!E7","v":""}]
[]
[null,"Programme costs"]
[]
[null,"Programme length (years)",null,null,null,null,null,{"$f":"Calcs!C3","v":2}]
[null,{"$f":"IF(Calcs!C2=3,\"Cost per child\",\"Annual programme cost\")","v":"Annual programme cost"},null,null,null,null,null,{"$f":"IF(Calcs!C2=3,TEXT('Programme costs'!F29,\"£#0.#0\"),SUM('Programme costs'!F15:F24))","v":0}]
[]
[]
[]
[null,"Results"]
[]
[null,"The results summarise the potential economic impact to local authorities and to the NHS by reducing levels of decay in the primary teeth, including the total cost savings for the population, and the return on investment of the selected programme.  The impact to the local economy includes the potential gained days at work by the carer as a result of improved school attendance through implementation of the programme. "]
[]
[null,{"$f":"CONCATENATE(\"The return on investment of a \" & LOWER(Calcs!D2) & \" programme incorporates both the benefits to the NHS and to the local economy. The ratio of investment to cost savings indicates the potential cost savings per pound invested.\")","v":"The return on investment of a supervised toothbrushing programme incorporates both the benefits to the NHS and to the local economy. The ratio of investment to cost savings indicates the potential cost savings per pound invested."}]
[]
[null,{"$f":"CONCATENATE(\"In your population, these are the expected outcomes of the introduction of a \"&LOWER(Calcs!D2)&\" programme:\")","v":"In your population, these are the expected outcomes of the introduction of a supervised toothbrushing programme:"}]
[]
[null,null,null,null,null,"At five years",null,"At ten years"]
[null,{"$f":"'Results tables'!D17","v":"Gross cost savings in local economy"}]
[null,"Gained days at school",null,null,null,{"$f":"'Results tables'!J19","v":""},null,{"$f":"'Results tables'!J21","v":""}]
[null,{"$f":"'Results tables'!D19","v":"Gained days at work (carer)"},null,null,null,{"$f":"'Results tables'!F19","v":""},null,{"$f":"'Results tables'!F22","v":""}]
[null,{"$f":"'Results tables'!D20","v":"Savings due to days gained at work"},null,null,null,{"$f":"'Results tables'!F20","v":""},null,{"$f":"'Results tables'!F23","v":""}]
[]
[null,{"$f":"'Results tables'!D26","v":"Gross cost savings to NHS"}]
[null,"Due to averted dental treatment",null,null,null,{"$f":"'Results tables'!F30","v":""},null,{"$f":"'Results tables'!F34","v":""}]
[]
[null,{"$f":"'Results tables'!H26","v":"Return on investment"}]
[null,{"$f":"'Results tables'!H28","v":"Net ROI"},null,null,null,{"$f":"'Results tables'!J28","v":""},null,{"$f":"'Results tables'!J31","v":""}]
[null,"Savings per pound invested",null,null,null,{"$f":"'Results tables'!J29","v":""},null,{"$f":"'Results tables'!J32","v":""}]
[null,{"$f":"'Results tables'!H36","v":"Year in which programme breaks-even"},null,null,null,null,{"$f":"'Results tables'!J36","v":""}]

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[]
[null,"Programme",1,{"$f":"CHOOSE(C2,Intervention!D16,Intervention!D17,Intervention!D18,Intervention!D19,Intervention!D20,Intervention!D21)","v":"Supervised toothbrushing"},null,null,null,"dmft option",1]
[null,"Prog length",{"$f":"CHOOSE(C2,'Study data'!D6,'Study data'!D10,'Study data'!D14,'Study data'!D18,'Study data'!D22,'Study data'!D26)","v":2},null,null,null,null,"Option 3 dmft",{"$f":"IF(SUM(Population!G41:K41)=1,SUMPRODUCT(Population!G41:K41,Population!G42:K42),\"\")","v":""}]
[null,"Calc info for diagram",8,null,null,null,null,"Option 4 dmft",{"$f":"IF(SUM(Population!G47:K47)<1,\"\",SUMPRODUCT(Population!G47:K47,Population!G48:K48))","v":""}]
[null,null,null,"Quintile",1,2,3,4,5]
[null,null,null,"National weighting",26119,23792,21122,20487,19980]
[null,null,null,"Baseline dmft",{"$f":"CHOOSE(I2,'Population (2)'!J13,IF(ISBLANK(Population!$G$37),\"\",Population!$G$37),I3,I4)","v":""}]
[]
[]
[]
[null,"Cost outcomes - programme cost"]
[]
[null,"Year","Not discounted","Discounted","Cumulative",null,"Discounting"]
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[null,2,{"$f":"IF(B15>ROUNDUP($C$3,0),0,IF(C2=3,'Programme costs'!G29*Population!$G$54,SUM('Programme costs'!G16:G24)))","v":0},{"$f":"C15/((1+$G$14)^(B15-1))","v":0},{"$f":"IF(Calcs!$G$125>0,\"\",E14+D15)","v":""}]
[null,3,{"$f":"IF(B16>ROUNDUP($C$3,0),0,IF(C2=3,'Programme costs'!H29*Population!$G$54,SUM('Programme costs'!H16:H24)))","v":0},0,{"$f":"IF(Calcs!$G$125>0,\"\",E15+D16)","v":""}]
[null,4,{"$f":"IF(B17>ROUNDUP($C$3,0),0,IF(C2=3,'Programme costs'!I29*Population!$G$54,SUM('Programme costs'!I16:I24)))","v":0},0,{"$f":"IF(Calcs!$G$125>0,\"\",E16+D17)","v":""}]
[null,5,{"$f":"IF(B18>ROUNDUP($C$3,0),0,IF(C2=3,'Programme costs'!J29*Population!$G$54,SUM('Programme costs'!J16:J24)))","v":0},0,{"$f":"IF(Calcs!$G$125>0,\"\",E17+D18)","v":""}]
[null,6,{"$f":"IF(B19>ROUNDUP($C$3,0),0,IF(C2=3,'Programme costs'!K29*Population!$G$54,SUM('Programme costs'!K16:K24)))","v":0},0,{"$f":"IF(Calcs!$G$125>0,\"\",E18+D19)","v":""}]
[null,7,{"$f":"IF(B20>ROUNDUP($C$3,0),0,IF(C2=3,'Programme costs'!K29*Population!$G$54,SUM('Programme costs'!K16:K24)))","v":0},0,{"$f":"IF(Calcs!$G$125>0,\"\",E19+D20)","v":""}]
[null,8,{"$f":"IF(B21>ROUNDUP($C$3,0),0,IF(C2=3,'Programme costs'!K29*Population!$G$54,SUM('Programme costs'!K16:K24)))","v":0},0,{"$f":"IF(Calcs!$G$125>0,\"\",E20+D21)","v":""}]
[null,9,{"$f":"IF(B22>ROUNDUP($C$3,0),0,IF(C2=3,'Programme costs'!K29*Population!$G$54,SUM('Programme costs'!K16:K24)))","v":0},0,{"$f":"IF(Calcs!$G$125>0,\"\",E21+D22)","v":""}]
[null,10,{"$f":"IF(B23>ROUNDUP($C$3,0),0,IF(C2=3,'Programme costs'!K29*Population!$G$54,SUM('Programme costs'!K16:K24)))","v":0},0,{"$f":"IF(Calcs!$G$125>0,\"\",E22+D23)","v":""}]
[]
[null,null,"At year 5:",{"$f":"SUM(D14:D18)","v":0}]
[null,null,"At year 10:",{"$f":"SUM(D14:D23)","v":0}]
[]
[]
[null,"Cost outcomes - treatment costs"]
[null,null,null,null,null,null,null,"Treatment averted - summary for programmes"]
[null,null,null,null,"Follow-up end (age 5)",null,"Difference","Fillings during programme","Extractions during programme","Time horizon for treatment","Untreated decay"]
[null,"Baby teeth only",null,"PF","Control","Programme","(Extra dmft)"]
[null,{"$f":"Intervention!D16","v":"Supervised toothbrushing"},null,{"$f":"'Study data'!H5","v":0.32352941176470595},{"$f":"$E$7","v":""},{"$f":"E33*(1-D33)","v":{"$error":"#VALUE!"}},{"$f":"E33-F33","v":{"$error":"#VALUE!"}},{"$f":"G33*Resources!$L$30","v":{"$error":"#VALUE!"}},{"$f":"G33*Resources!$L$28","v":{"$error":"#VALUE!"}},{"$f":"5-'Study data'!E6","v":2},{"$f":"G33-H33-I33","v":{"$error":"#VALUE!"}}]
[null,{"$f":"Intervention!D17","v":"Fluoride varnish"},null,{"$f":"'Study data'!I9","v":0.37},"",{"$error":"#VALUE!"},{"$error":"#VALUE!"},{"$f":"G34*Resources!$L$30","v":{"$error":"#VALUE!"}},{"$f":"G34*Resources!$L$28","v":{"$error":"#VALUE!"}},{"$f":"5-'Study data'!E10","v":2},{"$error":"#VALUE!"}]
[null,{"$f":"Intervention!D18","v":"Water fluoridation"},null,{"$f":"'Study data'!J13","v":0.35},"",{"$f":"E35*(1-D35)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"G35*Resources!$L$30","v":{"$error":"#VALUE!"}},{"$f":"G35*Resources!$L$28","v":{"$error":"#VALUE!"}},{"$f":"5-'Study data'!E14","v":5},{"$error":"#VALUE!"}]
[null,{"$f":"Intervention!D19","v":"Provision of toothbrushes and paste by post"},null,{"$f":"'Study data'!J17","v":0.16},"",{"$error":"#VALUE!"},{"$error":"#VALUE!"},{"$f":"G36*Resources!$L$30","v":{"$error":"#VALUE!"}},{"$f":"G36*Resources!$L$28","v":{"$error":"#VALUE!"}},{"$f":"5-'Study data'!E18","v":4},{"$error":"#VALUE!"}]
[null,{"$f":"Intervention!D20","v":"Provision of toothbrushes and paste by health visitors and post"},null,{"$f":"'Study data'!J21","v":0.40053763440860224},"",{"$error":"#VALUE!"},{"$error":"#VALUE!"},{"$f":"G37*Resources!$L$30","v":{"$error":"#VALUE!"}},{"$f":"G37*Resources!$L$28","v":{"$error":"#VALUE!"}},{"$f":"5-'Study data'!E22","v":4},{"$error":"#VALUE!"}]
[null,{"$f":"Intervention!D21","v":"Multi-component community promotion"},null,{"$f":"1-'Study data'!J25","v":0.33999999999999997},"",{"$error":"#VALUE!"},{"$error":"#VALUE!"},{"$f":"G38*Resources!$L$30","v":{"$error":"#VALUE!"}},{"$f":"G38*Resources!$L$28","v":{"$error":"#VALUE!"}},{"$f":"5-'Study data'!E26","v":5},{"$error":"#VALUE!"}]
[]
[null,null,"Selected",{"$f":"CHOOSE($C$2,D33,D34,D35,D36,D37,D38)","v":0.32352941176470595},{"$f":"CHOOSE($C$2,E33,E34,E35,E36,E37,E38)","v":""},{"$error":"#VALUE!"},"Selected",{"$f":"CHOOSE($C$2,H33,H34,H35,H36,H37,H38)","v":{"$error":"#VALUE!"}},{"$f":"CHOOSE($C$2,I33,I34,I35,I36,I37,I38)","v":{"$error":"#VALUE!"}}]
[null,null,null,null,null,null,"Cost",{"$f":"H40*Resources!G21","v":{"$error":"#VALUE!"}},{"$f":"I40*(Resources!G18*Resources!L25 + Resources!G21*(1-Resources!L25))","v":{"$error":"#VALUE!"}}]
[]
[]
[null,"For selected programme - fillings and extractions over programme time period"]
[null,null,null,null,null,null,null,null,null,null,"Per cycle, per average child",null,"Cumulative, for population",null,"Post-programme treatment for decay",null,null,null,"Cumulative, for population",null,"Per child",null,"Cumulative, for population"]
[null,"Time point (yr)","Age","In prog?","dmft (Control)","dmft (Programme)","Difference (Extra dmft)","Avoided fillings during programme (per 6 months)","Avoided extractions during programme (per 6 months)","Untreated decay (cumulative number of teeth)","Cost of fillings (per 6 months)","Cost of extractions  (per 6 months)","Fillings cost","Extractions cost","Number of fillings","Number of extractions","Fillings cost","Extractions cost","Fillings cost","Extractions cost","Days gained at school",null,"Total (all savings)","Primary care","Secondary care","Days at work","Programme cost","Break even?"]
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[null,"Untreated decay - expected treatment before exfoliation",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(AB67=\"N\",AB68,CHOOSE(AB68+1,\"First year\", \"Second year\", \"Third year\", \"Fourth year\", \"Fifth year\", \"Sixth year\", \"Seventh year\", \"Eighth year\", \"Ninth year\", \"Tenth year\"))","v":"Never breaks even"}]
[]
[null,"Untreated decayed teeth (end of programme)",null,null,{"$f":"CHOOSE($C$2,K33,K34,K35,K36,K37,K38)","v":{"$error":"#VALUE!"}},null,null,{"$f":"E48-E47","v":{"$error":"#VALUE!"}},{"$f":"F48-F47","v":{"$error":"#VALUE!"}}]
[null,"Treated before natural exfoliation",null,null,{"$f":"E71*Resources!L18","v":{"$error":"#VALUE!"}},null,null,{"$f":"E49-E48","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"}]
[null,"Programme length",null,null,{"$f":"CHOOSE($C$2,J33,J34,J35,J36,J37,J38)","v":2},null,null,{"$error":"#VALUE!"},{"$error":"#VALUE!"}]
[null,null,null,null,null,null,null,{"$error":"#VALUE!"},{"$error":"#VALUE!"}]
[null,null,null,null,"Fillings","Extractions",null,{"$error":"#N/A"},{"$error":"#N/A"}]
[null,"Total procedures before teeth exfoliated",null,null,{"$f":"E72*Resources!L20","v":{"$error":"#VALUE!"}},{"$f":"E72*Resources!L19","v":{"$error":"#VALUE!"}},null,{"$error":"#N/A"},{"$error":"#N/A"}]
[null,"Within 5 years of programme start",null,{"$f":"(5-E73)/5","v":0.6},{"$f":"SUM(Q47:Q57)","v":{"$error":"#VALUE!"}},{"$f":"SUM(R47:R57)","v":{"$error":"#VALUE!"}},null,{"$error":"#N/A"},{"$error":"#N/A"}]
[null,"Within 10 years of programme start",null,{"$f":"1-D77","v":0.4},{"$f":"SUM(Q58:Q67)","v":{"$error":"#VALUE!"}},{"$f":"SUM(R58:R67)","v":{"$error":"#VALUE!"}},null,{"$error":"#N/A"},{"$error":"#N/A"}]
[null,null,null,null,null,null,null,{"$f":"E56-E55","v":{"$error":"#N/A"}},{"$f":"F56-F55","v":{"$error":"#N/A"}}]
[null,null,null,null,null,null,null,{"$f":"E57-E56","v":{"$error":"#N/A"}},{"$error":"#N/A"}]
[]
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[]
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[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[null,"Results"]
[]
[]
[null,"Cost savings",null,null,null,"Patient impact"]
[null,null,"Per child","For population",null,null,"Per child","For population"]
[null,"At five years",null,null,null,"At five years"]
[null,"Primary care",{"$f":"Calcs!E77+SUM(K47:K67)","v":{"$error":"#VALUE!"}},{"$f":"C106*Population!$G$54","v":{"$error":"#VALUE!"}},null,"Gained days at school",{"$f":"(Calcs!H40+Calcs!E76*Calcs!D77)*Resources!$G$28 + (Calcs!I40+Calcs!F76*Calcs!D77)*Resources!$G$27 + (Calcs!I40+Calcs!F76*Calcs!D77)*Resources!$G$25*Resources!$G$26","v":{"$error":"#VALUE!"}},{"$f":"G106*Population!$G$54","v":{"$error":"#VALUE!"}}]
[null,"Secondary care",{"$f":"SUM(L47:L67)+Calcs!F77","v":{"$error":"#VALUE!"}},{"$f":"C107*Population!$G$54","v":{"$error":"#VALUE!"}},null,"Gained days at work",{"$f":"G106*Resources!G30","v":{"$error":"#VALUE!"}},{"$f":"G107*Population!$G$54","v":{"$error":"#VALUE!"}}]
[null,"Total",{"$f":"C106+C107","v":{"$error":"#VALUE!"}},{"$f":"D106+D107","v":{"$error":"#VALUE!"}},null,"Total",{"$f":"G106+G107","v":{"$error":"#VALUE!"}},{"$f":"H106+H107","v":{"$error":"#VALUE!"}}]
[null,"At ten years",null,null,null,"At ten years"]
[null,"Primary care",{"$f":"Calcs!E78+C106","v":{"$error":"#VALUE!"}},{"$f":"C110*Population!$G$54","v":{"$error":"#VALUE!"}},null,"Gained days at school",{"$f":"G106+Calcs!E76*Calcs!D78*Resources!G28 + Calcs!F76*Calcs!D78*(Resources!G27 + Resources!G25*Resources!G26)","v":{"$error":"#VALUE!"}},{"$f":"G110*Population!$G$54","v":{"$error":"#VALUE!"}}]
[null,"Secondary care",{"$f":"Calcs!F78+C107","v":{"$error":"#VALUE!"}},{"$f":"C111*Population!$G$54","v":{"$error":"#VALUE!"}},null,"Gained days at work",{"$f":"G110*Resources!G30","v":{"$error":"#VALUE!"}},{"$f":"G111*Population!$G$54","v":{"$error":"#VALUE!"}}]
[null,"Total",{"$f":"C110+C111","v":{"$error":"#VALUE!"}},{"$f":"D110+D111","v":{"$error":"#VALUE!"}},null,"Total",{"$f":"G110+G111","v":{"$error":"#VALUE!"}},{"$f":"H110+H111","v":{"$error":"#VALUE!"}}]
[null,null,null,{"$f":"D106/D108","v":{"$error":"#VALUE!"}}]
[]
[null,"Return on investment"]
[null,null,null,null,null,"For graph"]
[null,"At five years"]
[null,"ROI",{"$f":" (D108+D127) - Calcs!D25","v":{"$error":"#VALUE!"}},null,null,"Years","At school","At work"]
[null,"Ratio",{"$f":"CONCATENATE(\"£1: £\"&TEXT(D119,\"#,##0.00\"))","v":{"$error":"#VALUE!"}},{"$f":"(D108+D127)/Calcs!D25","v":{"$error":"#VALUE!"}},null,0,0,0]
[null,"At ten years",null,null,null,5,{"$f":"IF(Calcs!$G$125>0,\"\",H106)","v":""},{"$f":"IF(Calcs!$G$125>0,\"\",H107)","v":""}]
[null,"ROI",{"$f":" (D112+D129) - Calcs!D26","v":{"$error":"#VALUE!"}},null,null,10,{"$f":"IF(Calcs!$G$125>0,\"\",H110)","v":""},{"$f":"IF(Calcs!$G$125>0,\"\",H111)","v":""}]
[null,"Ratio",{"$f":"CONCATENATE(\"£1: £\"&TEXT(D122,\"#,##0.00\"))","v":{"$error":"#VALUE!"}},{"$f":"(D112+D129)/Calcs!D26","v":{"$error":"#VALUE!"}}]
[]
[]
[null,"Local economy","Per child","For population",null,"Display?",{"$f":"SUM(G126:G128)","v":3},"(display results if 0)"]
[null,"At five years",null,null,null,"dmft",{"$f":"IF(E7=\"\",1,0)","v":1}]
[null,"Due to days gained at work",{"$f":"G107*Resources!$G$31","v":{"$error":"#VALUE!"}},{"$f":"Z57","v":{"$error":"#VALUE!"}},null,"programme size",{"$f":"IF(Population!G54=\"\",1,0)","v":1}]
[null,"At ten years",null,null,null,"programme costs",{"$f":"IF(SUM(C14:C23)=0,1,0)","v":1}]
[null,"Due to days gained at work",{"$f":"G111*Resources!$G$31","v":{"$error":"#VALUE!"}},{"$f":"Z67","v":{"$error":"#VALUE!"}}]
[null,null,null,null,null,{"$f":"IF(G125=0,\"\",CONCATENATE(\"Please note that not all required inputs have been completed. Please enter information on \"&IF(G126=1,F126,\"\")&IF(G127=1,IF(G126=1,CONCATENATE(\", \"&F127),F127),\"\")&IF(G128=1,IF(SUM(G126:G127)>0,CONCATENATE(\", \"&F128),F128),\"\")&\" to view results below.\"))","v":"Please note that not all required inputs have been completed. Please enter information on dmft, programme size, programme costs to view results below."}]
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[null,"Selected page (input or info)"]
[]
[null,"Intervention","Population","Prog cost","Resources"]
[null,1,1,1,1]

{"sheet":"Study data","index":58,"n_rows":44,"n_cols":15,"rows_kept":44,"cut":false,"hidden":false,"merged":[]}
[null,"Note: This sheet will be hidden from the user in the final version"]
[]
[null,"Supervised toothbrushing"]
[null,"Targeted supervised tooth brushing in schools or nurseries is recommended as an effective intervention by NICE PH55 and CBOH. This model has used the preventive fraction reported by the Childsmile programme.\n\nThe Childsmile programme, which has been run throughout Scotland over the last decade, involves daily supervised tooth brushing in nurseries of 3 and 4 year old children and distribution by nurseries of fluoride toothpaste (at least 1000ppm) for use at home on 6 occasions. The Childsmile programme has also reported overall cost savings in Scotland (Anopa et al., 2015), with the largest reduction in estimated cost in the most deprived cohort of children.\n\nWhether this programme could have an impact on inequalities depends on a number of factors, including appropriate targeting of high-risk populations, as well as high rates of consent, compliance and retention.\n","Source study","Programme length","Age at start of programme","Post-programme dmft (5 year olds)","Pre-programme dmft (5 year olds)","Preventive fraction (derived from study data)",null,null,null,"Time point for PF (after programme start)","Age for PF",null,"Recommendations\nNICE PH55 sets out the following recommendations for the implementation of a supervised toothbrushing programme: a designated lead is required at all establishments where they are run; access to advice from a dental professional if needed; and free toothbrush and fluoride toothpaste packs (one set to use on the premises and one set to take home). Commissioning Better Oral Health recommends that staff will require ongoing support in terms of training, cross infection control and consent issues. The programme requires teacher supervision which can be time-consuming; a potential alternative is using older peers or parent supervisors.\n\nStaffing and consumables\nThe cost of an age-appropriate toothbrush, 100ml of toothpaste and an educational leaflet (purchasing a pack of 50 units via NHS Supply Chain) is currently between £27.20 and £33.60.\n\nThe cost of staffing such a scheme may depend on how it is structured and delivered. For example the designated lead may be a current member of staff, such as a teacher or teaching assistant working within core hours. If this is the case, it is likely that no additional staff costs will be incurred.\n\nTraining\nIt is anticipated that the support and training required for people delivering the scheme (including the designated leads) will be the main cost incurred. This training may be provided by members of an existing community oral health team, or by an external supplier. There are a wide range of potential suppliers of local or online courses on oral health.\n\nTraining may be needed for other frontline staff who work with groups at high risk of poor oral health. This is to ensure they can give advice on the importance of oral health and promote good practice. In one example provided in NICE Costing template for PH55, a 3.5 hour course for 20 delegates cost £15 per delegate. This included raising awareness of a range of oral health issues and equipping them to provide advice on good practice.\n\nExample programme\nStoke on Trent has developed a local supervised toothbrushing programme, targeting a number of special schools and playgroups (16 sites). Children are involved in the programme for the two years they attend nursery. Annual non-pay costs ranged from £9.12 per child in day nurseries (based on 355 children), and £12.59 per child (based on 75 children) in the special schools. The largest component of the non-pay costs were the toothbrushes, tooth paste, toiletry bags, gloves and parent packs. Project support was provided by a Band 5 worker, allocating approximately 10% of their working hours to the implementation of this programme. The project worker trained staff at the nurseries (approximately two hours), with a further visit to support implementation. Audits were carried out twice a year to observe the supervised brushing.\n\nThe cost of delivering the Childsmile programme on a national level in Scotland is also described in Anopa 2015. The largest cost component was staff salary, ranging from 49.1% to 90.4% of the total cost. Total annual costs ranged from £19,881 (under 600 children aged 3 to 4), to £399,650 (over 12,000 children aged 3 to 4).\n"]
[null,"Reference: Macpherson LM, Anopa Y, Conway DI et al. National supervised toothbrushing program and dental decay in Scotland.  J Dent Res.  2013;92(2):109-13.","Macpherson (2013)","2 years (at nursery)","3-4 years (nursery-aged children)",2.0699999999999998,3.06,{"$f":"1-F5/G5","v":0.32352941176470595},null,null,null,2,5]
[null,null,null,2,3]
[null,"Fluoride varnish"]
[null,"Targeted community fluoride varnish programmes are recommended by NICE PH55 and CBOH. Programmes centred on the applications of fluoride varnish in targeted community settings have strong evidence of effectiveness in preventing tooth decay. The model has used the preventive fraction based on the most recent systematic review (Marinho et al., 2013). This review updated the evidence from the first systematic review in 2002.\n\nThe systematic review and meta-analysis included evidence from ten clinical trials combined to estimate the overall impact of fluoride varnish. The majority of trials included were of two year duration, had a biannual application frequency, and were in both community and dental settings. Some of the studies were carried out in populations which may not be representative of the UK population and there was considerable variation in outcomes across the studies. The review suggests a substantial caries inhibiting effect of fluoride varnish in both permanent and primary teeth, however the quality of the evidence was assessed as moderate.\n\nEffectiveness and whether this programme could have an impact on inequalities depends on a number of factors, including appropriate targeting of high-risk populations, providing oral health improvement advice within the programme, as well as high rates of consent, compliance and retention over a two year period.","Source study","Programme length","Age at start of programme","Mean increment in intervention group","Mean increment in control group","Risk ratio for developing one or more new caries","Preventive fraction (reported in study)",null,null,"Time point for PF (after programme start)","Age for PF",null,"Recommendations\nNICE PH55 sets out a number of recommendations for the implementation of a fluoride varnish programme. Programmes should involve at least 2 applications of fluoride varnish per year, over a two year programme. This service could be provided by dental hygienists or specially trained dental nurses commissioned by the local authority. There may be a high cost due to need for clinical personnel. Commissioning Better Oral Health recommends that the use of skill mix may help to reduce costs (e.g. using dental nurses rather than dentists).\n\nStaffing and consumables\nA dental nurse on band 6 would have a salary midpoint of £30,357 (NHS Agenda for Change, 2016/17). Additional overheads, including management, facilities and transport costs should be assessed locally.\n\nThe cost of the materials required for fluoride varnishing should be checked with the provider, but is expected to account for a relatively small proportion of the programme costs.\n\nTraining\nTraining is needed for these staff to perform fluoride varnishing in schools. The associated costs depend on the provider and can vary widely. One example provided in NICE Costing template for PH55, is that training in how to deliver fluoride varnishing would cost £150 per delegate for a group of 15 delegates. The costs were primarily for the student workbooks, the venue and external speakers. \n\nTraining may be needed for other frontline staff who work with groups at high risk of poor oral health. This is to ensure they can give advice on the importance of oral health and promote good practice. In one example provided in NICE Costing template for PH55, a 3.5 hour course for 20 delegates cost £15 per delegate. This included raising awareness of a range of oral health issues and equipping them to provide advice on good practice.\n\nExample programme\nTees Valley has implemented a fluoride varnish programme, treating 50 pupils in a session. The staff requirements are dental nurses applying the varnish, and a dentist. For each session, two nurses delivered varnish over three hours – with an hourly cost of £10 per nurse, this is approximately £60 per session for nurse time. It was estimated that per year, the dentist cost per 200 pupils was £275. Materials required for the programme are fluoride varnish, and toothbrush and paste. The varnish cost is approximately £1.40 per head, per session, and provision of toothbrush and paste is £1.00 per head, per session. The annual administration cost was estimated to be £1.33 per head, and management fee is an additional 20% extra on the total running cost.\n\nThe NICE Costing template for PH55 provides an example of the costs for one local authority delivering twice-yearly fluoride varnish to children aged between 3 and 10. The programme treated around 6,000 children in this age range a year. Fluoride, disposables and other clinical equipment accounted for around 8% of the total cost. The total programme cost was £169,000, and the costs per child were approximately £28 per child per year (see cost breakdown on NICE website)."]
[null,"Reference: Marinho VCC, Worthing HV, Walsh T, Clarkson JE. Fluoride varnishes for preventing dental caries in children and adolescents. Cochrane Database of Systematic Reviews 2013, Issue 7. Art. No,: CD002279.","Marinho (2013)","Majority trials were of 2 years","N/A",1.04,1.65,0.81,0.37,null,null,2,5]
[null,null,null,2,3]
[null,"Water fluoridation"]
[null,"Community water fluoridation schemes are recommended by CBOH (PHE2014) and were not within the remit of the NICE PH55 review. The model has used the preventive fraction from the most recent systematic review of the effectiveness of water fluoridation (Cochrane 2015).\n\nThe systematic review and meta-analysis was undertaken by Cochrane. Insufficient evidence was found to determine whether fluoridation reduces differences in decay levels between deprived and affluent areas, though the review excluded more recent cross-sectional studies. There are a number of limitations with using the pooled analysis, namely that there was substantial variation across the studies, and the use of other sources of fluoride, including topical agents, was not taken into account. \n\nMany of the studies used to inform the Cochrane review were relatively old: of the 19 studies in the review, 70% were undertaken before 1975 with the most recent published in 1997. There were some concerns about the applicability of the findings. However, a recently-conducted study of the impact of water fluoridation in England (Health Monitoring Report for England 2014, PHE) supports the outcome of the Cochrane review, where a preventive fraction of 0.37 (95% CI 0.27 to 0.48) was estimated for 5 year olds.\n\nGiven that the approach targets geographic areas rather than specific population groups, it may be more difficult to target these kinds of programmes to benefit only children at high risk of disease, but the universal nature of the programme means that compliance is not an issue, as is the case with other kinds of programmes.","Source study","Programme length","Age at start of programme","Mean difference in dmft","Mean difference in DMFT","Mean difference in % caries free primary teeth","Mean difference in % caries free permanent teeth","Preventive fraction in primary teeth (reported in study)",null,"Time point for PF (after programme start)","Age for PF",null,"Recommendations\nThe Fluoridation toolkit published by Public Health England sets out the process for proposing and establishing a new fluoridation scheme.\n\nOverview\nThe capital and operating costs of an individual scheme will flow from the design of that scheme to reflect local water supply arrangements. In particular the number of dosing sites required, and the size of population served by each of those sites, will have a material effect on capital and operating costs. At present, PHE meets the capital cost of schemes and recovers the operating costs from local authorities. Local authorities also pay for the cost of feasibility studies.\n\nOperating costs\nThe operating costs may also vary from year to year dependent upon a number of factors, including the amount of (fluoridated) water supplied in that year, changes in unit cost of materials, particularly the fluoridation chemicals, and the operational status of the fluoridation plants, including times out of operation or ongoing maintenance costs.\n\nThe operating costs of an individual scheme will flow from the design of that scheme to reflect local water supply arrangements. In particular the number of dosing sites required, and the size of population served by each of those sites, will have a material effect on operating costs.\n\nExample programme\nThe more people supplied with fluoridated water from a single water source, the proportionally cheaper the scheme becomes. The largest scheme in England supplies fluoridated water to approximately 1,175,000 people in Birmingham. In 2007/08, the running costs were estimated as being £183,000, or 16p per head. In a consultation conducted in 2008 by South Central SHA, the annual running costs for providing fluoridated water to 195,000 people in Southampton would be £59,000 a year, or 30p per head (One in a Million)."]
[null,"Reference: Iheozor-Ejiofor Z, Worthington HV, Walsh T, et al. Water fluoridation for the prevention of dental caries. Cochrane Database of Systematic Reviews 2015, Issue 6."," Iheozor-Ejiofor (2015)","5 years","Mixed population",1.81,1.1599999999999999,0.15,0.14000000000000001,0.35,null,5,5]
[null,null,null,5,0]
[null,{"$f":"Intervention!E19","v":0}]
[null,"Provision of toothbrushes and paste by post is recommended by NICE PH55 and CBOH (PHE, 2014). The model has used the preventive fraction from Davies et al 2002.\n\nDavies et al., 2002 assessed the impact on the level of caries in the deciduous dentition at 5-6 years of age by regularly supplying free fluoride toothpaste (1450ppm) to children via post. Children were initially aged 12 months, and living in deprived areas of the north west of England. Toothpaste containing 1450 ppmF and dental health literature was posted at three monthly intervals and a toothbrush annually to children until they were aged 5-6 years. The cost-effectiveness of the programme has also been established, with an estimated cost per child saved from caries experience as £424.38 (Davies et al., 2003). \n\nTo increase effectiveness programmes should consider targeting to those with highest levels of disease, length of programme, frequency of postal drops, the use of 1450ppm fluoride toothpaste, age of commencement and provision of oral health advice information. There are a number of methods by which families can be supplied with toothbrush and paste, however postal delivery is thought to be likely to minimise uptake issues, making the impact on inequalities more favourable.","Source study","Programme length","Age at start of programme","dmft at age 5 (programme)","dmft at age 5 (control)","Caries free (% change) - Programme","Caries free (% change) - Control","Preventive fraction (reported in study)",null,"Time point for PF (after programme start)","Age for PF",null,"Recommendations\nThe targeted provision of toothbrushes and paste is considered by Commissioning Better Oral Health to be a good use of resources.\n\nStaffing and consumables\nThe cost of an age-appropriate toothbrush, 100ml of toothpaste and an educational leaflet (purchasing a pack of 50 units via NHS Supply Chain) is currently between £27.20 and £33.60.\n\nThere are a number of potential methods by which toothbrushes and paste can be delivered by post. The use of community distribution schemes such as Amazon or the milkman could also be explored. A parcel containing toothbrushing supplies for six months sent via second class post is currently £2.80 (2016).\n\nThe staffing requirements for the implementation would be limited to the administration of the programme. It has been estimated that this would require one Band 2 worker for one day a week, per around 800 families. The NHS Agenda for Change provides staffing salaries for a range of health professionals. A Band 2 worker would have a salary midpoint of £16,372 in 2016/2017.\n\nTraining\nMinimal training of staff is expected, given that there is no face-to-face contact with the children in the programme.\n\nExample programme\nA study by Davies 2003 established the costs (2003£) of providing toothpaste and toothbrushes to children four times a year, for four years. The overall total cost of delivering this programme was £27.93 per child. Labour costs were approximately £1.65 per child annually, and included the employment of a programme manager, an administrator and parcel packer. The annual cost of the product and its postal delivery was £4.40 per child (including four annual deliveries of four tubes of toothpaste and one toothbrush). The rental cost of the office and storage space was £2,500 per year. "]
[null,"Reference: Davies GM, Worthington HV, Ellwood RP, Bentley EM, et al. A randomised controlled trial of the effectiveness of providing free fluoride toothpaste from the age of 12 months on reducing caries in 5-6 year old children. Community Dent Health. 2002 Sep;19(3):131-6.","Davies (2002)","5 years","12 months",2.15,2.57,0.5,0.42,0.16,null,5,5]
[null,null,null,5,1]
[null,{"$f":"Intervention!E20","v":0}]
[null,"Provision of toothbrushes and paste by post and via health visitors is recommended by NICE PH55 and CBOH (PHE, 2014). The model has used t the preventive fractions from Davies et al 2005.\n\nHealth visitor mediated scheme: Davies et al., 2005 assessed the impact on the level of caries in the deciduous dentition at 5 years of age by using health visitors and a regular supply of free fluoride toothpaste regularly to children. The programme consisted of a series of interventions from 8 to 32 months of age gift bags containing trainer cup and toothpaste 1450ppm, toothbrush and advice given to parents on attendance at designated clinics and children’s centres, further paste and brushes were posted to homes. Toothbrushes and paste are handed out by health visitors and regular child development checks as part of the Brushing for Life programme.\n\nTo increase effectiveness programmes should consider targeting to those with highest levels of disease, length of programme, frequency of postal drops, the use of 1450ppm fluoride toothpaste, age of commencement and provision of oral health advice information. There are a number of methods by which families can be supplied with toothbrush and paste. Engaging with health visitors is important to ensure support for the programme and the consistency of messages.\n","Source study","Programme length","Age at start of programme","dmft at age 5 (programme)","dmft at age 5 (control)","Caries free - Programme","Caries free - Control","Preventive fraction (reported in study)",null,"Time point for PF (after programme start)","Age for PF",null,"Recommendations\nThe targeted provision of toothbrushes and paste is considered by Commissioning Better Oral Health to be a good use of resources.\n\nStaffing and consumables\nHealth visitors usually start at Band 6 of the NHS Agenda for Change (AfC) Pay Rates. The NHS Agenda for Change provides staffing salaries for a range of health professionals. A dental nurse on Band 6 would have a salary midpoint of £30,357 in 2016/2017. Team managers and health visitor specialists can earn up to £41,373 on Band 7 of the NHS pay scale (2016/2017).\n\nThe cost of an age-appropriate toothbrush, 100ml of toothpaste and an educational leaflet (purchasing a pack of 50 units via NHS Supply Chain) is currently between £27.20 and £33.60.\n\nThere are a number of potential methods by which toothbrushes and paste can be delivered by post. The use of community distribution schemes such as Amazon or the milkman could also be explored. A parcel containing toothbrushing supplies for six months sent via second class post is currently £2.80 (2016).\n\nThe administration of the programme (including producing the packs) has been estimated to require one Band 2 worker for one day a week, per around 800 families. The NHS Agenda for Change provides staffing salaries for a range of health professionals. A Band 2 worker would have a salary midpoint of £16,372 in 2016/2017.\n\nTraining\nIt is anticipated that the support and training required for health visitors delivering the scheme will be the main cost incurred. This training may be provided by members of an existing community oral health team, or by an external supplier. There are a wide range of potential suppliers of local or online courses on oral health.\n\nTraining may be needed for other frontline staff who work with groups at high risk of poor oral health. This is to ensure they can give advice on the importance of oral health and promote good practice. In one example provided in NICE Costing template for PH55, a 3.5 hour course for 20 delegates cost £15 per delegate. This included raising awareness of a range of oral health issues and equipping them to provide advice on good practice.\n\nExample programme\nStoke on Trent has made some local adaptation to the Brushing for Life programme. A weaning pack is provided, contained a free flow cup, toothpaste, brush and an educational leaflet. Weaning packs are estimated at being £2.37. The 12-24 month pack costs £1.29. These are distributed by health visitors. A Band 3 worker provided project support, and it was estimated that 10% of their working hours (approximately half a day a week) was allocated to the implementation of this programme. The project worker managed the recording distribution of the packs to the health visitors which arrive at the children centres ready packed."]
[null,"Reference: Davies GM, Duxbury JT, Boothman NJ, Davies RM. Challenges associated with the evaluation of a dental health promotion programme in a deprived urban area. Community Dent Health. 2007 Jun;24(2):117-21.","Davies (2007)","2 years","8 months",2.23,3.72,0.46,0.36,{"$f":"1-F21/G21","v":0.40053763440860224},null,5,5]
[null,null,null,2,1]
[null,{"$f":"Intervention!E21","v":0}]
[null,"Multi component programmes are recommended by CBOH. Oral health promotion programmes delivered through multiple venues and providing interventions at a local policy, supporting environment and programme level may be associated with a reduced risk of dental decay. Many local authorities commission a combination of individual programmes similar to the programme outlined by Blair et al., (2006), from which the model has used the preventive fraction.\n\nThis study assessed the impact of a programme targeting children under 5 attending breakfast clubs in schools and community centres in a severely deprived area of Glasgow. The programme incorporated a wide range of elements, including the promotion of sugar free medicines in National Smile Week, snack and meal policies for schools, fruit promotion in nurseries and schools, baby bottle swap/cup provision, annual community fairs, tooth brushing schemes (e.g. in nurseries), free toothbrush and fluoride toothpaste (1000ppm), opportunistic oral health promotion by health visitor, oral health related competitions, child friendly dentist scheme, and parenting support baby club.\n\nThe multicomponent nature of the programme and upstream policy interventions make it more likely to have an impact on inequalities.","Source study","Programme length","Age at start of programme","Post-programme dmft (5 year olds)","Pre-programme dmft (5 year olds)","Proportion caries free (post-programme)","Proportion caries free (pre-programme)","Odds ratio for tooth decay (reported in study)","Preventive fraction","Time point for PF (after programme start)","Age for PF",null,"Recommendations\nLocal authorities may wish to implement a programme that encompasses a number of different approaches to improving the oral health of their population. Recommendations of the resources needed to run the programme will vary according to the elements that are to be included in the programme – please refer to each individual programme type included in this tool for further details.\n\nStaffing and consumables\nThe staffing and materials requirements of the programme would be determined by the combination of elements in the programme (i.e. provision of toothbrush and paste, education leaflets, etc). The NHS Agenda for Change provides staffing salaries for a range of health professionals. A dental nurse on Band 6 would have a salary midpoint of £30,357 in 2016/2017.\n\nTraining \nIt is anticipated that the support and training required for those delivering the scheme will be the main cost incurred, and will depend on the elements of the programme being considered. This training may be provided by members of an existing community oral health team, or by an external supplier. There are a wide range of potential suppliers of local or online courses on oral health.\n\nTraining may be needed for other frontline staff who work with groups at high risk of poor oral health. This is to ensure they can give advice on the importance of oral health and promote good practice. In one example provided in NICE Costing template for PH55, a 3.5 hour course for 20 delegates cost £15 per delegate. This included raising awareness of a range of oral health issues and equipping them to provide advice on good practice.\n\nExample programme\nAn example programme is Smile4Life, an oral health improvement programme to help adults and children improve their oral health. The four key themes are encouraging health eating and drinking, encouraging regular toothbrushing, encouraging the promotion of a healthy lifestyle, and visiting the dentist regularly. This programme has been introduced in Cumbria, where children receive 18 hours in year 1, 12 hours in year 2 and 8 hours in year 3"]
[null,"Reference: Blair Y, Macpherson L, McCall D et al. Dental health of 5-year-olds following community based oral health promotion in Glasgow, UK.  Int J Paediatr Dent.  2006;16(6):388-98","Blair (2006)","From birth to 5 years","All children under age of 5",3.1,3.7,0.42,0.34,0.66,{"$f":"1-J25","v":0.33999999999999997},5,5]
[null,null,null,5]
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[]
[]
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[null,"Calculation information"]
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[null,"To view more information on how each step of the analysis has been calculated, please click on the relevant box, and details will provided to the right."]
[1,"The eligible population (A) refers to the number of children who are expected to be enrolled in the programme. This is a user-input on the \"Population\" sheet.\n\nNote, the total number of children in this analysis refers specifically to the number in one cohort or year group that will be exposed to the full length and receive full benefits of the programme. If a programme has a number of year cohorts recruited simultaneously, the size of only one year cohort should be entered."]
[2,"The composite measure of dmft refers to the total number of decayed, missing and filled teeth per child, and averaged for a population.\n\nThe expected level of severity of tooth decay (B) in the population at the age of five is measured by dmft in the model, and reflects the level of tooth decay if the child has not been enrolled in a programme.\n\nThis value (mean dmft) can be inputted on the \"Population\" sheet. There are a number of methods for doing so; please see the information on the \"Population\" sheet for more details."]
[3,"This step estimates the total number of expected cases of teeth with decay experience (C) by age 5, in the non-programme population.\n\nThis has been estimated by combining inputs \"A\" (population size) and \"B\" (decay at age 5).\n\nThis will allow us to estimate the dental treatment that has occurred by this time point. The analysis then estimates the total number of fillings, extractions and untreated decay at the end of the programme.\n\nIn order to estimate how many extractions and how many fillings have taken place for the non-programme population, the proportions of teeth with decay experience that are extracted or filled (also known as the care index) are applied to the dmft value. The tool uses national data for these two parameters; however, they can be updated by the user on the \"Resources\" sheet if you wish to use local data."]
[4,"The next step is to estimate the reduction in the number of teeth with decay experience by the age of five, due to the implementation of the oral health programme.\n\nThis has been done by estimating the preventive fraction (D) in the study programme. The preventive fraction represents the percentage of cases that can be prevented if a population is exposed to an intervention.\n\nThe preventive fraction for each type of programme in this analysis has been obtained from published studies. Details of each study are provided on the \"Intervention\" page, where the user can select which programme type they wish to evaluate.\n\nNote that the details provided on the \"Intervention\" page are for information purposes only. The user cannot update this information, as the analysis is intended to be based on the best available evidence."]
[5,"This step estimates the total fewer number of expected cases of teeth with decay experience (E) by age 5, due to the programme population.\n\nThis has been calculated by applying the risk reduction (equal to one minus the preventive fraction, or 1-D) to the total number of teeth with decay experience for children in the non-programme population (C).\n\nThe reduction in cases of fillings, extractions and untreated decay that arise due to the implementation of the programme is then estimated. This is done using the same method to estimate numbers of fillings, extractions and untreated decay as in Step C, but by applying this to the \"averted\" decay (the expected reduction in dmft) at the age of 5 years.\n\nA conservative assumption has been made in this analysis, whereby it was assumed that the benefit of the programme lasted only while children were enrolled. This is because very few studies report the long-term impact on levels of tooth decay, after children are no longer in the programme. This means that children in a programme would have the same risk of developing tooth decay as the children who are not part of a programme."]
[6,"We can link tooth decay to days lost at school. Children will miss school due to attending dental procedures, and due to pain while on the waiting list for a tooth extraction.\n\nThe proportion of children who miss school due to pain can be applied to the number of children who are expected to have a tooth extraction. The mean number of days missing from school is then applied to those children. The values of these inputs are based on a study of children in the North West of England (Goodwin, 2015). In addition, these children also have a number of days missing due to the procedure itself. Children undergoing a tooth restoration (filling) also have an associated time missed at school, due to attending the procedure.\n\nDays missing at school may also translate to days missed at work by the carer of the child. A proportion of carers will be employed. The default value that the tool is populated is based on a study of children in the North West of England (Goodwin, 2015), but it is suggested that this is reviewed and updated with local employment statistics, as this value may vary by region. The proportion of days missing at work is estimated by applying the employment rate of carers to the number of days missing at school.\n"]
[7,"Here, we establish the different costs of treating a decayed tooth (further details on cost assumptions can be found on the resources page).\n\nTreatment costs of tooth decay are split into several categories. These include extractions that occur during the programme, fillings that occur during the programme, and the future treatment of teeth with untreated decay at the end of the programme.\n\nThe unit costs of treatment (Units of Dental Activity, or UDAs) can be updated by the user so that the analysis is reflective of their local area, and are located on the \"Resources\" sheet. The model has been populated with the average UDA cost for England; this can be replaced by local averages if known. Further details around the default cost inputs are also provided on this page.\n\nFillings are assumed to take place in primary care, and are costed using two Units of Dental Activity (UDA) (the marginal cost over and above an examination). All extractions are assumed to take place in secondary care, as an inpatient in a hospital, although the user has the ability to indicate a proportion of extractions that take place in primary care.\n\nOf the teeth that are decayed but untreated at the end of the programme, a proportion will receive treatment before they are exfoliated (lost naturally). Of those that are treated, some will be filled and some will be extracted. The methodology to estimate these proportions is based on the health economic analysis of Childsmile (Anopa, 2015).\n\nTreatment costs that are incurred in the future are discounted at a rate of 3.5% (UK Treasury). This reflects society's preference for costs to be experienced in the future rather than the present. "]
[8,"Programme costs are entered by the user on the \"Programme costs\" page.\n\nFor water fluoridation the mean operating costs per child should be entered this has been prepopulated with the known average per head operating costs of schemes in England. No other costs including capital costs have been included.\n\nFor all other programmes the estimated or indicative costs should be entered for each year the programme will run. The costs should only be for one cohort: for example, a tooth brushing programme that runs for two years will have in any one year one cohort in the first year of the programme and one in the second year. In the model the number of children is one cohort and the costs are those relating to that one cohort.\n\nBoth of these methods result in a total cost of delivering the programme, for each year that a child is enrolled in it. \n\nProgramme costs that are incurred in the future (after Year 1) are discounted at a rate of 3.5% (UK Treasury). This reflects society's preference for costs to be experienced in the future rather than the present."]
[9,"A value can be assigned to the number of days missing at work experienced by the carer (estimated in Step F) to estimate the potential impact to the local authority. \n\nThe number of days gained at work through implementation of the programme is calculated, by estimating the days lost at work to the number of averted fillings and extractions (estimated in Step E).\n\nThe average daily wage has been obtained from national statistics, and applied to the days gained at work to provide the expected cost savings through implementation of the programme."]
[10,"Now that the treatment costs and the reduction in number of fillings and extractions have been calculated, the analysis can then estimate the total cost savings that may arise after implementation of an oral health programme.\n\nThe costs of treatment that were estimated in Step G have been applied to the total number of reduction in cases of decay (Step E). This calculates the total cost savings due to the programme.\n\nThese are the cost savings due to reduced levels of tooth decay in the primary teeth."]
[11,"Finally, the return on investment of the programme can be estimated.\n\nThis incorporates both the programme cost and the cost savings for the programme population, and represents the actual cost savings after the programme costs have been taken into account. This includes both savings to the wider economy (days gained at work) and to the NHS. This has been estimated at 5 years and at 10 years."]