Given that public sector budgets are increasingly stretched to meet competing demands, there is a growing need to analyze and report on the costs and benefits of public sector investments. Economic evaluation of costs, benefits and effects provides a valuable framework for thinking about choices in healthcare. Economic evaluation asks the question: "is this procedure, service or programme worth doing when compared with other things we could do with the same resources?" or "What are the benefits from  this treatment or from this programme and what are the costs, and do the former exceed the latter?"

Oral diseases pose a significant burden on the economy of both the industrialized and emerging states. The prevention of dental caries - a major oral disease - by fluoride has been well proven over the last 50 years world-wide. Water fluoridation has long been considered the most effective of the fluoridation methods. In this article, the authors examined several modalities of caries prevention through fluoride use - water fluoridation, salt fluoridation, school fluoride rinse programmes, fluoride tablet programmes, fluoride toothpaste, and professionally applied fluorides - and predict benefits, effects, and costs in Kuwait. Salt fluoridation, water fluoridation, and fluoride tablets provide maximal benefits, while salt fluoridation provides the best cost/effect ratio. Salt fluoridation also provides the consuíer the option of whether to use it or not, while also shifting the burden of cost from the public sector to the consumer. Salt fluoridation has proven highly successful in Switzerland, and France has recently become the leading producer of fluoridated salt. The results predicted here can allow the decision-maker the choices of whether to accept or reject alternative and competing fluoride disease prevention modalities taking into consideration benefits, costs, public perceptions and the cost either to the public sector or the consumer.

Saudi Dental Journal 1999;11(3):138-146.