Abstract
BackgroundCommunity water fluoridation (CWF) is considered one of the 10 greatest public health achievements of the twentieth century and has been a cornerstone strategies for the prevention and control of dental caries in many countries. However, for decision-makers the effectiveness and safety of any given intervention is not always sufficient to decide on the best option. Economic evaluations (EE) provide key information that managers weigh, alongside other evidence. This study reviews the relevant literature on EE in CWF.MethodsA systematic database search up to August 2019 was carried out using MEDLINE, EMBASE, Cochrane Library, LILACS, Paediatric Economic Database Evaluation and National Health Service Economic Evaluation Database. The review included full economic evaluations on CWF programs, written in English, Spanish or Portuguese. The selection process and data extraction were carried out by two researchers independently. A qualitative synthesis of the results was performed.ResultsOf 498 identified articles, 24 studies met the inclusion criteria; 11 corresponded to cost-benefit analysis; nine were cost-effectiveness analyses; and four cost-utility studies. Two cost-utility studies used Disability-Adjusted Life Years,, one used Quality-Adjusted Tooth Years, and another Quality-Adjusted Life Years. EEs were conducted in eight countries. All studies concluded that water fluoridation was a cost-effective strategy when it was compared with non-fluoridated communities, independently of the perspective, time horizon or discount rate applied. Four studies adopted a lifetime time horizon. The outcome measures included caries averted (n = 14) and savings cost of dental treatment (n = 4). Most of the studies reported a caries reduction effects between 25 and 40%.ConclusionFindings indicated that CWF represents an appropriate use of communities’ resources, using a range of economic evaluation methods and in different locations. These findings provide evidence to decision-makers which they could use as an aid to deciding on resource allocation.
Highlights
Dental caries is the most prevalent chronic disease in the world today, and affecting a significant proportion of the world’s population [1]
Fluoride is the leading strategy in the noninvasive management of dental caries, and it has been incorporated as a public health measure to reduce the prevalence of that disease [4]
Because some economic evaluations about water fluoridation are not published in the academic literature, reference listings of retrieved articles and previous systematic reviews were hand searched to identify other possible studies
Summary
Dental caries is the most prevalent chronic disease in the world today, and affecting a significant proportion of the world’s population [1]. Fluoride is the leading strategy in the noninvasive management of dental caries, and it has been incorporated as a public health measure to reduce the prevalence of that disease [4]. Fluoride can be delivered to individuals as a dental preventive measure through a variety of mechanisms. It can be administered systemically through water, milk, or salt or topically available as toothpastes and other dental products such as varnishes, gels and mouthwashes [5]. Community water fluoridation (CWF) is considered one of the 10 greatest public health achievements of the twentieth century and has been a cornerstone strategies for the prevention and control of dental caries in many countries. This study reviews the relevant literature on EE in CWF
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