Economic evaluations in water-fluoridation: a scoping review

Abstract

Background: 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. 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. Methods: A 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. Results: Of 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%. Conclusion: Findings 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.

Association of COVID-19-imposed lockdown and online searches for toothache in Iran

“…This negative association was observed in 2019 as well. There is a body of literature that water fluoridation is a cost-effective community-based preventive approach to manage dental caries [32,33]. However, currently, there is no water fluoridation programme in Iran, and the amount of fluoride in drinking water is different among various provinces based on the characteristics of the natural water.…”

Cost-effectiveness of caries preventive interventions – a systematic review

“…However, several such studies were captured in the systematic process and although they were not fully assessed by the reviewers, they seem to show dominant results, i.e. water fluoridation was found to save costs and to reduce caries [51,52]. Also fluoridated salt or milk-products may be cost-effective [53][54][55] and able to address inequities in dental health, but those studies in the present review were appraised as not transferable.…”

Socio‐economic status and access to fluoridated water in Queensland: an ecological data linkage study

“…Water fluoridation cost‐effectively reduces the prevalence of dental caries by 25–40% 3 . The benefits of fluoridated drinking water are most pronounced in areas of lower socio‐economic status, where people are at greater risk of dental caries and less likely to have access to other forms of oral health care.…”