Table 2 Characteristics of included studies by publication date
From: Economic evaluations in water-fluoridation: a scoping review
N | Reference | Country | Type of EE | Perspective | Source of effectiveness data | Outcome measure | Time Horizon /Discount Rate | Price Year/ Currency unit | Main Conclusion |
|---|---|---|---|---|---|---|---|---|---|
1 | Davies 1973 [34] | New Zealand | CBA | Public payer | Model (Observational data) | Saving cost dental treatment | 10 years/ NR | 1965/ NZD | CWF was cost-effective |
2 | Nelson 1976 [42] | USA | CBA | Payer | Model (Observational data) | DMFS averted | 20 years/ 10% | 1975/USD | CWF was cost-effective and socially profitable |
3 | Carr 1980 [49] | Australia | CBA | Public Payer | Model (Observational data) | DMFT averted | 10 years/7% | 1971/AUD | After seven to 11 years of fluoridation, treatment-cost savings would exceed costs of fluoridation. |
4 | Doessel 1985 [35] | Australia | CBA | Societal | Model (Observational data) | Saving dental service | 15 years/10% | 1965/AUD | The study indicates significant economic benefit and CWF was cost-effective. |
5 | Birch 1986 [30] | United Kingdom | CUA | Payer | Model (Observational data) | QATY | Lifetime/5% | NR/GBP | The lifetime benefit and cost of fluoridation was 18 QATY and GBP1.89 respectively. Cost for QATY produced by water fluoridation was 10.83 pence per QATY |
6 | Manau 1987 [38] | Spain | CEA | Payer | Model (Observational data) | DMFS averted | 20 years/None | 1986/ PTS | The CWF was the most cost-effective strategy when compared with other community programs like fluoride mouthrinses or supervised toothbrushing |
7 | Birch 1990 [29] | United Kingdom | CEA | Payer | Model (Observational data) | dmft/DMFT averted | 14 years/5% | 1988/GBP | CWF was cost-effective in population with low to high prevalence of caries |
8 | Millán 1991 [40] | Spain | CBA | Payer | Model (Review) | dmfs averted | 20 years/ 6.54% | 1988/PTS | The program for the fluoridation of the public water supply in Málaga was profitable from the first year. |
9 | Murgueytio 1995 [41] | Chile | CBA | Payer | Cohort | Caries averted | 10 years/ NR | 1995/CLP | CWF was highly cost-effective. |
10 | Arjunan 2000 [50] | Australia | CBA | Payer | Model (Review) | DMF averted | 20 years/ 5% | NR/AUD | Fluoridation of the water supply in small remote communities with a population of more than 1000 is an economically viable investment. |
11 | Griffin 2001 [36] | USA | CBA | Societal | Model (Review) | Cost averted caries | 15 years/ 4% | 1995/ USD | Fluoridation was still cost saving for communities of any size if we allowed increment, effectiveness, or the discount rate to take on their worst-case values, individually. For simultaneous variation of variables, fluoridation was cost saving for all but very small communities. |
12 | Wright 2001 [46] | New Zealand | CBA | Societal | Model (Observational data) | Averted costs of treating caries | 30 years/ 5% cost and benefit | 1999/ NZD | Fluoridation was cost-saving (dental cost savings exceeded fluoridation costs) for communities above about a thousand people. The true break-even community size may be lower. For smaller communities, fluoridation may be considered cost-effective depending on the non-monetised value assigned to an averted decayed surface. |
13 | O’Connell 2005 [44] | USA | CBA | Societal | Model | Caries averted | Lifetime/ 3% cost and effect | 2003/USD | CWF in Colorado was cost saving. Using lower rates of fluoride effectiveness for areas with fluoride levels greater than 0.3 ppm, CWF remains profitable. |
14 | Campain 2010 [31] | Australia | CBA | Societal | Model (Synthetic cohorts) | DMFS averted | Lifetime/ 7%/ | 2005/ AUD | Despite declining levels of dental decay, CWF continues to be a cost-effective preventive measure. However, the cost-effectiveness of CWF was shown to decline with age due to plateauing in decay increment and estimates of higher periodontal treatment needs. |
15 | Ciketic 2010 [32] | Australia | CUA | Societal | Model | DALY averted | 15 years/ 3% | 2002/ AUD | Fluoridation remains still a very cost-effective measure for reducing dental decay. CWF was a dominant strategy as more DALYs were saved along with significant cost savings. |
16 | Cobiac 2012 [33] | Australia | CUA | Payer | Model (Review) | DALY averted | 15 years/ 3% | 2003/ AUD | Extending coverage of fluoridation to all communities of at least 1000 people will lead to improved population health, with a dominant cost-effectiveness ratio and 100% probability of cost-savings. Extending coverage to smaller communities is not cost-effective. |
17 | South Africa | CEA/ CBA | Payer | Review | dmft averted Average fee for two surface amalgam | NR | 2011/USD | Water fluoridation leads to significant cost savings and remains a cost-effective measure for reducing dental caries, even when the caries-preventive effectiveness is modest. | |
18 | Chile | CEA | Societal | Model (Review) | Caries averted | 6 years/3% for cost | 2009/CLP | Based on cost required to prevent one carious tooth among schoolchildren, salt fluoridation and CWF were more cost-effective than school-based programmes such as milk-fluoridation, fluoridated mouthrinses, APF-Gel, and supervised toothbrushing with fluoride toothpaste | |
19 | Tchouaket 2013 [45] | Canada | CBA | Societal | Model (Review) | Averted costs of treating caries | 20 years/ 3% | 2010/CAD | The analyses showed that the water fluoridation program was cost-effective even with a conservatively estimated 1% reduction in dental caries. |
20 | Edelstein 2015 [51] | USA | CEA | NR | Model (Observational data) | Caries averted | 10 years/NR | NR/USD | CWF was the intervention with lowest unit cost and more disease reduction, reaching all children receiving Medicaid regardless of their caries risk |
21 | Fyfe 2015 [47] | New Zealand | CEA | Societal | Model (Observational data) | DMFT averted | 15 years/3,55 | 2012/NZD | CWF was profitable for communities of more than 5000. For communities of less than 5000, profitability would depend more on the risk profile of the community population. |
22 | Atkins 2016 [52] | USA | CEA | Payer | Model (Observational data) | Caries averted Full mouth dental reconstructions averted | 10 years/3% cost and benefit | 2011/USD | While all interventions (CWF, dental sealants, fluoride varnish, tooth brushing with fluoride toothpaste, and conducting initial dental exams on children < 18 months of age) generated a cost saving, CWF had the greatest cost benefit of preventing dental caries. |
23 | O’Connell 2016 [43] | USA | CBA | Societal | Model | Caries averted | Lifetime/ 3% cost and effect | 2013/USD | CWF was cost-effective. The program savings are likely to exceed costs. |
24 | Moore 2017 [48] | New Zeeland | CUA | Societal | Model (Observational data) | QALYs gained | 20 years/3.5% | NZD | Community water fluoridation was highly cost-effective for all but very small communities (< 500). |