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Table 2 Characteristics of included studies by publication date

From: Economic evaluations in water-fluoridation: a scoping review

NReferenceCountryType of EEPerspectiveSource of effectiveness dataOutcome measureTime Horizon /Discount RatePrice Year/ Currency unitMain Conclusion
1Davies 1973 [34]New ZealandCBAPublic payerModel (Observational data)Saving cost dental treatment10 years/ NR1965/ NZDCWF was cost-effective
2Nelson 1976 [42]USACBAPayerModel (Observational data)DMFS averted20 years/ 10%1975/USDCWF was cost-effective and socially profitable
3Carr 1980 [49]AustraliaCBAPublic PayerModel (Observational data)DMFT averted10 years/7%1971/AUDAfter seven to 11 years of fluoridation, treatment-cost savings would exceed costs of fluoridation.
4Doessel 1985 [35]AustraliaCBASocietalModel (Observational data)Saving dental service15 years/10%1965/AUDThe study indicates significant economic benefit and CWF was cost-effective.
5Birch 1986 [30]United KingdomCUAPayerModel (Observational data)QATYLifetime/5%NR/GBPThe 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
6Manau 1987 [38]SpainCEAPayerModel (Observational data)DMFS averted20 years/None1986/ PTSThe CWF was the most cost-effective strategy when compared with other community programs like fluoride mouthrinses or supervised toothbrushing
7Birch 1990 [29]United KingdomCEAPayerModel (Observational data)dmft/DMFT averted14 years/5%1988/GBPCWF was cost-effective in population with low to high prevalence of caries
8Millán 1991 [40]SpainCBAPayerModel (Review)dmfs averted20 years/ 6.54%1988/PTSThe program for the fluoridation of the public water supply in Málaga was profitable from the first year.
9Murgueytio 1995 [41]ChileCBAPayerCohortCaries averted10 years/ NR1995/CLPCWF was highly cost-effective.
10Arjunan 2000 [50]AustraliaCBAPayerModel (Review)DMF averted20 years/ 5%NR/AUDFluoridation of the water supply in small remote communities with a population of more than 1000 is an economically viable investment.
11Griffin 2001 [36]USACBASocietalModel (Review)Cost averted caries15 years/ 4%1995/ USDFluoridation 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.
12Wright 2001 [46]New ZealandCBASocietalModel (Observational data)Averted costs of treating
30 years/ 5% cost and benefit1999/ NZDFluoridation 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.
13O’Connell 2005 [44]USACBASocietalModelCaries avertedLifetime/ 3% cost and effect2003/USDCWF in Colorado was cost saving. Using lower rates of fluoride effectiveness for areas with fluoride levels greater than 0.3 ppm, CWF remains profitable.
14Campain 2010 [31]AustraliaCBASocietalModel (Synthetic cohorts)DMFS avertedLifetime/ 7%/2005/ AUDDespite 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.
15Ciketic 2010 [32]AustraliaCUASocietalModelDALY averted15 years/ 3%2002/ AUDFluoridation 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.
16Cobiac 2012 [33]AustraliaCUAPayerModel (Review)DALY averted15 years/ 3%2003/ AUDExtending 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.
17Kroon 2012 [37, 53]South AfricaCEA/ CBAPayerReviewdmft averted
Average fee for two surface amalgam
NR2011/USDWater fluoridation leads to significant cost savings and remains a cost-effective measure for reducing dental caries, even when the caries-preventive effectiveness is modest.
18Mariño 2012 [39, 54]ChileCEASocietalModel (Review)Caries averted6 years/3% for cost2009/CLPBased 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
19Tchouaket 2013 [45]CanadaCBASocietalModel (Review)Averted costs of treating caries20 years/ 3%2010/CADThe analyses showed that the water fluoridation program was cost-effective even with a conservatively estimated 1% reduction in dental caries.
20Edelstein 2015 [51]USACEANRModel (Observational data)Caries averted10 years/NRNR/USDCWF was the intervention with lowest unit cost and more disease reduction, reaching all children receiving Medicaid regardless of their caries risk
21Fyfe 2015 [47]New ZealandCEASocietalModel (Observational data)DMFT averted15 years/3,552012/NZDCWF 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.
22Atkins 2016 [52]USACEAPayerModel (Observational data)Caries averted
Full mouth dental reconstructions averted
10 years/3% cost and benefit2011/USDWhile 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.
23O’Connell 2016 [43]USACBASocietalModelCaries avertedLifetime/ 3% cost and effect2013/USDCWF was cost-effective. The program savings are likely to exceed costs.
24Moore 2017 [48]New ZeelandCUASocietalModel (Observational data)QALYs gained20 years/3.5%NZDCommunity water fluoridation was highly cost-effective for all but very small communities (< 500).
  1. CBA Cost-benefit, CEA Cost-effectiveness, CUA cost-utility; CWF Community water fluoridation, DALY Disability-Adjusted Life Year, EE Economic evaluation, QALY Quality-Adjusted Life Years, QATY Quality-Adjusted Tooth Years, DMFT/S Decayed, Missing and Filled tooth/tooth surface, NR Not reported