Economic Evaluation of Community Water Fluoridation: A Community Guide Systematic Review
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Economic Evaluation of Community Water Fluoridation: A Community Guide Systematic Review

Filetype[PDF-431.75 KB]

  • English

  • Details:

    • Alternative Title:
      Am J Prev Med
    • Description:

      A recently updated Community Guide systematic review of the effectiveness of community water fluoridation (CWF) still found strong evidence that CWF reduced dental caries across populations. Although CWF was found to have saved money in a 2002 Community Guide review, the conclusion was based on studies before year 1995. Given the update to the effectiveness review and changes in the economic environment, re-examination of the benefit and cost of CWF is necessary.

      Evidence acquisition:

      Using methods developed for Community Guide economic reviews, 564 potentially relevant papers were identified within a search period from January 1995 to November 2013. Ten studies were included in the current review, with four covering CWF benefits only and another six providing both cost and benefit information. Additionally, two of the six studies analyzed the cost-effectiveness of CWF. The economic review was conducted in 2014.

      Evidence synthesis:

      For all four benefit–only studies, which used regression analysis, dental costs in various forms were lower in communities with water fluoridation. For the remaining six studies, per capita annual intervention cost ranged from $0.11 to $4.89 in 2013 U.S dollars. Variation in cost was caused mainly by community population size, with decreasing per capita cost associated with increasing community population. Per capita annual benefit in the six studies ranged from $5.45 to $139.78. Variation in benefit was mainly due to the numbers and types of benefit components included in the benefit calculation. Benefit–cost ratios ranged from 1.12:1 to 135:1, and these ratios were positively associated with community population size.


      Recent evidence continues to indicate that the economic benefit of community water fluoridation exceeds the intervention cost. Further, the benefit–cost ratio increases with the community population size.

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