Fluoride varnish for preventing dental caries among children: a systematic review and meta-analysis of cost-effectiveness studies.

OBJECTIVES

This study aims to synthesize the incremental net monetary benefit (INMB) of fluoride varnish (FV) application in comparison with other caries preventive interventions in children.

DATA: Of 836 studies identified, a total of 23 studies were included. The majority of FV intervention studies conducted in comparison with oral health education (OHE) (n= 5), treatment as usual (TAU) (n= 3), and pit and fissure sealant intervention (n= 5), toothbrushing intervention (n= 5), and no intervention (n= 7). Only model-based studies on FV conducted in high-income countries (HICs), from a healthcare provider/payer perspective, comparing with other caries preventive interventions (OHE, TAU, or no intervention), irrespective of the setting, were eligible for pooling. A total INMB was calculated. The overall meta-analysis of FV compared with other caries preventive interventions revealed that the total INMB was $124.1 (95%CI: -$1.3 × 104, $1.3 × 104, I²=0%), showing no significant difference in the cost-effectiveness between FV and other caries preventive interventions.

SOURCES: A literature search was performed using electronic databases (PubMed, Web of Science, Scopus, and the Cochrane Library) for studies published from inception to January 2024. Risk of bias was assessed using a modified Economic Evaluations Bias checklist.

STUDY SELECTION: Two independent reviewers identified cost-effectiveness studies reporting dental health and/or generic health outcomes of FV application. Sub-group meta-analyses by type of comparators, study design, perspective, country income level, effect measure, and type of setting used were performed to pool INMB across studies.

CONCLUSIONS

Considering the limited evidence, the cost-effectiveness of FV application is uncertain in HICs from healthcare provider/payer perspective.

CLINICAL SIGNIFICANCE: Overall, the evidence highlights the potential economic value of fluoride varnish in caries prevention, especially in settings lacking robust cost-effectiveness data. The findings can guide policy decisions in resource-constrained environments where generating local evidence is challenging.

PROTOCOL REGISTRATION: Registered at PROSPERO (CRD42023483985).

SOURCE OF FUNDING: The authors declare that there was no funding for this study.