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D.O.I.

10.1922/CDH_00167Cronin11

Action

• Jodi Cronin
• Stephen Moore
• Máiréad Harding
• Helen Whelton
• Noel Woods

Abstract

Objectives: To critically appraise the methodological conduct and reporting quality of economic evaluations (EE) of community water
fluoridation (CWF). Methods: A systematic literature search was conducted in general databases and specialist directories of the economic
literature. The Consensus on Health Economic Criteria list (CHEC) appraised the methodological quality while the Consolidated Health
Economic Evaluation Reporting Standards (CHEERS) assessed the reporting quality of included studies. Results: A total of 1,138 records
were identified, of which 18 met the inclusion criteria. Cost analysis emerged as the most prevalent type of EE, though a growing trend
towards conducting full EEs is observed. CHEC revealed the items most frequently unfulfilled were the study design, measurement and
valuation of costs and outcomes, while CHEERS also identified reporting deficiencies in these aspects. Furthermore, the review highlights
subtleties in methodological aspects that may not be discerned by CHEC, such as the estimation of the impact of fluoridation and the
inclusion of treatment savings within cost estimates. Conclusions: While numerous studies were conducted before publication of these
assessment instruments, this review reveals that a noteworthy subset of studies exhibited good methodological conduct and reporting
quality. There has been a steady improvement in the methodological and reporting quality over time, with recently published EEs largely
adhering to best practice guidelines. The evidence presented will assist policymakers in leveraging the available evidence effectively to
inform resource allocation decisions. It may also serve as a resource for researchers to enhance the methodological and reporting standards
of future EEs of CWF.
Keywords: systematic review, oral health, fluoridation, cost-effectiveness analysis, cost-benefit analysis, costs and cost analysis