Complete economic evaluation of fluoride varnish and dental Caries in Preschoolers: A Systematic Review
Creators: name: Dhyppolito, Izabel
name: Santos, Ana
name: Nadanovsky, Paulo
name: Oliveira, Branca
name: Cruz, Laís
Publisher: name: Open Science Framework
Year: 2022
Subjects: subject: Dental Public Health and Education
subject: Medicine and Health Sciences
subject: Pediatric Dentistry and Pedodontics
subject: Dentistry
subject: FOS: Clinical medicine

description: 1. Objective To carry out a systematic review of complete economic evaluations of professionals fluoride varnish applications to reduce the incidence of caries in preschool children. 2. Study design Systematic review. 3. Eligibility criteria 3.1 Participants Studies with preschoolers (up to 71 months of age) were included, regardless of the initial level of tooth decay. Studies with participants who were selected due to special health conditions, such as those with syndromes, physical or cognitive disabilities, with multiple comorbidities or using other concomitant medications were excluded. 3.2 Interventions Studies were included in which fluoride varnish was used to control caries and that included data on the cost associated with another outcome measure (cost-effectiveness, cost-utility, cost-minimization and / or cost-benefit). In addition, the following comparisons were considered: professional application of fluoride varnish versus placebo; professional application of fluoride varnish versus standard care; professional application of fluoride varnish versus no intervention. The interventions described above were considered regardless of the number of applications of the varnish, the concentration of fluoride in the varnish, the agent used in the formulation and the trademark. Studies whose interventions have been associated with other measures of professional application of topical fluoride (gel, foam, silver diamino fluoride) or application of non-fluoridated agents (chlorhexidine, xylitol) were excluded to avoid the effect of co-interventions. Studies carried out in areas with fluoridated water and / or that used fluoridated toothpaste were included because they are conditions considered habitual for the collective and individual use of fluorides, respectively. 3.3 Outcomes In cost-effectiveness analyzes, the health outcome is measured in clinical benefit (considering the surface, tooth and individual levels). The same consideration was used in cost-minimization studies, which assumes equivalence of outcomes for different interventions in order to determine the lowest cost. In cost-utility analyzes, the outcome assessed is equivalent to the number of years of life adjusted for quality in relation to spending. In cost-benefit evaluation, the health benefits assessed are measured in monetary value as an outcome. The incremental cost-outcome ratio was considered in all complete economic assessments (except for cost-minimization assessments, since the outcome equivalence between the interventions is assumed) 3.4 Studies Studies of complete economic evaluation (the four types were considered) were carried out through economic modelling or piggyback evaluations. Studies of partial economic evaluation and clinical trials with a follow-up time of less than one year were excluded. In vitro and laboratory studies, letters, editorials, guidelines, case reports, methodology articles and literature reviews were also excluded. 4. Search strategy Searches were made in the following electronic databases (from the year available on the Internet until 2020: The Cochrane Library [Central Register of Controlled Trials (CENTRAL)]; MEDLINE via PubMed; WEB OF SCIENCE; EMBASE; SCOPUS; LILACS; BBO; BVS Health economics. The search strategy was developed for the MEDLINE database via Pubmed and adapted for the other selected databases, considering the rules for syntax and the use of controlled vocabulary and not restricting the language. Two researchers conducted a complementary manual search in 11 journals that are very likely to publish studies related to the topic in question. The OpenGrey and EconoLit databases, as well as the following records of clinical trials were consulted: Brazilian Registry of Clinical Trials (REBEC); Current Controlled Trials; ClinicalTrials.gov; EU Clinical Register; Australia New Zealand Clinical Trials Registry (ANZCTR). Theses and dissertations (at the Brazilian Digital Library of Theses and Dissertations - BDTD) and the bibliographic references of articles potentially eligible for review were also investigated. 5. Data collection and analysis Two reviewers will perform data extraction independently, using data extraction forms specially developed for the study. In case of disagreement, a third reviewer will be consulted. Authors of articles whose relevant data were incomplete will be consulted. The risk of bias in economic and complete assessments without modeling will be assessed using the “Drummond check-list 2005” tool. For studies of complete economic evaluation with modeling, the “Philips 2004” tool will be used.