Custo-efetividade das aplicações profissionais de verniz fluoretado em pré-escolares: revisão sistemática

Abstract

The aim of this study was to conduct an economic evaluation of the professional fuoride varnish application in preschoolers through a systematic review. Electronic searches were performed in the MEDLINE databases via pubmed, SCOPUS, EMBASE, CENTRAL, WEB OF SCIENCE, LILACS, BBO, BVS Health economics, and a handsearch in eleven specialized journals and in the Thesis and Dissertation Bank BDTD. Inclusion criteria were: complete economic evaluation conducted through economic modeling or direct clinical intervention, with children of preschool age, in which fluoride varnish was used for caries control compared to placebo, standard care or no intervention. The records were imported into the EndNote Web program and then exported to a Microsoft Excel® spreadsheet. Two researchers independently performed the selection and data extraction independently. The risk of bias in the included studies was assessed using the “Drummond check-list 2005” (clinical trials with economic evaluation) and “Philips 2004” (modeling) tools. After removing duplicates, 2285 articles remained, whose titles and abstracts were evaluated, and 168 articles were selected for reading in full. At the end of the process, 8 studies were included, all of them “cost-effectiveness” type, with five models and three clinical trials with economic evaluation. No study had a low risk of bias. The direct comparison between the results was difficult due to the great heterogeneity of the included studies. Three studies found a cost-effective result for fluoride varnish in preschoolers, but in one of these, the other interventions had even more cost-effective results than varnish. The other authors reported a large increase in costs caused by the application of varnish and / or low cost-effectiveness. Data such as these question the use of fluoride varnish in caries control as a public health policy and should be considered when setting priorities in the allocation of resources for more cost-effective interventions.