Custo-efetividade da aplicação de verniz fluoretado em pré-escolares no cenário odontológico brasileiro

Abstract

Dental caries is a highly prevalent disease in Brazil and worldwide. In addition to compromising quality of life, it imposes a significant economic burden. Fluoride varnish (FV) is one of the most recommended strategies for caries control in preschool children. Given the scarcity of economic evaluations in Brazil, the objective of this study is to assess the cost-effectiveness of professional application of FV in preschool children (deciduous dentition) within the Brazilian context. Economic evaluations were conducted using two Markov models developed in TreeAge Pro 2022 software. FV was compared with standard care for caries prevention and disability-adjusted life years (DALYs) averted. Simulations were conducted over a 4-year time horizon with 6-month cycles. Transition probabilities were derived from national epidemiological surveys and randomized controlled trials (RCTs). The effectiveness of FV was obtained from a systematic review of RCTs. Costs (in Brazilian Reais) were obtained from the Brazilian National Health Agency's dental procedures list for 2022. A discount rate of 5% was applied. Cost-effectiveness analyses were conducted to obtain the incremental cost-effectiveness ratio (ICER) for caries prevention and DALYs, Markov simulations (MS), and sensitivity analyses (SA). FV showed increased effectiveness (0.01894 for caries, 0.00116 for DALY) with an additional cost of 131.27 Reais. The ICER was calculated at 6,929.09 Reais per cavity prevented and 727,604.84 Reais per DALY averted. MS revealed little difference in the percentage of individuals in each state at the end of simulations. The average cost to prevent and treat dental caries per child over 4 years in the group without FV application was 203 Reais, while in the FV application group it was 334 Reais. Therefore, the average cost per child over 4 years is 131 Reais higher in the group that received FV compared to standard care, resulting in an annual average of 33 Reais per child. The analysis shows that FV was able to reduce 4 cases of caries per 100 children at this cost. Deterministic SA indicated that FV effectiveness is the parameter with the greatest potential to interfere with ICER. Probabilistic SA indicated high cost-effectiveness thresholds above which FV would be considered cost-effective: 7,000 Reais for caries and 730,000 Reais for DALYs. The results raise questions about the efficiency (Sensatez? Vantagem?) of FV application, given the small gain in effectiveness compared to substantial costs. Despite limitations, this study provides novel data in the Brazilian dental context and is relevant considering the widespread recommendation for FV use in preschool children.