Economic Evaluation of Community Water Fluoridation: A Community Guide Systematic Review

Am J Prev Med. 2016 Jun;50(6):790-796. doi: 10.1016/j.amepre.2015.10.014. Epub 2016 Jan 6.


Context: A recently updated Community Guide systematic review of the effectiveness of community water fluoridation once again found evidence that it reduces dental caries. Although community water fluoridation was found to save money in a 2002 Community Guide systematic review, the conclusion was based on studies conducted before 1995. Given the update to the effectiveness review, re-examination of the benefit and cost of community water fluoridation is necessary.

Evidence acquisition: Using methods developed for Community Guide economic reviews, 564 studies were identified within a search period from January 1995 to November 2013. Ten studies were included in the current review, with four covering community fluoridation benefits only and another six providing both cost and benefit information. Additionally, two of the six studies analyzed the cost effectiveness of community water fluoridation. All currencies were converted to 2013 dollars.

Evidence synthesis: The analysis was conducted in 2014. The benefit-only studies used regression analysis, showing that different measures of dental costs were always lower in communities with water fluoridation. For the six cost-benefit studies, per capita annual intervention cost ranged from $0.11 to $4.92 for communities with at least 1,000 population, and per capita annual benefit ranged from $5.49 to $93.19. Benefit-cost ratios ranged from 1.12:1 to 135:1, and these ratios were positively associated with community population size.

Conclusions: Recent evidence continues to indicate that the economic benefit of community water fluoridation exceeds the intervention cost. Further, the benefit-cost ratio increases with the community population size.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Cost-Benefit Analysis / economics*
  • Dental Caries / prevention & control
  • Fluoridation / economics*
  • Humans
  • Models, Economic
  • Residence Characteristics*