{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T14:11:26Z","timestamp":1773929486596,"version":"3.50.1"},"reference-count":29,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T00:00:00Z","timestamp":1763596800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T00:00:00Z","timestamp":1763596800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100002322","name":"Coordena\u00e7\u00e3o de Aperfei\u00e7oamento de Pessoal de N\u00edvel Superior","doi-asserted-by":"publisher","award":["finance code 001"],"award-info":[{"award-number":["finance code 001"]}],"id":[{"id":"10.13039\/501100002322","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004586","name":"Funda\u00e7\u00e3o Carlos Chagas Filho de Amparo \u00e0 Pesquisa do Estado do Rio de Janeiro","doi-asserted-by":"publisher","award":["E\u201026\/211.929\/2021"],"award-info":[{"award-number":["E\u201026\/211.929\/2021"]}],"id":[{"id":"10.13039\/501100004586","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003593","name":"Conselho Nacional de Desenvolvimento Cient\u00edfico e Tecnol\u00f3gico","doi-asserted-by":"publisher","award":["309803\/2022\u20105"],"award-info":[{"award-number":["309803\/2022\u20105"]}],"id":[{"id":"10.13039\/501100003593","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Comm Dent Oral Epid"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>International economic evaluations have not found convincing evidence that the application of fluoride varnish (FV) in preschool children is a cost\u2010effective anti\u2010caries measure, and there is a lack of economic evaluations of FV in the Brazilian context.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>This study evaluated the cost\u2010effectiveness (CE) of standard care plus FV for Brazilian preschoolers in the general population, comparing it to standard care in terms of prevention of cavitated caries lesions and disability\u2010adjusted life years (DALY) outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Markov models were used, with a 4\u2010year time horizon and 6\u2010month\u2009cycles. Transition probabilities were obtained from a national epidemiological survey and randomised controlled trials (RCTs). The effectiveness of FV was derived from a systematic review of RCTs. Costs (in Brazilian reais) were sourced from the 2022 National Agency for Supplemental Health dental procedures list. A discount rate of 5% was applied. CE analyses, Markov simulations (MS), and sensitivity analyses (SA) were conducted. Deterministic sensitivity analysis (DSA) used a 95% confidence interval for each variable. For probabilistic sensitivity analysis (PSA), beta distribution curves were used for probabilities, gamma for costs, and lognormal for effectiveness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Standard care plus FV showed an increase in effectiveness (0.01894 and 0.00018 for avoided caries and DALY, respectively) compared to standard care, with an additional cost of R$131.27 per child in the 4\u2010year period. The ICER (incremental cost\u2010effectiveness ratio) was calculated at R$6929.09 per cavitated caries lesion prevented and R$727604.84 per DALY avoided. MS revealed little difference in the percentage of individuals in each health state at the end of the simulations. FV prevented cavities in 4 out of every 100 children over a 4\u2010year period, at an average annual cost of R$33 per child (assuming each child who developed cavitated caries lesions had only one). DSA indicated that FV effectiveness was the parameter with the highest potential to influence the ICER. PSA suggested high CE thresholds, from which FV would be considered cost\u2010effective: R$7000 for caries and R$730000 for DALY.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The total cost of care was lower in the group that invested less in prevention (without FV) compared to the group that invested more (with FV). While it is often said that \u201cmore prevention is always better,\u201d economic evaluations remind us that not all preventive strategies provide good value for money.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/cdoe.70031","type":"journal-article","created":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T06:22:46Z","timestamp":1763706166000},"page":"191-202","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cost\u2010Effectiveness of Applying Fluoride Varnish to Preschoolers in a Brazilian Scenario: An Economic Modelling Study"],"prefix":"10.1111","volume":"54","author":[{"given":"Izabel Monteiro","family":"Dhyppolito","sequence":"first","affiliation":[{"name":"Department of Epidemiology, Institute of Social Medicine Rio de Janeiro State University  Rio de Janeiro Brazil"},{"name":"Arthur S\u00e1 Earp Neto University Center\/Medicine Faculty of Petr\u00f3polis\u2010UNIFASE\/FMP  Petr\u00f3polis Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rodolfo","family":"Castro","sequence":"additional","affiliation":[{"name":"Department of Health Administration and Planning National School of Public Health Oswaldo Cruz Foundation  Rio de Janeiro Brazil"},{"name":"Department of Permanent Education and Integrality in Health Institute of Collective Health, Federal University of the State of Rio de Janeiro  Rio de Janeiro Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5688-4747","authenticated-orcid":false,"given":"Ana Paula Pires","family":"dos Santos","sequence":"additional","affiliation":[{"name":"Department of Community and Preventive Dentistry, Faculty of Dentistry Rio de Janeiro State University  Rio de Janeiro Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paulo","family":"Nadanovsky","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Institute of Social Medicine Rio de Janeiro State University  Rio de Janeiro Brazil"},{"name":"Department of Epidemiology and Quantitative Methods in Health, National School of Public Health Oswaldo Cruz Foundation  Rio de Janeiro Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,11,20]]},"reference":[{"key":"e_1_2_9_2_1","volume-title":"Pesquisa Nacional de Sa\u00fade Bucal: Resultados Principais","author":"Brasil","year":"2010"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(19)31146-8"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1177\/0022034520908533"},{"issue":"7","key":"e_1_2_9_5_1","first-page":"403","article-title":"Is Caries Associated With Negative Impact on Oral Health\u2010Related Quality of Life of Pre\u2010School Children? 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