Discounting Practices in Cost-Effectiveness Analyses in Dentistry: A Systematic Review of Studies Published After 2020.

Abstract

Economic evaluations guide resource allocation decisions in dentistry, where preventive interventions often involve upfront costs and long-term benefits. Discounting can strongly influence results, yet inconsistencies in rate selection and justification persist. Despite growing recognition that discount rate selection substantially influences cost-effectiveness conclusions, no systematic review has focused specifically on discounting practices in dental economic evaluations published under the CHEERS 2022 framework. We therefore reviewed discounting practices in cost-effectiveness analyses (CEAs) of dental interventions published after January 1, 2020. We systematically searched eight databases (MEDLINE via PubMed, Web of Science, EconLit, Embase, PROSPERO, Central, Scopus, CEA Registry) for full economic evaluations of dental interventions published after January 1, 2020, with time horizons >1 year. Inclusion was limited to Latin alphabet publications and empirical studies. Backward/forward citation tracking supplemented the search. Reporting quality was appraised using CHEERS 2022. Extracted data included discount rates, justifications, perspectives, model types, and intervention categories. From 2581 records, 83 studies were included. Discount rates ranged from 1.5% to 9%; 3% was most common (41%). Thirteen percent omitted discounting, and 27% provided no justification; when justified, 60% cited government guidelines. Perspectives were predominantly healthcare sector (44%), with societal only 8%. Preventive interventions accounted for 47%. Average CHEERS 2022 compliance was 80.4%. Discounting practices in recent dental CEAs remain inconsistent, potentially biasing against preventive strategies. Greater adherence to reporting standards and context-specific guideline updates are needed.