Cost-effectiveness of oral care in institutionalized older people

Objectives: There is need for optimized oral care in institutionalized older people. The aim of this health-economic evaluation was to evaluate cost-effectiveness of different alternatives for preventive and curative oral care in institutionalized older people. Methods: An age- and gender-specific Markov model was developed, consisting of six states: at risk, caries, periodontitis, prosthetics treatment need, persistent functional oral problems, and death. The open-cohort model compared estimated costs and health effects of four alternatives: (1) usual care; (2) in-house preventive care; (3) in-house preventive care + curative care in the community; and (4) in-house preventive care + in-house curative care. Health effects were expressed in healthy oral years (HOYs), which was the average time patients spent in the at risk state (i.e. without complications). A healthcare payer perspective was adopted, the time horizon was 10 years, and the setting was Flanders (Belgium). Sensitivity analyses were performed. Results: Alternative 2 and 3 were extendedly dominated by the two other alternatives. The incremental cost-effectiveness ratio (ICER) of ‘in-house prevention + in-house curation’ compared to usual care was 1,132 € per HOY gained. The probability that an intervention would be dominant, compared to usual care, was