Falk Schwendicke1, Michael Stolpe2, Frauke Müller3. 1. Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Berlin, Germany. 2. Kiel Institute for the World Economy, Kiel, Germany. 3. Division of Gerodontology and Removable Prosthodontics, University Clinics of Dental Medicine, Geneva, Switzerland.
Abstract
AIM: Professional oral health care (POHC) prevents nursing home-acquired pneumonia (NHAP) and its related mortality. We assessed the cost-effectiveness of POHC versus no POHC (nPOHC) and the monetary value of eliminating uncertainty by future research. METHODS: A German public-private payer perspective was adopted. A Markov model was used, following long-term care residents from admission to death. Cost-effectiveness was estimated as Euro/disability-adjusted life year (DALY) using Monte Carlo microsimulations. Value-of-information analyses were performed. The willingness-to-pay threshold/DALY was assumed to be 66% (range 50%-100%) of per-capita gross domestic product (GDP). RESULTS: nPOHC was less costly (€3,024) but also less effective (0.89 DALYs) than POHC (€10,249, 0.55 DALYs). For most presumed payers, POHC was cost-effective. The cost-effectiveness of POHC was higher in smokers, underweight or pulmonary disease patients. Eliminating uncertainty about the NHAP costs, NHAP incidence/mortality, and POHC effectiveness would result in an expected net value of 47 million €/year (and even higher values at lower GDP thresholds), and is likely to decrease with time. CONCLUSIONS: Within the chosen setting and on the basis of current evidence, POHC was cost-effective. Given the detected uncertainty, further research seems warranted.
AIM: Professional oral health care (POHC) prevents nursing home-acquired pneumonia (NHAP) and its related mortality. We assessed the cost-effectiveness of POHC versus no POHC (nPOHC) and the monetary value of eliminating uncertainty by future research. METHODS: A German public-private payer perspective was adopted. A Markov model was used, following long-term care residents from admission to death. Cost-effectiveness was estimated as Euro/disability-adjusted life year (DALY) using Monte Carlo microsimulations. Value-of-information analyses were performed. The willingness-to-pay threshold/DALY was assumed to be 66% (range 50%-100%) of per-capita gross domestic product (GDP). RESULTS: nPOHC was less costly (€3,024) but also less effective (0.89 DALYs) than POHC (€10,249, 0.55 DALYs). For most presumed payers, POHC was cost-effective. The cost-effectiveness of POHC was higher in smokers, underweight or pulmonary diseasepatients. Eliminating uncertainty about the NHAP costs, NHAP incidence/mortality, and POHC effectiveness would result in an expected net value of 47 million €/year (and even higher values at lower GDP thresholds), and is likely to decrease with time. CONCLUSIONS: Within the chosen setting and on the basis of current evidence, POHC was cost-effective. Given the detected uncertainty, further research seems warranted.
Authors: Jesus Gomez-Rossi; Jondis Schwartzkopff; Anne Müller; Katrin Hertrampf; Jens Abraham; Georg Gassmann; Peter Schlattmann; Gerd Göstemeyer; Falk Schwendicke Journal: BMJ Open Date: 2022-03-29 Impact factor: 2.692
Authors: Falk Schwendicke; Joachim Krois; Thomas Kocher; Thomas Hoffmann; Wolfgang Micheelis; Rainer A Jordan Journal: J Clin Periodontol Date: 2018-11-20 Impact factor: 8.728