Economic evaluation of a community dental care model for people experiencing homelessness

Tan Minh Nguyen; Robert Witton; Lyndsey Withers; Martha Paisi

doi:10.1038/s41415-024-8166-1

Economic evaluation of a community dental care model for people experiencing homelessness

Br Dent J. 2024 Dec 12. doi: 10.1038/s41415-024-8166-1. Online ahead of print.

Authors

Tan Minh Nguyen¹, Robert Witton², Lyndsey Withers³, Martha Paisi⁴

Affiliations

¹ Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Melbourne, Australia; Health Economics Division, Public Health and Preventive Medicine, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Australia; Dental Health Services, Victoria, Melbourne, Australia. tan.nguyen@deakin.edu.au.
² Peninsula Dental School, University of Plymouth, Plymouth, UK.
³ Community Research Partner, Plymouth, UK.
⁴ Peninsula Dental School, University of Plymouth, Plymouth, UK; School of Nursing and Midwifery, University of Plymouth, Plymouth, UK.

PMID: 39668201
DOI: 10.1038/s41415-024-8166-1

Abstract

Aim The study aims to conduct economic evaluation of the Peninsula Dental Social Enterprise (PDSE) programme for people experiencing homelessness over an 18-month period, when compared to a hypothetical base-case scenario ('status quo').Methods A decision tree model was generated in TreeAge Pro Healthcare 2024. Benefit-cost analysis and cost-effectiveness analysis were performed using data informed by the literature and probabilistic sensitivity analysis (Monte Carlo simulation with 1,000 cycles). The pre-determined willingness-to-pay threshold was estimated to be £59,502 per disability-adjusted life year (DALY) averted. Costs (£) and benefits were valued in 2020 prices. Health benefits in DALYs included dental treatment for dental caries, periodontitis and severe tooth loss.Results The hypothetical cohort of 89 patients costs £11,502 (SD: 488) and £57,118 (SD: 2,784) for the base-scenario and the PDSE programme, respectively. The health outcomes generated 0.9 (SD: 0.2) DALYs averted for the base-case scenario, and 5.4 (SD: 0.9) DALYs averted for the PDSE programme. The DALYs averted generated £26,648 (SD: 4,805) and £163,910 (SD: 28,542) in benefits for the base-scenario and the PDSE programme, respectively. The calculated incremental benefit-cost ratio was 3.02 (SD: 0.5) and incremental cost-effectiveness ratio was £10,472 (SD: 2,073) per DALY averted. Uncertainty analysis demonstrated that the PDSE programme was 100% cost-effective.Conclusions Funding a targeted dental programme from the UK healthcare perspective that provides timely and affordable access to dental services for people experiencing homelessness is cost-effective.