Oral healthcare delivery in institutionalised older people: A health-economic evaluation

Amber Werbrouck, Masja Schmidt, Lieven Annemans, Joke Duyck, Barbara Janssens, Steven Simoens, Nick Verhaeghe, Koen Putman

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OBJECTIVES: This health-economic evaluation aimed to assess the cost-effectiveness of a number of alternatives for preventive and curative oral health care in institutionalised older people in Flanders.

METHODS: A six-state Markov model was used to compare expected costs and healthy oral years (HOYs) of four alternatives: (1) usual care; (2) on-site preventive care; (3) on-site preventive care + curative care in the community; and (4) on-site preventive care + on-site curative care. A healthcare payer perspective was adopted, and the time horizon was 10 years. Deterministic and probabilistic sensitivity analyses were performed.

RESULTS: Incremental cost-effectiveness ratios (ICERs) of alternatives 2, 3 and 4 (all compared to alternative 1) were as follows: (2) 7944 €/HOY gained; (3) 1576 €/HOY gained; and (4) 1132 €/HOY gained. Hence, alternatives 2 and 3 were not cost-effective compared to alternative 4. The probability that oral care interventions are more effective and cost-saving than usual care was <3% for all three interventions.

CONCLUSIONS: For institutionalised older people, on-site solutions for preventive and curative oral health care might be the most cost-effective alternative. It should be kept in mind that on-site solutions require large initial investment and that the advanced age of the population and the high costs of oral health care make it unlikely that these interventions would become cost-saving, even in the long term.

Original languageEnglish
Pages (from-to)107-120
Number of pages14
Issue number2
Early online date25 Jan 2021
Publication statusPublished - Jun 2022

Bibliographical note

© 2021 Gerodontology Association. John Wiley & Sons Ltd.


  • aged
  • cost-effectiveness analysis
  • oral health care
  • residential facilities


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