Cost-effectiveness of professional oral health care in Australian residential aged care facilities
Cost-effectiveness of professional oral health care in Australian residential aged care facilities
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DOI：
10.1111/ger.12386
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发表时间：
2019-06-01
期刊：
影响因子：
2
通讯作者：
Hsueh, Arthur
中科院分区：
文献类型：
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作者：
Munzenmayer, Melisa A.;Marino, Rodrigo;Hsueh, Arthur
目的从卫生保健系统的角度对澳大利亚维多利亚州社区老年护理机构(RACF)使用口腔卫生专业人员提供口腔卫生服务与现行做法(CP)进行成本-效果分析。背景越来越多的老年人进入RACF，迫切需要进一步发展和提供老龄化牙科的口腔保健方案。材料和方法该模型基于维多利亚州47624个RACF场所一年多的时间。衡量的主要结果是“避免了每个肺炎病例的成本”。四种不同的口腔卫生方案与CP进行了比较。费用包括RACF员工培训、专业人员工资、方案协调员办公室费用、牙科设备和住院费用。每种方案的有效性假设都是基于系统评价和随机对照试验。结果四种情景均为主导策略。负增量成本效益比的大小不能提供信息；因此，增量成本和增量效益被用来显示结果。“每两周提供一次专业口腔保健(POHC)，其他几天提供目前的口腔保健”是最节省成本的替代方案(每个居民节省896澳元)。最有效的替代方案是“每周提供一次POHC，其他日子由训练有素的护士每天提供两次非POHC”(避免了6779例肺炎)。单向敏感性分析证实了结果的稳健性。结论与CP方案相比，四种方案均具有较高的成本效益。这些结果可能是在澳大利亚RACF实施新的口腔健康计划的强有力的基础。
Objective To conduct a model-based cost-effectiveness analysis, from a health care system perspective, of using oral health professionals to provide oral hygiene services at residential aged care facilities (RACFs) in Victoria, Australia, compared to current practice (CP). Background Increasingly dentate cohorts of older adults are entering RACFs, making urgent the need of further development and provision of oral health programmes in ageing dentitions. Materials and Methods The model was based on 47 624 RACFs' places in Victoria over one year. The main outcome measured was "cost per pneumonia case averted." Four different scenarios of oral hygiene provision were compared to CP. Costs included were RACF staff training, professional salaries, programme coordinator office expenses, dental equipment and hospitalisation costs. Effectiveness assumptions for each scenario were based on systematic reviews and randomised control trials. Results All four scenarios were dominant strategies. The magnitude of negative incremental cost-effectiveness ratio was not informative; therefore, incremental costs and incremental effectiveness were used to present results. "Professional oral health care (POHC) provision once every two weeks and current provision of oral health care the other days" was the most cost-saving alternative (AU $896 per resident saved). The most effective alternative was "POHC provision once a week and non-POHC provision by trained Nurse aids twice per day the other days" (6779 pneumonia cases averted). One-way sensitivity analyses confirmed the robustness of results. Conclusion The four scenarios were highly cost-effective compared to CP. These results could be a strong basis to implement new oral health programmes in Australian RACFs.