Economic Evaluation of the RETURN Intervention to Increase Routine Dental Attendance Among Disadvantaged Adults: Net Health Benefit (QALYs) and Patient Cost Outcomes From a Randomised Controlled Trial.

IF 2.9 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Community dentistry and oral epidemiology Pub Date : 2026-06-19 DOI:10.1111/cdoe.70085

Tayamika Zabula, Victoria Lowers, Dan Howdon, Rebecca Harris

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Abstract

Objectives: Routine dental attendance is associated with better health outcomes, yet those from disadvantaged backgrounds are more likely to seek problem-driven, episodic care. The RETURN intervention, a brief behavioural intervention delivered by dental nurses in urgent care, was designed to support urgent care users to take up planned dental care. This study evaluates the cost-effectiveness of the RETURN intervention.

Methods: A cost-utility analysis was conducted alongside a randomised controlled trial. Resource use and health outcomes, measured in Quality-Adjusted Life Years (QALYs) derived from the EQ-5D-5L questionnaire, were evaluated at 12 and 18 months. The primary analysis used a cost-effectiveness threshold of £20 000 per QALY. Multiple imputation was used to account for missing data. Objectives also included providing an estimated incremental cost per improved Oral health impact profile (OHIP-14) point.

Results: The intervention was found to be cost-effective with high confidence. At 12 months, intervention incremental cost was £18.83 with incremental Quality-Adjusted Life Year (QALY) gain of 0.014, and an incremental net health benefit (NHB) of 0.013 QALYs. The probability of cost-effectiveness was 90.5%. At 18 months, the incremental cost was £15.11 for a QALY gain of 0.009, and incremental NHB of 0.008 (probability of cost-effectiveness 70.9%). The findings were supported by complete case analysis, which showed probabilities of cost-effectiveness of 99.7% at 12 months and 98.5% at 18 months. Sub-group analysis gave the strongest evidence of cost-effectiveness in the most deprived populations.

Conclusions: The RETURN intervention is highly likely to be a cost-effective use of National Health Service resources. Its impact appears particularly strong among those living in the most deprived areas, suggesting the potential to reduce inequalities in access to routine dental care.

Trial registration: The RETURN trial was registered at isrctn.com (ISRCTN84666712).

查看原文本刊更多论文

RETURN干预增加弱势成人常规牙科就诊的经济评价：一项随机对照试验的净健康效益（QALYs）和患者成本结果

目的：常规牙科检查与更好的健康结果相关，但那些来自弱势背景的人更有可能寻求问题驱动的偶发性护理。回归干预是一项由牙科护士在紧急护理中提供的简短行为干预，旨在支持紧急护理使用者接受计划的牙科护理。本研究评估回归干预的成本效益。方法：在随机对照试验的同时进行成本-效用分析。通过EQ-5D-5L问卷得出的质量调整生命年（QALYs）测量资源利用和健康结果，在12个月和18个月时进行评估。初步分析使用每个QALY 20,000英镑的成本效益阈值。使用多重输入来解释缺失的数据。目标还包括提供每个改善口腔健康影响概况（OHIP-14）点的估计增量成本。结果：该干预措施具有较高的置信度和成本效益。在12个月时，干预的增量成本为18.83英镑，质量调整生命年（QALY）的增量收益为0.014，净健康效益（NHB）的增量为0.013 QALYs。成本-效果概率为90.5%。在18个月时，增量成本为15.11英镑，QALY收益为0.009，增量NHB为0.008（成本-效果概率为70.9%）。研究结果得到完整病例分析的支持，12个月的成本-效果概率为99.7%，18个月的成本-效果概率为98.5%。亚组分析为最贫困人群的成本效益提供了最有力的证据。结论：回归干预极有可能是对国家卫生服务资源的有效利用。它对生活在最贫困地区的人的影响似乎特别大，这表明有可能减少获得常规牙科护理的不平等现象。试验注册：在isrctn.com上注册了RETURN试验（ISRCTN84666712）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Community dentistry and oral epidemiology 医学-公共卫生、环境卫生与职业卫生

CiteScore

4.40

自引率

8.70%

发文量

审稿时长

6 months

期刊介绍： The aim of Community Dentistry and Oral Epidemiology is to serve as a forum for scientifically based information in community dentistry, with the intention of continually expanding the knowledge base in the field. The scope is therefore broad, ranging from original studies in epidemiology, behavioral sciences related to dentistry, and health services research through to methodological reports in program planning, implementation and evaluation. Reports dealing with people of all age groups are welcome. The journal encourages manuscripts which present methodologically detailed scientific research findings from original data collection or analysis of existing databases. Preference is given to new findings. Confirmations of previous findings can be of value, but the journal seeks to avoid needless repetition. It also encourages thoughtful, provocative commentaries on subjects ranging from research methods to public policies. Purely descriptive reports are not encouraged, nor are behavioral science reports with only marginal application to dentistry. The journal is published bimonthly.