OBJECTIVES: There is need for optimized oral care in institutionalized older people. The aim of this health-economic evaluation was to evaluate cost-effectiveness of different alternatives for preventive and curative oral care in institutionalized older people.

METHODS: An age- and gender-specific Markov model was developed, consisting of six states: at risk, caries, periodontitis, prosthetics treatment need, persistent functional oral problems, and death. The open-cohort model compared estimated costs and health effects of four alternatives: (1) usual care; (2) in-house preventive care; (3) in-house preventive care + curative care in the community; and (4) in-house preventive care + in-house curative care. Health effects were expressed in healthy oral years (HOYs), which was the average time patients spent in the at risk state (i.e. without complications). A healthcare payer perspective was adopted, the time horizon was 10 years, and the setting was Flanders (Belgium). Sensitivity analyses were performed.

RESULTS: Alternative 2 and 3 were extendedly dominated by the two other alternatives. The incremental cost-effectiveness ratio (ICER) of ‘in-house prevention + in-house curation’ compared to usual care was 1,132 € per HOY gained. The probability that an intervention would be dominant, compared to usual care, was <3% for all interventions.

CONCLUSIONS: Based on our findings we would recommend health care policy makers to adopt a policy combining preventive and curative oral care, and to consider in-house solutions for oral health care in institutionalized older people. Whether such an in-house preventive and curative approach is cost-effective depends on health care decision makers’ willingness-to-pay to improve oral health in this population. One should keep in mind that large investments are required at the beginning of this approach, and that - even in the long term - it is unlikely that this intervention will become dominant.