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

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)