An Economics-based Priority Setting Process For National Dental Resource Allocation

Objectives: Traditionally decisions about health service budgets have perpetuated historical allocations or allocate resources to where the “loudest” case is made, leading to inefficient allocations. Economics has developed approaches to efficiently allocate resources, e.g. programme budgeting and marginal analysis (PBMA). Public views can be incorporated by using valuation techniques such as willingness to pay (WTP). The objective was to undertake a PBMA process for NHS England dentistry incorporating WTP.
Methods: A panel of stakeholders was formed and followed the PBMA process:
1. Consider current dental spending by treatment items/specialty
2. Agree criteria for an ideal service and weight for importance
3. Identify potential new services/growth areas and services for stopping/reduction
4. Collect WTP values from nationally representative sample of the public
5. Find evidence and score each service against criteria
6. Determine a consensus list of services for continued/new funding/disinvestment
Results: The services considered, their scores and final decisions are shown in the table.
Conclusions: Several areas for disinvestment have been recommended focussed around aesthetic treatments, allowing new investments to be suggested principally relating to patient access to services.