Cost effectiveness of implementation strategies in primary care: an RCT

Objectives: To evaluate the cost effectiveness of two strategies designed to promote the implementation of a evidence-based caries preventive treatment for children. Methods: A four-arm cluster RCT in Dental Practices across Scotland. The fee group were offered fees for PFS placed; the education group invited to a EBD workshop; the both group offered fees plus workshop; the control group offered neither. The economic evaluation compared costs and effectiveness from a societal perspective. The costs included the time and travel costs for patients and dentists, the labour and materials costs of treatment and the development costs of the interventions. The effectiveness measure was the proportion of 12-14 year olds receiving PFS on second permanent molars. An additional analysis was conducted to estimate the impact of the introduction of a fee on NHS budgets using the effectiveness data in the trial. Results: Total costs per dentist were: £95 (Control arm); £133 (fee arm); £360 (education arm); and £363 (both arm). Incremental effectiveness of each intervention group relative to the control group was: 0.10 (fee), 0.02 (education), 0.06 (both). An additional analysis estimated that the cost to the NHS of a new fee for placing PFS on children aged 12-14 was estimated to be about £900,000 per year, based on the number of such children attending the GDS in Scotland in 2004-05 (117,695) and the mean number of PFS placed per child in the present study (1.08). Conclusions: From these data, the fee only group is said to strictly dominate the other two intervention groups, being both more effective and less costly. In November 2005, the Scottish Executive announced such a fee, operative from 1 April 2006. Funders: Chief Scientist's Office, Scottish Executive; Scottish Higher Education Funding Council.