Department of Health Care Policy and Health Economics, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
Department of Clinical Laboratory Medicine, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan.
J Am Geriatr Soc. 2023 Mar;71(3):756-764. doi: 10.1111/jgs.18122. Epub 2022 Nov 5.
Pneumonia is common in nursing home residents and is a leading cause of hospitalization and death. Nursing home residents with cerebrovascular diseases and impaired consciousness are at high risk of aspiration pneumonia. Professional and mechanical oral care by dentists and hygienists in addition to daily oral care by caregivers was shown to be effective in preventing pneumonia in nursing home residents. However, professional and mechanical oral care has not been widely provided in Japan, while daily oral care by caregivers has been widely provided as a basic service in nursing homes. This study aimed to evaluate the cost-effectiveness of providing professional and mechanical oral care for preventing pneumonia in nursing home residents.
Using a decision tree and Markov modeling, we conducted a cost-effectiveness analysis from the payer's perspective (social insurers and patients) in Japan.
The incremental cost-effectiveness ratio for professional and mechanical oral care compared with daily oral care only was calculated as 4,079,313 Japanese yen (¥; 33,994 United States dollars [US$], US$1 = ¥120) per quality-adjusted life year.
Using the official value of social willingness to pay for a one-quality-adjusted life year gain in Japan of ¥5 million (US$41,667) as the threshold to judge cost-effectiveness, providing professional and mechanical oral care is cost-effective. Our results suggest professional and mechanical oral care for preventing pneumonia in nursing home residents could be justifiable as efficient use of finite healthcare resources. The results have implications for oral care in nursing homes both in Japan and worldwide.
肺炎在养老院居民中很常见，是导致住院和死亡的主要原因。患有脑血管疾病和意识障碍的养老院居民患吸入性肺炎的风险很高。牙医和保健师提供的专业和机械口腔护理以及护理人员的日常口腔护理被证明可有效预防养老院居民的肺炎。然而，在日本，专业和机械口腔护理并未广泛提供，而护理人员的日常口腔护理已作为养老院的基本服务广泛提供。本研究旨在评估为预防养老院居民肺炎而提供专业和机械口腔护理的成本效益。
使用决策树和马尔可夫模型，我们从支付者（社会保险人及患者）的角度对日本的成本效益进行了分析。
与仅进行日常口腔护理相比，专业和机械口腔护理的增量成本效益比为 4,079,313 日元（¥；33,994 美元[US$]，1 美元=¥120）/质量调整生命年。
使用日本官方的每获得一个质量调整生命年的社会意愿支付价值 500 万日元（US$41,667）作为判断成本效益的阈值，提供专业和机械口腔护理具有成本效益。我们的结果表明，为预防养老院居民肺炎而提供专业和机械口腔护理可能是合理利用有限医疗资源的一种方式。这些结果对日本和全球的养老院口腔护理都具有启示意义。
