title: Should we provide oral health training for staff caring for people with intellectual disabilities in community based residential care? A cost-effectiveness analysis.
abstract: Oral health training is often introduced into community-based residential settings to improve the oral health of people with intellectual disabilities (ID). There is a lack of appropriate evaluation of such programs, leading to difficulty in deciding how best to allocate scarce resources to achieve maximum effect. This article reports an economic analysis of one such oral health program, undertaken as part of a cluster randomized controlled trial. Firstly, we report a cost-effectiveness analysis of training care-staff compared to no training, using incremental cost-effectiveness ratios (ICERs). Effectiveness was measured as change in knowledge, reported behaviors, attitude and self-efficacy, using validated scales (K&BAS). Secondly, we costed training as it was scaled up to include all staff within the service provider in question. Data were collected in Dublin, Ireland in 2009. It cost between €7000 and €10,000 more to achieve modest improvement in K&BAS scores among a subsample of 162 care-staff, in comparison to doing nothing. Considering scaled up first round training, it cost between €58,000 and €64,000 to train the whole population of staff, from a combined dental and disability service perspective. Less than €15,000-€20,000 of this was additional to the cost of doing nothing (incremental cost). From a dental perspective, a further, second training cycle including all staff would cost between €561 and €3484 (capital costs) and €5815 (operating costs) on a two yearly basis. This study indicates that the program was a cost-effective means of improving self-reported measures and possibly oral health, relative to doing nothing. This was mainly due to low cost, rather than the large effect. In this instance, the use of cost effectiveness analysis has produced evidence, which may be more useful to decision makers than that arising from traditional methods of evaluation. There is a need for CEAs of effective interventions to allow comparison between programs. Suggestions to reduce cost are presented.
authors.affiliation: Department of Child and Public Dental Health, Dublin Dental University Hospital, Lincoln Place, Dublin 2, Ireland; School of Dental Science, Trinity College Dublin, Lincoln Place, Dublin 2, Ireland. Electronic address: macgiolla@dental.tcd.ie.
authors.forename: Caoimhin
authors.initials: C
authors.lastname: Mac Giolla Phadraig
authors.affiliation: Department of Child and Public Dental Health, Dublin Dental University Hospital, Lincoln Place, Dublin 2, Ireland; School of Dental Science, Trinity College Dublin, Lincoln Place, Dublin 2, Ireland.
authors.forename: June
authors.initials: J
authors.lastname: Nunn
authors.affiliation: Centre for Disability Studies, School of Psychology, UCD, Dublin, Ireland.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Guerin
authors.affiliation: School of Medicine, Trinity College Dublin, Dublin 2, Ireland.
authors.forename: Charles
authors.initials: C
authors.lastname: Normand
mesh_terms: D003362:Cost-Benefit Analysis; D003730:Dental Care for Persons with Disabilities / Q000191:economics*; D005260:Female; D006801:Humans; D007318:Inservice Training; D008607:Intellectual Disability; D007494:Ireland; D008297:Male; D015397:Program Evaluation; D012112:Residential Facilities
keywords: Economics; Educational evaluation; Evaluation and community-based research; Health promotion; Intellectual disabilities; Oral health