Cost‐effectiveness of professional and mechanical oral care for preventing pneumonia in nursing home residents

Abstract

Background 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. Methods Using a decision tree and Markov modeling, we conducted a cost‐effectiveness analysis from the payer's perspective (social insurers and patients) in Japan. Results 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. Conclusions 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.

Lack of Physician-Dentist Collaboration in Aspiration Pneumonia Prevention

“…The dentists did not tend to cooperate with doctors or other professionals and communicate with them regularly. In addition, professional oral care by dentists is cost-effective; 7 however, reimbursements are not high, which may not motivate dentists to provide oral care.…”

Impacts of body positions on the geniohyoid muscle contraction and swallowing difficulty in healthy adults

“…The number of deaths caused by aspiration and non‐aspiration pneumonia is increasing due aging of the population worldwide (Okubo et al, 2023 ; Shiokawa et al, 2023 ). Impairments in swallowing and cough reflexes cause aspiration pneumonia (Nihei et al, 2015 ; Yamaya et al, 2001 ).…”