Designing Value-Based Dental Benefit Packages: A Multicriteria Decision Analysis in the Netherlands

Sarroukh, Ziade; Jeurissen, Patrick; Baltussen, Rob; Akter, Shaila; Janssen, Jip; Listl, Stefan

Designing Value-Based Dental Benefit Packages: A Multicriteria Decision Analysis in the Netherlands

Articles in Press

Document Type : Original Article

Authors

Ziade Sarroukh ¹

Patrick Jeurissen ²

Rob Baltussen ²

Shaila Akter ³^{, 1}

Jip Janssen ¹

Stefan Listl ³^{, 1}

¹ Department of Dentistry, Radboud University Medical Center, Nijmegen, The Netherlands

² Department of IQ Health, Radboud University Medical Center, Nijmegen, The Netherlands

³ Heidelberg Institute of Global Health, Section for Oral Health, Heidelberg University Hospital, Heidelberg, Germany

Abstract

Background
Oral diseases increasingly pose pressing challenges on the global political agenda. Given the vast absence of evidence-informed optimization of oral health resources, this study aimed to evaluate the application of multicriteria decision analysis (MCDA) for the design of value-based dental benefit packages in the Netherlands.

Methods
The MCDA approach of this study was aligned with three workshops, during which representatives from patient organizations, the dental profession, health insurers, policy-makers, and academic experts participated in an advisory panel to design benefit packages. Participants selected 17 conventional dental services for assessment through literature review and expert elicitation. Decision criteria included severity of treated oral diseases, the extent to which interventions produce positive effects on clinical and quality of life outcomes, the rate of complications resulting from interventions and the extent of high and unpredictable costs posing insurance risk. Performance on these criteria were combined via swing weights into cost-value ratios and informed deliberation of the advisory panel to determine priority rankings for interventions as well as allocate into minimal, moderately sized, and maximal packages. The overall priority setting process was evaluated with an online questionnaire.

Results
Following deliberation, the advisory panel ranked routine dental checkup, tooth extraction, oral hygiene instruction and direct restoration among highest priority interventions eligible for minimal coverage. Participants expanded this coverage with root canal treatment, scaling and polishing, partial denture, and occlusal splint in the moderately sized package. Periodontal therapy, tooth replacement, and indirect restoration were covered in the maximally expanded package. Participants expressed overall satisfaction with the process.

Conclusion
The findings of this study suggest MCDA to be a suitable approach to inform deliberative optimization of oral health resources and derive value-based benefit packages for oral healthcare. The highest priority ranking was identified for routine dental checkup and the lowest ranking for indirect restoration.

Keywords

Benefits Package

Multicriteria Decision Analysis

Oral Healthcare

Priority Setting

The Netherlands

ValueBased Care

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