The study relied on economic modelling to determine the long-term costs and benefits, with a contingent valuation method providing the monetary value of the benefits (in terms of the value of different health states). 

Construction of CWF Markov model 

A probabilistic microsimulation Markov decision analysis model was constructed to simulate the costs and benefits of implementing CWF schemes in England over a lifetime horizon.

Model perspective  

The model takes a societal perspective and assumes each individual to be an NHS patient. Direct costs were considered including CWF scheme implementation and maintenance, direct costs of dental treatment, and indirect costs such as productivity losses. A discount rate of 3.5% was applied to all costs and WTP benefits in the model. 

The model takes a whole population approach incorporating both children and adults.

Model design  

A Markov cohort simulation model was used with a lifetime horizon of up to a maximum of 100 years for those entering the model at birth.

Illustration of model structure 

In each model cycle, assumed to be six months, the population is exposed to a probability of disease progression according to the arrows in the figure above.  Each transition (arrow) is assigned a transition probability based on the literature.