Strengthening adult oral health priority setting in Estonia: value-based revision of dental benefits

Background

Oral diseases remain highly prevalent across Europe, yet decisions on publicly funded dental benefits are often incremental and lack transparent prioritisation. In Estonia, the adult dental care benefit has undergone adjustments without a formal value-based assessment. This study applies Multi-Criteria Decision Analysis (MCDA) to support an evidence-informed revision of coverage and facilitate deliberation on population group eligibility.

Methods

Using Nominal Group Technique, an advisory panel (n = 8) of policymakers, patient representatives, dentists, health insurers, and clinical academics defined interventions for prioritisation and selected decision criteria. Interventions are evaluated against agreed criteria, and criteria weights are elicited through individual panel questionnaires. Literature- and expert-informed performance scores are combined with cost-per-adult estimates derived from utilisation and tariff data to generate a comparative ranking. A process evaluation assesses participants’ experiences.

Results

The panel proposed a revised set of candidate interventions for the benefit scheme, targeting gingivitis, periodontitis, caries, and pulpal and apical disease. Decision criteria comprised disease burden, clinical efficacy, patient safety, and impact on quality of life, forming the basis for comparison. Ongoing scoring and costing, still preliminary, are expected to generate differentiated performance profiles that inform prioritisation and coverage discussions.

Conclusions

This study explores the potential of applying MCDA within a stakeholder-based deliberative context to support revision of a national adult dental benefit. By introducing explicit criteria and structured scoring, the approach, novel in dentistry, may strengthen transparency and legitimacy in oral health priority setting, inform benefit redesign, and promote accountable and rational allocation of public resources for dental care in Estonia.

Key messages

• MCDA with a stakeholder panel supports transparent prioritisation of adult dental services, enabling value-based revision of public benefit coverage and more rational resource allocation in Estonia.

• Combining deliberation with explicit criteria and structured scoring strengthens legitimacy in oral health priority setting and promotes systematic decisions on interventions and population coverage.