The distributional impact of the UK soft drinks industry levy on dental care costs: An extended cost-effectiveness analysis

OBJECTIVE: To evaluate the dental healthcare benefits among children and the financial impacts of the soft drinks industry levy (SDIL) as well as the distributional effects of benefits and costs across different socioeconomic groups in England, using real-world data. METHODS: We conducted an extended cost-effectiveness analysis (ECEA) to evaluate the impact of the SDIL on: (i) averted dental treatment activity and hospitalisations in children under 18 years, (ii) associated NHS cost savings and (iii) the distributional impact across deprivation quintiles, covering the period from April 2018 to December 2024. Dental treatment activity was obtained as courses of treatment (CoTs) by treatment bands from NHS Dental Statistics, while admissions for caries-related extractions were from Hospital Episode Statistics. Five separate interrupted time series models were fitted for CoTs (bands 1-3 and urgent care) and hospitalisations. Averted treatment was calculated as the absolute difference between predicted and counterfactual trends. RESULTS: 3.48 (95% CI: 1.50, 5.67) million CoTs were avoided, saving £124.75 (48.32, 210.34) million. The largest reductions were in the second least deprived and middle quintiles whereas CoTs increased in the two most deprived quintiles. Furthermore, 53,093 (43,119, 62,209) dental hospitalisations were averted, saving £76.61 (60.22, 91.17) million. Reductions were observed across all deprivation quintiles, with the largest reductions among the two most deprived groups. CONCLUSION: Dental treatment activity and dental hospitalisations among children fell following implementation of the SDIL, generating NHS cost savings in England. Differences by area deprivation were consistent with expected shifts in caries distribution and reductions in socioeconomic inequalities in childhood dental caries achieved through the SDIL.