Costing analysis of the Government Assisted Populations oral health program

Refugee populations face tremendous psychological, financial, and physical health challenges due to traumatic experiences and the stresses of resettlement. Access to oral healthcare represents a significant challenge due to language barriers, cost, and lack of familiarity with the healthcare system. Robust costing analyses are necessary to inform oral health programs tailored to newly landed refugees. The purpose of this study was to estimate the costs associated with delivering the Government Assisted Populations (GAP) oral health program for refugees settling in Nova Scotia, Canada.

Using a bottom-up micro-costing method, we calculated the yearly direct and indirect costs associated with the delivery of oral health services via the GAP program between 2016 and 2024 from a healthcare system and societal perspectives. Direct costs consisted of the treatments rendered, and the salaries of a program coordinator and two language interpreters. Indirect costs were measured as opportunity costs. The valuation of costs was done according to published professional documents (i.e., Nova Scotia Dental Association suggested fee guide) and the current market values for goods and services. All costs were adjusted to the 2025 Canadian Dollars (CAD).

Data from nine years of the GAP program data (2016-2024) were analyzed. The number of beneficiaries of the program/year rose from 67 patients in 2016 to 187 in 2024. The average annual treatment costs ranged from CAD 191 (SD 73) in 2016 to CAD 1,188 (SD 1,297) in 2024. The average annual productivity losses incurred by patients also rose from CAD 51 (SD 21) in 2016 to CAD 164 (SD 156) in 2024. Except for the first year, during which only hygiene services were administered, unmet needs were highest for restorative (19%-69%), preventive (13%-48%), and oral surgical (1%-10%). Total direct costs of the program ranged from CAD 53,589 in 2016 to CAD 267,622 in 2024. Over the same period, total indirect costs ranged from CAD 3,411 to CAD 30,561.

The GAP oral health program addressed substantial oral healthcare needs among refugees, with costs increasing alongside service demand. These findings provide evidence to inform resource allocation and support equitable, culturally appropriate oral healthcare programs for newly resettled refugee populations.