Economic Evaluation of Oral Health Preventive Interventions Using a Priority-Setting Approach in Australia

OBJECTIVES: To undertake economic evaluation on five preventive interventions for dental caries among Australian children from low household income: anticipatory guidance provided by dental practitioners via 1) home visits or 2) telehealth consultations; school-based dental screening and fluoride varnish program delivered by 3) dental practitioners or 4) non-dental health practitioners (no screening); and 5) school-based fissure sealant program.

METHODS: Modelling from the healthcare perspective was performed using the dental caries model developed for the ‘Assessing Cost-Effectiveness on Oral Health Preventive Interventions’ project, adapting methods from the 2019 Global Burden of Disease Study. The start age is 0 for interventions 1) and 2) with a time horizon of six years, while interventions 3), 4) and 5) had a two-year time horizon, to reflect the selected effectiveness studies. The base-case scenario included only direct dental caries costs, consisting of a dental check-up and restoration. The alternative scenario included indirect dental caries costs, including children aged <5 years accruing costs for potentially preventable hospitalisations and dental general anaesthesia. The willingness-to-pay thresholds were chosen: AUD$50,000 per disability-adjusted life year (DALY) averted and AUD$50,000 per quality-adjusted life year (QALY) gained.

RESULTS: All interventions had large incremental cost-effectiveness ratios (ICER), which meant none of the interventions were cost-effective when compared to the compared to pre-defined threshold for the base-case and alternative scenarios. The relative cost-effectiveness in order with the lowest to highest ICER values were home visits, fluoride varnish delivered by non-dental health practitioners, telehealth, school-based dental screening and fluoride varnish program and school-based fissure sealant program.

CONCLUSIONS: This study demonstrated there are significant limitations to synthesise evidence to support resource allocation for oral health using existing economic evaluation methodology relying on DALYs or QALYs for dental caries. Addressing the knowledge gap on the long-term cost-consequences from dental caries is essential for investing in oral health.