Publication: Cost-Effectiveness Analysis comparing six-monthly Dental Home Visits (DHVs) and Educational Leaflets (ELs) with Educational Leaflets (ELs) alone in caries prevention among 5-6-year-olds for 24 months in Malaysia
Date
2024-04
Authors
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Publisher
International Medical University
Abstract
Introduction: According to the National Oral Health Survey of
Preschool Children (NOHPS) in 2015, in Malaysia, caries affects
71.3% of preschool children, most of which remain untreated. Caries is preventable; thus, the caries lesion formation and progression can be controlled. There is a need to find a cost-effective caries prevention
intervention for 5-6-year-olds that is attractive to governmental and private investment. This study investigates the effectiveness and costeffectiveness of delivering 6-monthly Dental Home Visits (DHVs)
and Education Leaflets (ELs) compared to delivering only ELs in
caries prevention of 5-6-year-olds in Malaysia.
Objectives: This study aimed to evaluate the cost-effectiveness of 6-
monthly DHVs and ELs in preventing new caries development in 5–
6-year-olds compared to those receiving only ELs over 24 months.
Methodology: The study design is a community-based randomized controlled trial with two arms. A nested sample of 5–6-year-olds
attending government-funded kindergartens in the state of Selangor within the 2015 NOHPS was randomized to receive 6-monthly DHVs and ELs for the intervention group and only ELs delivered to the control group over 24 months. This study analyzed the costeffectiveness of each arm in preventing new caries development, OHRQoL, and potential dental treatment cost avoidance in 24 months.
This study adopted a government or health provider perspective. The cost data of this study was the estimated cost data, and a conservative approach was adopted to perform sensitivity analysis.
Results: Fourteen out of 100 5-6-year-olds in the intervention group,
and 60 out of 100 5-6-year-olds in the control group developed new caries at the 24-month follow-up. The estimated cost avoidance of
dental treatment on the dental chair of 5-6-year-olds in the intervention group for 24 months was RM 1,500.25, and RM 4,800.00 was the estimated cost avoidance of 5-6-year-olds in the control group
for 24 months. The estimated cost avoidance of comprehensive dental treatment under GA of 5-6-year-olds in the intervention group for 24 months was RM 21,945.25, and RM 90,007.70 was the estimated cost
avoidance of 5-6-year-olds in the control group for 24 months. ICER for dental treatment on the dental chair was RM -72.50, and RM –
1,492.60 was ICER for comprehensive dental treatment under GA. The sensitivity analysis demonstrated consistent negative results, after calculating with different values of total estimated intervention costs
and the total estimated control costs with the range of 15.0-30.0%. 6-
monthly DHVs and ELs remained at quadrant II in the costeffectiveness plane.
Conclusions: Delivering 6-monthly DHVs and ELs resulted in fewer number of 5-6-year-olds developing new caries at 24-month followup.
It would reduce the number of 5-6-year-olds that need dental
treatment and potentially avoid expensive dental treatment due to
caries. 6-monthly DHVs and ELs could reduce the economic burden of caries in 5-6-year-olds in Malaysia
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Keywords
Child, Preschool, Oral Health, Dental Caries, Cost-Effectiveness Analysis, House Calls, Randomized Controlled Trial