Relative cost-effectiveness of home visits and telephone contacts in preventing early childhood caries

Abstract

Objectives: To evaluate the cost‐effectiveness of a home‐visit intervention conducted by oral health therapists relative to a telephone‐based alternative and no intervention.

Methods: A Markov model was built to combine data on dental caries incidence, dental treatments, quality of life and costs for a cohort of children from age 6 months to 6 years. The probabilities of developing caries and subsequent treatments were derived primarily from the key intervention study. The outcome measures were costs (US dollars), quality‐adjusted life years (QALYs) and the number of carious teeth prevented. One‐way and probabilistic sensitivity analyses were used to test the stability of the model.

Results: For every group of 100 children, the model predicted that having the home‐visit intervention would save $167 032 and telephone contacts $144 709 over 5½ years relative to no intervention (usual care). The home visits and telephone intervention would prevent 113 and 100 carious teeth (per 100 children) relative to no intervention in a period of 5½ years. Sensitivity analysis showed that a lower rate of caries reduced the intervention's cost‐effectiveness primarily through reducing general anaesthesia costs. The home visits and telephone interventions resulted in 7 and 6 QALYs, respectively, gained over the usual care group for the 100 children over 5½ years. Both interventions were ‘dominant,’ as they saved costs and produced health benefits over usual care.

Conclusions: Both the home visits and telephone‐based community interventions conducted by oral health therapists were highly cost‐effective than no intervention in preventing early childhood caries.