Cost-effectiveness analysis of school-based Oral Health Preventive Program at public primary school in Bangkok

Abstract

The Department of Community Dentistry, Faculty of Dentistry, Mahidol University has been involved in the rendering of mobile oral health preventive services to children at some public primary schools in Bangkok, Thailand as part of their dental students community-based teaching and training. This is a retrospective study based on secondary data collected during 1995-2000. A quasi- experimental design was used to test the differences between two groups of children, one implementing the school-based oral health preventive program and the other group not implementing the program. The purpose of this study was to analyze the cost-effectiveness of five years school-based oral health preventive program at public primary school in Bangkok. The analysis was based on a community intervention comparing an experimental group receiving pit and fissure dental sealant, fluoride mouthrinsing, professional fluoride-containing paste application, preventive resin restoration and an annual oral health education, with a control group doing nothing. The study outcomes were mean differences in DMFT increments between study groups. The results showed that decayed, missing and filled teeth in the permanent dentition (DMFT) in the 11- 12 years in experimental group (1.60) differ from the DMFT (1.993) of the control group at 5% level of statistical significane. Moreover, the experimental group had 19.72% fewer caries than their counterparts in control group. However, the caries reduction was only 23.59%. Furthermore, the findings indicated that, from the provider perspective, the average cost over 5 years was 2,298.02 baths per person which divided into capital costs 1,509.84 baths (65.70%) and the recurrent costs 788.18 baths (34.30%). Recurrent costs were classified into 2 categories; labor costs and material costs. Costs of dental equipments, salaries of supervisor and costs of material for pit and fissure sealant were a majority part of capital costs, labor costs and material costs respectively. Especially, the dental equipment ‘s costs were responsible for more than half of total costs. The annual average cost per person was 459.73 baths. The cost-effectiveness of this program was 1,677.38 baths, and incremental cost-effectiveness ratio was 5,432.66 baths per additional DMFT prevented per person over five years. According to the results finding, to achieve DMFT ≤1.5 in the national oral health goals by the year 2000 at 12-year-olds under the certain circumstance criteria, the estimated additional costs were 543.26 baths per person over five years.