Cost-effectiveness of school oral health prevention program: a case study of community dentistry, Mahidol University

Abstract

School may be the only place where oral health services are provided for high-risk children with limited access to dental care. We found this to be a common situation in many low-income countries, compounded by a lack of dental personnel. A school oral health prevention program is widely implemented in Thailand; however, the program's costeffectiveness is under-investigated. This research project evaluated the cost-effectiveness of a comprehensive school oral health program implemented in the academic setting from the provider’s perspective. The retrospective study was conducted using profile data of primary school children in low socioeconomic areas during the academic years 2009–2018 from the Mahidol school oral health program database. The program's effectiveness was measured as DMFT increment scores from the first to the sixth grade between the intervention and control groups. To estimate unit costs for preventive dental services, cost data were collected according to the WHO CostIt program. The total cost was determined based on two elements: recurrent cost and capital cost. The economic costs of the program in the 2015 academic year for first-to sixth-grade children were an average of 1,196,839.37 Baht (34,944.42 USD), comprised of recurrent costs (36.1%) and capital costs (63.9%). Personnel costs and equipment depreciation costs were a major part of recurrent costs and capital costs, respectively. Specifically, capital costs were accountable for more than half of total program costs. The incremental cost-effectiveness ratio (ICER) of the completed 5-year program compared with the control group was 4,035.31 Baht per DMFT avoided. The study findings, which suggested the effectiveness of this program, are useful for its extension and expansion. The cost-effectiveness of the oral prevention program indicated that it is worth implementing, especially for outreach and children of low socioeconomic status at high risk of caries.