Cost-effectiveness of a telephone-delivered education programme to prevent early childhood caries in a disadvantaged area: a cohort study

Objectives: Early childhood caries is a highly destructive dental disease which is compounded by the need for young children to be treated under general anaesthesia. In Australia, there are long waiting periods for treatment at public hospitals. In this paper, we examined the costs and patient outcomes of a prevention programme for early childhood caries to assess its value for government services. Design: Cost-effectiveness analysis using a Markov model. Setting: Public dental patients in a low socioeconomic, socially disadvantaged area in the State of Queensland, Australia. Participants: Children aged 6 months to 6 years received either a telephone prevention programme or usual care. Primary and secondary outcome measures: A mathematical model was used to assess caries incidence and public dental treatment costs for a cohort of children. Healthcare costs, treatment probabilities and caries incidence were modelled from 6 months to 6 years of age based on trial data from mothers and their children who received either a telephone prevention programme or usual care. Sensitivity analyses were used to assess the robustness of the findings to uncertainty in the model estimates. Results: By age 6 years, the telephone intervention programme had prevented an estimated 43 carious teeth and saved 69 pound 984 in healthcare costs per 100 children. The results were sensitive to the cost of general anaesthesia (cost-savings range 36 pound 043-97 pound 298) and the incidence of caries in the prevention group (cost-savings range 59 pound 496-83 pound 368) and usual care (cost-savings range 46 pound 833-93 pound 328), but there were cost savings in all scenarios. Conclusions: A telephone intervention that aims to prevent early childhood caries is likely to generate considerable and immediate patient benefits and cost savings to the public dental health service in disadvantaged communities.