Economic evaluation of the Midwifery Initiated Oral Health-Dental Service programme in Australia

Kathy W Tannous; Ajesh George; Moin Uddin Ahmed; Anthony Blinkhorn; Hannah G Dahlen; John Skinner; Shilpi Ajwani; Sameer Bhole; Albert Yaacoub; Ravi Srinivas; Maree Johnson

doi:10.1136/bmjopen-2020-047072

Economic evaluation of the Midwifery Initiated Oral Health-Dental Service programme in Australia

BMJ Open. 2021 Aug 2;11(8):e047072. doi: 10.1136/bmjopen-2020-047072.

Authors

Kathy W Tannous¹, Ajesh George^{2

3}, Moin Uddin Ahmed⁴, Anthony Blinkhorn³, Hannah G Dahlen^{5

6}, John Skinner⁷, Shilpi Ajwani^{3

8}, Sameer Bhole^{3

8}, Albert Yaacoub⁹, Ravi Srinivas^{10

3

11}, Maree Johnson^{6

12}

Affiliations

¹ Translational Health Research Institute, Digital Health Cooperative Research Centre, Economics, Finance and Property, School of Business, Western Sydney University, Penrith, New South Wales, Australia.
² Centre for Oral Health Outcomes & Research Translation (COHORT), Western Sydney University, South Western Sydney Local Health District, Ingham Institute Applied Medical Research, Liverpool, New South Wales, Australia a.george@westernsydney.edu.au.
³ School of Dentistry, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia.
⁴ Translational Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia.
⁵ School of Nursing and Midwifery, Western Sydney University, Penrith, New South Wales, Australia.
⁶ Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia.
⁷ Poche Centre for Indigenous Health, The University of Sydney, Sydney, New South Wales, Australia.
⁸ Oral Health Services and Sydney Dental Hospital, Sydney Local Health District, Surry Hills, New South Wales, Australia.
⁹ Oral Health Services, Nepean Blue Mountains Local Health District, Penrith, New South Wales, Australia.
¹⁰ Centre for Oral Health Outcomes & Research Translation (COHORT), Western Sydney University, South Western Sydney Local Health District, Ingham Institute Applied Medical Research, Liverpool, New South Wales, Australia.
¹¹ Oral Health Services, South Western Sydney Local Health District, Liverpool, New South Wales, Australia.
¹² Australian Catholic University, North Sydney, New South Wales, Australia.

Abstract

Objectives: To critically evaluate the cost-effectiveness of the Midwifery Initiated Oral Health-Dental Service (MIOH-DS) designed to improve oral health of pregnant Australian women. Previous efficacy and process evaluations of MIOH-DS showed positive outcomes and improvements across various measures.

Design and setting: The evaluation used a cost-utility model based on the initial study design of the MIOH-DS trial in Sydney, Australia from the perspective of public healthcare provider for a duration of 3 months to 4 years.

Participants: Data were sourced from pregnant women (n=638), midwives (n=17) and dentists (n=3) involved in the MIOH trial and long-term follow-up.

Cost measures: Data included in analysis were the cost of the time required by midwives and dentists to deliver the intervention and the cost of dental treatment provided. Costs were measured using data on utilisation and unit price of intervention components and obtained from a micro-costing approach.

Outcome measures: Utility was measured as the number of Disability Adjusted Life Years (DALYs) from health-benefit components of the intervention. Three cost-effectiveness analyses were undertaken using different comparators, thresholds and time scenarios.

Results: Compared with current practice, midwives only intervention meets the Australian threshold (A$50 000) of being cost-effective. The midwives and accessible/affordable dentists joint intervention was only 'cost-effective' in 6 months or beyond scenarios. When the midwife only intervention is the comparator, the midwife/dentist programme was 'cost-effective' in all scenarios except at 3 months scenario.

Conclusions: The midwives' only intervention providing oral health education, assessment and referral to existing dental services was cost-effective, and represents a low cost intervention. Midwives' and dentists' combined interventions were cost-effective when the benefits were considered over longer periods. The findings highlight short and long term economic benefits of the programme and support the need for policymakers to consider adding an oral health component into antenatal care Australia wide.

Trial registration number: ACTRN12612001271897; Post-results.

Keywords: health economics; obstetrics; public health.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Australia
Cost-Benefit Analysis
Dental Care
Female
Humans
Midwifery*
Oral Health
Pregnancy

Associated data

ANZCTR/ACTRN12612001271897