Economic evaluation of the Midwifery Initiated Oral Health-Dental Service programme in Australia
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 measure...
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| Language: | English |
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BMJ Publishing Group
2021-08-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/11/8/e047072.full |
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| author | Hannah G Dahlen Maree Johnson John Skinner Ajesh George Kathy W Tannous Moin Uddin Ahmed Anthony Blinkhorn Shilpi Ajwani Sameer Bhole Albert Yaacoub Ravi Srinivas |
| author_facet | Hannah G Dahlen Maree Johnson John Skinner Ajesh George Kathy W Tannous Moin Uddin Ahmed Anthony Blinkhorn Shilpi Ajwani Sameer Bhole Albert Yaacoub Ravi Srinivas |
| author_sort | Hannah G Dahlen |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-0183967adb7c4edab395a3572b9deaae |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2021-08-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-0183967adb7c4edab395a3572b9deaae2024-12-09T00:05:07ZengBMJ Publishing GroupBMJ Open2044-60552021-08-0111810.1136/bmjopen-2020-047072Economic evaluation of the Midwifery Initiated Oral Health-Dental Service programme in AustraliaHannah G Dahlen0Maree Johnson1John Skinner2Ajesh George3Kathy W Tannous4Moin Uddin Ahmed5Anthony Blinkhorn6Shilpi Ajwani7Sameer Bhole8Albert Yaacoub9Ravi Srinivas101 School of Nursing and Midwifery, Western Sydney University, Penrith South, New South Wales, AustraliaIngham Institute for Applied Medical Research, Liverpool, New South Wales, AustraliaHeart Research Institute Ltd, Newtown, New South Wales, Australia2 Australian Centre for Integration of Oral Health, School of Nursing & Midwifery, Western Sydney University, Liverpool, New South Wales, AustraliaTranslational Health Research Institute, Digital Health Cooperative Research Centre, Economics, Finance and Property, School of Business, Western Sydney University, Penrith, New South Wales, AustraliaTranslational Health Research Institute, Western Sydney University, Penrith, New South Wales, AustraliaSchool of Dentistry, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, AustraliaSchool of Dentistry, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, AustraliaSchool of Dentistry, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, AustraliaOral Health Services, Nepean Blue Mountains Local Health District, Penrith, New South Wales, AustraliaCentre 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, AustraliaObjectives 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.https://bmjopen.bmj.com/content/11/8/e047072.full |
| spellingShingle | Hannah G Dahlen Maree Johnson John Skinner Ajesh George Kathy W Tannous Moin Uddin Ahmed Anthony Blinkhorn Shilpi Ajwani Sameer Bhole Albert Yaacoub Ravi Srinivas Economic evaluation of the Midwifery Initiated Oral Health-Dental Service programme in Australia BMJ Open |
| title | Economic evaluation of the Midwifery Initiated Oral Health-Dental Service programme in Australia |
| title_full | Economic evaluation of the Midwifery Initiated Oral Health-Dental Service programme in Australia |
| title_fullStr | Economic evaluation of the Midwifery Initiated Oral Health-Dental Service programme in Australia |
| title_full_unstemmed | Economic evaluation of the Midwifery Initiated Oral Health-Dental Service programme in Australia |
| title_short | Economic evaluation of the Midwifery Initiated Oral Health-Dental Service programme in Australia |
| title_sort | economic evaluation of the midwifery initiated oral health dental service programme in australia |
| url | https://bmjopen.bmj.com/content/11/8/e047072.full |
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