Phase I orthodontic treatment decision making using Cost-Effectiveness Model

Objectives: Currently, health care in the United States comprise 18% of the GDP which means clinical decision making has to consider financial constraints of patients. This study utilizes economic analysis models, commonly used in medicine, to assess the cost-effectiveness of early interceptive orthodontic treatment protocols.
Methods: We used a combination of available information from current literature and clinical costs to develop an economic decision tree for early interceptive treatment. From these estimates and decision tree we used a one way-sensitivity analysis to determine what the acceptable range of results and costs are for two different early interceptive treatment modalities.
Results: We developed a basic decision tree for our cost-effectiveness model (Figure). Using this decision tree and known estimates of treatment outcomes we were able to analyze hypothetical phase I orthodontic treatment models using one-way sensitivity. Our one-analysis shows the removable appliance-based group is cost-effective only if the upper limit is 15% no change in improvement with combination of 30% greatly improved and 55% improved (based on PAR Index).
Conclusions: Cost-effectiveness requires a combination of improved cost of treatment and similar levels of treatment success. Compared to fixed appliance phase I treatment, in order for the alternative treatment method to be cost-effective the treatment outcome must be at most no worse than the percent difference in costs. Cost-effectiveness and decision analysis is used extensively in medicine, while limited in use in dentistry it is an analysis that merits extensive use in orthodontic research.