Cost-effectiveness of interceptive orthodontics: a long-term evaluation of early treatment strategies.

Abstract

Objectives: Malocclusions occur at high frequencies in children and adolescents. While early orthodontic (interceptive) interventions may reduce the need for later comprehensive treatment, their cost-effectiveness in publicly funded health systems is unclear. This study compares the cost-effectiveness of interceptive orthodontic care and fixed-appliance therapy, focusing on total costs, treatment outcomes, and resource use.

Methods: A decision tree model was developed using observational data on treatment success rates, duration, and appointments to estimate resource use and costs for interceptive orthodontic care; Fixed Appliance therapy was modeled as an optimal 2-year treatment pathway. A health-care payer perspective was applied. Incremental costs and effects were calculated for four interceptive modalities: Quad Helix, Extraoral Traction (EOT), Removable Plates, and Activator appliances, as compared to fixed appliance therapy. Minimum required success rates were estimated for achieving cost-neutrality. Probabilistic sensitivity analyses (10 000 Monte Carlo simulations) and scenario analyses assessed the robustness of the results.

Results: All the interceptive treatments demonstrated lower expected costs than the fixed appliance therapy, albeit with lower clinical effectiveness. Quad Helix exceeded the minimum required success rate 20% points, representing a clear margin of cost-effectiveness. Removable Plates also exceeded the minimum required success rate, but with a smaller margin of 6% points. The Activator and EOT appliances were more dependent on patient compliance and failed to meet the minimum required success rate, requiring increases of 13% and 10% points, respectively, to achieve cost-neutrality. Sensitivity analyses confirmed these patterns and underscored the importance of long-term treatment stability.

Limitations: The model assumed a 100% success rate for fixed appliances and relied on expert opinion for long-term stability parameters, given the limited availability of relapse data.

Conclusions: In the publicly funded dental care context studied, the use of Quad Helix and removable plates in publicly funded health-care systems appears to be cost-effective. Activator and EOT appliances should be used selectively. The study also contributes a transparent, adaptable modeling framework that can incorporate locally relevant costs and future long-term outcome data, supporting use in other publicly funded settings.