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Cost-utility of dental implant placement to

support lower complete denture in Thailand

Warisa Panichkriangkrai1

Sirinart Tongsiri 2

Jongkol Lertiendumrong 1

Kumaree Pachanee 1

Chitpranee Vasavid 1

Phusit Prakongsai 1

1 International Health Policy Program (IHPP) – Thailand2 Faculty of Medicine, Mahasarakham University

The First Annual Conference of HTAsiaLinkGrand Pacific Sovereign Hotel, Petchaburi,Thailand

May 14‐16, 2012

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• Background information– Demand for complete denture and dental

implant placement in Thailand

• Methodologies• Research findings • Discussion• Policy recommendations

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Outline of presentation

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“Complete dentures" are prosthetic devices constructed to replace missing all teeth in dental arch, and which are supported by surrounding soft and hard tissues of the oral cavity.

However, when teeth are absent, the bone, especially lower Mandible, slowly desorbs. This desorption can cause problems in

terms of both function and esthetics and can lead to the instability of denture.

Those who do wear dentures can decrease the amount of bone loss by retaining dental implant in the form of over denture

abutments.

Complete denture

Dental implant

Background (1)

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National dental health survey in 2006-2007 shows that

more than 1,100,000 of Thais have already worn lower

complete denture,

Almost 100,000 patients have problems with their

denture such as pain, instability of denture and

discomfort ,

The dental implant placement can evidently improve

patients’ quality of life, however the CE of this treatment

using ICER has never been explored in Thailand,

The dental implant has not been included into the UHC

benefit package yet.

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Background (2)

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Choices of treatments for conventional complete denture and dental implant

Source: Data from the Royal Dental Implant Project, Institute of Dentistry, 2010

92,509 cases

1,156,360 cases

22,202 cases

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Methods (1)

Comprehensive literature reviews and interviews key stakeholders, Employed ICER to estimate the costs per QALYs gained between having and not having dental implant,

Costs of treatment included direct medical costs, indirect costs, cost of dental implantation, and capacity building costs,

Quality-adjusted life years or the outcome of treatment, calculated from degree of quality of life and life expectancy at specified age or age of patients receiving dental implants,

Uncertainty analysis was applied and average value was used to calculate ICER. The comparator of this study was no treatment which means patients continue wearing uncomfortable denture.

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Target population

Those who wear lower complete denture

Comparator

Lower complete denture wearers who are suffering from denture wearing problems, and haven’t got any treatment

Timeline Dental implants can function well for the rest of patients’ life

Methods (2)

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Research findings

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Costs of dental implant placement

Cost (Baht)

Direct medical costsMedical

services33,600

Dental implant

6,420

Preparation 840Indirect cost 1,356

total cost 42,116

Table 2:

Estimates of budget impact in 5 year

Table 1:Cost of dental implant

placement

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- The sample of 75 cases comprised mostly women (70.7%) aged between 18-73 yrs, with the average age of 41.7 yrs,

- Using decision tree from choices of treatments, highest level of QOL in term of satisfaction (score 0-1) for those samples :

• Wearing complete denture without dental implant (0.829), • Success in wearing implant-supported dentures (0.771), • Having contraindication for dental implant (0.53), and • Failure in dental implant (0.459)

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Quality of life (QOL) improvements

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Incremental cost-effectiveness ratio (ICER)

Starting age (year) 45 60

Difference in costs

(Baht & US dollars)

40,504 Baht

(1,306 USD)

40,504 Baht

(1,306 USD)

Difference in outcome

(QALYs)12.22 7.87

ICER (per QALY)3,314 Baht

(106 USD)

5,147 Baht

(166 USD)

Note: 1USD = 31 Baht

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Dental implant placement is cost-effective and has low budget impact, comparing with standard criteria of National Health Security Office (NHSO) Any treatment with ICER lower than 1 GDP per cap per QALY

would be considered to be cost-effective,

• The tool to measure QOL of patients receiving complete denture and dental implant is very limited, and this study had limitations in sampling bias,

• The UCBP subcommittee decided not to include this treatment into the UHC benefit package due to the shortage of dentists and a large share of elderly unable to access complete denture,

• Economic evaluation is not only the single criteria for making decisions on including any health interventions into the UHC benefit package.

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Discussion and Conclusions

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There are a number of priorities for scaling up health system capacity for dental care in Thailand, number of trained dentists, access to complete denture of the elderly, and Appropriate financing system for improving access

to dental care in Thailand,

The most important priority is to increase access of elderly patients to get complete dentures which is the basic treatment of edentulous arch, and already included in the UHC benefit package.

Health system readiness and capacity to implement the policy is another key issue for policy making decision.

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Policy recommendations

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• National Health Security Office (NHSO) of Thailand,• The Universal Coverage Benefit Package

Subcommittee of NHSO,• Ministry of Public Health (MOPH) of Thailand• Institute of Dentistry of Thailand

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Acknowledgement