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

Abstract

ObjectivesTo 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 settingThe 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.ParticipantsData 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 measuresData 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 measuresUtility 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.ResultsCompared 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.ConclusionsThe 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 numberACTRN12612001271897; Post-results.

Aboriginal Health Workers promoting oral health among Aboriginal and Torres Strait Islander women during pregnancy: Development and pilot testing of the Grinnin’ Up Mums & Bubs program

“…Even without access to dental services; however, oral health advice can still provide a protective effect to a pregnant woman's oral health. A recent study in Australia among pregnant women found that oral health knowledge delivered by midwives was effective in improving oral health even without a clear referral pathway in the short term [21]. As suggested in the ndings, this advice could also be more effectively delivered among Aboriginal and Torres Strait Islander women if culturally appropriate oral health promotion resources are complemented with oral health products.…”

“…These follow up evaluations are important to measure to determine the long-term health and economic impact of the Grinnin' Up Mums & Bubs model of care. Previous evaluations on the e cacy and cost-effectiveness of the MIOH model of care have established that it can reduce dental treatment costs in the long term [21], although more research is needed to determine the long-term impact of the Grinnin' Up Mums & Bubs model. In terms of long-term sustainability, there is also the need to consider the policy barriers that impact on the effectiveness of the model.…”

“…The MIOH intervention was found to be effective in increasing the knowledge and con dence of midwives to promote oral health as well as improving maternal oral health and the uptake of dental services during pregnancy [18]. The intervention was also widely acceptable and feasible for all stakeholders [19,20], effective in increasing the uptake to dental services during pregnancy, improved the maternal oral health of pregnant women [17], and cost effective for health services [21]. The World Health Organization has recently included the MIOH model in their 2021 implementation guidance document as a case study to showcase integration of oral health into primary health care [22].…”

Aboriginal Health Workers Promoting Oral Health among Aboriginal and Torres Strait Islander Women during Pregnancy: Development and Pilot Testing of the Grinnin’ Up Mums & Bubs Program

“…These follow-up evaluations are important to measure to determine the long-term health and economic impact of the Grinnin’ Up Mums & Bubs model of care. Previous evaluations of the efficacy and cost-effectiveness of the MIOH model of care have established that it can reduce dental treatment costs in the long term [ 21 ], although more research is needed to determine the long-term impact of the Grinnin’ Up Mums & Bubs model.…”

“…The MIOH intervention was found to be effective in increasing the knowledge and confidence of midwives to promote oral health as well as improving maternal oral health and the uptake of dental services during pregnancy [ 18 ]. The intervention was also widely acceptable and feasible for all stakeholders [ 19 , 20 ], effective in increasing the uptake to dental services during pregnancy, improved the maternal oral health of pregnant women [ 17 ], and was cost effective for health services [ 21 ]. The World Health Organization has recently included the MIOH model in their 2021 implementation guidance document as a case study to showcase integration of oral health into primary health care [ 22 ].…”