Cost effectiveness modelling of a 'watchful monitoring strategy' for impacted third molars vs prophylactic removal under GA: an Australian perspective

Abstract

Objective: To develop a national level cost model of both the direct and indirect costs of hospitalisations for impacted teeth in Australia. This model will then be used to compare a watchful monitoring strategy for impacted third molars versus prophylactic removal under GA, and calculate possible cost savings in the scenario where Australia would adopt guidelines comparable to the UK.

Methods: Western Australian real hospitalisation data for impacted/embedded teeth removal for 2008/2009 were extrapolated into a national, Australian-wide cost-distribution model for removal strategy. The components of a watchful monitoring strategy were calculated over a one-year, and 20-year period. Cost estimates for both strategies were then compared.

Results: The estimated number of hospitalisations for impacted teeth in Australia in 2008/2009 for the age group 15-34 years was 97,949. The estimated average annual direct cost was $350 million, the indirect cost was $181 million and total cost was $531 million. Individual cost of the watchful monitoring strategy over 20 years was $1,077, with an annual estimated cost of $53. The proposed guidelines would lead to an annual figure of 83,850 individuals avoiding hospitalisation and shifting to watchful monitoring strategy, and an annual reduction of costs ranging between $420-513 million.

Conclusion: With no evidence to support the prophylactic removal of asymptomatic wisdom teeth, a proposed watchful monitoring strategy is a more cost-effective alternative in the Australian context.