Cost-Utility Analysis of Treatments for Early Childhood Caries in Remote Aboriginal Communities

Introduction: Early childhood caries is a significant problem affecting Aboriginal preschoolers in remote communities who lack access to dental services. A trial was conducted to assess the benefits of atraumatic restorative treatment combined with the Hall technique (ART-HT) versus usual care for managing early childhood caries in this population. Objectives: This trial-based cost-utility analysis evaluates costs and quality-adjusted life-years (QALYs) of ART-HT compared with usual care within a 1-y time frame. Methods: A decision-analytic model simulated the costs and QALYs for 2 scenarios: trial service delivery and minimum ART-HT delivery. The incremental cost per QALY gain ratio (ICER) was calculated for each scenario. QALY were estimated using the Early Childhood Oral Health Impact Scale-4D (ECOHIS-4D) and adjusted for baseline. Probabilistic sensitivity analyses were conducted to assess the robustness of the base-case results. Cost-effectiveness acceptability curves were generated to determine the likelihood of ART-HT being cost-effective at various willingness-to-pay thresholds. All costs are presented in Australian dollars for 2021. Results: Children receiving ART-HT had slightly higher QALYs than those receiving usual care did (0.85 vs. 0.83). The base-case analysis showed an average ICER of $2,013/QALY gained (95% uncertainty interval −$45,246 to $21,676). In the sensitivity analysis, the average ICER was $2,573/QALY gained (95% uncertainty interval −$43,658 to $23,352). ART-HT had an 85% and 81% chance of being cost-effective at a $15,000/QALY gained threshold in the base-case and alternative scenario, respectively. Conclusion: ART-HT showed potential cost-effectiveness compared with usual care within the observed period. While QALY gains were modest, ART-HT may offer a valuable strategy to improve service access for Aboriginal children in remote communities. Knowledge Transfer Statement: This study demonstrates that atraumatic restorative treatment combined with the Hall technique (ART-HT) is cost-effective in managing early childhood caries in remote Aboriginal communities. By providing a viable dental care strategy, ART-HT can improve access to essential dental services, enhance oral health outcomes for Aboriginal preschoolers, and offer value for money, thereby contributing to overall better health in these underserved populations.