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

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.

International benchmarking of hospitalisations for impacted teeth: a 10-year retrospective study from the United Kingdom, France and Australia.

BACKGROUND: The United Kingdom and its national healthcare system represent a unique comparison for many other developed countries (such as Australia and France), as the practice of prophylactic removal of third molars in the United Kingdom has been discouraged for nearly two decades, with clear guidelines issued by the National Institute of Health and Care Excellence (NICE) in 2000 to limit third molar removal to only pathological situations. No such guidelines exist in Australia or France. The healthcare systems in England, France and Australia all use the International Classification of Disease (ICD) coding system for diagnostic categorising of all admissions to hospitals. AIM: This study rested upon the opportunity of a universal coding system and semi-open access data to complete the first comparative study on an international scale of hospitalisations for removal of impacted teeth (between 99/00 and 08/09). RESULTS: Our international comparison revealed significant differences in rates of admission, with England having rates approximately five times less than France, and seven times less than Australia. Those results could be explained by the implementation of guidelines in the United Kingdom, and the absence of similar guidelines in France and Australia.