THE COST MINIMIZATION ANALYSIS OF AN OUTREACH DENTAL SERVICE: A PILOT STUDY AT AKINYELE LOCAL GOVERNMENT AREA IN NIGERIA

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O.T. Alade, O.A. Arikawe, F.B. Lawal and J.O. Taiwo

Department of Periodontology and Community Dentistry, University College Hospital, Ibadan

Abstract

Background: Access to dental services improves oral health and thereby, overall general health. For people with limited or no access to oral health care services,
outreach dental services may be used to reduce oral health inequality. There is however paucity of information on the economic analysis of outreach dental services in sub Saharan Africa.

Objective: To report a cost minimization analysis of an outreach dental service as compared with a primary oral health clinic.

Method: A comparative analysis of the costs expended in the treatment of patients at an outreach dental service of the University College Hospital, Ibadan was done versus the costs that would have been incurred if the patients had been treated at a Primary Oral Health Clinic of the same institution.

Results: A total of three hundred and forty two (342) participants were attended to at the outreach dental service. More than 80% of the 123 participants examined
had an unmet oral health need. The procedures carried out were in keeping with the basic package of oral care. The average cost of the outreach perparticipant was N530 (~$2.50) only versus an estimate of N868 (~$4.13) per participant if the programme had been clinic based. The total cost savings was N115,344 (~$549.26).

Conclusion: Outreach dental services provide similar dental treatment to services in a primary oral health clinic at a reduced cost.

Keywords: Access, Basic package of oral care, Cost analysis, Dental services, Oral health care, Oral health inequalities

Introduction

Access to oral health care is a challenge faced by a sizeable proportion of Nigerians.¹ Paradoxically, those with the greatest need for oral care have the least access to care.² Outreach dental services are uniquely poised to reduce disparities in access to oral health care services and are therefore one of the approaches to increasing access to dental services.^3,4 They remove barriers to access such as cost of transport to the clinic, child minding concerns and geographic obstacles⁵ while still providing services of comparable quality to that offered in the clinic based services.⁶ Epidemiological surveys carried out in Ibadan, Nigeria have shown low caries prevalence among school children.⁷ Likewise, a study conducted in a local government area of Ibadan revealed low caries prevalence among the elderly and a mean Decayed Missing and Filled Teeth (DMFT) of 0.46.⁸ However, in a study assessing the periodontal health status in a population of elderly inhabitants of a local government area in Ibadan, periodontal disease was found to be of high prevalence, 94.8%.⁹ There is a low caries prevalence in the young and elderly, however most of the people affected are unable to access dental treatment¹⁰ and this results in a high rate of untreated dental disease.8 This further results in premature loss of teeth, orofacial infections and deaths.^{11, 12}

Outreach dental services offer a remarkable and practical approach to reducing inequalities in health and improving access to oral health care.^{4, 13} In a systematic review of outreach dental services, it was found that outreach dental services are effective, reach a wider coverage and overcome barriers of access to care.¹³ Likewise, studies have shown that outreach dental services have lower unit costs per treatment than traditional stationary dental clinics.^{14, 15} However, there is a dearth of information on cost analysis studies of outreach dental services in Nigeria. This should be addressed because the field of health economics has assumed increasing significance in the decision making process for health interventions and programmes.¹⁶ This is due to the need to allocate scarce resources efficiently, especially in low resource settings with grossly inadequate health financing.¹⁷

The four basic types of analyses described in health economics are Cost Minimization, Cost-Benefit, Cost- Utility and Cost Effectiveness analyses.¹⁸ A cost minimization analysis is appropriate when the outcomes for two programmes or interventions are similar but there is a need to determine the less expensive approach.¹⁹ This pilot study therefore aimed to report the cost minimization analysis of a dental outreach programme as compared with a primary oral health clinic.