Comparison of the Cost Effectiveness of orthognathic Surgery Treatment Between orthodontic-first and Surgery-first Approaches in the Surgical Phase in Thammasat University Hospital
Objectives: This retrospective cohort study aims to evaluate the costs and advantages of the surgical phase of the surgery-first approach (SFA) versus the orthodontic-first approach (OFA).
Methods: Orthognathic surgery has been described as having two concepts: an orthodontic-first approach and a surgery-first approach. However, there was no consensus on which group has the best cost effectiveness in the surgical treatment phase. In total, 70 patients were treated; half of the patients were treated via the SFA, and another half were treated via the OFA. The information collected included operation cost, operation time, total hospital cost, and length of hospitalization. Effectiveness was determined by quality of life, which was measured with the Orthognathic Quality of Life Questionnaire Thai Version (OQLQ) before and then 6 months after treatment. The cost effectiveness was assessed with an incremental cost effectiveness ratio (ICER) and an incremental time effectiveness ratio (ITER).
Results: The results indicated the intervention cost and time of SFA were slightly higher but more effective than those of OFA. However, the operation cost (p=0.375), operation time (p=0.556), total hospital cost (p=0.363), and length of hospitalization (p=0.643) and OQLQ scores (p=0.344) of both groups were not significantly different.
Conclusions: The intervention cost and time of SFA were slightly higher but more effective than those of OFA. Depending on the result of this study, SFA treatment planning was a good choice for orthognathic treatment.
1. Kurabe K, Kojima T, Kato Y, Saito I, Kobayashi T. Impact of orthognathic surgery on oral health-related quality of life in patients with jaw deformities. Int J Oral Maxillofac Surg. 2016;45(12):1513-9.
2. Liou EJ, Chen PH, Wang YC, Yu CC, Huang CS, Chen YR. Surgery-first accelerated orthognathic surgery: postoperative rapid orthodontic tooth movement. J Oral Maxillofac Surg. 2011;69(3):781-5.
3. Shiell A, Donaldson C, Mitton C, Currie G. Health economic evaluation. J Epidemiol Community Health. 2002;56(2):85.
4. Bambha K, Kim W. Cost-effectiveness analysis and incremental cost-effectiveness ratios: uses and pitfalls. Eur J Gastroenterol Hepatol. 2004;16:519-26.
5. Rustemeyer J, Gregersen J. Quality of life in orthognathic surgery patients: post-surgical improvements in aesthetics and self-confidence. J Craniomaxillofac Surg. 2012;40(5):400-4.
6. Lee S, McGrath C, Samman N. Quality of life in patients with dentofacial deformity: a comparison of measurement approaches. Int J Oral Maxillofac Surg. 2007;36(6):488-92.
7. Soh CL, Narayanan V. Quality of life assessment in patients with dentofacial deformity undergoing orthognathic surgery--a systematic review. Int J Oral Maxillofac Surg. 2013;42(8):974-80.
8. Hu J, Jiang Y, Wang D, Guo S, Li S, Jiang H, et al. Comparison of cost-effectiveness and benefits of surgery-first versus orthodontics-first orthognathic correction of skeletal class III malocclusion. Int J Oral Maxillofac Surg. 2021;50(3):367-72.
9. Kotsis SV, Chung KC. Fundamental principles of conducting a surgery economic analysis study. Plast Reconstr Surg. 2010;125(2):727-35.
10. Murphy C, Kearns G, Sleeman D, Cronin M, Allen PF. The clinical relevance of orthognathic surgery on quality of life. Int J Oral Maxillofac Surg. 2011;40(9):926-30.
11. Posnick JC, Wallace J. Complex orthognathic surgery: assessment of patient satisfaction. J Oral Maxillofac Surg. 2008;66(5):934-42.
12. Mirhashemi AH, Ghadirian H, Samimi SM. Surgery-first approach; from claims to evidence: a comprehensive review. Front Dent. 2022;19:23.
13. Jeong WS, Choi JW, Kim DY, Lee JY, Kwon SM. Can a surgery-first orthognathic approach reduce the total treatment time? Int J Oral Maxillofac Surg. 2017;46(4):473-82.
14. Thitiyuk C, Patchanee S, Klaisiri A, Chaiprakit N. Comparison of “orthodontic first” and “surgery first” approaches to quality of life in orthognathic surgery patients: a prospective cohort study. Applied Sciences. 2022;12(23):12137.
15. Vongkamolchoon S, Sinha SP, Liao YF, Chen YR, Huang CS. The impact of a surgery-first approach on oral health-related quality of life. Int J Oral Maxillofac Surg. 2021;50(10):1336-41.
16. Sun H, Shang HT, He LS, Ding MC, Su ZP, Shi YL. Assessing the quality of life in patients with dentofacial deformities before and after orthognathic surgery. J Oral Maxillofac Surg. 2018;76(10):2192-201.
17. Choi WS, Lee S, McGrath C, Samman N. Change in quality of life after combined orthodontic-surgical treatment of dentofacial deformities. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010;109(1):46-51.
18. Baherimoghaddam T, Tabrizi R, Naseri N, Pouzesh A, Oshagh M, Torkan S. Assessment of the changes in quality of life of patients with class II and III deformities during and after orthodontic-surgical treatment. Int J Oral Maxillofac Surg. 2016;45(4):476-85.
19. Jermyn O, Bister D, Jin H. Cost-effectiveness of orthodontics: a systematic review. Eur J Orthod. 2022;44(5):566-77.
20. Silva I, Cardemil C, Kashani H, Bazargani F, Tarnow P, Rasmusson L, et al. Quality of life in patients undergoing orthognathic surgery - a two-centered Swedish study. J Craniomaxillofac Surg. 2016;44(8):973-8.
21. Göelzer JG, Becker OE, Haas Junior OL, Scolari N, Santos Melo MF, Heitz C, et al. Assessing change in quality of life using the oral health impact profile (OHIP) in patients with different dentofacial deformities undergoing orthognathic surgery: a before and after comparison. Int J Oral Maxillofac Surg. 2014;43(11):1352-9.
22. Ngoc H, Raucharernporn S, Kiattavorncharoen S, Boonsiriseth K, Wongsirichat N, Dental M, et al. Surgery first approach in orthognathic surgery. M Dent J. 2016;36(2):209-18.
23. Pelo S, Saponaro G, Patini R, Staderini E, Giordano A, Gasparini G, et al. Risks in surgery-first orthognathic approach: complications of segmental osteotomies of the jaws. a systematic review. Eur Rev Med Pharmacol Sci. 2017;21(1):4-12.
24. Barone S, Morice A, Picard A, Giudice A. Surgery-first orthognathic approach vs conventional orthognathic approach: a systematic review of systematic reviews. J Stomatol Oral Maxillofac Surg. 2021;122(2):162-72.