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Updated: Jan 11, 2026
Author Spotlight: Unlocking the Mysteries of Oral Potential Malignancies
Published on: August 11, 2023
Cost-Effectiveness Analysis of Non-Surgical Interventions for Oral Submucous Fibrosis: A Novel Economic Framework
Anusa Arunachalam Mohandoss1, Krishnan Sumathy2, Rooban Thavarajah3,4
1Department of Psychiatry, Shree Satya Sai Medical College and Research Institute, Affiliated to Sri Balaji Vidyapeeth, Deemed to be University, Chennai, Tamil Nadu, India.
Background:
Oral submucous fibrosis (OSF) is a chronic, progressive disorder characterised by reduced mouth opening (MO) and a risk of malignant transformation. Despite numerous non-surgical interventions, sustained functional improvement remains elusive. This study introduces a cost-effectiveness analysis framework to compare various OSF treatments, addressing a critical knowledge gap.
Materials And Methods:
Data from a previously published network meta-analysis (NMA) comprising 72 studies ( N = 5268 patients) were analysed. Cost/millimeter of MO improvement (cost/mm) and cost/millimeter/week (cost/mm/week) were calculated. Incremental Cost-Effectiveness Ratio (ICER) was computed against placebo and multivitamins. P ≤0.05 considered significant.
Results:
The median cost/mm was INR 1906.57, ranging from INR 403.35 (ultrasound + exercise) to INR 10,368.36 (steroids + exercise). Cost/mm/week ranged from INR 59.97 (topical steroids) to INR 2292.83 (steroids + exercise). Kruskal-Wallis tests showed significant differences in cost/mm ( P = 0.002) and cost/mm/week ( P = 0.004). ICER analysis identified steroid with or with spreading factor (SSF) + exercise as the most cost-effective (-4918.38 INR/placebo, -2365.78 INR/multivitamins), while SSF + placebo was least cost-effective (ICER: 8540.79 INR/placebo, 8382.25 INR/multivitamins).
Discussion And Conclusion:
This study presents the first cost-effectiveness analysis of non-surgical OSF treatments, revealing substantial economic variations across interventions. Ultrasound with exercise and SSF + exercise was the most cost-efficient, supporting the integration of multimodal non-pharmacological therapies into OSF management. Conversely, nutraceutical products (NPs) demonstrated inconsistent cost-effectiveness, with systemic NPs outperforming topical applications. Given the economic burden and limited efficacy of some treatments, these findings emphasise the need for evidence-based, cost-conscious decision-making. The cost/mm and cost/mm/week metrics provide a novel perspective, facilitating better resource allocation in OSF care.
