The surgery-first approach for orthognathic treatment: is it cost-effective?

High-quality healthcare aims to deliver patient-centred cost-effective treatment. The aim of this study was to assess the costs in British pound (£) of the orthodontics-first approach (OFA) and the surgery-first approach (SFA) for the management of dentofacial deformities. This study was based on the retrospective analysis of 55 patients who had undergone orthognathic treatment, with either the SFA or OFA, for correction of dentofacial deformities. The SFA was used for 24 patients and the OFA for 31. All were treated with a Le Fort I osteotomy. The number of appointments for the OFA group was 24, compared to 14 for the SFA group. We calculated the direct medical costs, which included the duration of treatment, the number of consultation clinics, the radiographic imaging, and the surgery and hospitalisation, as well as the indirect costs, which included the time needed to attend the outpatient appointments, any travelling expenses, and loss of income for both patient and carer. The total cost of the OFA (direct and indirect, medical and non-medical), including a discount of 3.5% after the first year, as recommended by the National Institute for Health and Care Excellence, was £16,194, compared to £12,605 for the SFA. The £3590 difference represents a financial efficiency of 22.17% per patient. The difference in the direct medical cost between the two approaches was about £2676, which is 16% of the total costs. The opportunity cost saved by reducing the number of appointments between the two approaches, the average hourly cost per consultant, and the number of consultants, was £517.14, which represented about 3% of the total cost of the OFA case. Therefore, the total cost saving for each SFA case was 25.36%, which included a 22.17% saving of the direct cost and 3.19% of the consultant capacity cost saving. The direct non-medical costs were £366.10 per SFA case and £627.60 per OFA case, which generated a saving of £261.70 for each SFA case. The achieved saving of the indirect cost was £674 per SFA case. The SFA was more cost-efficient than the OFA for delivering orthognathic treatment.