Comparison the cost-effectiveness of orthognathic surgery treatment between orthodontics-first and surgery-first approaches in the surgical phase in Thammasat University Hospital

This retrospective cohort study aims to evaluate the costs and advantages of the surgicalphase of the surgery-first approach (SFA) versus the orthodontic-first approach (OFA). In total,70 patients were treated; half of the patients were treated via the SFA, and another halfwere treated via the OFA. The information collected included operative cost, operative time,total hospital cost, and length of hospital stay. Effectiveness was determined based onquality of life, which was measured with the Orthognathic Quality of Life Questionnaire ThaiVersion (OQLQ) before and 6 months after treatment. The cost-effectiveness was assessedwith an incremental cost-effectiveness ratio (ICER) and an incremental time effectivenessratio (ITER). The ICER of operative cost revealed an increase of 345.55 baht per OQLQ pointgained, and the ITER of operative time revealed a minimally higher operative time of 2.58minutes per OQLQ compared between SFA and OFA. The results indicate the interventioncost and time of SFA are slightly higher but more effective than those of OFA. However, theoperative cost (P=0.375), operative time (P=0.556), total hospital cost (P=0.363), andRef. code: 25666413030435JEFlength of hospital stay (P=0.643) and OQLQ scores (P=0.344) of both groups are notsignificantly different. Thus, if the proper criteria are to use both SFA and OFA, thedecision to plan treatment depends on the preferences of the patient and clinician.Although the previous study showed significantly more intraoperative time spent inthe SFA group, this study shows no significant difference between SFA and OFA.Moreover, the SFA has higher outcomes (QOL score). Depending on the result of thisstudy, SFA treatment planning is a good choice for orthognathic treatment. This studyconcerns only the surgical phase of orthognathic treatment; it may be better to do along-term study of total treatment time in the future.