Cost savings from a teledentistry model for school dental screening: an Australian health system perspective
Mohamed Estai A D , Stuart Bunt B , Yogesan Kanagasingam C and Marc Tennant AA International Research Collaborative – Oral Health and Equity, School of Human Sciences, University of Western Australia (M309), 35 Stirling Highway, Crawley, WA 6009, Australia. Email: marc.tennant@uwa.edu.au
B Department of Anatomy and Human Biology, School of Human Sciences, University of Western Australia, Crawley, WA6009, Australia. Email: stuart.bunt@uwa.edu.au
C Australian e-Health Research Centre, CSIRO, Butterfield Street and Bowen Bridge Road, Herston, Qld 4029, Australia. Email: Yogi.Kanagasingam@csiro.au
D Corresponding author. Email: abdalla177@gmail.com
Australian Health Review 42(5) 482-490 https://doi.org/10.1071/AH16119
Submitted: 7 June 2016 Accepted: 6 April 2017 Published: 5 June 2017
Abstract
Objective The aim of the present study was to compare the costs of teledentistry and traditional dental screening approaches in Australian school children.
Methods A cost-minimisation analysis was performed from the perspective of the oral health system, comparing the cost of dental screening in school children using a traditional visual examination approach with the cost of mid-level dental practitioners (MLDPs), such as dental therapists, screening the same cohort of children remotely using teledentistry. A model was developed to simulate the costs (over a 12-month period) of the two models of dental screening for all school children (2.7 million children) aged 5–14 years across all Australian states and territories. The fixed costs and the variable costs, including staff salary, travel and accommodation costs, and cost of supply were calculated. All costs are given in Australian dollars.
Results The total estimated cost of the teledentistry model was $50 million. The fixed cost of teledentistry was $1 million and that of staff salaries (tele-assistants, charters and their supervisors, as well as information technology support was estimated to be $49 million. The estimated staff salary saved with the teledentistry model was $56 million, and the estimated travel allowance and supply expenses avoided were $16 million and $14 million respectively; an annual reduction of $85 million in total.
Conclusions The present study shows that the teledentistry model of dental screening can minimise costs. The estimated savings were due primarily to the low salaries of dental therapists and the avoidance of travel and accommodation costs. Such savings could be redistributed to improve infrastructure and oral health services in rural or other underserved areas.
What is known about the topic? Caries is a preventable disease, which, if it remains untreated, can cause significant morbidity requiring costly treatment. Regular dental screening and oral health education have the great potential to improve oral health and save significant resources. The use of role substitution, such as using MLDPs to provide oral care has been well acknowledged worldwide because of their ability to provide safe and effective care. The teledentistry approach for dental screening offers a comparable diagnostic performance to the traditional visual approach.
What does this paper add? The results of the present study suggest that teledentistry is a practical and economically viable approach for mass dental screening not only for isolated communities, but also for underserved urban communities. The costs of the teledentistry model were substantially lower than the costs associated with a conventional, face-to-face approach to dental screening in both remote and urban areas. The primary driver of net savings is the low salary of MLDPs and avoidance of travel and overnight accommodation by MLDPs.
What are the implications for practitioners? The use of lower-cost MLDPs and a teledentistry model for dental screening has the potential to save significant economic and human resources that can be redirected to improve infrastructure and oral care services in underserved regions. In the absence of evidence of the economic usefulness of teledentistry, studies such as the present one can increase the acceptance of this technology among dental care providers and guide future decisions on whether or not to implement teledentistry services.
Additional keywords: caries, children, cost-analysis, smartphone.
References
[1] Mejia G, Amarasena N, Ha DH, Roberts-Thomson K, Ellershaw A. Child dental health survey Australia 2007: 30-year trends in child oral health . Canberra: Australian Institute of Health and Welfare; 2012.[2] Nash DA, Friedman JW, Kardos TB, Schwarz E, Satur J, Berg DG, Nasruddin J, Mumghamba EG, Davenport ES, Nagel R. Dental therapists: a global perspective. Int Dent J 2008; 58 61–70.
| Dental therapists: a global perspective.Crossref | GoogleScholarGoogle Scholar |
[3] Hopcraft M, Martin‐Kerry JM, Calache H. Dental therapists’ expanded scope of practice in Australia: a 12‐month follow‐up of an educational bridging program to facilitate the provision of oral health care to patients 26+ years. J Public Health Dent 2015; 75 234–44.
| Dental therapists’ expanded scope of practice in Australia: a 12‐month follow‐up of an educational bridging program to facilitate the provision of oral health care to patients 26+ years.Crossref | GoogleScholarGoogle Scholar |
[4] Spencer AJ. Narrowing the inequality gap in oral health and dental care in Australia . Sydney: Australian Health Policy Institute, University of Sydney; 2004.
[5] Harford J, Luzzi L. Child and teenager oral health and dental visiting . Canberra: Australian Institute of Health and Welfare; 2013.
[6] Kruger E, Smith K, Tennant M. Non‐working dental therapists: opportunities to ameliorate workforce shortages. Aust Dent J 2007; 52 22–5.
| Non‐working dental therapists: opportunities to ameliorate workforce shortages.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD2s3ovFynuw%3D%3D&md5=a1b03c551b85f5b8fd3a3e9f51010fcfCAS |
[7] Teusner DN, Amarasena N, Satur J, Chrisopoulos S, Brennan DS. Applied scope of practice of oral health therapists, dental hygienists and dental therapists. Aust Dent J 2016; 61 342–9.
| Applied scope of practice of oral health therapists, dental hygienists and dental therapists.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC28zhslKmug%3D%3D&md5=076de46f20886a3e862790b8d80435a4CAS |
[8] Chrisopoulos S, Harford J, Ellershaw A. Oral health and dental care in Australia: key facts and figures 2015. Catalogue no. DEN 229 . Canberra: Australian Institute of Health and Welfare; 2016.
[9] Donahue GJ, Waddell N, Plough AL, del Aguila MA, Garland TE. The ABCDs of treating the most prevalent childhood disease. Am J Public Health 2005; 95 1322–4.
| The ABCDs of treating the most prevalent childhood disease.Crossref | GoogleScholarGoogle Scholar |
[10] Australian Institute of Health and Welfare (AIHW). Health expenditure Australia 2013–14. Health and Welfare Expenditure Series no. 54. Catalogue no. HWE 63. Canberra: AIHW; 2015.
[11] Selwitz RH, Ismail AI, Pitts NB. Dental caries. Lancet 2007; 369 51–9.
| Dental caries.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD2sXit12itA%3D%3D&md5=000bbb727fe1ebd1d1f4687f8f494c7dCAS |
[12] Greenberg BL, Glick M. Assessing systemic disease risk in a dental setting: a public health perspective. Dent Clin North Am 2012; 56 863–74.
| Assessing systemic disease risk in a dental setting: a public health perspective.Crossref | GoogleScholarGoogle Scholar |
[13] Brocklehurst P, Ashley J, Walsh T, Tickle M. Relative performance of different dental professional groups in screening for occlusal caries. Community Dent Oral Epidemiol 2012; 40 239–46.
| Relative performance of different dental professional groups in screening for occlusal caries.Crossref | GoogleScholarGoogle Scholar |
[14] Macey R, Glenny A, Walsh T, Tickle M, Worthington H, Ashley J, Brocklehurst P. The efficacy of screening for common dental diseases by hygiene-therapists a diagnostic test accuracy study. J Dent Res 2015; 94 70S–8S.
| The efficacy of screening for common dental diseases by hygiene-therapists a diagnostic test accuracy study.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC2MvnvFelsw%3D%3D&md5=3d04aff4fc141a3980fb49eb1ee0a08dCAS |
[15] Nash DA. Adding dental therapists to the health care team to improve access to oral health care for children. Acad Pediatr 2009; 9 446–51.
| Adding dental therapists to the health care team to improve access to oral health care for children.Crossref | GoogleScholarGoogle Scholar |
[16] Brocklehurst P, Ashley J, Tickle M. Patient assessment in general dental practice – risk assessment or clinical monitoring? Br Dent J 2011; 210 351–4.
| Patient assessment in general dental practice – risk assessment or clinical monitoring?Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC3Mvlt1Kjsg%3D%3D&md5=eecefce8878c19c8fce996afaf093135CAS |
[17] Estai M, Kanagasingam Y, Xiao D, Vignarajan J, Huang B, Kruger E, Tennant M. A proof-of-concept evaluation of a cloud-based store-and-forward telemedicine app for screening for oral diseases. J Telemed Telecare 2016; 22 319–25.
| A proof-of-concept evaluation of a cloud-based store-and-forward telemedicine app for screening for oral diseases.Crossref | GoogleScholarGoogle Scholar |
[18] Estai M, Kanagasingam Y, Huang B, Checker H, Steele L, Kruger E, Tennant M. The efficacy of remote screening for dental caries by mid-level dental providers using a mobile teledentistry model. Community Dent Oral Epidemiol 2016; 44 435–41.
| The efficacy of remote screening for dental caries by mid-level dental providers using a mobile teledentistry model.Crossref | GoogleScholarGoogle Scholar |
[19] Kopycka-Kedzierawski DT, Billings RJ. Comparative effectiveness study to assess two examination modalities used to detect dental caries in preschool urban children. Telemed J E Health 2013; 19 834–40.
| Comparative effectiveness study to assess two examination modalities used to detect dental caries in preschool urban children.Crossref | GoogleScholarGoogle Scholar |
[20] Mariño R, Tonmukayakul U, Manton D, Stranieri A, Clarke K. Cost-analysis of teledentistry in residential aged care facilities. J Telemed Telecare 2016; 22 326–32.
| Cost-analysis of teledentistry in residential aged care facilities.Crossref | GoogleScholarGoogle Scholar |
[21] Boye U, Willasey A, Walsh T, Tickle M, Pretty IA. Comparison of an intra‐oral photographic caries assessment with an established visual caries assessment method for use in dental epidemiological studies of children. Community Dent Oral Epidemiol 2013; 41 526–33.
| Comparison of an intra‐oral photographic caries assessment with an established visual caries assessment method for use in dental epidemiological studies of children.Crossref | GoogleScholarGoogle Scholar |
[22] Morosini Ide A, de Oliveira DC, Ferreira Fde M, Fraiz FC, Torres-Pereira CC. Performance of distant diagnosis of dental caries by teledentistry in juvenile offenders. Telemed J E Health 2014; 20 584–9.
| Performance of distant diagnosis of dental caries by teledentistry in juvenile offenders.Crossref | GoogleScholarGoogle Scholar |
[23] Salazar-Fernandez CI, Herce J, Garcia-Palma A, Delgado J, Martín JF, Soto T. Telemedicine as an effective tool for the management of temporomandibular joint disorders. J Oral Maxillofac Surg 2012; 70 295–301.
| Telemedicine as an effective tool for the management of temporomandibular joint disorders.Crossref | GoogleScholarGoogle Scholar |
[24] Mariño R, Ghanim A. Teledentistry: a systematic review of the literature. J Telemed Telecare 2013; 19 179–83.
[25] Khan SA, Omar H. Teledentistry in practice: literature review. Telemed J E Health 2013; 19 565–7.
| Teledentistry in practice: literature review.Crossref | GoogleScholarGoogle Scholar |
[26] Scuffham PA, Steed M. An economic evaluation of the Highlands and Islands teledentistry project. J Telemed Telecare 2002; 8 165–77.
| An economic evaluation of the Highlands and Islands teledentistry project.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD38zltl2msA%3D%3D&md5=9c0921d217fb31ddd2e897e011c19624CAS |
[27] Xiao D, Vignarajan J, Boyle J, Zhang M, Estai MR, Tennant M, Tay-Kearney ML, Kanagasingam Y. Development and practice of store-and-forward telehealth systems in ophthalmology dental and emergency. Stud Health Technol Inform 2015; 214 167–73.
[28] World Health Organization (WHO). Oral health surveys: basic methods. 5th edn. Geneva: WHO; 2013.
[29] Estai M, Kanagasingam Y, Huang B, Shiikha J, Kruger E, Bunt S, Tennant M. Comparison of a smartphone-based photographic method with face-to-face caries assessment: a mobile teledentistry model. Telemed J E Health 2016;
| Comparison of a smartphone-based photographic method with face-to-face caries assessment: a mobile teledentistry model.Crossref | GoogleScholarGoogle Scholar |
[30] Australian Bureau of Statistics (ABS). 4102.0 – Australian Social Trends. Canberra: ABS; 2008.
[31] Working Days. Business days calculator in Australia. 2017. Available at: http://www.workingdays.com.au/ [verified 24 April 2017].
[32] Pay Scale. Salary survey. 2017. Available at: http://www.payscale.com/research/AU/Job=General_Dentist/Salary/ [verified 24 April 2017].
[33] Pay Scale. Salary survey. 2017. Available at: http://www.payscale.com/research/AU/Job=Registered_Dental_Assistant_(RDA)/Salary/ [verified 24 April 2017].
[34] Estai M, Kanagasingam Y, Xiao D, Vignarajan J, Bunt S, Kruger E, Tennant M. End-user acceptance of a cloud-based teledentistry system and Android phone app for remote screening for oral diseases. J Telemed Telecare 2015; 23 44–52.
| End-user acceptance of a cloud-based teledentistry system and Android phone app for remote screening for oral diseases.Crossref | GoogleScholarGoogle Scholar |
[35] Pay Scale. Salary survey. 2017. Available at: http://www.payscale.com/research/AU/Job=Dental_Hygienist/Hourly_Rate/ [verified 24 April 2017].
[36] Pay Scale. Salary survey. 2017. Available at: http://www.payscale.com/research/AU/Job=Support_Technician%2c_Information_Technology_(IT)/Salary/ [verified 24 April 2017].
[37] Croucher N. A letter from New Zealand: improving access to high quality dental services for children. J Calif Dent Assoc 2011; 39 83–7.
[38] Australian Bureau of Statistics (ABS). Australian demographic statistics, December 2013. Catalogue no. 3101. Canberra: ABS; 2014.
[39] Schwarz E. Access to oral health care – an Australian perspective. Community Dent Oral Epidemiol 2006; 34 225–31.
| Access to oral health care – an Australian perspective.Crossref | GoogleScholarGoogle Scholar |
[40] Harford J, Islam S. Adult oral health and dental visiting in Australia . Canberra: Australian Institute of Health and Welfare; 2013.
[41] Nash DA, Friedman JW, Mathu‐Muju KR, Robinson PG, Satur J, Moffat S, Kardos R, Lo EC, Wong AH, Jaafar N, van den Heuvel J, Phantumvanit P, Chu EO, Naidu R, Naidoo L, McKenzie I, Fernando E. A review of the global literature on dental therapists. Community Dent Oral Epidemiol 2014; 42 1–10.
| A review of the global literature on dental therapists.Crossref | GoogleScholarGoogle Scholar |
[42] Estai M, Kruger E, Tennant M. Role of telemedicine and mid-level dental providers in expanding dental-care access: potential application in rural Australia. Int Dent J 2016; 66 195–200.
| Role of telemedicine and mid-level dental providers in expanding dental-care access: potential application in rural Australia.Crossref | GoogleScholarGoogle Scholar |
