Dental Protraction Versus Surgery for Cleft Lip and Palate: A Budget Impact Analysis

• Published in: The Journal of craniofacial surgery Vol. 35; no. 1; p. 129
• Main Authors: Gong, Cynthia L, Choi, Dylan G, Dominguez, Annaliza, Deng, Ronald, Lo, Richard, Pappa, Sean, Johns, Alexis L, Urata, Mark M, Hammoudeh, Jeffrey A, Yen, Stephen L-K
• Format: Journal Article
• Language: English
• Published: United States 01.01.2024
• Subjects: Cleft Lip - surgery; Cleft Palate - surgery; Humans; Malocclusion, Angle Class III
• DOI: 10.1097/SCS.0000000000009870

Class III malocclusion for individuals with cleft lip and palate has historically been managed with surgery. Orthodontic protraction is a noninvasive alternative that may be associated with lower costs. This analysis investigated the budget impact of protraction versus surgery from an institutional perspective. Using a decision tree, analysis was conducted using costs derived from Medicaid reimbursement codes and using actual institutional reimbursement. Probabilities of success, failure, and complications were based on a clinical trial comparing the 2 treatment modalities. One-way and probabilistic sensitivity analyses tested the robustness of results to model parameters. Based on Medicaid fee schedules and failure rates requiring additional surgery, the total cost of protraction was $79,506 versus $172,807 for surgery, resulting in $93,302 cost-savings per patient. The cost and probability of surgery success, as well as the cost of surgery failure and repeat surgery, had the largest impact on these cost-savings. Probabilistic sensitivity analysis showed cost-savings of nearly $92,000 or higher in >50% of simulations. This study showed that protraction is associated with lower costs than surgery and may present a cost-effective alternative to surgery in eligible, appropriate patients.