Abstract
Background: Oral cancer in Malaysia disproportionately affects certain rural communities due to their sociodemographic factors and healthcare accessibility barriers. Furthermore, the low number of specialists and geographical difficulties limit the feasibility of routine community screening visits. Patients are thus mostly diagnosed at later stages, leading to substantial social and economic burdens. To address these challenges, a novel application called MeMoSA ® was developed by incorporating a mobile phone imaging teledentistry for oral examinations (MOE). This study aims to report the cost-effectiveness of the proposed MOE in rural primary clinics, for screening patients with oral potentially malignant disorders (OPMD) and oral cancer compared to the conventional oral examination (COE) conducted routinely via high-risk community screening visits.
Methods: Markov modeling was applied to simulate the cost and quality-adjusted life-years (QALY) for a hypothetical cohort of 100,000 adults aged 40 years. Following local reports, the coverage of high-risk rural communities was set at 0.03%. A societal perspective was adopted to include the cost of screening programs, disease management, household out-of-pocket expenditures and loss of productivity. Variables used were derived from a cross-sectional costing study and patient surveys in two tertiary healthcare centers, in addition to reviews of local and international literature. Cost-effectiveness was determined based on the incremental cost-effectiveness ratio. One-way sensitivity analysis was performed for several key parameters.
Results: Based on model simulations, the number of individuals screened by COE was higher than MOE (784.4 vs 47.9), while the number of successful diagnoses was small in both (2.39 vs 0.33). As the QALY generated in COE and MOE were comparable at 1,957,041 and 1,957,043, a cost-minimization approach was applied, where only the cost parameter was evaluated. The discounted societal cost was MYR 132,471 for COE and MYR11,760 for MOE. Larger costs in COE were primarily contributed by resources required to conduct community screening visits in rural areas and the loss of household productivity. As the population coverage for MOE was arbitrarily increased from 0.03% to 0.10% in the sensitivity analysis, the calculated societal cost saved increased from MYR 120,711 to MYR 402,355. The analysis also evidenced that factors such as the test performance of MeMoSA ®, self-referral rates of patients and progression of OPMD to stage I oral cancer had minimal impact on the total societal cost and QALY.
Discussion: The overall lower number of cases diagnosed was mainly because both strategies only targeted smaller pockets of high-risk communities. MOE was however shown to be a viable alternative to replace the conventional practice as the coverage can be easily extended via the introduction of new sites. In contrast, the conduct of current community screening visits will continually be limited by logistical challenges and the availability of resources. The savings from the switch can further be used to improve screening infrastructure in underserved areas, strengthen awareness campaigns and conduct MeMoSA ® user training.
Links
- https://apcph.cphm.my/wp-content/uploads/2022/07/APCPH2022-O-10.pdf
- https://apcph.cphm.my/events/oral-session-7-ballroom-A/
BibTeX (Download)
@proceedings{APCPH2022-O-10,
title = {Cost-Effectiveness Of Mobile Phone Imaging Teledentistry For Oral Cancer Screening In Rural High-Risk Communities},
author = {Sivaraj Raman and Asrul Akmal Shafie and Mannil Thomas Abraham and Shim Chen Kiong and Thaddius Herman Maling and Senthilmani Rajendran and Sok Ching Cheong},
url = {https://apcph.cphm.my/wp-content/uploads/2022/07/APCPH2022-O-10.pdf
https://apcph.cphm.my/events/oral-session-7-ballroom-A/},
year = {2022},
date = {2022-08-01},
urldate = {2022-08-02},
issue = {7},
abstract = {Background: Oral cancer in Malaysia disproportionately affects certain rural communities due to their sociodemographic factors and healthcare accessibility barriers. Furthermore, the low number of specialists and geographical difficulties limit the feasibility of routine community screening visits. Patients are thus mostly diagnosed at later stages, leading to substantial social and economic burdens. To address these challenges, a novel application called MeMoSA ® was developed by incorporating a mobile phone imaging teledentistry for oral examinations (MOE). This study aims to report the cost-effectiveness of the proposed MOE in rural primary clinics, for screening patients with oral potentially malignant disorders (OPMD) and oral cancer compared to the conventional oral examination (COE) conducted routinely via high-risk community screening visits.
Methods: Markov modeling was applied to simulate the cost and quality-adjusted life-years (QALY) for a hypothetical cohort of 100,000 adults aged 40 years. Following local reports, the coverage of high-risk rural communities was set at 0.03%. A societal perspective was adopted to include the cost of screening programs, disease management, household out-of-pocket expenditures and loss of productivity. Variables used were derived from a cross-sectional costing study and patient surveys in two tertiary healthcare centers, in addition to reviews of local and international literature. Cost-effectiveness was determined based on the incremental cost-effectiveness ratio. One-way sensitivity analysis was performed for several key parameters.
Results: Based on model simulations, the number of individuals screened by COE was higher than MOE (784.4 vs 47.9), while the number of successful diagnoses was small in both (2.39 vs 0.33). As the QALY generated in COE and MOE were comparable at 1,957,041 and 1,957,043, a cost-minimization approach was applied, where only the cost parameter was evaluated. The discounted societal cost was MYR 132,471 for COE and MYR11,760 for MOE. Larger costs in COE were primarily contributed by resources required to conduct community screening visits in rural areas and the loss of household productivity. As the population coverage for MOE was arbitrarily increased from 0.03% to 0.10% in the sensitivity analysis, the calculated societal cost saved increased from MYR 120,711 to MYR 402,355. The analysis also evidenced that factors such as the test performance of MeMoSA ®, self-referral rates of patients and progression of OPMD to stage I oral cancer had minimal impact on the total societal cost and QALY.
Discussion: The overall lower number of cases diagnosed was mainly because both strategies only targeted smaller pockets of high-risk communities. MOE was however shown to be a viable alternative to replace the conventional practice as the coverage can be easily extended via the introduction of new sites. In contrast, the conduct of current community screening visits will continually be limited by logistical challenges and the availability of resources. The savings from the switch can further be used to improve screening infrastructure in underserved areas, strengthen awareness campaigns and conduct MeMoSA ® user training.},
howpublished = {published online at https://apcph.cphm.my},
note = {Type: ORAL PRESENTATION; Organisation: Institute for Health Systems Research, National Institutes of Health; Institutional Planning and Strategic Center, Universiti Sains Malaysia; Oral and Maxillofacial Surgery Department, Hospital Tengku Ampuan Rahimah; Oral and Maxillofacial Surgery Department, Hospital Umum Sarawak; Samarahan Divisional Dental Office, Sarawak State Health Department; Digital Health Research Unit, Cancer Research Malaysia; Department of Oral and Maxillofacial Clinical Sciences, Faculty of Dentistry, University of Malaya},
keywords = {cost-effectiveness, oral cancer, Rural, screening, teledentistry},
pubstate = {published},
tppubtype = {proceedings}
}