Comparison of cost-effectiveness and benefits of surgery-first versus orthodontics-first orthognathic correction of skeletal class III malocclusion

The aim of this study was to compare the costs and benefits of surgery-first (SF) and orthodontics-first (OF) approaches in patients with skeletal class III malocclusion. This retrospective study recruited 54 patients who received combined orthognathic-orthodontic treatment via SF or OF approach. Data collected included orthodontic time, operating time, hospital stay, and detailed expenditures. Effectiveness was defined as quality of life, assessed by Orthognathic Quality of Life Questionnaire (OQLQ-22) before and 1 year after treatment. Cost-effectiveness was measured by incremental cost-effectiveness ratio (ICER) and incremental time-effectiveness ratio (ITER). The duration of SF was shorter than that of OF, due to a reduced orthodontic time (P=0.003). The operating time was longer with SF than with OF (P=0.015). There was no significant difference in hospital stay (P=0.868), cost of hospitalization (P=0.924) or orthodontics (P=0.171), or OQLQ score (P=0.41) between the two approaches. Cost-effectiveness analyses revealed a reduction in cost of US$ 6.43/OQLQ point and reduction in time of 8.60 months/OQLQ point gained by SF versus OF. The study findings revealed that the total treatment time was significantly shorter with SF than with OF, although the two approaches did not differ significantly in terms of total cost (P=0.979). Further studies on the cost-effectiveness of the two approaches in different healthcare systems across diverse countries are warranted.