Abstract
Introduction
Dental caries in permanent teeth remains highly prevalent across all age groups. When
caries progresses to involve the dental pulp but the tooth is still restorable, the tooth can be
retained through root canal treatment combined with appropriate restorations. This benefit
was proposed by patient networks, the general public, and civil society. This study aims to:
(1) evaluate the cost-utility of root canal treatment combined with various restoration options;
(2) assess the budget impact of the proposed new benefits package compared to the existing
one; and (3) evaluate the readiness of the healthcare system to implement the new benefits
package for root canal treatment and restoration.
This study employed an economic evaluation approach, gathering a variety of data
sources, including cost and utility data from five hospitals, collected from patients who
received both the proposed and existing benefits packages over a 10-year period. Data
collection included clinical assessments, interviews, literature reviews, and documents from
reliable sources. For the budget impact analysis, findings from objective 1 were combined with
data from the national population registry and the 9th National Oral Health Survey (2022-
2023). For assessing system readiness, information on equipment, workforce, and waiting times
was gathered through online questionnaires completed by dentists in both public and private
sectors. Quality control of data collection instruments, standardization of examiners and
interviewers, and analyses were conducted using HITAP’s GEAR4Health, Excel, and SPSS
Version 29.0.0.0 (241).
Results
The cost-utility evaluation revealed that the new benefits package—which includes root canal
treatment combined with various restorations ( fillings, crowns, and post and core with
crowns) — yields both higher costs and greater utility measured by the OHIP- 14 ( Oral Health
Impact Profile- 14) questionnaire, converted to utility values based on literature review
equations. The incremental cost- effectiveness ratio ( ICER) for the new benefits package
compared to the existing package was 14,717. 45 THB per unit of effectiveness. Stakeholders
recommended using OHIP- 14- based results over EQ- 5D- 5L for better alignment with oral
health–specific measurements. However, both analyses were presented by the researchers.
The budget impact analysis estimated that, if the new benefits package were implemented
for all age groups, the additional medical costs ( excluding labor) in Year 1 ( 2025) would be
149,140,035 THB and in Year 5 ( 2029) would be 148,822,612 THB at 3% coverage. At 5%
coverage, the additional costs would be 248,566,726 THB in Year 1 and 248,037,686 THB in
Year 5.
The system readiness assessment found that public hospitals had 78.0% readiness
for root canal treatment across all steps and 85% readiness for post and crown procedures.
The average waiting time in public hospitals was 104 days for root canal treatment and 114
days for post and crown procedures. Private dentists reported higher readiness rates, with
87.6% readiness for root canal treatment and 91. 2% for post and crown procedures, with
average waiting times of 8 and 11 days, respectively. Most dentists (69–77%) considered the
Ministry of Public Health’s current fee rates for root canal treatment in anterior, premolar, and
molar teeth (3,400, 5,000, and 7,000 THB respectively) and post (2,000 THB) and crown (6,000
THB) fees to be inadequate. They suggested median fees of 5,000, 7,000, 9,500, 3,500, and
9,000 THB, respectively.
Policy Recommendations
1. The new benefits package increases both costs and quality of life. Although costs are
higher, the incremental cost per QALY is significantly lower than the current threshold
of 160,000 THB per QALY.
2. The additional budget burden is substantial. Currently, the government provides some
root canal treatments reimbursed under civil servant welfare or out- of- pocket
payments for patients with social security or universal coverage. Expanding to a full
benefits package would require careful planning of provider payment mechanisms, as
treatment costs exceed the current per capita budget (capitation). At 3–5% coverage,
the budget impact for 2025– 2029 ranges from 149,140,035– 148,822,612 THB to
248,566,726–248,037,686 THB, which is significant and would be unsustainable without
additional payment mechanisms in place.
3. Engaging private sector providers could enhance overall system readiness. Appropriate
service fees should be considered for both NHSO and private sector providers.
4. Budget impact projections for three scenarios—(a) all age groups, (b) ages 6–15 years,
and ( c) accident/ lesion cases— show the lowest cost for accident/ lesion cases,
followed by ages 6–15, and the highest cost for all age groups.
