Economic evaluation of the Midwifery Initiated Oral Health-Dental Service programme in Australia

Journal article

Tannous, Kathy W, George, Ajesh, Ahmed, Moin Uddin, Blinkhorn, Anthony, Dahlen, Hannah, Skinner, John, Ajwani, Shilpi, Bhole, Sameer, Yaacoub, Albert, Srinivas, Ravi and Johnson, Maree. (2021). Economic evaluation of the Midwifery Initiated Oral Health-Dental Service programme in Australia. BMJ Open. 11(8), p. Article e047072. https://doi.org/10.1136/bmjopen-2020-047072
AuthorsTannous, Kathy W, George, Ajesh, Ahmed, Moin Uddin, Blinkhorn, Anthony, Dahlen, Hannah, Skinner, John, Ajwani, Shilpi, Bhole, Sameer, Yaacoub, Albert, Srinivas, Ravi and Johnson, Maree
Abstract

Objectives
To critically evaluate the cost-effectiveness of the Midwifery Initiated Oral Health-Dental Service (MIOH-DS) designed to improve oral health of pregnant Australian women. Previous efficacy and process evaluations of MIOH-DS showed positive outcomes and improvements across various measures.

Design and setting
The evaluation used a cost-utility model based on the initial study design of the MIOH-DS trial in Sydney, Australia from the perspective of public healthcare provider for a duration of 3 months to 4 years.

Participants
Data were sourced from pregnant women (n=638), midwives (n=17) and dentists (n=3) involved in the MIOH trial and long-term follow-up.

Cost measures
Data included in analysis were the cost of the time required by midwives and dentists to deliver the intervention and the cost of dental treatment provided. Costs were measured using data on utilisation and unit price of intervention components and obtained from a micro-costing approach.

Outcome measures
Utility was measured as the number of Disability Adjusted Life Years (DALYs) from health-benefit components of the intervention. Three cost-effectiveness analyses were undertaken using different comparators, thresholds and time scenarios.

Results
Compared with current practice, midwives only intervention meets the Australian threshold (A$50 000) of being cost-effective. The midwives and accessible/affordable dentists joint intervention was only ‘cost-effective’ in 6 months or beyond scenarios. When the midwife only intervention is the comparator, the midwife/dentist programme was ‘cost-effective’ in all scenarios except at 3 months scenario.

Conclusions
The midwives’ only intervention providing oral health education, assessment and referral to existing dental services was cost-effective, and represents a low cost intervention. Midwives’ and dentists’ combined interventions were cost-effective when the benefits were considered over longer periods. The findings highlight short and long term economic benefits of the programme and support the need for policymakers to consider adding an oral health component into antenatal care Australia wide.

Trial registration number ACTRN12612001271897; Post-results.

Year2021
JournalBMJ Open
Journal citation11 (8), p. Article e047072
PublisherBMJ Publishing Group
ISSN2044-6055
Digital Object Identifier (DOI)https://doi.org/10.1136/bmjopen-2020-047072
PubMed ID34341045
Scopus EID2-s2.0-85112047608
PubMed Central IDPMC8330572
Open accessPublished as ‘gold’ (paid) open access
Research or scholarlyResearch
Page range1-12
FunderNational Health and Medical Research Council (NHMRC)
Publisher's version
License
File Access Level
Open
Output statusPublished
Publication dates
Online02 Aug 2021
Publication process dates
Accepted19 Jul 2021
Deposited22 Dec 2021
Grant IDNHMRC/1022007
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Myors, Karen, Schmied, Virginia, Johnson, Maree and Cleary, Michelle. (2013). Collaboration and integrated services for perinatal mental health : An integrative review. Child and Adolescent Mental Health. https://doi.org/10.1111/j.1475-3588.2011.00639.x
Specialist perinatal mental health services: Characteristics of women and services provided
Johnson, Karen Anne, Schmied, Virginia, Johnson, Maree and Cleary, Michelle. (2013). Specialist perinatal mental health services: Characteristics of women and services provided. The Marcé International Society International Biennial General Scientific Meeting. Germany: Springer-Verlag. pp. S36 - 146 https://doi.org/10.1007/s00737-013-0355-x
Outcome of routine psychosocial assessment: A pilot study of the relationship between risk factors, service utilisation and outcomes in women at 6 weeks and 12 months after birth
Schmied, Virginia, Johnson, Maree, Langdon, Rachel, Austin, Marie-Paule, Matthey, Stephen and Kemp, Lynn. (2013). Outcome of routine psychosocial assessment: A pilot study of the relationship between risk factors, service utilisation and outcomes in women at 6 weeks and 12 months after birth. Women and Birth. 26(Supplement 1), pp. 37 - 37. https://doi.org/10.1016/j.wombi.2013.08.209
Maternal Mental Health in Australia and New Zealand : A review of longitudinal studies
Schmied, Virginia, Johnson, Maree, Naidoo, Norell, Austin, Marie-Paule, Matthey, Stephen, Kemp, L, Mills, Annie, Meade, Tanya and Yeo, A. (2013). Maternal Mental Health in Australia and New Zealand : A review of longitudinal studies. Women and Birth. https://doi.org/10.1016/j.wombi.2013.02.006
Views of pregnant women in South Western Sydney towards dental care and an oral-health program initiated by midwives
George, Ajesh, Johnson, Maree, Blinkhorn, Anthony, Ajwani, Shilpi, Ellis, Sharon and Bhole, Sameer. (2013). Views of pregnant women in South Western Sydney towards dental care and an oral-health program initiated by midwives. Health Promotion Journal of Australia. https://doi.org/10.1071/HE13040
Measuring the qualities of nurses : Development and testing of the Qualities of Nurses Scale
Johnson, Maree and Cowin, Leanne. (2013). Measuring the qualities of nurses : Development and testing of the Qualities of Nurses Scale. Nursing Education Perspectives. 34(2), pp. 111 - 117. https://doi.org/10.5480/1536-5026-34.2.111
Oral health care during pregnancy
George, Ajesh, Johnson, Maree, Reath, Jennifer, Dahlen, Hannah, Bhole, Sameer, Ajwani, Shilpi and Korda, Andrew. (2013). Oral health care during pregnancy. Australian Nursing and Midwifery Journal. 21(3), pp. 42 - 42.
The role of anxiety and other factors in predicting post-natal fatigue : From birth to 6 months
Taylor, Jan and Johnson, Maree. (2013). The role of anxiety and other factors in predicting post-natal fatigue : From birth to 6 months. Midwifery. https://doi.org/10.1016/j.midw.2012.04.011
Assessment of the elderly : It's worth covering the risks
Langdon, R, Johnson, Maree, Carroll, Vince and Antonio, Geraldine. (2013). Assessment of the elderly : It's worth covering the risks. Journal of Nursing Management. https://doi.org/10.1111/j.1365-2834.2012.01421.x
How Do Dental and Prenatal Care Practitioners Perceive Dental Care During Pregnancy? : Current Evidence and Implications
George, Ajesh, Shamin, Simin, Johnson, Maree, Dahlen, Hannah, Ajwani, Shilpi, Bhole, Sameer and Yeo, Anthony. (2012). How Do Dental and Prenatal Care Practitioners Perceive Dental Care During Pregnancy? : Current Evidence and Implications. Birth : Issues in perinatal care. 39(3), pp. 238 - 247. https://doi.org/10.1111/j.1523-536X.2012.00553.x
Models of care in nursing : A systematic review
Fernandez, Ritin, Johnson, Maree, Tran, Duong and Miranda, Charmaine. (2012). Models of care in nursing : A systematic review. International Journal of Evidence-Based Healthcare. 10(4), pp. 324 - 337. https://doi.org/10.1111/j.1744-1609.2012.00287.x
Building research capacity in South West Sydney through a Primary Community Health Research Unit
Friesen, Emma, Comino, Elizabeth, Reath, Jennifer, Derrett, Alison, Johnson, Maree, Powell Davies, Gawaine, Teng-Liaw, Siaw and Kemp, L. (2012). Building research capacity in South West Sydney through a Primary Community Health Research Unit. Australian Journal of Primary Health: the issues influencing community health services and primary health care. 20(1), pp. 4 - 8. https://doi.org/10.1071/PY12081
A ward-based writing coach program to improve the quality of nursing documentation
Jefferies, Diana, Johnson, Maree, Nicholls, Daniel and Lad, Shushila. (2012). A ward-based writing coach program to improve the quality of nursing documentation. Nurse Education Today. 32(6), pp. 647 - 651. https://doi.org/10.1016/j.nedt.2011.08.017
Developing a minimum data set for electronic nursing handover
Johnson, Maree, Jefferies, Diana and Nicholls, Daniel. (2012). Developing a minimum data set for electronic nursing handover. Journal of Clinical Nursing. 21(2016-04-03), pp. 331 - 343. https://doi.org/10.1111/j.1365-2702.2011.03891.x
Midwives and oral health care during pregnancy : Perceptions of pregnant women in South-Western Sydney, Australia
George, Ajesh, Johnson, Maree, Duff, Margaret, Ajwani, Shilpi, Bhole, Sameer, Blinkhorn, Anthony and Ellis, Sharon. (2012). Midwives and oral health care during pregnancy : Perceptions of pregnant women in South-Western Sydney, Australia. Journal of Clinical Nursing. 21(2016-08-07), pp. 1087 - 1096. https://doi.org/10.1111/j.1365-2702.2011.03870.x
Country of birth recording in Australian hospital morbidity data : Accuracy and predictors
Tran, Duong, Jorm, Louisa, Lujic, Sanja, Bambrick, Hilary and Johnson, Maree. (2012). Country of birth recording in Australian hospital morbidity data : Accuracy and predictors. Australian and New Zealand Journal of Public Health. 36(4), pp. 310 - 316. https://doi.org/10.1111/j.1753-6405.2012.00893.x
Developing standard data for handover
Nicholls, Daniel, Johnson, Maree and Jefferies, Diana. (2012). Developing standard data for handover. Nursing Times. 108(12), pp. 20 - 20.
Falls e-learning program
Johnson, Maree, Kelly, Linda, Siric, Katica and Overs, Bronwyn. (2012). Falls e-learning program. Australian Nursing Journal. 19(7), pp. 37 - 37.
Comparing written and oral approaches to clinical reporting in nursing
Jefferies, Diana, Johnson, Maree and Nicholls, Daniel. (2012). Comparing written and oral approaches to clinical reporting in nursing. Contemporary Nurse: Health care across the lifespan. 42(1), pp. 158 - 167. https://doi.org/10.5172/conu.2012.42.1.129
Exploring the structure and organization of information within nursing clinical handovers
Johnson, Maree, Jefferies, Diana and Nicholls, Daniel. (2012). Exploring the structure and organization of information within nursing clinical handovers. International Journal of Nursing Practice. 18(5), pp. 462 - 470. https://doi.org/10.1111/j.1440-172X.2012.02059.x
The psychometric properties of five Professional Identity measures in a sample of nursing students
Cowin, Leanne, Johnson, Maree, Wilson, Ian and Borgese, Kaye. (2012). The psychometric properties of five Professional Identity measures in a sample of nursing students. Nurse Education Today. 33(6), pp. 608 - 613. https://doi.org/10.1016/j.nedt.2012.07.008
Evaluating an intensive ward-based writing coach programme to improve nursing documentation : Lessons learned
Jefferies, Diana, Johnson, Maree, Nicholls, Daniel, Langdon, Rachel and Lad, Shushila. (2012). Evaluating an intensive ward-based writing coach programme to improve nursing documentation : Lessons learned. International Nursing Review. 59(3), pp. 394 - 401. https://doi.org/10.1111/j.1466-7657.2012.00994.x
Measuring perinatal mental health
Johnson, Maree, Schmeid, V, Lupton, S, Austin, Marie-Paule, Matthey, Stephen, Kemp, L, Meade, Tanya and Yeo, A. (2012). Measuring perinatal mental health. Archives of Women's Mental Health. 15(5), pp. 375 - 386. https://doi.org/10.1007/s00737-012-0297-8
Barriers to clinical leadership development :Findings from a national survey
Fealy, Gerard, McNamara, Martin, Casey, Mary, Geraghty, Ruth, Butler, Michelle, Halligan, Phil, Treacy, Margaret and Johnson, Maree. (2011). Barriers to clinical leadership development :Findings from a national survey. Journal of Clinical Nursing. 20(13-14), pp. 2023 - 2032. https://doi.org/10.1111/j.1365-2702.2010.03599.x
Nurturing and Nourishing :The nurses' role in nutritional care
Jefferies, Diana, Johnson, Maree and Ravens, Jennifer. (2011). Nurturing and Nourishing :The nurses' role in nutritional care. Journal of Clinical Nursing. 20(3/4), pp. 317 - 330. https://doi.org/10.1111/j.1365-2702.2010.03502.x
Analysis of falls incidents :Nurse and patient preventative behaviours
Johnson, Maree, George, Ajesh and Tran, Duong. (2011). Analysis of falls incidents :Nurse and patient preventative behaviours. International Journal of Nursing Practice. 17(1), pp. 60 - 66. https://doi.org/10.1111/j.1440-172X.2010.01907.x
Nursing documentation :How meaning is obscured by fragmentary
Jefferies, Diana, Johnson, Maree and Nicholls, Daniel. (2011). Nursing documentation :How meaning is obscured by fragmentary. Nursing Outlook. 59(6), pp. e6 - e12. https://doi.org/10.1016/j.outlook.2011.04.002
Many paths lead to nursing :Factors influencing students' perceptions of nursing
Cowin, Leanne and Johnson, Maree. (2011). Many paths lead to nursing :Factors influencing students' perceptions of nursing. International Nursing Review. 58(4), pp. 413 - 419. https://doi.org/10.1111/j.1466-7657.2011.00905.x
Many paths lead to nursing: Factors influencing students' perceptions of nursing
Cowin, Leanne S. and Johnson, Maree. (2011). Many paths lead to nursing: Factors influencing students' perceptions of nursing. International Nursing Review. 58(4), pp. 413 - 419. https://doi.org/10.1111/j.1466-7657.2011.00905.x
Maintaining oral health during pregnancy :Perceptions of midwives in Southwest Sydney
George, Ajesh, Johnson, Maree, Duff, Margaret, Blinkhorn, Anthony, Ajwani, Shilpi, Bhole, Sameer and Ellis, Sharon. (2011). Maintaining oral health during pregnancy :Perceptions of midwives in Southwest Sydney. Collegian. 18(2), pp. 71 - 79. https://doi.org/10.1016/j.colegn.2010.10.003
Developing risk management behaviours for nurses through medication incident analysis
Johnson, Maree, Tran, Duong and Young, Helen. (2011). Developing risk management behaviours for nurses through medication incident analysis. International Journal of Nursing Practice. 17(6), pp. 548 - 555. https://doi.org/10.1111/j.1440-172X.2011.01977.x
Periodontal treatment during pregnancy and birth outcomes :A meta-analysis of randomised trials
George, Ajesh, Shamin, Simin, Johnson, Maree, Ajwani, Shilpi, Bhole, Sameer, Blinkhorn, Anthony, Ellis, Sharon and Andrews, Karen. (2011). Periodontal treatment during pregnancy and birth outcomes :A meta-analysis of randomised trials. International Journal of Evidence-Based Healthcare. 9(2), pp. 122 - 147. https://doi.org/10.1111/j.1744-1609.2011.00210.x
The Application of ARonson's Taxonony to Medication Errors in Nursing
Johnson, Maree and Young, Helen. (2011). The Application of ARonson's Taxonony to Medication Errors in Nursing. Journal of Nursing Care Quality. 26(2), pp. 128 - 135. https://doi.org/10.1097/NCQ.0b013e3181f54b14
Boundary matters: Clinical leadership and the distinctive disciplinary contribution of nursing to multidisciplinary care
McNamara, Martin, Fealy, Gerard, Casey, Mary, Geraghty, Ruth, Johnson, Maree, Halligan, Phil, Treacy, Pearl and Butler, Michelle. (2011). Boundary matters: Clinical leadership and the distinctive disciplinary contribution of nursing to multidisciplinary care. Journal of Clinical Nursing. 20(23-24), pp. 3502 - 3512. https://doi.org/10.1111/j.1365-2702.2011.03719.x
A new role for midwives in promoting dental health
George, Ajesh, Johnson, Maree, Ellis, Sharon, Dahlen, Hannah, Blinkhorn, Anthony, Bhole, Sameer and Ajwani, Shilpi. (2010). A new role for midwives in promoting dental health. Australian Nursing and Midwifery Journal. 18(1), pp. 37-37.
A shared care model vs. a patient allocation model of nursing care delivery : Comparing nursing staff satisfaction and stress outcomes
Tran, Duong, Johnson, Maree, Fernandez, Ritin and Jones, Sonya. (2010). A shared care model vs. a patient allocation model of nursing care delivery : Comparing nursing staff satisfaction and stress outcomes. International Journal of Nursing Practice. 16(2), pp. 148 - 158. https://doi.org/10.1111/j.1440-172X.2010.01823.x;10.1111/j.1440-172X.2010.01823.x
Interdisciplinary communication in general medical and surgical wards using two different models of nursing care delivery
Fernandez, Ritin, Tran, Duong, Johnson, Maree and Jones, Sonya. (2010). Interdisciplinary communication in general medical and surgical wards using two different models of nursing care delivery. Journal of Nursing Management. 18(3), pp. 265 - 274. https://doi.org/10.1111/j.1365-2834.2010.01058.x;10.1111/j.1365-2834.2010.01058.x
A meta-study of the essentials of quality nursing documentation
Jefferies, Diana, Johnson, Maree and Griffiths, Rhonda. (2010). A meta-study of the essentials of quality nursing documentation. International Journal of Nursing Practice. 16(2), pp. 112 - 124. https://doi.org/10.1111/j.1440-172X.2009.01815.x;10.1111/j.1440-172X.2009.01815.x
Promoting oral health during pregnancy : Current evidence and implications for Australian midwives
George, Ajesh, Johnson, Maree, Blinkhorn, Anthony, Ellis, Sharon, Bhole, Sameer and Ajwani, Shilpi. (2010). Promoting oral health during pregnancy : Current evidence and implications for Australian midwives. Journal of Clinical Nursing. 19(23-24), pp. 3324 - 3333. https://doi.org/10.1111/j.1365-2702.2010.03426.x;10.1111/j.1365-2702.2010.03426.x
Engaging clinicians in evidence based policy development: The case of nursing documentation
Jefferies, Diana, Johnson, Maree, Griffiths, R., Arthurs, Kathy, Beard, David, Chen, Tanghua, Edgetton-Winn, Maureen, Hecimovic, Tony, Hughes, Margaret, Linten, Karen, Maddox, Julie, McCaul, Damien, Robson, Kim, Scott, Shelley and Zarkos, Tina. (2010). Engaging clinicians in evidence based policy development: The case of nursing documentation. Contemporary Nurse. 35(2), pp. 254 - 264. https://doi.org/10.5172/conu.2010.35.2.254
How women manage fatigue after childbirth
Taylor, Jan and Johnson, Maree. (2010). How women manage fatigue after childbirth. Midwifery. 26(3), pp. 367 - 375. https://doi.org/10.1016/j.midw.2008.07.004
The Nursing and Midwifery Content Audit Tool (NMCAT) : A short nursing dcumentation audit tool
Johnson, Maree, Jefferies, Diana and Langdon, Rachel. (2010). The Nursing and Midwifery Content Audit Tool (NMCAT) : A short nursing dcumentation audit tool. Journal of Nursing Management. 18(7), pp. 832 - 845. https://doi.org/10.1111/j.1365-2834.2010.01156.x;10.1111/j.1365-2834.2010.01156.x
Classifying nursing errors in clinical management within an Australian hospital
Tran, Duong and Johnson, Maree. (2010). Classifying nursing errors in clinical management within an Australian hospital. International Nursing Review. 57(4), pp. 454 - 462. https://doi.org/10.1111/j.1466-7657.2010.00846.x;10.1111/j.1466-7657.2010.00846.x
Identifying research priorities for midwifery in Ireland
Butler, Michelle M., Meehan, Therese C., Kemple, Mary, Drennan, Jonathan, Treacy, Margaret and Johnson, Maree. (2009). Identifying research priorities for midwifery in Ireland. Midwifery. 25(5), pp. 576 - 587. https://doi.org/10.1016/j.midw.2007.08.004
Personality, Gender and Medico-Legal Matters in Medical Practice
Nash, Louise, Daly, Michele, Johnson, Maree, Coulston, Carissa, Tennant, Chris, van Ekert, Elizabeth, Walter, Garry, Willcock, Simon and Walton, Merrilyn. (2009). Personality, Gender and Medico-Legal Matters in Medical Practice. Australasian Psychiatry. 17(1), pp. 19 - 24. https://doi.org/10.1080/10398560802085359
Does the implementation of a clinical guideline change nursing practice in screening for alcohol and other substance use?
Johnson, Maree. (2009). Does the implementation of a clinical guideline change nursing practice in screening for alcohol and other substance use? Contemporary Nurse. 33, pp. 13 - 19.
GPs' concerns about medicolegal issues: How it affects their practice
Nash, Louise, Walton, Merrilyn, Daly, Michele, Johnson, Maree, Walter, Garry, van Ekert, Elizabeth, Willcock, Simon and Tennant, Chris. (2009). GPs' concerns about medicolegal issues: How it affects their practice. Australian Family Physician. 38(1/2), pp. 66 - 70.
Changes in general nurses knowledge of alcohol and substance use and misuse after education
Tran, Duong Thuy, Stone, Andrea M., Fernandez, Ritin S., Griffiths, Rhonda D. and Johnson, Maree. (2009). Changes in general nurses knowledge of alcohol and substance use and misuse after education. Perspectives in Psychiatric Care. 45(2), pp. 128 - 139. https://doi.org/10.1111/j.1744-6163.2009.00213.x
Perinatal oral health care: Implications for midwives
Johnson, Maree. (2009). Perinatal oral health care: Implications for midwives. Midwifery Matters. 27(4), pp. 22 - 23.
GP's concerns about medicolegal issues: How it affects their practice
Johnson, Maree. (2009). GP's concerns about medicolegal issues: How it affects their practice. Australian Family Physician. 38, pp. 66 - 70.
Does implementation of clinical practice guidelines change nurses' screening for alcohol and other substance abuse?
Tran, Duong Thuy, Stone, Andrea M., Fernandez, Ritin, Griffiths, Rhonda and Johnson, Maree. (2009). Does implementation of clinical practice guidelines change nurses' screening for alcohol and other substance abuse? Contemporary Nurse: Health care across the lifespan. 33(1), pp. 13 - 19. https://doi.org/10.5172/conu.33.1.13
Causal modeling of self-concept, job satisfaction, and retention of nurses
Cowin, Leanne S., Johnson, Maree, Craven, Rhonda Gai and Marsh, Herbert Warren. (2008). Causal modeling of self-concept, job satisfaction, and retention of nurses. International Journal of Nursing Studies. 45(10), pp. 1449 - 1459. https://doi.org/10.1016/j.ijnurstu.2007.10.009
A piece of the puzzle - The role of ethnic health staff in hospitals
Matthews, Clair, Whelan, Anna Klinken, Johnson, Maree and Noble, Cathy. (2008). A piece of the puzzle - The role of ethnic health staff in hospitals. Australian Health Review. 32, pp. 236 - 245.
A survey of the risk-management behaviours of Australian general practitioners
Johnson, Maree, Chang, Sungwon, Murphy, Brooke and Payne, Sheryn. (2008). A survey of the risk-management behaviours of Australian general practitioners. Quality in Primary Care. 16, pp. 7 - 15.
Self-assessment of medico-legal risk by doctors: The Know Your Risk Version 1- short form
Johnson, Maree, Murphy, Brooke, Payne, Sheryn and Chang, Sungwon. (2008). Self-assessment of medico-legal risk by doctors: The Know Your Risk Version 1- short form. Australian Health Review. 32(2), pp. 330 - 348. https://doi.org/10.1071/AH080339
A longitudinal study of student and experienced nurses' self-concept.
Cowin, Leanne S., Craven, Rhonda G., Johnson, Maree and Marsh, Herbert W.. (2006). A longitudinal study of student and experienced nurses' self-concept. Collegian. 13(3), pp. 25-31. https://doi.org/10.1016/S1322-7696(08)60529-6