Analytical Study of Cost-Effectiveness of Preventive Versus Restorative Dental Care in Nigerian Primary Healthcare

Preventive dental interventions offer potential long-term cost savings over restorative care, but their cost-effectiveness relative to current restorative-dominated practice in Nigerian PHC has not been analytically evaluated. This study analytically evaluated the cost-effectiveness of preventive dental interventions (fluoride varnish, sealants, and oral health education) versus restorative care (amalgam and composite fillings, extractions) in Nigerian primary healthcare settings. A cost-effectiveness analysis was conducted using decision tree modelling based on clinical data from 500 patient episodes across five PHC dental units in Ogun State. Cost data were collected from facility expenditure records and direct patient expense surveys. Effectiveness was measured in prevented carious lesions and quality-adjusted life months. Fluoride varnish application had the lowest cost per prevented carious lesion at N3,200, compared to N8,400 for amalgam restoration. A 3-year modelled scenario showed that a preventive-focused approach yielded 42 percent lower per-patient costs than a restorative-focused approach for the paediatric population. Sensitivity analysis confirmed the cost-effectiveness advantage across all reasonable parameter ranges. Oral health education alone was not cost-effective without combined topical fluoride. The study provides the first cost-effectiveness analysis of the preventive versus restorative decision in Nigerian PHC and recommends a phased reorientation of PHC dental services toward prevention, with capital investment in preventive materials and training as the primary policy requirement.

Keywords: cost-effectiveness, preventive dentistry, restorative dentistry, primary healthcare, Ogun State