Comparing the Cost-Effectiveness of Orthognathic Surgery Treatment Between Orthodontics-First and Surgery-First Approaches in Thammasat University Hospital: A Retrospective Study

Objectives: This study aimed to evaluate and compare the cost-effectiveness of the surgery-first and orthodontic-first approaches in Thai patients with dentofacial deformities undergoing orthognathic surgery. Methods: This retrospective cohort study included 30 patients with dentofacial deformities, divided into the surgery-first approach (SFA, n = 15) and orthodontic-first approach (OFA, n = 15). All underwent double-jaw surgery without genioplasty performed by a single surgeon and orthodontist. Data collected included operative and orthodontic costs, operative time, total treatment and hospital costs, treatment duration, and length of hospital stay. Cost-effectiveness was assessed using the incremental cost-effectiveness ratio (ICER) and incremental time-effectiveness ratio (ITER), with effectiveness measured by quality of life via the Thai Orthognathic Quality of Life Questionnaire (OQLQ) before and at the time of debonding the orthodontic appliance. Results: Overall, the SFA demonstrated greater cost-effectiveness than the OFA. However, the SFA group incurred slightly higher hospital costs. There were no statistically significant differences between the two groups in operative cost, hospital cost, total cost, operative time, or length of hospital stay (p > 0.05). By contrast, orthodontic cost, orthodontic treatment duration, and total treatment duration were significantly lower in the SFA group compared with the OFA group (p < 0.05). Conclusions: Within limits, the SFA is a potentially beneficial alternative to OFA. Patients and clinicians may benefit from using SFA by experiencing shorter treatment duration, lower orthodontic treatment costs, and improvements in certain aspects of quality of life. Further studies with larger sample sizes and longitudinal data are necessary to establish the long-term effectiveness.