Cost-effectiveness of intraoral camera use for caries screening in school-based oral health programmes

Dental caries remains the most common chronic disease among children in England, despite being preventable. Early detection can reduce treatment costs and prevent progression, yet visual screening methods in schools often miss early lesions. This study evaluated the costeffectiveness of using intraoral cameras (IOCs) for caries screening within the existing BrushUP school oral health programme in Portsmouth. A diagnostic decision tree model compared IOC-based screening (TeleBrushUP) with standard visual examination from an NHS public health perspective over a four-year horizon. Costs included staff, consumables, and equipment, discounted at 3.5% annually. Effectiveness was measured as cost per true positive and cost per correct diagnosis. Sensitivity and specificity inputs for IOC and visual methods were derived from a pilot study and published literature. Stochastic sensitivity analysis was performed using bootstrapping to explore uncertainty. For a modelled population of 835 children per arm, IOC screening was both more effective and less costly than visual examination. The cost per child per year was £4.15 for IOC versus £6.75 for standard care. IOC sensitivity (91.7%) exceeded that of visual screening (86.0%), though specificity was lower (59.1% vs. 77.0%). The base-case analysis reported a negative ICER for both analysis cost per caries correctly identified and cost per correct diagnosis, indicating IOC dominance (both less costly and more effective). Sensitivity analyses confirmed IOC dominance in nearly all simulations. Incorporating intraoral camera screening into school-based oral health programmes is both feasible and cost-effective. It improves early caries detection at lower overall cost, primarily through reduced staff time and simpler logistics. Despite lower specificity, the benefits of early detection outweigh the risk of over-referral, particularly in high-need areas. IOC screening offers a practical, scalable, and economically sound approach to improving child oral health in the UK.