Cost-Effectiveness Analysis of Non-Surgical Interventions for Oral Submucous Fibrosis: A Novel Economic Framework

Background: Oral submucous fibrosis (OSF) is a chronic, progressive disorder characterised by reduced mouth opening (MO) and a risk of malignant transformation. Despite numerous non-surgical interventions, sustained functional improvement remains elusive. This study introduces a cost-effectiveness analysis framework to compare various OSF treatments, addressing a critical knowledge gap. Materials and Methods: Data from a previously published network meta-analysis (NMA) comprising 72 studies ( N = 5268 patients) were analysed. Cost/millimeter of MO improvement (cost/mm) and cost/millimeter/week (cost/mm/week) were calculated. Incremental Cost-Effectiveness Ratio (ICER) was computed against placebo and multivitamins. P ≤0.05 considered significant. Results: The median cost/mm was INR 1906.57, ranging from INR 403.35 (ultrasound + exercise) to INR 10,368.36 (steroids + exercise). Cost/mm/week ranged from INR 59.97 (topical steroids) to INR 2292.83 (steroids + exercise). Kruskal–Wallis tests showed significant differences in cost/mm ( P = 0.002) and cost/mm/week ( P = 0.004). ICER analysis identified steroid with or with spreading factor (SSF) + exercise as the most cost-effective (–4918.38 INR/placebo, –2365.78 INR/multivitamins), while SSF + placebo was least cost-effective (ICER: 8540.79 INR/placebo, 8382.25 INR/multivitamins). Discussion and Conclusion: This study presents the first cost-effectiveness analysis of non-surgical OSF treatments, revealing substantial economic variations across interventions. Ultrasound with exercise and SSF + exercise was the most cost-efficient, supporting the integration of multimodal non-pharmacological therapies into OSF management. Conversely, nutraceutical products (NPs) demonstrated inconsistent cost-effectiveness, with systemic NPs outperforming topical applications. Given the economic burden and limited efficacy of some treatments, these findings emphasise the need for evidence-based, cost-conscious decision-making. The cost/mm and cost/mm/week metrics provide a novel perspective, facilitating better resource allocation in OSF care.