Cost-benefit, cost-effectiveness and cost-utility analyses of periodontitis prevention.
OBJECTIVE
The aim of this paper was to determine whether there is evidence that periodontitis prevention is economically justified.


METHODS
The characteristics of economic assessments such as cost-benefit, cost-effectiveness and cost-utility analyses were first derived from the literature on health economy. A literature search was conducted using PubMed up to December 2004. Inclusion criteria required that economic analyses be based on scientific principles including a hypothesis, valid comparative groups as well as a cost/benefit, cost/effectiveness and cost/utility assessment.


RESULTS
Only 14 papers were located, which included, in the broadest sense, economic parameters. From these papers, three were systematic reviews, three were randomized controlled studies, four were controlled studies, one was a longitudinal cohort study and three papers were based on statistical modelling. Only one paper reported actual costs for periodontal and dental treatment. Extensive programmes aimed at prevention of periodontal disease in a general population group showed no economic benefit. Adjunctive genetic/and or microbiological testing likewise showed no economic benefit. Economic assessments and real costs are not generally available in the literature. Statistical modelling suggested that non-surgical periodontal procedures are more economical compared with surgical interventions. The use of local delivery devices as an adjunct to Sc/RP showed no economic advantage.


CONCLUSIONS
It is suggested that economic parameters as well as patient-centred outcomes be included in clinical trials. These data are essential for the appropriate allocation of resources for preventive measures on an individual patient and population base.
Braegger
Urs
U
Department of Periodontology and Fixed Prosthodontics, School of Dental Medicine, University of Bern, Bern, Switzerland. urs.braegger@zmk.unibe.ch
D000891:Anti-Infective Agents, Local / Q000191:economics; D002710:Chlorhexidine / Q000008:administration & dosage / Q000191:economics; D003362:Cost-Benefit Analysis; D003777:Dental Prophylaxis / Q000191:economics; D017048:Health Care Costs; D006801:Humans; D018803:Models, Economic; D010514:Periodontal Pocket / Q000188:drug therapy; D010518:Periodontitis / Q000517:prevention & control*; D011313:Preventive Dentistry / Q000191:economics*; D016540:Smoking Cessation / Q000191:economics
D000891:Anti-Infective Agents, Local; D002710:Chlorhexidine