title: The cost-effectiveness of supportive periodontal care: a global perspective.
abstract: OBJECTIVE
  To evaluate the cost-effectiveness of supportive periodontal care (SPC) provided in generalist and periodontal specialist practices under publicly subsidized or private dental care.
  
  
  METHODS
  SPC cost data and the costs of replacing teeth were synthesized with estimates of the effectiveness of SPC in preventing attachment and tooth loss and adjusted for differences in clinician's time. Incremental cost-effectiveness ratios were calculated for both outcomes assuming a time horizon of 30 years.
  
  
  RESULTS
  SPC in specialist periodontal practice provides improved outcomes but at higher costs than SPC provided by publicly subsidized or private systems. SPC in specialist periodontal practice is usually more cost-effective than in private dental practice. For private dental practices in Spain, United Kingdom and Australia, specialist SPC is cost-effective at modest values of attachment loss averted. Variation in the threshold arises primarily from clinician's time.
  
  
  CONCLUSIONS
  SPC in specialist periodontal practice represents good value for money for patients (publicly subsidized or private) in the United Kingdom and Australia and in Spain if they place relatively modest values on avoiding attachment loss. For patients in Ireland, Germany, Japan and the United State, a higher valuation on avoiding attachment loss is needed to justify SPC in private or specialist practices.
authors.affiliation: London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Pennington
authors.forename: Peter
authors.initials: P
authors.lastname: Heasman
authors.forename: Francesca
authors.initials: F
authors.lastname: Gaunt
authors.forename: Arndt
authors.initials: A
authors.lastname: Güntsch
authors.forename: Saso
authors.initials: S
authors.lastname: Ivanovski
authors.forename: Satoshi
authors.initials: S
authors.lastname: Imazato
authors.forename: Sunethra
authors.initials: S
authors.lastname: Rajapakse
authors.forename: Edith
authors.initials: E
authors.lastname: Allen
authors.forename: Thomas
authors.initials: T
authors.lastname: Flemmig
authors.forename: Mariano
authors.initials: M
authors.lastname: Sanz
authors.forename: Chris
authors.initials: C
authors.lastname: Vernazza
mesh_terms: D001315:Australia; D003362:Cost-Benefit Analysis; D003777:Dental Prophylaxis / Q000191:economics*; D005792:General Practice, Dental / Q000191:economics*; D005858:Germany; D017048:Health Care Costs; D006801:Humans; D007494:Ireland; D007564:Japan; D017622:Periodontal Attachment Loss / Q000191:economics* / Q000517:prevention & control; D010517:Periodontics / Q000191:economics*; D011331:Private Practice / Q000191:economics; D013030:Spain; D013188:Sri Lanka; D013218:State Dentistry / Q000191:economics; D016388:Tooth Loss / Q000191:economics* / Q000517:prevention & control; D006113:United Kingdom; D014481:United States