title: Preventing and Treating Peri-Implantitis: A Cost-Effectiveness Analysis.
abstract: BACKGROUND
  A large number of treatments for peri-implantitis are available, but their cost-effectiveness remains uncertain. This study evaluates the cost-effectiveness of preventing and treating peri-implantitis.
  
  
  METHODS
  A Markov model was constructed that followed each implant over 20 years. Supportive implant therapy (SIT) for managing peri-implant mucositis and preventing development of peri-implantitis was either provided or not. Risk of peri-implantitis was assumed to be affected by SIT and the patient's risk profile. If peri-implantitis occurred, 11 treatment strategies (non-surgical or surgical debridement alone or combined with adjunct therapies) were compared. Treatments and risk profiles determined disease progression. Modeling was performed based on systematically collected data. Primary outcomes were costs and proportion of lost implants, as assessed via Monte Carlo microsimulations.
  
  
  RESULTS
  Not providing SIT and performing only non-surgical debridement was both least costly and least effective. The next best (more costly and effective) option was to provide SIT and perform surgical debridement (additional 0.89 euros per 1% fewer implants lost). The most effective option included bone grafts, membranes, and laser treatment (56 euros per 1%). For patients at high risk, the cost-effectiveness of SIT increased, whereas in low-risk groups, a cost-optimized strategy was cost-effective.
  
  
  CONCLUSIONS
  Although clinical decision-making will be guided mainly by clinical condition, cost-effectiveness analyses might add another perspective. Based on these findings, an unambiguous comparative effectiveness ranking was not established. However, cost-effectiveness was predominantly determined by provision of SIT and initial treatment costs. Transferability of these findings to other healthcare systems needs further confirmation.
authors: Department of Operative and Preventive Dentistry, Charité - University of Medicine Berlin, Berlin, Germany.
authors: Falk
authors: F
authors: Schwendicke
authors: Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
authors: Yu-Kang
authors: YK
authors: Tu
authors: Kiel Institute for the World Economy, Kiel, Germany.
authors: Michael
authors: M
authors: Stolpe
mesh_terms: D000465:Algorithms; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use; D016025:Bone Transplantation / Q000191:economics; D002710:Chlorhexidine / Q000627:therapeutic use; D003131:Combined Modality Therapy / Q000191:economics; D003362:Cost-Benefit Analysis; D003646:Debridement / Q000191:economics; D015921:Dental Implants; D003777:Dental Prophylaxis / Q000191:economics; D019232:Dental Restoration Failure / Q000191:economics; D018450:Disease Progression; D005382:Financing, Personal / Q000191:economics; D005500:Follow-Up Studies; D006801:Humans; D053685:Laser Therapy / Q000191:economics; D008390:Markov Chains; D008567:Membranes, Artificial; D057873:Peri-Implantitis / Q000191:economics / Q000517:prevention & control* / Q000628:therapy; D017622:Periodontal Attachment Loss / Q000191:economics / Q000517:prevention & control / Q000628:therapy; D057747:Periodontal Debridement / Q000191:economics; D010778:Photochemotherapy / Q000191:economics; D012307:Risk Factors; D013280:Stomatitis / Q000517:prevention & control / Q000628:therapy; D035501:Uncertainty
chemical_list: D000900:Anti-Bacterial Agents; D000891:Anti-Infective Agents, Local; D015921:Dental Implants; D008567:Membranes, Artificial; D002710:Chlorhexidine
keywords: Dental economics; Markov chains; dental implants; health care economics and organizations; peri-implantitis; periodontal disease