Cost-effectiveness of non-surgical periodontal therapy for patients with type 2 diabetes in the UK

Abstract

Aim: Periodontal therapy has been shown to reduce glycated haemoglobin in patients with diabetes, although considerable uncertainty remains regarding the sustainability of such changes. We evaluate the cost-effectiveness of non-surgical periodontal therapy and rigorous maintenance treatment in patients with type 2 diabetes and periodontitis from a provider perspective in the UK.

Method: Lifetime costs relating to periodontal treatment were modelled for a cohort of patients with type 2 diabetes. The projected lifetime impact of changes in glycated haemoglobin on diabetes treatment costs and quality adjusted life expectancy were estimated from a published simulation model. Costs and outcomes were combined to estimate the Incremental Cost-Effectiveness Ratio for periodontal therapy in patients with type 2 diabetes.

Results: The Incremental Cost-Effectiveness Ratio was £28,000 per Quality Adjusted Life-Year for a man aged 58 with glycated haemoglobin of 7%-7.9%. The results were particularly sensitive to assumptions on the impact of periodontal therapy on glycated haemoglobin, the proportion of patients who comply with maintenance therapy and the proportion of compliant patients who respond to treatment.

Conclusion: Assuming improvements in glycated haemoglobin can be maintained, periodontal therapy may be cost-effective for patients with type 2 diabetes at acceptable cost-per-Quality Adjusted Life-Year thresholds in the UK.

Keywords: Quality Adjusted Life-Year; cost-effectiveness; periodontitis; spreadsheet model; type 2 diabetes.