Journal of clinical periodontology · 2008
The cost-effectiveness of supportive periodontal care for patients with chronic periodontitis.
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Gaunt Francesca, Devine Maria, Pennington Mark, Vernazza Chris, Gwynnett Erika, Steen Nick, Heasman Peter
Аннотация
OBJECTIVE: To systematically evaluate the evidence for effectiveness of supportive periodontal care (SPC) provided in specialist care and general practice for patients with chronic periodontitis; to construct a model for the cost effectiveness of SPC.
SEARCH STRATEGY: Electronic database searches of MEDLINE, EMBASE and SCOPUS were performed with hand searching of relevant journals and Workshops of Periodontology.
SELECTION CRITERIA: SPC for patients with chronic periodontitis, at least 12 months follow-up and clinical attachment level as a primary outcome.
RESULTS: Three articles addressed the question (Nyman et al. 1975, Axelsson & Lindhe 1981, Cortellini et al. 1994): Deltas CAL for patients undergoing "specialist" SPC were 0.1 mm (2 years), 0.2 mm (6 years) and -0.01 mm (3 years) respectively. In generalist care the Deltas CAL during SPC were -2.2, -1.8 and -2.8 mm. Differences between specialist and generalist SPC were an extra 20.59 tooth years and 3.95 mm attachment loss for generalist SPC. Incremental cost-effectiveness ratios were an extra 288 euros for one tooth year or an extra 1503 euros/1 mm reduction in loss of attachment for SPC delivered in specialist care.
CONCLUSION: SPC delivered in specialist as compared with general practice will result in greater stability of clinical attachment but this will be achieved at relatively greater cost.
SEARCH STRATEGY: Electronic database searches of MEDLINE, EMBASE and SCOPUS were performed with hand searching of relevant journals and Workshops of Periodontology.
SELECTION CRITERIA: SPC for patients with chronic periodontitis, at least 12 months follow-up and clinical attachment level as a primary outcome.
RESULTS: Three articles addressed the question (Nyman et al. 1975, Axelsson & Lindhe 1981, Cortellini et al. 1994): Deltas CAL for patients undergoing "specialist" SPC were 0.1 mm (2 years), 0.2 mm (6 years) and -0.01 mm (3 years) respectively. In generalist care the Deltas CAL during SPC were -2.2, -1.8 and -2.8 mm. Differences between specialist and generalist SPC were an extra 20.59 tooth years and 3.95 mm attachment loss for generalist SPC. Incremental cost-effectiveness ratios were an extra 288 euros for one tooth year or an extra 1503 euros/1 mm reduction in loss of attachment for SPC delivered in specialist care.
CONCLUSION: SPC delivered in specialist as compared with general practice will result in greater stability of clinical attachment but this will be achieved at relatively greater cost.