The cost-effectiveness of supportive periodontal care for patients with chronic periodontitis

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): Δs 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 Δs 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 for one tooth year or an extra €1503/1 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.