Resumen de Incorporating Severity and Risk as Factors to the Fardal Cost-Effectiveness Model to Create a Cost�Benefit Model for Periodontal Treatment
John A. Martin, Oystein Fardal, Roy C. Page, Carl F. Loeb, Elizabeth Krall Kaye
Background: A previously described economic model was based on average values for patients diagnosed with chronic periodontitis (CP). However, tooth loss varies among treated patients and factors for tooth loss include CP severity and risk. The model was refined to incorporate CP severity and risk to determine the cost of treating a specific level of CP severity and risk that is associated with the benefit of tooth preservation.
Methods: A population that received and another that did not receive periodontal treatment were used to determine treatment costs and tooth loss. The number of teeth preserved was the difference of the number of teeth lost between the two populations. The cost of periodontal treatment was divided by the number of teeth preserved for combinations of CP severity and risk.
Results: The cost of periodontal treatment divided by the number of teeth preserved ranged from (US) $1,405 to $4,895 for high or moderate risk combined with any severity of CP and was more than $8,639 for low risk combined with mild CP. The cost of a three-unit bridge was $3,416, and the cost of a single-tooth replacement was $4,787.
Conclusion: Periodontal treatment could be justified on the sole basis of tooth preservation when CP risk is moderate or high regardless of disease severity.
A recent study by Fardal et al.1 reported that the direct life costs for periodontal therapy were cost effective if the patient chose not to have treatment for their periodontal condition and had no more than four teeth replaced with bridges or implants. The timeframe of the model was 33 years during periodontal maintenance and costs included: 1) periodontal scaling and surgery; 2) prosthetic tooth replacement; 3) follow-on costs of periodontal retreatment and prosthetic replacement; and 4) periodontal maintenance. The conclusion was based on average values for patients diagnosed with mild, moderate, or severe chronic periodontitis (CP). Regarding tooth loss, patients did not lose the same number of teeth. In fact, five of the 100 patients studied accounted for 42% of the teeth lost, 74% lost no teeth, and the number of teeth lost increased with increasing severity of CP,2 which is consistent with other reports.3-12 Reasons for this effect include: 1) tooth loss among individual patients varies as a consequence of progressive bone loss attributable to untreated CP over time;13,14 2) bone loss and tooth loss correlate to CP severity and risk;15,16 3) severity and risk of CP vary among patients;12,16-18 and 4) response to periodontal treatment varies among patients.3-12,18 Refining the Fardal model of the lifetime direct cost of periodontal treatment to accommodate severity and risk as tooth loss predictors and indicated specific treatment may produce a model with greater precision and utility that could be helpful in making treatment decisions and designing an insurance plan. Accordingly, the purpose of this study is to describe a model of the cost of treating a specific level of CP severity and risk that is associated with the single benefit of tooth preservation.
