Cost-effectiveness of regular versus irregular supportive periodontal therapy or tooth removal

Aim: For periodontitis patients, regular supportive periodontal therapy (SPT) decreases risks of tooth loss, with savings for tooth replacement possibly compensating SPT-costs. We aimed to assess the cost-effectiveness of regular versus irregular SPT, and to compare both strategies with immediate tooth removal. Methods: A private payer perspective within German healthcare was adopted. A tooth-level Markov model was constructed. Replacement of 50% of removed teeth via implant-supported crowns was modelled in the base case. Cost-effectiveness was estimated as Euro/tooth retention year using Monte Carlo microsimulations. Scenario analyses were performed. Results: Regular SPT was more effective (tooth retention 28.7 versus 26.1 years), but more costly (806 versus 731 Euro per tooth), with an incremental cost-effectiveness ratio (additional costs per tooth retention year) of 29 Euro/year. Regular SPT was less costly if costs for SPT per tooth and visit were <5.03 Euro, patients had high risk of tooth loss, or teeth were regularly replaced. Immediately removing and replacing teeth was usually most costly. Conclusions: Within the chosen healthcare setting and on the basis of current evidence, regular SPT retains teeth longer than irregular SPT, but does not necessarily reduce expenses. Decision-making should consider the subjective value placed on retaining teeth, the technical feasibility of replacement, and the impact of periodontal on general health.