Abstract
BackgroundSmokers present a higher prevalence and severity of periodontitis and, consequently, higher prevalence of tooth loss. Smoking cessation improves the response to periodontal treatment and reduces tooth loss. So, the aim of this study was to evaluate the efficiency in resources allocation when implementing smoking cessation therapy vs. its non-implementation in smokers with periodontitis.MethodsWe adopted the Brazilian public system perspective to determine the incremental cost-effectiveness (cost per tooth loss avoided) and cost-utility (cost per oral-related quality-adjusted life-year ([QALY] gained) of implementing smoking cessation therapy. Base-case was defined as a 48 years-old male subject and horizon of 30 years. Effects and costs were combined in a decision analytic modeling framework to permit a quantitative approach aiming to estimate the value of the consequences of smoking cessation therapy adjusted for their probability of occurrence. Markov models were carried over annual cycles. Sensitivity analysis tested methodological assumptions.ResultsImplementing the therapy saved approximately US$ 100 over the time horizon accompanied by a slightly better effect, both in CEA and CUA. Considering uncertainties, the therapy could be cost-effective in the most part of simulated cases, even being cheaper and more effective in 35% of cases in which the oral-health related outcome is used as effect. Considering a willingness-to-pay of US$100 per health effect, smoking cessation therapy was cost-effective, respectively, in 72% and 99% of cases in cost-utility and cost-effectiveness analyses.ConclusionsImplementation of smoking cessation therapy may be cost-effective, considering the avoidance of tooth loss and oral health-related consequences to patients.
Highlights
Smokers present a higher prevalence and severity of periodontitis and, higher prevalence of tooth loss
This study aimed to evaluate the efficiency in resource allocation when implementing smoking cessation therapy (SCT) vs. its non-implementation in smokers with periodontitis that received periodontal treatment to prevent tooth loss, in the context of the Brazilian public health system (PHS). This economic evaluation has been prepared according to the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) [22]
A similar trend was observed when we tested a much lower probability of smoking cessation observed in a non-population based study [40], resulting in a still better effect of SCT, increasing on average 100 dollars per patient at the adopted time horizon
Summary
Smokers present a higher prevalence and severity of periodontitis and, higher prevalence of tooth loss. Smoking cessation improves the response to periodontal treatment and reduces tooth loss. The aim of this study was to evaluate the efficiency in resources allocation when implementing smoking cessation therapy vs its non-implementation in smokers with periodontitis. Cigarette smoking is a global public health problem associated with high morbidity and mortality [1]. It is a major risk factor for health problems, such as cancer, cardiovascular and respiratory diseases. Smoking is a risk factor for oral diseases, such as oral cancer, periodontitis, gingival recession, tooth loss and implant failure [2,3,4]. Smoking cessation therapy (SCT) is recommended as an important component of periodontal treatment [14]
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