Economic of periodontal disease management

1. Tuti Ningseh Mohd Dom (BDS, MPH, PhD)
Faculty of Dentistry
Universiti Kebangsaan Malaysia
Health Economic & its Application in
the control of Periodontal Disease

2. Lecture Contents
Way forward
Economic evaluations of periodontal therapies
Economic evaluation
Health economics
Economics

3. Economics Health economics
Economic
evaluations
Periodontal
therapies
Way forward
 Economics is all about how societies allocate scarce
resources to meet societal needs.
 Consumers may have unlimited wants, but the
resources with which to meet those needs are not
limitless.
 In the area of health care, people may want all the
medical services they require, but means to pay for
such services are limited, as are the number of
physicians and other medical providers.

What is economics?

4. Economics Health economics
Economic
evaluations
Periodontal
therapies
Way forward
 Necessary to make choices among competing
claims on limited resources
 Resources allocated to one chosen area is a
loss of opportunity for another
 Compromise between what you want and
what you can afford
Economics: Scarcity of resources

5. Economics Health economics
Economic
evaluations
Periodontal
therapies
Way forward
 Health economics is a branch of economics
 Its subject matter is the optimum use of resources for the
care of the sick and the promotion of health
 Its task is to appraise the efficiency of the organization of
health services, and to suggest ways of improving this
organization
Toward a definition of health economics
Selma J. Mushkin
Public Health Rep. 1958 September; 73(9): 785–794.
Health economics defined

6. Economics Health economics
Economic
evaluations
Periodontal
therapies
Way forward
1. Increasing health care costs
2. Changes in consumer expectations
3. Government inability to provide
appropriate level of health care for all
4. Proliferation of new and technology
Economic issues in health care:
Relevance to the dental practitioner

7. Economics Health economics
Economic
evaluations
Periodontal
therapies
Way forward
 Of all oral health problems, periodontal disease is
one of the most common
 Review of epidemiological studies (Morris et al
2001, Borris et al 2002) & WHO data bank
(Petersen & Ogawa 2005): over 90% general
population have periodontal disease
 5-20% have severe forms of periodontal disease
(Albandar 1999, Hugoson & Laurell 2000, Petersen
& Ogawa 2005)
Periodontal disease

8. Economics Health economics
Economic
evaluations
Periodontal
therapies
Way forward
 Chronic & recurrent – patients regularly need to
seek treatment throughout their lifetime – will
have considerable economic burden for patients
and health care providers
 High prevalence, uncertain long-term outcomes
Economic implication of chronic periodontitis

9. Economics Health economics
Economic
evaluations
Periodontal
therapies
Way forward
Cost = The total money , time and resources
associated with a purchase or activity
 Fixed cost vs variable cost
 Total cost = Fixed cost + variable cost
 Direct cost vs indirect cost
 Capital cost vs recurrent cost
 Intangible cost

10. Economics Health economics
Economic
evaluations
Periodontal
therapies
Way forward
 Direct cost: costs for purchasing equipment, building, utilities,
staff salary or paying for periodontal services by general
dentists, periodontists, hygienists, use of drugs, mouthrinses,
cleaning aids, diagnostic tests
 Indirect costs: expenditures for treatment of side effects such
as treatment of recessions, toothbrush abrasions. Loss of
productivity can also be calculated on the basis of human capital
method
 Intangible costs: a monetary validation of anxiety, pain,
distress, discomfort, esthetic impairment and social handicap,
which are very difficult to express in monetary terms
Examples of costs in periodontal management

11. Economics Health economics
Economic
evaluations
Periodontal
therapies
Way forward
Importance of viewpoint in cost analysis
 Patients
 Health care providers or systems
 Employers
 Third party funders (insurance companies)
 Society

12. Economics Health economics
Economic
evaluations
Periodontal
therapies
Way forward
 Defined as the comparative analysis of alternative
courses of action in terms of their costs and
consequences (Drummond et al 1997)
 Provides evidence on clinical effectiveness of
treatments as well as information on “value for
money” when allocating resources (Buck, 2000)
What is economic evaluation?

14. Economics Health economics
Economic
evaluations
Periodontal
therapies
Way forward
 Less pain and discomfort due to periodontal conditions
 Save money by avoiding having to pay for treatment such as
surgery, extractions and need for replacement of teeth lost
due to periodontal disease
 Higher chance of maintaining teeth for life
 Fewer teeth with exposed roots, increased mobility,
functional and aesthetic impairment
 Patient-centred outcomes: better cosmetics, better
appearance, fresh breath and social advantages
Examples of benefits for patients

15. Economics Health economics
Economic
evaluations
Periodontal
therapies
Way forward
 Clinical trials measure health care outcomes to
determine the efficacy or effectiveness of health
 care interventions.
 If resources are unlimited, this is the only
information we require to decide which
interventions to use
 But when resources are limited we also need to
know whether the intervention represents good
value for money
Why do we need economic evaluation?

16. Economics Health economics
Economic
evaluations
Periodontal
therapies
Way forward
Periodontal therapies that have undergone
economic evaluations analyses
Type of therapy/ management Authors, Year
Preventive and promotive Gjermo & Grytten 2009, Braegger et al 2005
Adjunctive antimicrobials Heasmen et al 2011, Niedermen et al 2001, Henke et
al 2001, Lundgren et al 2001, De Lissovey 1999
Removal of subgingival deposits Gjermo & Grytten 2009
Access surgery Gjermo & Grytten 2009
Surgical vs nonsurgical Antzack-Bouckoms & Weinstein 1987
Treatment of infrabony defects/
lesions
Listl & Faggion 2010
Supportive periodontal care Pennington et al 2009, Pretzl et al 2009, Gjermo &
Grytten 2009

17. Economics Health economics
Economic
evaluations
Periodontal
therapies
Way forward
 Economic assessments and real costs are generally not
available in the literature
 Lack of care pathways to address complexities of managing
periodontitis and this affects costing of the various
procedures
 Problem with having to use surrogate endpoints as
measures of outcomes
 Measures of outcomes that can relate to cost have yet to be
defined and refined
Issues in economic analyses of periodontitis

20. Economics Health economics
Economic
evaluations
Periodontal
therapies
Way forward
 Resources in health care are always scarce
 Prioritizing requires trade-offs - need to establish
values for different health outcomes
 It is timely that an evidence-based approach is
undertaken with regard to allocating resources in
oral health care services – this may be facilitated by
use of sound health economic principles
Way forward

21. “It's not your salary that makes you rich, it's
your spending habits.”
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