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The Cost-Effectiveness of Periodontal Care in Patients with Type 2 Diabetes 

Jun 6, 2020
 
Editor: Steve Freed, R.PH., CDE

Author: Mia Flowers, PharmD. Candidate of Florida Agricultural & Mechanical University School of Pharmacy

Treating periodontitis in type 2 diabetes could have benefits beyond better oral condition.  

Periodontitis is a gum disease characterized by chronic inflammation of the tissue around the teeth and bones supporting the mouth. Nearly 50% of adults above the age of 30 in the United States have been diagnosed with periodontitis, and there is a threefold increase in the risk associated with patients with diabetes in comparison to those who do not have diabetes. Previous trials have discovered treating periodontitis can lower HbA1c, improve blood glucose control, and decrease the incidence of cardiovascular risks. Periodontal care in patients with type 2 diabetes is seldom sought after because of the cost of dental treatment and the lack of communication amongst primary care providers and dentists. With increasing awareness, insurance plans began to offer complete coverage of root planing and periodontal scaling to patients with other chronic conditions, including cardiovascular disease, diabetes, HIV/AIDS, and rheumatoid arthritis. These treatments have been studied retrospectively through insurance claims and found to be correlated with a decline in medical expenses and hospitalizations amongst the population living with chronic diseases. The objective of this computer-based model analysis was to distinguish the cost-effectiveness of the expansion of nonsurgical dental work.  

The Markov cohort model was used to simulate 10,000 American individuals ranging from 30 to 85 years of age versus an average population, which allowed for the adjustment of variations in traits involving demographics and risks of chronic disease that could affect cost savings.  A stochastic microsimulation model of cardiovascular disease in the U.S., oral health conditions, type 2 diabetes, and microvascular complications was utilized to conduct a cost-effective analysis of health benefits and lifelong costs of receiving the aforementioned periodontal work. The National Health and Nutrition Examination Survey (NHANES) and other randomized control trials provided model parameters for observing periodontal care in type 2 diabetes. The subjects were divided into groups by age, ethnicity, income, race, and sex.  To imitate real people living with diabetes, risk factors such as cholesterol, blood pressure, renal function, smoking, history of stroke or heart attack, and medications were dispersed equally amongst the individuals of the simulation. Costs were integrated into the lifespan of the simulated individuals with the assumption that all patients would complete annual dental visits for maintenance post-periodontal procedures. U.S dollars were used to express all costs, which were derived from the American Dental Association survey to estimate dental fees and the U.S. Medical Expenditure Panel Survey to assess annual costs specified by disease.  

The expansion of coverage in this patient population would help avoid the loss of teeth by about 34% and stimulate a decline in microvascular complications associated with diabetes including nephropathy, neuropathy, and retinopathy by 20.5% (95% CI −31.2, −9.1), 17.7 % (95% CI −32.7, −4.7), and 18.4% (95% CI −34.5, −3.5) respectively. Periodontal care in patients with type 2 diabetes could produce a net cost savings of over $5900 (95% CI −6,039, −5,769) in health care with a 0.6 (95% CI 0.5, 0.6) increase in quality-adjusted life years (QALY) per capita.  

Improved glycemic control, fewer microvascular complications, and a reduction in the loss of teeth can be seen when patients with type 2 diabetes and periodontitis are provided periodontal care of the nonsurgical variety. It is essential to encourage this target population to seek out treatment for oral conditions and diseases to help increase overall health outcomes as well as long-term health care costs. Limitations of this study are mainly based on simulation modeling in that there were assumptions made. Future studies could involve more extended follow-up periods after periodontal care and take into account other factors such as cognitive impairment, chronic kidney disease, or respiratory diseases impacting the treatment of periodontitis. There is no way to assure every potential uncertainty captured in the simulation, and there is a possibility the model could have overestimated disease-related risks.  

Practice Pearls: 

  • Recent studies have found benefits in encouraging patients with type 2 diabetes to seek out periodontal treatment. 
  • The treatment of periodontitis in type 2 diabetes could improve glycemic control and lower the incidence of microvascular complications including neuropathy, nephropathy, and retinopathy. 
  • Ultimately, periodontal care can lower lifetime healthcare costs for those with type 2 diabetes by over $5,000. 

 

Choi, Sung Eun, et al. Impact of Treating Oral Disease on Preventing Vascular Diseases: A Model-Based Cost-Effectiveness Analysis of Periodontal Treatment Among Patients With Type 2 Diabetes. Diabetes Care, vol. 43, no. 3, Mar. 2020, pp. 563 LP – 571, doi:10.2337/dc19-1201. 

Mia Flowers, PharmD. Candidate of Florida Agricultural & Mechanical University School of Pharmacy

 

 

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