health economics application for periodontal disease

Tuti Ningseh Mohd Dom (BDS, MPH, PhD)

Faculty of Dentistry

Universiti Kebangsaan Malaysia

Health Economic & its Application in the control of Periodontal Disease

Lecture Contents

Way forward

Economic evaluations of periodontal therapies

Economic evaluation

Health economics

Economics

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?



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



Health economics is a branch of economicsIts subject matter is the optimum use of resources for the

care of the sick and the promotion of healthIts 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



1. Increasing health care costs2. Changes in consumer expectations3. Government inability to provide

appropriate level of health care for all4. Proliferation of new and technology

Economic issues in health care:Relevance to the dental practitioner



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



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



Cost = The total money , time and resources associated with a purchase or activity

Fixed cost vs variable costTotal cost = Fixed cost + variable costDirect cost vs indirect costCapital cost vs recurrent costIntangible cost



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



Importance of viewpoint in cost analysis

PatientsHealth care providers or systemsEmployersThird party funders (insurance companies)Society



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?



Less pain and discomfort due to periodontal conditionsSave 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 lifeFewer teeth with exposed roots, increased mobility,

functional and aesthetic impairmentPatient-centred outcomes: better cosmetics, better

appearance, fresh breath and social advantages

Examples of benefits for patients



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?



Periodontal therapies that have undergone economic evaluations analysesType 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



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



Resources in health care are always scarcePrioritizing requires trade-offs - need to establish

values for different health outcomesIt 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

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

Terima kasih

health economics application for periodontal disease

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