Objectives: to construct a model to evaluate the cost-effectiveness of SPC when delivered in specialist or general dental practice (private or NHS-based) with 30-minute and 20-minute appointments respectively.
Methods: The model was constructed from the perspective of a single patient over 30 years. The primary outcomes were tooth years lost and clinical attachment level .The clinical data for the model were extrapolated from a systematic review undertaken by the authors (Gaunt et al. 2008; in press).
Results: Over 30 years, difference in costs incurred by the patient when SPC was provided in specialist compared to private general practice was €4466; difference in costs between specialist and general (NHS) practice SPC provision was €5938. In terms of discounted tooth loss, an extra 20.59 tooth years were lost for generalist compared to specialist SPC and an extra 3.95mm of discounted clinical attachment loss. Using private, generalist SPC as baseline, the incremental cost-effectiveness ratios (ICERs) for SPC delivered in specialist care were €217 for 1 extra tooth year and an additional €1130 for 1mm less attachment loss. Using NHS generalist SPC provision as the baseline, the ICERs were an extra Euros288 for 1 extra tooth year or an extra €1503 per 1mm less loss of attachment in specialist care. A sensitivity analysis was undertaken to vary appointment times: for example, by increasing specialist appointments to 60-minutes and maintaining generalist appointments at 20-minutes. The respective ICERs increase to €515 per tooth year and €2683 per mm of attachment.
Conclusion: SPC delivered in specialist compared to generalist dental practice, will be more expensive but will likely result in greater periodontal stability and higher tooth survival rates.