SPC delivered in specialist as compared with general practice will result in greater stability of clinical attachment but this will be achieved at relatively greater cost.

Pennington M, Heasman P, Gaunt F, Güntsch A, Ivanovski S, Imazato S, Rajapakse S, Allen E, Flemmig T, Sanz M, Vernazza C. The cost‐effectiveness of supportive periodontal care: a global perspective. J Clin Periodontol 2011; doi: 10.1111/j.1600‐051X.2011.01722.x. Abstract Aim: To evaluate the cost‐effectiveness of supportive periodontal care (SPC) provided in generalist and periodontal specialist practices under publicly subsidized or private dental care. Material and methods: SPC cost data and the costs of replacing teeth were synthesized with estimates of the effectiveness of SPC in preventing attachment and tooth loss and adjusted for differences in clinician's time. Incremental cost‐effectiveness ratios were calculated for both outcomes assuming a time horizon of 30 years. Results: SPC in specialist periodontal practice provides improved outcomes but at higher costs than SPC provided by publicly subsidized or private systems. SPC in specialist periodontal practice is usually more cost‐effective than in private dental practice. For private dental practices in Spain, United Kingdom and Australia, specialist SPC is cost‐effective at modest values of attachment loss averted. Variation in the threshold arises primarily from clinician's time. Conclusion: SPC in specialist periodontal practice represents good value for money for patients (publicly subsidized or private) in the United Kingdom and Australia and in Spain if they place relatively modest values on avoiding attachment loss. For patients in Ireland, Germany, Japan and the United State, a higher valuation on avoiding attachment loss is needed to justify SPC in private or specialist practices.

There is a need to measure efficiency of periodontal treatments. Efficiency questions can be addressed through a variety of economic evaluation techniques: cost minimization, cost-effectiveness, cost utility and cost-benefit analysis. Each of these techniques is outlined in this article, including a detailed discussion of different preference-based outcome (utility) measures. Despite the need, few analyses have been undertaken in periodontology. There are several issues in undertaking cost-effectiveness analyses specific to periodontology and these are examined in detail: outcome measures including patient-based vs. clinical measures of outcome; discounting or taking into account time preference for outcomes and costs; problems of costing, including the perspective taken in an analysis; interpreting the evidence, in particular using incremental cost-effectiveness ratios; and global variation in periodontal care delivery, including healthcare systems and the use of hygienists. The need for cost-effectiveness analysis in periodontology is explored further, and the need to involve a health economist in such an evaluation is underlined.

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