Smoking Cessation Therapy is a Cost-Effective Intervention to Avoid Tooth Loss in Subjects With Periodontitis – An Economic Evaluation 

Abstract

Background: Smokers present a higher prevalence and severity of periodontitis and, consequently, higher prevalence of tooth loss. Smoking cessation improves the response to periodontal treatment and reduces tooth loss. So, the aim of this study was evaluated the efficiency in resources allocation when implementing smoking cessation therapy vs. its non-implementation in smokers with periodontitis. Methods: We adopted the Brazilian public system perspective to determine the incremental cost-effectiveness (cost per tooth loss avoided) and cost-utility (cost per oral-related quality-adjusted life-year ([QALY] gained) of implementing smoking cessation therapy. Base-case was defined as a 48 years-old male subject and horizon of 30 years. Effects and costs were combined in a decision analytic modeling framework to permit a quantitative approach aiming to estimate the value of the consequences of smoking cessation therapy adjusted for their probability of occurrence. Markov models were carried over annual cycles. Sensitivity analysis tested methodological assumptions. Results: Implementation of smoking cessation therapy had an average incremental cost of U$60.58 per tooth loss avoided and U$4.55 per oral related-QALY gained. Considering uncertainties, the therapy could be cost-effective in the most part of simulated cases, even being cheaper and more effective in 53% of cases in which the oral-health related outcome is used as effect. Considering a willingness-to-pay of US$100 per health effect, smoking cessation therapy was cost-effective, respectively, in 81% and 100% of cases in cost-utility and cost-effectiveness analyses. Conclusions: Implementation of smoking cessation therapy may be cost-effective, considering the avoidance of tooth loss and oral health-related consequences to patients.