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?
Economics Health economics Economic evaluations
Periodontal therapies Way forward
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
Economics Health economics Economic evaluations
Periodontal therapies Way forward
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
Economics Health economics Economic evaluations
Periodontal therapies Way forward
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
Economics Health economics Economic evaluations
Periodontal therapies Way forward
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
Economics Health economics Economic evaluations
Periodontal therapies Way forward
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
Economics Health economics Economic evaluations
Periodontal therapies Way forward
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
Economics Health economics Economic evaluations
Periodontal therapies Way forward
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
Economics Health economics Economic evaluations
Periodontal therapies Way forward
Importance of viewpoint in cost analysis
PatientsHealth care providers or systemsEmployersThird party funders (insurance companies)Society
Economics Health economics Economic evaluations
Periodontal therapies Way forward
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?
Economics Health economics Economic evaluations
Periodontal therapies Way forward
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
Economics Health economics Economic evaluations
Periodontal therapies Way forward
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?
Economics Health economics Economic evaluations
Periodontal therapies Way forward
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
Economics Health economics Economic evaluations
Periodontal therapies Way forward
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
Economics Health economics Economic evaluations
Periodontal therapies Way forward
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
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