Cost-effectiveness analysis of non-surgical periodontal treatment to prevent strokes and myocardial infarctions in the United Kingdom

Periodontal disease (PD) is common in the UK and is associated with higher risks of stroke and myocardial infarction (MI). Non-surgical periodontal treatment (NSPT) may therefore generate downstream cardiovascular benefits, but its value for money as a CVD-prevention strategy for the NHS is unclear.

A Markov cohort model simulated 65-year-olds with severe PD and no prior CVD over 10 years (with a 25-year scenario). Eight health states captured acute and chronic phases of stroke, MI, combined events, and death. Baseline CVD risks were derived from published sources; NSPT effects (stroke HR 0.55, MI HR 0.70) were taken from large international cohort studies. Costs (2024 € , NHS payer perspective) and QALYs (EQ-5D) were discounted at 3.5%. Deterministic and probabilistic sensitivity analyses assessed parameter and structural uncertainty and identified effect sizes required to meet NICE thresholds.

Over a 25-year horizon, NSPT increased costs by € 9,755 and QALYs by 0.50 per patient (ICER € 19,322 per QALY). NSPT reduced non-fatal stroke and MI by 41% and 22%, respectively, with 22% of treated individuals event-free at 25 years and a 12% reduction in cumulative mortality. Probabilistic analysis resulted in a PSA mean ICER of € 19,129. The 10-year scenario produced an ICER of € 49,847, and a five-year scenario produced an ICER of € 197,614, demonstrating that NSPT is an intervention with a long payback period.

Using a lifetime horizon and given current available evidence, NSPT potentially provides cost-effective prevention against CVD events at current NICE thresholds. Conclusions are sensitive to the magnitude of NSPT’s cardiovascular effect, which is the main source of parameter uncertainty. We advocate for high-quality UK longitudinal evidence on NSPT’s effect on hard CVD endpoints.