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Published on: May 9, 2022
Cost-Effectiveness of Periodontal Intervention Combined with Diabetes Management in China: A Markov Analysis
Xinhai Yin1, Yuhan Dai2, Guohui Bai2
1Department of Oral and Maxillofacial Surgery, Guizhou Provincial People's Hospital, Guiyang, China.
Background:
To evaluate the long-term cost-effectiveness of integrating periodontal intervention with diabetes management for Chinese adults with comorbid type 2 diabetes mellitus (T2DM) and periodontitis.
Methods:
A 9-state Markov cohort model (1-year cycle; 40-year horizon) was constructed for a hypothetical cohort of 50-year-old Chinese adults with comorbid T2DM and periodontitis. Three strategies were compared: usual care (UC), scaling and root planing plus intensified diabetes management (SRP+DM), and comprehensive integrated management (CIM). Transition probabilities, costs (2024 CNY; 5% discount rate), and utilities were derived from Chinese national data and systematic reviews. One-way and probabilistic sensitivity analyses (PSA; 10,000 Monte Carlo simulations) were performed. Willingness-to-pay (WTP) thresholds were CNY 90,000/QALY (1 × GDP per capita) and CNY 270,000/QALY.
Results:
Usual care generated CNY 104,028 and 11.749 QALYs. SRP+DM yielded an incremental cost-utility ratio (ICUR) of CNY 5,308/QALY versus UC; CIM yielded CNY 6,608/QALY. Both strategies were cost-effective at CNY 90,000/QALY. In patients with uncontrolled diabetes (HbA1c ≥7%), both were cost-saving. CIM reduced cumulative 40-year DM complication incidence by 11.9 percentage points, tooth loss by 12.7 percentage points, and all-cause mortality by 4.8 percentage points versus UC. CIM was cost-optimal in 99.4% of simulations.
Conclusions:
Subject to the model's assumptions-notably extrapolation of short-term randomized-trial effects over a lifetime, pooled estimates of periodontal recurrence and HbA1c-benefit durability, and indirectly derived utilities-integrated periodontal-diabetes management appears cost-effective in China across all WTP thresholds tested in deterministic and probabilistic sensitivity analyses. In durability scenario analyses, this conclusion remained robust when the treatment effect was lost after 1, 3, or 5 years, except when the benefit disappeared within 1-3 years while maintenance costs continued. These findings support including periodontal intervention in China's national diabetes care pathway but require confirmation by long-term empirical studies.