In France, a public-health strategy based on eliminating of gingivitis (and thus preventing progression to periodontitis) would more than halve the costs involved in a “business as usual” approach, according to the recent report on the financial and human cost of periodontitis, commissioned by the EFP and published by the Economist Intelligence Unit (EIU).
The report, Time to take gum disease seriously: The societal and economic impact of periodontitis, shows that the “baseline” costs – the “business as usual” scenario – amount to €19.4 billion over a ten-year period, which equates to €39 per “healthy life year”.
If eliminating gingivitis – the scenario which the report suggests is the most cost-effective – were adopted, costs would fall to just over €9 billion, representing €18 per healthy life year, a gain of 4.7 million healthy life years, and a return-on-investment (ROI) – the ratio between gains and costs – of 40.4.
In contrast, managing only 10% of gingivitis would increase costs to €20.7 billion, or €42 per healthy life year, a 4.3 million reduction in the number of healthy life years, and a negative ROI of 295.4.
The scenario of a 90% periodontitis diagnosis rate with all diagnosed cases managed would increase costs considerably – to €55.4 billion (€111 per healthy life year), but it would lead to a substantial increase in the number of healthy life years (2.4 million) and represent a positive ROI of 4.7.
Philippe Bouchard, professor of periodontology at the University of Paris and one of the experts consulted by the report’s authors, said that the EIU report was “one of the most important non-scientific publications that has been published so far in our disciplinary field. The target is not the dental professional – because most of them are aware of the systemic consequences of oral inflammation – but the overall population, and more specifically the policy makers.”
Prof Bouchard said that the potential impact of the report should be considered on two levels. First, from an economic point of view, there should be a greater awareness of the indirect costs associated with untreated periodontitis. Second, in terms of public health, “the important information that periodontal diseases are not limited to the oral cavity may allow ministries of health to exert pressure on finance ministers that are today the real decision-makers in matters of healthcare reimbursement.”
The EIU report notes that consultations with dentists in France are covered by public-health Insurance and that dental care, prostheses, and orthodontic treatments are reimbursed at a 70% fee-per-item basis for all standard treatments such as extractions, conservative dentistry, prostheses, and scaling. However, most prosthodontic treatment is paid for entirely by patients. In 2013, about 90% of people used complementary insurance schemes to cover all or part of their treatments. About 5% of the population, belonging to either low-income groups or to groups without any income, benefit from free care.
“Although dental care appears ‘free on paper’ […] only part of the dental procedures for treating periodontitis are covered and the remainder is paid for out-of-pocket,” the report says.
Prof Bouchard said that, on reading the EIU report’s comparison with the other featured countries (Germany, Italy, the Netherlands, Spain, and the UK), “I was surprised that my country was not in a bad position when compared with others even if, leaving aside Italy, the incremental costs by scenario were rather the same whatever the countries.”
One of the report’s key recommendations is that the affordability of dental and periodontal care needs to be improved and that policy makers should review the provision of publicly covered care for periodontitis. Prof Bouchard points out that this may not be as easy as it sounds.
“One cannot imagine that the improvement of the affordability of dental care could be detrimental in terms of overall health,” he said. “Consequently, a better reimbursement of periodontal treatment is obviously beneficial for access to care. The problem is that it is not easy to evaluate the magnitude of the difference because – as this report stresses – the benefit must not only include the direct costs but also the indirect costs. The present report is a key milestone is this evaluation.”
He added that there could be some “side-effects” if completely free treatment were provided in terms of the consumption of healthcare. “The economic appraisal (macro- and microeconomics) must be carefully weighed to balance the cost-benefit ratio at the societal level but also at the patient level.”