Perio therapy as CVD prevention: cost-effective only over a lifetime horizon
Coote E, Patel N, Vijayanarayanan R
Source study: Cost-effectiveness analysis of non-surgical periodontal treatment to prevent strokes and myocardial infarctions in the United Kingdom. — Cost Effectiveness and Resource Allocation
In brief
- •Over a 25-year horizon, NSPT reached an ICER of €19,322/QALY — within NICE thresholds; at 10 years the ICER more than doubled to €49,847.
- •The model projected 41% fewer non-fatal strokes, 22% fewer MIs, and 12% lower cumulative mortality in treated versus untreated patients.
- •Cost-effectiveness conclusions rest on observational cardiovascular HRs (stroke HR 0.55, MI HR 0.70), not interventional evidence — the authors flag this as the dominant uncertainty.
- •High-quality longitudinal data on hard CVD endpoints are needed before NSPT can be recommended as a systemic prevention strategy.
Periodontal disease travels with cardiovascular risk — that link is now well established. The harder question is economic: if non-surgical periodontal treatment (NSPT) lowers the chance of stroke and myocardial infarction, is treating gums a defensible way for a health system to spend money on heart disease prevention? This UK study builds a Markov cohort model to find out. It simulates 65-year-olds with severe periodontal disease and no prior cardiovascular disease over a 10-year horizon, with a 25-year scenario. Eight health states capture the acute and chronic phases of stroke, MI, combined events, and death. The cardiovascular effect of NSPT was drawn from large international cohort studies (stroke HR 0.55, MI HR 0.70); costs were in 2024 euros from an NHS payer perspective, with QALYs from EQ-5D, both discounted at 3.5%.
Over 25 years, NSPT added €9,755 in cost and 0.50 QALYs per patient — an ICER of €19,322 per QALY, comfortably within NICE thresholds, and confirmed by probabilistic analysis (mean ICER €19,129). The modelled treatment cut non-fatal stroke by 41% and MI by 22%, left 22% of treated patients event-free at 25 years, and reduced cumulative mortality by 12%. But the time horizon matters enormously: the 10-year ICER rose to €49,847 and the 5-year ICER to €197,614. This is an intervention with a long payback period.
Two honest caveats anchor the conclusion. First, cost-effectiveness here depends heavily on the size of NSPT's true cardiovascular effect, which remains the dominant source of uncertainty and rests on observational rather than interventional data. Second, the benefit only materialises over a lifetime horizon. Still, the direction is striking: routine perio therapy may be a cost-effective cardiovascular preventive, strengthening the case for treating periodontitis as part of systemic health, not just oral health. The authors call — rightly — for high-quality UK longitudinal evidence on hard cardiovascular endpoints to close the gap.
Why it matters in practice
This Markov model suggests that treating severe periodontitis in 65-year-olds could be cost-effective cardiovascular prevention for the NHS — but only when the full lifetime benefit is counted; a 10-year accounting roughly triples the cost per QALY. Clinicians should understand that the economic case for perio-systemic linkage depends heavily on unresolved uncertainty about the true cardiovascular effect of periodontal treatment.
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