Reconsidering value for money in periodontal treatment

The relevance of comparing costs and outcomes of periodontal treatment has repeatedly and increasingly been emphasized in the periodontal literature (Braegger 2005, Palmer & Cortellini 2008, Tonetti & Hämmerle 2008, Pennington et al. 2009, Petersen & Baehni 2012). This reflects the fact that health care resources (e.g. dentists and dentist assistants′ time, diagnostic equipment, surgical instruments, materials to retain, restore and replace teeth) are limited and decisions have to be made about how to make best use of those resources. Although we can always train more dentists or purchase more equipment this does not remove the need to make careful choices about using whatever resources are available in ways that make greatest impact on oral health outcomes. A major challenge is presented by the rapid advance of medical technology. Although such developments may lead to more effective treatment options, they often involve higher costs than existing therapeutic approaches. Hence, the decision is not simply concerned with the choice between the new treatment and the existing treatment, but also requires that something else is given up to generate the additional resources required by the new treatment. The question then is whether the improvement in treatment outcome of the new treatment option justifies its higher cost in comparison with currently existing treatment standards. In other words, is the new technology more efficient than the status quo? The aim of this paper was to reflect on current economic evaluation methods and to motivate future methodological advancements in the economics of periodontal care.