Schwendicke Falk, Tu Yu-Kang, Stolpe Michael
Department of Operative and Preventive Dentistry, Charité - University of Medicine Berlin, Berlin, Germany.
Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
J Periodontol. 2015 Sep;86(9):1020-9. doi: 10.1902/jop.2015.150071. Epub 2015 Apr 9.
A large number of treatments for peri-implantitis are available, but their cost-effectiveness remains uncertain. This study evaluates the cost-effectiveness of preventing and treating peri-implantitis.
A Markov model was constructed that followed each implant over 20 years. Supportive implant therapy (SIT) for managing peri-implant mucositis and preventing development of peri-implantitis was either provided or not. Risk of peri-implantitis was assumed to be affected by SIT and the patient's risk profile. If peri-implantitis occurred, 11 treatment strategies (non-surgical or surgical debridement alone or combined with adjunct therapies) were compared. Treatments and risk profiles determined disease progression. Modeling was performed based on systematically collected data. Primary outcomes were costs and proportion of lost implants, as assessed via Monte Carlo microsimulations.
Not providing SIT and performing only non-surgical debridement was both least costly and least effective. The next best (more costly and effective) option was to provide SIT and perform surgical debridement (additional 0.89 euros per 1% fewer implants lost). The most effective option included bone grafts, membranes, and laser treatment (56 euros per 1%). For patients at high risk, the cost-effectiveness of SIT increased, whereas in low-risk groups, a cost-optimized strategy was cost-effective.
Although clinical decision-making will be guided mainly by clinical condition, cost-effectiveness analyses might add another perspective. Based on these findings, an unambiguous comparative effectiveness ranking was not established. However, cost-effectiveness was predominantly determined by provision of SIT and initial treatment costs. Transferability of these findings to other healthcare systems needs further confirmation.
目前有大量治疗种植体周围炎的方法，但其成本效益仍不明确。本研究评估预防和治疗种植体周围炎的成本效益。
构建一个马尔可夫模型，对每个种植体随访20年。提供或不提供用于管理种植体周围黏膜炎和预防种植体周围炎发展的支持性种植体治疗（SIT）。假设种植体周围炎的风险受SIT和患者风险状况的影响。如果发生种植体周围炎，则比较11种治疗策略（单独非手术或手术清创或联合辅助治疗）。治疗方法和风险状况决定疾病进展。基于系统收集的数据进行建模。主要结局是成本和种植体丢失比例，通过蒙特卡洛微观模拟进行评估。
不提供SIT且仅进行非手术清创的成本最低且效果最差。次优（成本更高且效果更好）的选择是提供SIT并进行手术清创（每减少1%的种植体丢失额外花费0.89欧元）。最有效的选择包括骨移植、屏障膜和激光治疗（每1%花费56欧元）。对于高风险患者，SIT的成本效益增加，而在低风险组中，成本优化策略具有成本效益。
虽然临床决策主要将由临床状况指导，但成本效益分析可能会提供另一个视角。基于这些发现，未建立明确的相对疗效排名。然而，成本效益主要由SIT的提供和初始治疗成本决定。这些发现向其他医疗保健系统的可转移性需要进一步证实。
