Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Oral Health
Published in: BMC Oral Health 1/2021

Open Access 01-12-2021 | Public Health | Research

Smoking Cessation therapy is a cost-effective intervention to avoid tooth loss in Brazilian subjects with periodontitis: an economic evaluation

Authors: Maria Luisa Silveira Souto, Fernanda Campos de Almeida Carrer, Mariana Minatel Braga, Cláudio Mendes Pannuti

Published in: BMC Oral Health | Issue 1/2021

Login to get access

Abstract

Background

Smokers present a higher prevalence and severity of periodontitis and, consequently, higher prevalence of tooth loss. Smoking cessation improves the response to periodontal treatment and reduces tooth loss. So, the aim of this study was to evaluate the efficiency in resources allocation when implementing smoking cessation therapy vs. its non-implementation in smokers with periodontitis.

Methods

We adopted the Brazilian public system perspective to determine the incremental cost-effectiveness (cost per tooth loss avoided) and cost-utility (cost per oral-related quality-adjusted life-year ([QALY] gained) of implementing smoking cessation therapy. Base-case was defined as a 48 years-old male subject and horizon of 30 years. Effects and costs were combined in a decision analytic modeling framework to permit a quantitative approach aiming to estimate the value of the consequences of smoking cessation therapy adjusted for their probability of occurrence. Markov models were carried over annual cycles. Sensitivity analysis tested methodological assumptions.

Results

Implementing the therapy saved approximately US$ 100 over the time horizon accompanied by a slightly better effect, both in CEA and CUA. Considering uncertainties, the therapy could be cost-effective in the most part of simulated cases, even being cheaper and more effective in 35% of cases in which the oral-health related outcome is used as effect. Considering a willingness-to-pay of US$100 per health effect, smoking cessation therapy was cost-effective, respectively, in 72% and 99% of cases in cost-utility and cost-effectiveness analyses.

Conclusions

Implementation of smoking cessation therapy may be cost-effective, considering the avoidance of tooth loss and oral health-related consequences to patients.
Appendix
Available only for authorised users
Literature
1.
2.
Naseri R, Yaghini J, Feizi A. Levels of smoking and dental implants failure: A systematic review and meta-analysis. J Clin Periodontol. 2020;47(4):518–28.PubMed
3.
Helal O, Göstemeyer G, Krois J, Fawzy El Sayed K, Graetz C, Schwendicke F. Predictors for tooth loss in periodontitis patients: Systematic review and meta-analysis. J Clin Periodontol. 2019;46(7):699–712.PubMed
4.
Zhang Y, He J, He B, Huang R, Li M. Effect of tobacco on periodontal disease and oral cancer. Tob Induc Dis. 2019;17:40.PubMedPubMedCentral
5.
Ide R, Hoshuyama T, Wilson D, Takahashi K, Higashi T. The effects of smoking on dental care utilization and its costs in Japan. J Dent Res. 2009;88(1):66–70.PubMed
6.
Park YD, Kang JO, Kim SJ, Kwon HJ, Hwang JH, Hwang KS. Estimation of the costs of smoking-related oral disease: a representative South Korean study. Int Dent J. 2012;62(5):256–61.PubMed
7.
Fardal Ø, Grytten J, Martin J, Ellingsen S, Fardal P, Heasman P, Linden GJ. Adding smoking to the Fardal model of cost-effectiveness for the lifetime treatment of periodontal diseases. J Periodontol. 2018;89(11):1283–9.PubMed
8.
Bai JW, Chen XX, Liu S, Yu L, Xu JF. Smoking cessation affects the natural history of COPD. Int J Chron Obstruct Pulmon Dis. 2017;12:3323–8.PubMedPubMedCentral
9.
Jha P, Ramasundarahettige C, Landsman V, Rostron B, Thun M, Anderson RN, McAfee T, Peto R. 21st-century hazards of smoking and benefits of cessation in the United States. N Engl J Med. 2013;368(4):341–50.PubMed
10.
Preshaw PM, Heasman L, Stacey F, Steen N, McCracken GI, Heasman PA. The effect of quitting smoking on chronic periodontitis. J Clin Periodontol. 2005;32(8):869–79.PubMed
11.
Rosa EF, Corraini P, de Carvalho VF, Inoue G, Gomes EF, Lotufo JP, De Micheli G, Pannuti CM. A prospective 12-month study of the effect of smoking cessation on periodontal clinical parameters. J Clin Periodontol. 2011;38(6):562–71.PubMed
12.
Dietrich T, Walter C, Oluwagbemigun K, Bergmann M, Pischon T, Pischon N, Boeing H. Smoking, smoking cessation, and risk of tooth loss: the EPIC-potsdam study. J Dent Res. 2015;94(10):1369–75.PubMed
13.
Souto MLS, Rovai ES, Villar CC, Braga MM, Pannuti CM. Effect of smoking cessation on tooth loss: a systematic review with meta-analysis. BMC Oral Health. 2019;19(1):245.PubMedPubMedCentral
14.
Sanz M, Herrera D, Kebschull M, Chapple I, Jepsen S, Beglundh T, Sculean A, Tonetti MS. EFP Workshop Participants and Methodological Consultants. Treatment of stage I-III periodontitis-The EFP S3 level clinical practice guideline. J Clin Periodontol. 2020;47(Suppl 22):4–60.PubMedPubMedCentral
15.
Kahende JW, Loomis BR, Adhikari B, Marshall L. A review of economic evaluations of tobacco control programs. Int J Environ Res Public Health. 2009;6(1):51–68.PubMed
16.
Ruger JP, Lazar CM. Economic evaluation of pharmaco- and behavioral therapies for smoking cessation: a critical and systematic review of empirical research. Annu Rev Public Health. 2012;33:279–305.PubMedPubMedCentral
17.
Gaunt F, Devine M, Pennington M, Vernazza C, Gwynnett E, Steen N, Heasman P. The cost-effectiveness of supportive periodontal care for patients with chronic periodontitis. J Clin Periodontol. 2008;35(8 Suppl):67–82.PubMed
18.
Schwendicke F, Stolpe M, Plaumann A, Graetz C. Cost-effectiveness of regular versus irregular supportive periodontal therapy or tooth removal. J Clin Periodontol. 2016;43(11):940–7.PubMed
19.
Solowiej-Wedderburn J, Ide M, Pennington M. Cost-effectiveness of non-surgical periodontal therapy for patients with type 2 diabetes in the UK. J Clin Periodontol. 2017;44(7):700–7.PubMed
20.
Tay JRH, Ng E, Nair R, Tan ZS, Tan SHX. Economic evaluations in the treatment and evaluation of patients with periodontal disease: a critical review. J Clin Periodontol. 2021;48(5):679–94.PubMed
21.
Gafini A. Economic evaluation of health care interventions: an economist’s perspective. ACP J Club. 1996;124(2):A12–4.
22.
Husereau D, Drummond M, Petrou S, Carswell C, Moher D, Greenberg D, Augustovski F, Briggs AH, Mauskopf J, Loder E; CHEERS Task Force. Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement. BMJ. 2013;346:f1049.
23.
24.
Caton JG, Armitage G, Berglundh T, Chapple ILC, Jepsen S, Kornman KS, Mealey BL, Papapanou PN, Sanz M, Tonetti MS. A new classification scheme for periodontal and peri-implant diseases and conditions—introduction and key changes from the 1999 classification. J Clin Periodontol. 2018;45(Suppl 20):S1–8.PubMed
25.
Tonetti MS, Greenwell H, Kornman KS. Staging and grading of periodontitis: framework and proposal of a new classification and case definition. J Clin Periodontol. 2018;45 Suppl 20:S149-S161. https://​doi.​org/​10.​1111/​jcpe.​12945. Erratum in: J Clin Periodontol. 2019 Jul;46(7):787.
26.
Rosa EF, Corraini P, Inoue G, Gomes EF, Guglielmetti MR, Sanda SR, Lotufo JP, Romito GA, Pannuti CM. Effect of smoking cessation on non-surgical periodontal therapy: results after 24 months. J Clin Periodontol. 2014;41(12):1145–53.PubMed
27.
Brasil. Ministério da Saúde. Secretaria de Ciência T e IED de C e T. Diretrizes metodológicas: diretriz de avaliação econômica. 2014. Availabe from: bvsms.saude.gov.br/bvs/publicacoes/diretrizes_metodologicas_diretriz_avaliac ao_economica.pdf
28.
Prado GF, Lombardi EM, Bussacos MA, Arrabal-Fernandes FL, Terra-Filho M, Santos UP. A real-life study of the effectiveness of different pharmacological approaches to the treatment of smoking cessation: re-discussing the predictors of success. Clinics (Sao Paulo). 2011;66(1):65–71.
29.
Zhu S, Melcer T, Sun J, Rosbrook B, Pierce JP. Smoking cessation with and without assistance: a population-based analysis. Am J Prev Med. 2000;18(4):305–11.PubMed
30.
Pereira, A. C., Vieira, V., & Frias, A. C. 2016. SB São Paulo Pesquisa Estadual de Saúde Bucal. Águas de São Pedro.
31.
Vernazza C, Heasman P, Gaunt F, Pennington M. How to measure the cost-effectiveness of periodontal treatments. Periodontol 2000. 2012;60(1):138–46.
32.
Slade GD, Spencer AJ. Development and evaluation of the Oral Health Impact Profile. Community Dent Health. 1994;11(1):3–11.PubMed
33.
Pires CP, Ferraz MB, de Abreu MH. Translation into Brazilian Portuguese, cultural adaptation and validation of the oral health impact profile (OHIP-49). Braz Oral Res. 2006;20(3):263–8.PubMed
34.
Mendes AC, Toscano CM, Barcellos RM, Ribeiro AL, Ritzel JB, Cunha VS, Duncan BB. Costs of the smoking cessation program in Brazil. Rev Saude Publica. 2016;50:66.PubMedPubMedCentral
35.
de Oliveira RS, de Morais HMM, de Goes PSA, Botazzo C. Magalhães BG Relações contratuais e perfil dos cirurgiões dentistas em centros de especialidades odontológicas de baixo e alto desempenho no Brazil. Saude e Sociedade. 2015;24:792–802.
36.
37.
Chambrone LA, Chambrone L. Tooth loss in well-maintained patients with chronic periodontitis during long-term supportive therapy in Brazil. J Clin Periodontol. 2006;33(10):759–64.PubMed
38.
Stadler AF, Mendez M, Oppermann RV, Gomes SC. Tooth loss in patients under periodontal maintenance in a private practice: a retrospective study. Braz Dent J. 2017;28(4):440–6.PubMed
39.
40.
Pretzl B, Sayed S, Weber D, Eickholz P, Baumer A. Tooth loss in periodontally compromised patients: results 20 years after active periodontal therapy. J Clin Periodontol. 2018;45(11):1356–64.PubMed
41.
Castro MC, Massuda A, Almeida G, Menezes-Filho NA, Andrade MV, de Souza Noronha KVM, Rocha R, Macinko J, Hone T, Tasca R, Giovanella L, Malik AM, Werneck H, Fachini LA, Atun R. Brazil’s unified health system: the first 30 years and prospects for the future. Lancet. 2019;394(10195):345–56.PubMed
42.
Pucca GA Jr, Gabriel M, de Araujo ME, de Almeida FC. Ten years of a national oral health policy in Brazil: innovation, boldness, and numerous challenges. J Dent Res. 2015;94(10):1333–7.PubMed
43.
Holliday R, Hong B, McColl E, Livingstone-Banks J, Pershaw P, Carr AB, Ebbert J. Interventions for tobacco cessation delivered by dental professionals. Cochrane Database Syst Rev. 2021;2(2):CD005084.PubMed
44.
Feldman I, Helgason AR, Johansson P, Tegelberg Å, Nohlert E. Cost-effectiveness of a high-intensity versus a low-intensity smoking cessation intervention in a dental setting: long-term follow-up. BMJ Open. 2019;9(8):e030934.PubMedPubMedCentral
45.
Sendi P, Gafni A, Birch S. Opportunity costs and uncertainty in the economic evaluation of health care interventions. Health Econ. 2002;11(1):23–31.PubMed
46.
Hujoel PP, DeRouen TA. A survey of endpoint characteristics in periodontal clinical trials published 1988–1992, and implications for future studies. J Clin Periodontol. 1995;22(5):397–407.PubMed
47.
Pannuti CM, Sendyk DI, GraÇas YTD, Takai SL, SabÓia VPA, Romito GA, Mendes FM. Clinically relevant outcomes in dental clinical trials: challenges and proposals. Braz Oral Res. 2020;34(Suppl 2):e073.PubMed
48.
Listl S, Tu YK, Faggion CM Jr. A cost-effectiveness evaluation of enamel matrix derivatives alone or in conjunction with regenerative devices in the treatment of periodontal intra-osseous defects. J Clin Periodontol. 2010;37(10):920–7.PubMed
49.
Jönsson B, Ohrn K, Lindberg P, Oscarson N. Cost-effectiveness of an individually tailored oral health educational programme based on cognitive behavioural strategies in non-surgical periodontal treatment. J Clin Periodontol. 2012;39(7):659–65. PubMed
50.
Mohd-Dom TN, Wan-Puteh SE, Muhd-Nur A, Ayob R, Abdul-Manaf MR, Abdul-Muttalib K, Aljunid SM. Cost-effectiveness of periodontitis management in public sector specialist periodontal clinics: a societal perspective research in Malaysia. Value Health Reg Issues. 2014;3:117–23.PubMed
51.
Hettiarachchi RM, Kularatna S, Downes MJ, Byrnes J, Kroon J, Lalloo R, Johnson NW, Scuffham PA. The cost-effectiveness of oral health interventions: a systematic review of cost-utility analyses. Community Dent Oral Epidemiol. 2018;46(2):118–24.PubMed
52.
Brooks R. EuroQol: the current state of play. Health Policy. 1996;37(1):53–72.PubMed
53.
Brazier JE, Harper R, Jones NM, O’Cathain A, Thomas KJ, Usherwood T, Westlake L. Validating the SF-36 health survey questionnaire: new outcome measure for primary care. BMJ. 1992;305(6846):160–4.PubMedPubMedCentral
54.
Stone SJ, McCracken GI, Heasman PA, Staines KS, Pennington M. Cost-effectiveness of personalized plaque control for managing the gingival manifestations of oral lichen planus: a randomized controlled study. J Clin Periodontol. 2013;40(9):859–67.PubMed
55.
Korenori A, Koji K, Yuki T, Murata T, Sachiko TM, Shunsuke B. Cost-effectiveness of molar single-implant versus fixed dental prosthesis. BMC Oral Health. 2018;18(1):141.PubMedPubMedCentral
56.
57.
Listl S, Grytten JI, Birch S. What is health economics? Community Dent Health. 2019;36(4):262–74.PubMed
58.
Eow J, Duane B, Solaiman A, Hussain U, Lemasney N, Ang R, O’Kelly-Lynch N, Girgis G, Collazo L, Johnston B. What evidence do economic evaluations in dental care provide? A scoping review Community Dent Health. 2019;36(2):118–25.PubMed
59.
Neumann PJ, Johannesson M. From principle to public policy: using cost-effectiveness analysis. Health Aff (Millwood). 1994 Summer;13(3):206–14.
60.
Metadata
Title
Smoking Cessation therapy is a cost-effective intervention to avoid tooth loss in Brazilian subjects with periodontitis: an economic evaluation
Authors
Maria Luisa Silveira Souto
Fernanda Campos de Almeida Carrer
Mariana Minatel Braga
Cláudio Mendes Pannuti
Publication date
01-12-2021
Publisher
BioMed Central
Published in
BMC Oral Health / Issue 1/2021
Electronic ISSN: 1472-6831
DOI
https://doi.org/10.1186/s12903-021-01932-2

Other articles of this Issue 1/2021

BMC Oral Health 1/2021 Go to the issue

Research

Assessment of the relationship between the maxillary sinus and the canine root tip using cone beam computed tomography

Research

The evaluation of alveolar fractures of trauma patients in Iran

Research

Clinical benefits and adverse effects of siwak (S. persica) use on periodontal health: a scoping review of literature

Research

STAT1: a novel candidate biomarker and potential therapeutic target of the recurrent aphthous stomatitis

Research

Clinical relevance of interdental papilla biopsy in chronic erosive gingivitis (desquamative gingivitis): retrospective bicentric study of 148 specimens

Correspondence

Is trigeminal neuralgia the only definitive diagnosis for pain in a tooth extraction site?