The cost-effectiveness of a new chlorhexidine delivery system in the treatment of adult periodontitis

Background. Periodontal treatment is costly. The authors assessed the poten tial economic impact of a new periodontal chemotherapeutic, testing the hyp othesis that its adjunctive use would result in reduced periodontal surgica l needs. Methods. An economic model estimated treatment needs following two clinical trials of the adjunctive use of a chlorhexidine, or CHX, -containing chip compared with scaling and root planing, or SRP, alone. Needs were based on periodontal status at nine months and a probabilistic algorithm; costs were assigned on the basis of a national dental survey and an average wholesale price of the CHX chip. Results. The base case model projected significantly more maintenance proce dures and significantly fewer periodontal surgical procedures for patients treated with SRP and the CHX chip compared with patients who were treated w ith SRP alone (54.4 percent vs. 46.4 percent, P = .014; 29.2 percent vs. 35 .5 percent, P = .015, respectively). Average total costs of care for patien ts treated with SRP and CHX chip were $737 +/- $244 compared with $734 +/- $239 for patients treated with SRP alone. Sensitivity analyses to account f or variations in practice patterns did not appreciably alter the results. W hen data were analyzed after only three or six months of treatment, the sig nificant differences in treatment needs disappeared. Conclusions. The CHX chip is a new, apparently cast-effective treatment opt ion for nonsurgical periodontal therapy. Adjunctive use of the CHX chip cou ld reduce periodontal surgical needs significantly at little or no addition al cost. Clinical Implications. Results suggest that incorporating the CHX chip into routine practice requires a new algorithm for management of periodontal di sease. To obtain full clinical benefit, treatment needs to be continued for nine months.