The economic impact of periodontitis in Switzerland: estimating potential healthcare savings

In an effort to address the economic impact of periodontitis, the EFP commissioned the report Time to take gum disease seriously: the societal and economic impact of periodontitis from the EIU, the research and analysis division of the Economist Group. The report, sponsored by Oral-B and published in June 2021, estimated the potential cost benefits of periodontal treatment in the healthcare systems of six European countries: France, Germany, Italy, the Netherlands, Spain, and the UK.

The report highlighted the importance of treating periodontal disease to reduce oral-healthcare costs and improve the quality of life of those affected. As this study did not include Switzerland, there was a need for further research in the Swiss context to improve our understanding of the economic impact of periodontitis and the potential cost savings associated with its treatment.

Applying the model to Switzerland

We attempted to fill this gap in the literature by estimating the cost savings of periodontal treatment in Switzerland, not only for the oral-healthcare system but also for the entire healthcare system. This broader perspective is essential, because it allows a more comprehensive understanding of the economic impact of periodontitis and the potential benefits of investing in its prevention and treatment.

Our analysis considers both the direct costs associated with periodontal care and the indirect costs of non-communicable diseases (NCDs) that are related to periodontal disease, such as diabetes and cardiovascular disease.

Switzerland, with its unique healthcare system and high standard of living, provides an interesting context for this research. The Swiss healthcare system is characterised by universal coverage, a decentralised structure, and a variety of insurance providers. In addition, the country's high average income and strong social safety nets create an environment in which the financial burden of chronic diseases such as periodontitis can be more accurately assessed.

In Switzerland, periodontal treatment and supportive periodontal care are generally paid for “out-of-pocket” – that is, directly by patients.

By focusing on the Swiss context, our study contributes to the growing body of literature on the economic and societal impact of periodontitis and provides valuable insights that can inform health-policy decisions and resource allocation.

Swiss general-health expenditure has increased by 3.7% per year since 1995, reaching CHF82.5 billion (€84.1 billion) in 2017. It is estimated that it could increase to CHF155 billion by 2040. Dental costs the country reached CHF4.2 million (€4.28 million) in 2020, while the total cost of periodontitis in Europe was estimated at €158.6 billion in 2018 (Bothelo et al. 2022).

The aim of our study was to estimate the direct and indirect costs of treating gingivitis, periodontitis, and related NCDs in Switzerland. A simulation model was used to examine whether professional periodontal care reduces healthcare costs. The model was based on the economic model used in the EIU report for the EFP, which assessed the financial impact on oral-healthcare costs of treating and preventing gingivitis and periodontitis in the six countries studied.

Estimating the lifetime costs of periodontitis for Swiss citizens

The simulation considered three types of periodontitis: mild, moderate, and severe and the model used in the EIU report was adjusted to derive transition probabilities from general prevalences in the Swiss population. The simulated individuals were aged from 35 to 100 years’ old and were divided into younger (35-64) and older (65-100) groups. The only difference between the groups was the prevalence of periodontal disease, which was higher in the older group. The simulation included different disease states and treatment steps, which were adopted and expanded from the EIU study.

Three scenarios were simulated with different prevalences for the age groups, representing different levels of dental-hygiene visits and improvements in disease and prevention information. The study also included out-of-pocket and social welfare-funded costs directly related to periodontitis treatment, as well as indirect costs from treating NCDs.

The simulation and statistical analyses were performed using RStudio software, with 200,000 simulated individuals included to ensure an accurate estimation of means and quantiles.

The power of prevention

The average total cost of treating gingivitis, periodontitis, and associated secondary damage from NCDs in Swiss citizens aged 35 to 100 years was analysed under three different scenarios. In each scenario, the costs were divided into out-of-pocket costs and costs paid by the social-welfare system.

• Scenario 1: One prophylactic appointment per year for patients with gingivitis (current situation).
• Scenario 2: Two prophylactic appointments per year for patients with gingivitis, leading to a better early detection of periodontitis and a reduction in overall treatment costs.
• Scenario 3: One prophylactic appointment per year for healthy patients and two appointments per year for patients with gingivitis, leading to a reduction in overall treatment costs. In this scenario, patients are also given more information about the disease and its prevention.

The highest average out-of-pocket costs were found in scenario 1, followed by scenario 2, while scenario 3 had the lowest expected total costs for all age groups.

A different trend was observed for the costs paid by social welfare, with the highest average amounts generated for scenario 2, followed by scenario 1 up to the age of 69. After this age, the order was the same as for out-of-pocket costs.

When the costs were examined by type of treatment, it was found that out-of-pocket and social-welfare costs for the treatment of periodontitis and secondary damage from NCDs accounted for over 60% of all expected lifetime costs in scenario 1. In scenarios 2 and 3, the costs of treating periodontitis and secondary damage were halved, and the costs of treating gingivitis increased significantly, accounting for up to 60% (out-of-pocket) and about 66% (social welfare) of all costs.

The return on investment (ROI) was calculated by comparing the total costs for the current Swiss population aged 35 to 100 years under each scenario. The total costs for this population were highest in scenario 1, and the ROI was CHF2.6 billion for scenario 2 and CHF5.9 billion for scenario 3.

This suggests that, on average, individuals could save up to CHF500 under scenario 2 and more than CHF1,100 under scenario 3 over their lifetime. In terms of total costs paid by the social-welfare system, the differences were smaller, with a negative ROI for scenario 2 and a positive ROI of CHF1.0 billion for scenario 3.

Overall, appropriate diagnosis and adherence to professional periodontal care at the individual level – as assumed in scenario 3 – can reduce total costs by approximately CHF1,700 per person.

While the total cost of prevention for the individual under this scenario increases by about CHF3,750, the total cost of treating periodontitis decreases by CHF3,100 and the cost of treating secondary damage decreases by CHF2,350 – an overall saving of CHF1,700. Assuming that a Swiss citizen in Scenario 3 has an average of 100 periodontal care visits, a total of CHF17 in healthcare costs can be saved for each dental and dental-hygiene visit.