Journal of Pharmaceutical Health Services Research, 2022, 13, 52–60 https://doi.org/10.1093/jphsr/rmac008 Advance access publication 15 May 2022 Research Paper © The Author(s) 2022. Published by Oxford University Press on behalf of the Royal Pharmaceutical Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com Received: 26 July 2021 Accepted: 5 April 2022 Health economic potential of oral aMMP-8 biomarker diagnostics for personalised prevention of periodontal and peri-implant diseases Roland Frankenberger 1,2 , Nicole B. Arweiler 2,3 , Timo A. Sorsa 4,5 , Gerd Volland 6 , Georg Gaßmann 7 , Cornelia Fietz 8 , Helena Thiem 8 and Reinhard P. T. Rychlik 8,*, 1 Department of Operative Dentistry and Endodontology, Medical Center for Dentistry and Oral Medicine, University of Marburg, Marburg, Germany 2 University Hospital Giessen and Marburg, Campus Marburg, Marburg, Germany 3 Department of Periodontology and Peri-Implant Diseases, Medical Center for Dentistry and Oral Medicine, University of Marburg, Marburg, Germany 4 Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki University Hospital, Helsinki, Finland 5 Section of Periodontology and Dental Prevention, Division of Oral Diseases, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden 6 Private Practice, Heilbronn, Germany 7 Dental Hygiene and Prevention Management, European University of Applied Sciences, Cologne, Germany 8 Institute of Empirical Health Economics, Burscheid, Germany *Correspondence: Reinhard P. T. Rychlik, Institute for Empirical Health Economics, Am Ziegelfeld 28 51399 Burscheid, Germany. Tel: +49(0)-2174-7151-12; Fax: +49(0)2174-7151-98; Email: reinhard.rychlik@ifeg.de Abstract Objectives Active matrix metalloproteinase-8 (aMMP-8) biomarkers can be used in chair side tests for the detection of periodontitis or peri- implantitis and for targeting and monitoring individual therapy. Combined with effective secondary preventive measures, this procedure can reduce tooth loss and related costs. The authors evaluated whether out-of-pocket costs for the patient can be saved additionally. Methods A health economic evaluation of the total costs for secondary preventive versus prosthodontic measures was performed from the patient’s perspective using a Markov-based state transition model with three health states of periodontitis. The intervention group used aMMP-8 biomarker diagnostics in addition to standard prevention services in Germany; the control group received standard care only. Starting age of the patients was 35 years; the modelled period was 50 years. Additionally, a frst estimate of the costs for patients with implants for a period of three decades was made. Key fndings In the frst decade (age group 35–44 years), patients from the intervention group initially have to bear additional costs of 929.53 € compared with the control group. From the age group 45–54 years, the savings potential for the patient increases continuously. Total costs of the intervention group, including additional aMMP-8 assessments, are 32 310.82 € compared with 47 452.04 € in the control group for the 50-year period. The greatest savings potential for patients with aMMP-8 screening and monitoring is in the feld of dentures (−18.521.91 €). For the subgroup of patients with implants, the frst cost statement leads to costs of 12 672.66 € with additional use of aMMP-8 biomarker diagnostics (control group: 23 185.83 €). Conclusions Despite higher initial costs, secondary prevention not only improves oral health but also importantly can save signifcant costs in the long run. Especially in implant patients, need-based prevention can prolong the lifetime of dental implants and thus signifcantly save long- term treatment costs. Keywords: aMMP-8; periodontitis; peri-implantitis; Markov model; cost-effectiveness. Introduction Periodontal and peri-implant diseases rank 11th among the most prevalent global diseases [1] and lead to serious consequences like tooth or implant loss. [2, 3] Accordingly, the burden of disease is immense: nearly every second young adult in Germany suffers from mild periodontitis. In the elderly, 9 out of 10 suffer from severe periodontitis. [3] The consequence of the infammatory condition that leads to degradation of the soft- and hard tissue of stabilising teeth is tooth loss, which requires elaborate and costly restorative treatment. [4, 5] Younger senior citizens in Germany (65–74 years) miss 11.1 teeth on average, the elderly (75–100 years) 17.8. [3] According to the Institute of German Dentists (IDZ), periodontitis is re- sponsible for one-third of lost teeth. [6] As dental implants are one replacement option for teeth lost due to periodontitis, the number of implants placed drastically increased in recent years. [7] Implant penetration in Germany is estimated to be 30%. [8] This is associated with an increasing number of peri- implant diseases. One in three patients or one in fve implants are affected by peri-implantitis. [2] Downloaded from https://academic.oup.com/jphsr/article/13/2/52/6586024 by guest on 13 November 2023