Cost-effectiveness analysis of non-surgical periodontal treatment to prevent strokes and myocardial infarctions in the United Kingdom

Background: Periodontal disease (PD) is common in the UK and is associated with higher risks of stroke and myocardial infarction (MI). Non-surgical periodontal treatment (NSPT) may therefore generate downstream cardiovascular benefits, but its value for money as a CVD-prevention strategy for the NHS is unclear. Methods: A Markov cohort model simulated 65-year-olds with severe PD and no prior CVD over 10 years (with a 25-year scenario). Eight health states captured acute and chronic phases of stroke, MI, combined events, and death. Baseline CVD risks were derived from published sources; NSPT effects (stroke HR 0.55, MI HR 0.70) were taken from large international cohort studies. Costs (2024 £, NHS payer perspective) and QALYs (EQ-5D) were discounted at 3.5%. Deterministic and probabilistic sensitivity analyses assessed parameter and structural uncertainty and identified effect sizes required to meet NICE thresholds. Results: Over 10 years, NSPT increased costs by £6,487 and QALYs by 0.15 (ICER £44,858/QALY), exceeding NICE thresholds. NSPT reduced non-fatal stroke and MI by 41% and 24%, respectively, increasing event-free survival at 10 years (56% vs 44%). Probabilistic analysis produced a mean ICER of £34,777/QALY and a 25% (at £20,000) to 52% (at £30,000) probability of cost-effectiveness. Extend­ing the horizon to 25 years increased incremental QALYs to 0.82 and reduced the ICER to £16,121/QALY, illustrating strong time-horizon dependence for chronic preventive effects. Conclusions: NSPT is unlikely to be cost-effective for CVD prevention alone over a 10-year horizon under current evidence, but longer horizons materially im­prove value. The model also likely underestimates benefits by excluding direct oral-health quality-of-life gains. Improved UK evidence on NSPT’s cardiovascular effect size is the key driver of decision uncertainty.