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

Cost-effectiveness analysis of non-surgical periodontal treatment to prevent strokes and myocardial infarctions in the United Kingdom | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Cost-effectiveness analysis of non-surgical periodontal treatment to prevent strokes and myocardial infarctions in the United Kingdom Edward Coote, Nitesh Patel This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8699531/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract 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. Cost-effectiveness periodontal disease cardiovascular disease NHS Markov model Full Text Additional Declarations Competing interest reported. EC and NP work for 21D Clinical Limited. This is a for-profit company that offer long-term dental prosthetics. The purpose of this study was the provide evidence on the impact of treating oral health conditions non-surgically through the National Health Service, in order to increase holistic understanding about the benefits of oral health and the methods used to investigate. Funding: The funders had no role in the study design, collection of data, presentation of results or writing of the article. The authors declares no conflicts of interest with this study. The authors does not have any direct or indirect financial interests in the information listed or data used in the study. The model used can be requested from the corresponding author, or found on Github ( https://github.com/edcoote/Periodontal-disease---cardiovascular-cost-effectiveness-markov-model ). Supplementary Files Suppl.Info.pdf Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 08 May, 2026 Reviews received at journal 08 May, 2026 Reviewers agreed at journal 16 Apr, 2026 Reviews received at journal 13 Feb, 2026 Reviewers agreed at journal 13 Feb, 2026 Reviewers agreed at journal 10 Feb, 2026 Reviewers invited by journal 10 Feb, 2026 Editor assigned by journal 02 Feb, 2026 Submission checks completed at journal 02 Feb, 2026 First submitted to journal 26 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8699531","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":584319943,"identity":"9bce66f6-dd63-496f-9caf-538403682a21","order_by":0,"name":"Edward Coote","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5UlEQVRIiWNgGAWjYFCCBCBmg7I/VEgwNoBZB4jSwszAOOOMBYlamHnbKghr4WfPMfxcUcYgz8/ef/CxDZuEbAP74QPMPGdwa5HseWMseeYcg+HMnsPMxjk8EsYNPGkJzDw3cGsxuJG7QbKxjSHB4EYym3SOhERigwSPATPPB9xa7G/kbv4J1cL+28KACC0GErnb4LYwMyTAtOBxmMSZ998sG85JgPxiLNlzQMK4DeiXg3PweJ+/PS35ZkOZDTDEGh9++PmvTraf/fDBB2+O4dYCswzBBMXRAYIaRsEoGAWjYBTgBQAm/kzfempIygAAAABJRU5ErkJggg==","orcid":"","institution":"21D Clinical Limited","correspondingAuthor":true,"prefix":"","firstName":"Edward","middleName":"","lastName":"Coote","suffix":""},{"id":584319944,"identity":"efe03e05-f824-4517-88d6-af66c17c7086","order_by":1,"name":"Nitesh Patel","email":"","orcid":"","institution":"21D Clinical Limited","correspondingAuthor":false,"prefix":"","firstName":"Nitesh","middleName":"","lastName":"Patel","suffix":""}],"badges":[],"createdAt":"2026-01-26 11:08:23","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8699531/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8699531/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102174751,"identity":"73fd89e3-f928-463d-af8f-751c72544785","added_by":"auto","created_at":"2026-02-09 05:48:50","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":561834,"visible":true,"origin":"","legend":"","description":"","filename":"CVDPaper.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8699531/v1_covered_4e429ab1-54ec-4c8c-a6b2-16973881a9f4.pdf"},{"id":102174747,"identity":"0fb5b39b-16c1-4ef4-bade-e6f19e663ede","added_by":"auto","created_at":"2026-02-09 05:48:39","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":170410,"visible":true,"origin":"","legend":"","description":"","filename":"Suppl.Info.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8699531/v1/5eb7eca390608fc54456e821.pdf"}],"financialInterests":"Competing interest reported. EC and NP work for 21D Clinical Limited. This is a for-profit company that offer long-term dental prosthetics. The purpose of this study was the provide evidence on the impact of treating oral health conditions non-surgically through the National Health Service, in order to increase holistic understanding about the benefits of oral health and the methods used to investigate. Funding: The funders had no role in the study design, collection of data, presentation of results or writing of the article. The authors declares no conflicts of interest with this study. The authors does not have any direct or indirect financial interests in the information listed or data used in the study. 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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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eA 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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eOver 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. 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Improved UK evidence on NSPT’s cardiovascular effect size is the key driver of decision uncertainty.\u003c/p\u003e","manuscriptTitle":"Cost-effectiveness analysis of non-surgical periodontal treatment to prevent strokes and myocardial infarctions in the United Kingdom","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-09 05:48:34","doi":"10.21203/rs.3.rs-8699531/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-05-08T20:30:18+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-08T16:52:25+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"311979037068334602549500623806211789401","date":"2026-04-16T12:29:16+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-13T12:05:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"124692638236353804206702955945745691450","date":"2026-02-13T10:37:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"246943983778577767299871846019160141819","date":"2026-02-10T15:19:47+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-10T12:01:02+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-02T12:03:21+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-02T12:02:02+00:00","index":"","fulltext":""},{"type":"submitted","content":"Cost Effectiveness and Resource Allocation","date":"2026-01-26T11:00:32+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"cost-effectiveness-and-resource-allocation","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"cera","sideBox":"Learn more about [Cost Effectiveness and Resource Allocation](http://resource-allocation.biomedcentral.com)","snPcode":"12962","submissionUrl":"https://submission.nature.com/new-submission/12962/3","title":"Cost Effectiveness and Resource Allocation","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e12dfd2c-db40-4b02-be31-994759021b83","owner":[],"postedDate":"February 9th, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Revision requested","date":"2026-05-08T20:30:18+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-08T16:52:25+00:00","index":107,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-16T20:23:18+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-09 05:48:34","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8699531","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8699531","identity":"rs-8699531","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}