Análise econômica das técnicas para tratamento periodontal não cirúrgico e o seu impacto na saúde pública

Abstract

Periodontal diseases represent a public health challenge, as they affect a large number of individuals around the world. The concepts of economic evaluation must be part of the routine of systems, services, health management and clinics. The general objective of this study was to economically analyze the techniques for treating periodontal disease and the provision of specialized periodontal procedures in Dental Specialty Centers (CEO) in Brazil. To answer the objective, this study established three analysis plans (AP). AP 1 (article 1) investigated in the literature the advantages of ultrasonic and manual instrumentation for periodontal treatment in clinical dental practice. A scoping review was developed following the precepts of the Joanna Briggs Institute, based on the acronym PCC, where the population was periodontal disease, the concept of manual and ultrasonic instrumentation and the context of periodontal disease treatment. The bibliographic research was carried out in the following databases: PubMed, Scopus, Web of Science, Lilacs, Embase, Livivo, Open Grey, Google Scholar and Cochrane. 940 studies were identified by searching bibliographic databases and checking the references of included articles. After removing duplicates, 804 records remained and were read for titles and abstracts. Of these, 783 were excluded because they did not fit the research question. After reading 21 articles in full, 13 were selected for data extraction. Three articles were added later. AP 2 (article 2) investigated the factors associated with carrying out specialized procedures and achieving the goal in periodontics in DSCs in Brazil. This was an analytical and cross-sectional study using secondary data. The database from the second cycle of the External Assessment of the National Program for Improving Access and Quality in CEO (PMAQ-CEO) was used, which evaluated, in person, 1,042 CEOs in 2018. The data were analyzed using Poisson multiple regression, estimating the prevalence ratio (PR) (p<0.05). One third of CEOs (n=305) underwent all specialized procedures, with a higher prevalence observed in those with more than one unit of bicarbonate jet prophylaxis (RP=2.12; 95% CI: 1.160-3.881; p=0.015) and when they had a higher percentage of specialist professionals (PR=1.004; 95%CI: 1.002-1.006; p<0.001). The periodontics goal was achieved by 617 (59.2%) CEOs, with a higher prevalence among those who had a manager with additional training (RP=1.21; 95% CI: 1.100-1.335; p<0.001) and with greater workload of work for the periodontist dentist (RP=1.15; 95% CI: 1.103-1.201; p<0.001). The last AP (article 3) verified the cost-effectiveness of ultrasonic and manual instruments for the treatment of periodontal disease, from the perspective of the public health system in Brazil. It was a complete economic analysis of the cost-effectiveness type. Cost data collection was based on the micro-costing technique, in which the direct costs incurred to perform a scaling and root planing (SRP) session in the case of periodontitis were considered. Decision trees were modeled to compare the techniques used in each session, the model consisted of two clinical parameters used to diagnose periodontal disease, bleeding on probing and probing depth. A Monte Carlo microsimulation estimated the cost-effectiveness for 1,000 visits. The incremental cost-effectiveness ratio (ICER) was used to indicate the cost of each RAR session. TreeAge Pro software was used to perform the analyses. As a result, it was observed that in relation to bleeding and probing, the price of a RAR session varied between R$ 19.95 (traditional technique) and R$ 23.07 (mechanical technique). Regarding the probing depth parameter, the price per session varied from 20.10 for manual and 23.09 for ultrasound instrumentation. Therefore, the two instrumentation techniques presented similar clinical and economic results. The bicarbonate jet prophylaxis device and the number of specialized professionals positively influence the performance of all specialized procedures. In relation to goals, a positive influence is observed when the service is managed by someone with additional training and when the periodontist's weekly working hours are aligned with the reality of the service.