An examination of periodontal treatment and per member per month (PMPM) medical costs in an insured population

BMC Health Serv Res. 2006 Aug 16;6:103. doi: 10.1186/1472-6963-6-103.

Abstract

Background: Chronic medical conditions have been associated with periodontal disease. This study examined if periodontal treatment can contribute to changes in overall risk and medical expenditures for three chronic conditions [Diabetes Mellitus (DM), Coronary Artery Disease (CAD), and Cerebrovascular Disease (CVD)].

Methods: 116,306 enrollees participating in a preferred provider organization (PPO) insurance plan with continuous dental and medical coverage between January 1, 2001 and December 30, 2002, exhibiting one of three chronic conditions (DM, CAD, or CVD) were examined. This study was a population-based retrospective cohort study. Aggregate costs for medical services were used as a proxy for overall disease burden. The cost for medical care was measured in Per Member Per Month (PMPM) dollars by aggregating all medical expenditures by diagnoses that corresponded to the International Classification of Diseases, 9th Edition, (ICD-9) codebook. To control for differences in the overall disease burden of each group, a previously calculated retrospective risk score utilizing Symmetry Health Data Systems, Inc. Episode Risk Groups (ERGs) were utilized for DM, CAD or CVD diagnosis groups within distinct dental services groups including; periodontal treatment (periodontitis or gingivitis), dental maintenance services (DMS), other dental services, or to a no dental services group. The differences between group means were tested for statistical significance using log-transformed values of the individual total paid amounts.

Results: The DM, CAD and CVD condition groups who received periodontitis treatment incurred significantly higher PMPM medical costs than enrollees who received gingivitis treatment, DMS, other dental services, or no dental services (p < .001). DM, CAD, and CVD condition groups who received periodontitis treatment had significantly lower retrospective risk scores (ERGs) than enrollees who received gingivitis treatment, DMS, other dental services, or no dental services (p < .001).

Conclusion: This two-year retrospective examination of a large insurance company database revealed a possible association between periodontal treatment and PMPM medical costs. The findings suggest that periodontitis treatment (a proxy for the presence of periodontitis) has an impact on the PMPM medical costs for the three chronic conditions (DM, CAD, and CVD). Additional studies are indicated to examine if this relationship is maintained after adjusting for confounding factors such as smoking and SES.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Capitation Fee
  • Centers for Medicare and Medicaid Services, U.S.
  • Cerebrovascular Disorders / complications
  • Cerebrovascular Disorders / economics*
  • Chronic Disease
  • Cohort Studies
  • Coronary Artery Disease / complications
  • Coronary Artery Disease / economics*
  • Dental Health Services / economics*
  • Dental Health Services / statistics & numerical data
  • Diabetes Complications / economics*
  • Female
  • Health Care Costs / statistics & numerical data*
  • Health Expenditures / statistics & numerical data*
  • Humans
  • Insurance, Dental*
  • Male
  • Middle Aged
  • Periodontal Diseases / complications
  • Periodontal Diseases / economics*
  • Periodontal Diseases / therapy
  • Preferred Provider Organizations / economics*
  • Preferred Provider Organizations / statistics & numerical data
  • Retrospective Studies
  • Risk Assessment
  • United States