Cost-Utility of Integrated Urate-Lowering and Periodontal Care in Chinese Adults: A Markov Study

ABSTRACT Objectives Hyperuricaemia/gout (HUA) and periodontitis frequently coexist in Chinese adults and share inflammatory mechanisms, yet the economic value of integrating non-surgical periodontal therapy into HUA/gout care is unquantified in China. We evaluated the cost-utility of three management strategies. Methods A nine-state Markov cohort model (1-year cycles, 40-year horizon) was developed from the Chinese healthcare-payer perspective for 50-year-old patients, stratified into HUA-controlled/-uncontrolled subgroups. Three strategies were compared: usual care (UC), scaling and root planing plus urate-lowering therapy (SRP+ULT), and comprehensive integrated management (CIM). Transition probabilities were derived from national oral-health and hyperuricaemia surveys and the Taiwan National Health Insurance Database. Costs (2024 CNY; NHSA schedules) and quality-adjusted life-years (QALYs; Chinese EQ-5D-5L tariff) were discounted at 5% annually. Incremental cost-utility ratios (ICURs) were compared with willingness-to-pay (WTP) thresholds of CNY 90,000 and 270,000/QALY. Deterministic and probabilistic sensitivity analyses (10,000 simulations), value-of-information and 5-year budget-impact analyses were performed. Reporting followed CHEERS 2022. Results In the HUA-controlled subgroup, SRP+ULT yielded an ICUR of CNY 5,592/QALY and CIM CNY 30,159/QALY versus UC – both well below CNY 90,000/QALY. In the HUA-uncontrolled subgroup, SRP+ULT was strictly dominant (cost-saving of CNY 3,586/patient with +0.398 QALYs) and CIM yielded CNY 13,217/QALY. Tooth-loss incidence fell from 10.3% (UC) to 5.7% (CIM), and gout complications from 14.5% to 8.0% in the uncontrolled cohort. Findings were robust to all univariate perturbations; at CNY 270,000/QALY, CIM was optimal in 89.2% (controlled) and 96.7% (uncontrolled) of simulations, and cost-effective versus UC in >98% of simulations in both subgroups. Conclusions Integrating non-surgical periodontal therapy with urate-lowering therapy is cost-effective in Chinese adults with comorbid HUA/gout and periodontitis; in those with uncontrolled HUA, adding scaling and root planing is cost-saving (dominant). The findings support including periodontal screening and SRP in gout-management pathways for Chinese and ethnic-Chinese populations, prioritising patients whose HUA is poorly controlled. CIM's cost-effectiveness in the HUA-controlled subgroup, however, depends on treatment-effect durability: its ICUR rises to approximately CNY 93,900/QALY at a five-year effect half-life and CNY 143,500/QALY at three years, whereas SRP+ULT and both HUA-uncontrolled strategies remain cost-effective regardless. Clinical significance Dental and rheumatology clinicians managing Chinese adults with hyperuricaemia or gout should routinely screen for periodontitis and refer affected patients for scaling and root planing as an integral component of gout care. This integrated approach delivers better long-term oral and systemic outcomes – including reduced tooth loss and fewer gout complications – at no additional net cost in patients with poorly controlled serum urate, and at acceptable cost in those with controlled disease. Embedding periodontal assessment into gout-management pathways is justified by current Chinese willingness-to-pay thresholds.