Cost-Utility Analysis of Comprehensive Integrated Management for Psoriasis and Periodontitis: A Markov Cohort Study

Abstract

Objectives Psoriasis and periodontitis co-occur in Chinese adults beyond chance expectation, sharing proinflammatory pathways. We modelled the long-term economic value of integrating periodontal care into psoriasis management in China. Methods A nine-state Markov cohort model (1-year cycle, 40-year horizon, baseline age 45) compared usual care (UC), scaling and root planing with systemic psoriasis management (SRP + Pso), and comprehensive integrated management (CIM). Natural-history and treatment-effect inputs, derived from cross-sectional evidence, were explicitly treated as calibration assumptions, not observed annual rates; Chinese-tariff utilities were used where available, with external proxies flagged. Costs and QALYs were discounted at 5%/y; willingness-to-pay thresholds were CNY 95,749 and CNY 287,247/QALY (2024 GDP per capita). Deterministic and probabilistic sensitivity analyses (10,000 simulations), value-of-information, and 5-year budget impact analyses were performed. Results In Pso-Stable, UC yielded 13.200 QALYs at CNY 107,295; incremental cost-utility ratios vs UC were CNY 13,933/QALY (SRP + Pso) and CNY 8337/QALY (CIM), with SRP + Pso strongly dominated by CIM sequentially. In Pso-Active, both active strategies dominated UC, and SRP + Pso was again dominated. At CNY 95,749/QALY, CIM was optimal in 94.8% and 99.2% of simulations. Per-patient expected value of perfect information was CNY 658.88 and CNY 68.52, respectively; combined-state utilities contributed 88% of the former. Five-year cumulative budget impact was CNY 836.2 million. Conclusions CIM was cost-effective or cost-saving at every threshold tested. Because treatment-effect parameters are assumption-based, these hypothesis-generating findings support evaluating periodontal care within China’s national psoriasis pathway pending longitudinal Chinese data.