Critical review of willingness to pay for clinical oral health interventions

Fit for Purpose? The Suitability of Oral Health Outcome Measures to Inform Policy

KNOWLEDGE TRANSFER STATEMENT

Oral health research and program evaluation should consider alternative outcome measures for population oral health other than the DMFT index.

UK general population's willingness to pay for dental check-ups

OBJECTIVES

Choices about which dental treatments to provide in a publicly funded system should be guided by the value that the general population place on those treatments. The aim of this study was to estimate United Kingdom (UK) general population willingness to pay (WTP) for dental check-ups, and to investigate what factors influence WTP.

METHODS

WTP was elicited using a hypothetical question in an online survey. The sample consisted of 594 participants, nationally representative of the UK general population in terms of age and gender. Regression analysis was used to examine what factors are associated with WTP. Analyses were conducted including and excluding protest answers.

RESULTS

The mean WTP for a dental check-up is £31.32 for the full sample and £33.17 excluding protest answers. Respondents on higher incomes and those with higher university education had higher WTP. Respondents in Scotland were WTP less than respondents living in the rest of the UK which may be the result of NHS dental check-ups being free to patients in Scotland.

CONCLUSION

The general UK population value dental check-ups. This study provides estimates of WTP for dental check-ups which can be used in Cost-Benefit Analyses.

Telehealth Consultation for Malaysian Citizens' Willingness to Pay Assessed by the Double-Bounded Dichotomous Choice Method

Background

Re-envisioning healthcare in technology tools includes robust utilisation of telehealth, improvement in access, quality, care efficiencies and cost-effectiveness of healthcare services. In reality, the technology's potential to transform healthcare may be limited by the ability to pay for it. This study aims to estimate Malaysian citizens' willingness to pay (WTP) for telehealth consultations and determine the factors contributing to it. This is vital to inform decision-making about expansion, preferences and deployment of a pricing strategy for telehealth services.

Methods

A random sample of 220 adult Malaysians was surveyed using social network services (SNS). Three different WTP bid arrays were identified and each respondent received a randomly drawn bid price. The WTP fee for using the telehealth consultation for 30 min was measured and estimated using a Double-Bounded Dichotomous Choice (DBDC) and the Random Utility Logit Model.

Result

The median WTP was estimated to be RM58 (JPY2,198), RM78 (JPY2,956) for 132 respondents' willingness to use telehealth consultation and RM26 (JPY985) for 51 respondents who were unwilling. Further analysis found that WTP is correlated with the perception and willingness of the respondents to use it.

Conclusion

Despite most respondents being willing to pay for telehealth consultations, sociodemographic characteristics and affordability influenced the process of making decisions about WTP for telehealth consultation. This finding suggests that the private sector can play a crucial role in the deployment of telehealth. However, there may be a need to consider affordability and how to increase access and use of telehealth services.

The general public's attitude towards accepting payment for kidney donation

Introduction

Kidney transplantation has become the most cost-effective treatment for patients with end-stage kidney disease (ESKD) and offers them the highest quality of life. Yet, kidney donation is often inaccessible due to cultural and traditional beliefs about organ donation. The goal of our study is to assess the value of kidney donation using the Willingness to Accept (WTA) technique. We also aim to understand the factors influencing an individual's willingness to donate an organ.

Methods

A self-administered survey was completed by 985 participants from the general public. The quantitative method and survey design that were chosen used descriptive, correlational, nonparametric, and multivariate statistical tests.

Results

Most of the respondents, 895 (90.9%) are not willing to donate a kidney while alive. Four hundred and five (41.1%) of the respondents are not willing to donate a kidney after their death, while the rest are willing to donate their kidney after their death without financial compensation. The same attitude applies to the donation of a kidney from their relatives. Significant predictors from the results of the logistic regression model in predicting the lowest (minimal) amount that will encourage donation of one kidney after death were: Marital status; Nationality; Adi card holder; Knowing people who need a kidney donation; confidence in the medical staff; and consideration of the family's opinions regarding organ donation.

Discussion

Using cost benefit analysis (CBA), with the aim of evaluating the willingness of individuals to accept payment for innovative medical procedures, such as kidney donation, allows an assessment of the perceived value of the medical procedure and enables policymakers to decide whether to allocate funds or offer subsidies for kidney donation, given the limited healthcare resources available. During our research, we found that most participants did not support the commercialization of organs. Our recommendation for policymakers and health professionals is to continue providing adequate funding for kidney donations and to implement educational programs aimed at improving attitudes towards organ donation.

Application of the extended theory of planned behavior to predict dentist intention and behavior in providing caries preventive care for preschool children

BACKGROUND

Various studies show a gap between evidence-based recommendations and the preventive practice of dentists. This study aimed to create and assess an extended Theory of Planned Behavior (TPB) model on dentists' intentions to do caries preventive measures and related barriers experienced by dentists.

METHODS

A total of 362 general dentists from 34 Indonesian provinces were included in this study. A self-administered online questionnaire consisted of three sections: dentist characteristics and practice pattern, TPB questionnaire, and dentist perceived behavior regarding preventive care for pediatric patients. The questionnaire was distributed and the data was analyzed through structural equation modeling.

RESULTS

TPB's extended version is a fit and relevant model, explaining 55.3% of dentists' intentions to undertake preventive procedures and 17.8% of preventive practices. Perceived behavioral control was the most powerful predictor of intention (44.2%) and practice (8.8%), while parental barriers were the most significant barrier to provide preventive care (18.9%).

CONCLUSION

Extending the TPB by taking barriers from multiple stakeholders as a consideration has a higher predictive level for preventive practices. Each barrier should be addressed through oral health programs and policies, and dentists must be taught to overcome these barriers (through formal or continuing education) in order to maximize caries prevention strategies.

The role of income and frequency of dental visits in the relationship between dental sealant use and resin fillings after extended coverage: a retrospective cohort study

BACKGROUND

Prevention and treatment services use is closely associated with socioeconomic factors, such as income. This study aimed to investigate the relationship between implementing the sealant program and resin fillings restoration and to explore the role of income and frequency of dental visits in this relationship.

METHODS

This retrospective cohort study used the cohort database from the National Health Information Database of the National Health Insurance Service. The study population comprised 494,731 children born in 2007. A logistic regression model for the experience of resin fillings and a linear regression model for weighted utilization of them were used to identify the independent effects of dental sealants, income, and frequency of dental visits. All analyses were conducted using the SAS Enterprise Guide version 7.1 (SAS Institute Inc., Cary, NC, USA).

RESULTS

The ratio based on income level was almost proportional in all groups except the medical aid group, which had a rate as high as that of the wealthier group. Children without sealants were 1.05 times more likely to have resin fillings than others after adjusting for income level and frequency of visiting dental clinics in the final model. However, an opposite relationship between sealant experiences and resin fillings was observed in the previous model without dental visits. The gap in the weighted resin filling scores according to socioeconomic variables showed a similar tendency.

CONCLUSIONS

Income and frequency of dental visits might be confounding factors for the relationship between dental sealant and resin fillings. It is necessary to consider the complex relationship between socioeconomic indicators and service use while studying oral health inequality.

Cost-Effectiveness Analysis of Regenerative Endodontics versus MTA Apexification

INTRODUCTION

With the introduction of stem cell engineering in dentistry, regenerative endodontics has emerged as a potential alternative to mineral trioxide aggregate (MTA) apexification in the management of necrotic immature permanent teeth. However, the utility of this modality in terms of cost-effectiveness has not yet been established. Therefore, we performed cost-effectiveness analysis to determine the dominant treatment modality that would influence decision making from the private payer perspective.

METHODS

A Markov model was constructed with a necrotic immature permanent tooth in a 7-y-old patient, followed over the lifetime using TreeAge Pro Healthcare 2022. Transition probabilities were estimated based on the existing literature. Costs were estimated based on United States health care, and cost-effectiveness was determined using Monte Carlo microsimulations. The model was validated internally by sensitivity analyses, and face validation was performed by an experienced endodontist and health economist.

RESULTS

In the base-case scenario, regenerative endodontics did not turn out to be a dominant treatment option as it was associated with an additional cost of USD$1,012 and fewer retained tooth-years (15.48 y). Likewise, in the probabilistic sensitivity analysis, regenerative endodontics was again dominated by apexification against different willingness-to-pay values.

CONCLUSION

Based on current evidence, regenerative endodontic treatment was not cost-effective compared with apexification in the management of necrotic immature permanent teeth over an individual's lifetime.

KNOWLEDGE TRANSFER STATEMENT

The study provides valuable insight regarding the cost valuation and cost-efficacy of regenerative endodontic treatment versus apexification in the management of necrotic immature permanent teeth, as this would aid in effective clinical decision making, allowing for the functional allocation of resources.

Assessing Patients' Preferences for Preventive Dental Care: A Discrete Choice Experiment

Background It is crucial to recognize patients' behavioral responses to improve oral healthcare delivery. A discrete choice experiment (DCE) is typically used to measure service user preferences. The purpose of this study was to examine the preferences of the Saudi population regarding primary dental care using a DCE. Materials and methods An online DCE survey was distributed among adults aged 18 years and older living in Saudi Arabia. An orthogonal design was used to reduce the number of combinations while maintaining the main effects that reflect patient preferences. Respondents were presented with a reduced set of 10 cards (tasks), and each of the cards had two concepts (offers). Descriptive statistics were used to summarize the sample characteristics. The coefficients were calculated based on discrete choice results on the Qualtrics platform. Results A total of 532 participants completed the survey. Among patients seeking a preventive dental visit, the ability to get an appointment was rated the most important influence on their decision with a relative importance of 41%, followed by the dental care provider (29%) and the dental clinic in relation to the sector and the fees (20%). The least important attribute was the waiting time in minutes, with a relative importance of 10%. Conclusion The study findings revealed that patients make trade-offs when deciding to receive primary dental care. Policymakers can use the study's findings to inform their decisions concerning dental clinic services. The study results suggest that it is possible to improve access to primary dental care by improving the accessibility of appointments.

People's Willingness to Pay for Dental Checkups and the Associated Individual Characteristics: A Nationwide Web-Based Survey among Japanese Adults

This study aimed to determine the willingness-to-pay (WTP) values for dental checkups and analyze the association between the values and individual characteristics. This cross-sectional study was conducted using a nationwide web-based survey, and 3336 participants were allocated into groups that received regular dental checkups (RDC; n = 1785) and those who did not (non-RDC; n = 1551). There was a statistically significant difference in the WTP value for dental checkups between the RDC (median: 3000 yen [22.51 USD]) and non-RDC groups (2000 yen [15.01 USD]). In the RDC group, age 50-59 years, household income <2 million yen, homemaker and part-time worker employment status, and having children were significantly associated with decreased WTP values; male sex, household incomes ≥8 million yen, and tooth brushing ≥3 times daily were associated with increased WTP values. In the non-RDC group, age ≥30 years, household incomes <4 million yen, and having ≥28 teeth were significantly associated with decreased WTP values; household income ≥8 million yen was associated with increased WTP values. Conclusively, WTP values for dental checkups were lower in the non-RDC group than in the RDC group; in the non-RDC group, those with lower household income aged ≥30 years were more likely to propose lower WTP values, suggesting the need for policy intervention to improve access to RDC.

Cost/effectiveness analysis of treatment options for the rehabilitation of the total edentulous mandible

BACKGROUND

Several solutions are available for the rehabilitation of edentulous jaws. Each treatment option is characterised by specific advantages and drawbacks.

OBJECTIVE

The aim of this research was to perform a cost-effectiveness (CE) analysis of the main rehabilitative solutions of totally edentulous mandibles.

METHODS

Decision tree models were built using TreeAge Pro Healthcare 2021 software to compare the following strategies: Conventional Denture (CD), Overdenture retained by two implants (OD-2), Overdenture retained by a bar on two implants (ODbar), Overdenture retained by 4 mini-implants (ODmini) and Fixed denture supported by 4 implants (FD). Costs were estimated using data from public rate tables. Effectiveness measures were obtained from a meta-analysis of literature data, normalising the different scales in 0-1 range. A value of 30 000€ per 1 normalised utility points was set as threshold of willingness to pay (WTP). Probabilistic sensitivity analysis (PSA) with 1000 Monte Carlo Simulations was performed to characterise uncertainty.

RESULTS

Total costs ranged between 1804,40€ for CD and 10 008,80€ for FD rehabilitations, with an effectiveness of 0,69 and 0,95 normalised points (0-1 scale) for the two solutions. The ODbar resulted to be the most CE strategy at the established WTP value, with the highest Net Monetary Benefit (22 001,20€), followed by the OD-2 rehabilitation (21 866,80€). PSA analysis confirmed the dominance of OD-2 and ODbar strategies, confirming a net separation from the other alternatives.

CONCLUSION

OD stabilised by 2 implants could represent a good rehabilitative solution for patients with edentulous mandible, being a good trade-off in terms of costs and effectiveness. Nevertheless, a standardised measure of oral health-related quality of life is needed to obtain more reliable results.

Socioeconomic Determinants of Willingness to Pay for Emergency Public Dental Services in Saudi Arabia: A Contingent Valuation Approach

Dental diseases remain major health problems worldwide, leading to pain, discomfort, and even death. In Saudi Arabia, public dental care services (i.e., services provided by government-owned health facilities) are provided free of charge for all Saudi citizens. However, public dental care facilities are overburdened and overcrowded, resulting in long waiting times to access dental care services. The consequent limited access to dental services can prolong discomfort and delay pain management, thereby exacerbating the suffering of patients. Therefore, the aim of this study was to examine the socioeconomic determinants of the willingness to pay for immediate public dental care in the face of a dental emergency in Saudi Arabia. A cross-sectional design was employed to obtain data from adult citizens of Saudi Arabia who were residents of the Holy City of Makkah. A pre-tested online questionnaire was used to obtain the responses from 549 individuals, selected through a snowball sampling technique, from 15 July to 10 August 2021. Descriptive statistics (frequencies and percentages), Pearson's chi-square test, and binary probit regression were used as estimation techniques. The findings showed that 79.4% of the respondents were willing to pay for immediate public dental services, with the majority (86%) expressing a willingness to pay less than 500 Saudi Riyal (SAR). The binary probit regression estimates showed that respondents who were unemployed, those with a high school level of education or below, and those without private health insurance were less likely to be willing to pay for immediate public dental services. Thus, policies and initiatives aimed at enhancing the willingness to pay for immediate public dental services should target the unemployed, those with a high school level of education or below, and people without private health insurance.

Preserving natural teeth versus extracting them: a willingness to pay analysis

BACKGROUND

Maximum willingness to pay (WTP) for a health benefit is related to perceived value. The goal of this study was to find out how much Iranian healthy people would be willing to pay to keep their natural teeth instead of having them pulled. This was done separately for the anterior and posterior teeth.

METHODS

The highest value was posed as an open-ended question in this cross-sectional analysis conducted in 2021. Four distinct scenarios for treating a tooth with a poor prognosis for natural tooth preservation versus extraction were offered. WTP for the preferred treatment option was asked for painful and painless anterior and posterior teeth separately. A two-stage hurdle approach was employed to determine factors influencing the WTP for a hopeless case. The level of significance was fixed at 0.05.

RESULTS

Out of 795 individuals, 355 (44.7%) were male and 209 (26.3%) had poor self-stated dental health. Over 65% of those interviewed said they wanted to keep their teeth. The mean WTP was highest for dental preservation up to 94 USD and the lowest was for extraction without replacement 19 USD. The WTP for anterior tooth therapy was greater than the WTP for posterior dental care, regardless of treatment type or tooth discomfort. Participants with higher education, jobs, income-to-expenditure matching, older age, preference for the treatment in a private office, and female gender (except for WTP for a painful posterior tooth) were more likely to have a WTP of at least 1 USD.

CONCLUSION

The average WTP for treatment of teeth with a poor prognosis was lower than the average fee charged in dental facilities, and more than 65% of participants preferred to keep their teeth. Regardless of the treatment option or whether it was painful or not, WTP for anterior teeth treatment was higher than for posterior teeth. Generally, we found that sociodemographic factors influenced WTP decision-making the most. This study has practical implications for public oral health policymakers and insurance organizations.

Public Valuation of Direct Restorations: A Discrete Choice Experiment

Direct posterior dental restorations are commonly provided following management of dental caries. Amalgam use has been phased down and the feasibility of a phase-out by 2030 is being explored. Alternative direct restorative materials differ in their outcomes and provision. This research aimed to elicit the UK population's preferences for different attributes of restorations and their willingness to pay (WTP) for restorative services and outcomes. A discrete choice experiment (DCE) was designed with patient and public involvement and distributed to a representative sample of the UK general population using an online survey. Respondents answered 17 choice tasks between pairs of scenarios that varied in levels of 7 attributes (wait for filling, clinician type, filling color, length of procedure, likely discomfort after filling, average life span of filling, and cost). An opt-out (no treatment) was included. Mixed logit models were used for data analysis. Marginal WTP for attribute levels and relative attribute importance were calculated. In total, 1,002 respondents completed the DCE. Overall, respondents were willing to pay £39.52 to reduce a 6-wk wait for treatment to 2 wk, £13.55 to have treatment by a dentist rather than a therapist, £41.66 to change filling color from silvery/gray to white, £0.27 per minute of reduced treatment time, £116.52 to move from persistent to no postoperative pain, and £5.44 per year of increased restoration longevity. Ability to pay affected willingness to pay, with low-income respondents more likely to opt out of treatment and value restoration color (white) and increased longevity significantly lower than those with higher income. Clinicians should understand potential drivers of restoration choice, so they can be discussed with individual patients to obtain consent. It is important that policy makers consider general population preferences for restorative outcomes and services, with an awareness of how income affects these, when considering the potential phase-out of amalgam restorations.

The value of adult orthodontics: Do the public's willingness-to-pay values reflect the profession's?

OBJECTIVE

To explore how the public and dental professionals would value an orthodontic service for adults by eliciting their willingness-to-pay (WTP), a standardised health economics technique which quantifies 'strength of preference' in monetary terms. Despite increasing demand, adults in the UK are only eligible for NHS orthodontic treatment if there is severe dental health or complex multidisciplinary need. Orthodontic services are provided to children aged under 18 years who are eligible by their Index of Orthodontic Treatment Need (IOTN) score. Consequently, many adults who may have a need for treatment as determined by IOTN are unable to access this service.

DESIGN

Cross-sectional survey.

SETTING

General dental practices in North East England and national specialists approached through the British Orthodontic Society (BOS).

PARTICIPANTS

Public participants were recruited from general dental practices. Dentists were recruited from local dental lists and members of the BOS.

METHODS

Participants were asked if they would be willing to pay to see an orthodontic service extended to all adults in England with a qualifying IOTN. Clinical photographs of three malocclusions were presented and maximum WTP in additional tax per household per year was elicited using shuffled payment cards.

RESULTS

A total of 205 dentists and 206 public participants were recruited. Pairwise tests showed a statistically significant difference in WTP between the public and professionals for all malocclusions, with the public giving higher valuations. In both groups, the Class III scenario elicited a higher WTP than the class I or II malocclusion. However, when all other factors were controlled for using a regression analysis, the group (public or profession) and the other variables did not significantly influence WTP.

CONCLUSION

The public and professionals were willing to pay for an adult orthodontic service. Due to this variability and unpredictability the allocation of healthcare resources will remain contentious.

Differential Willingness to Pay for Kidney Transplantation From Living and Deceased Donors: Empirical Study Among End-Stage Kidney Disease (ESKD) Patients

Kidney transplantation has developed to the stage where it is currently the most cost-effective treatment for patients suffering from end-stage kidney disease (ESKD) and, when available, offers them the highest quality of life. Yet, kidney transplantation is challenged by cultural and traditional beliefs; thus, this study sought to evaluate the willingness to pay for a kidney transplant in a culturally sensitive population. A self-administered survey was completed by 734 end-stage kidney disease (ESKD) patients. A quantitative method and survey design were chosen and employed descriptive, correlational, nonparametric, and multivariate statistical tests. Participants were willing to pay a mean amount of $40 751.36 for a living donor kidney transplant, whereas the mean is considerably lower, $18 350.51, for a deceased donor kidney. Significant predictors of the willingness to pay (WTP) for a kidney transplant from a living donor and a deceased donor were found, among them: religiosity and ethnicity. The participants' willingness to pay for a kidney transplant could attest to significant benefits in enhancing patient well-being. The willingness to pay differentially for a donation from a deceased or a living donor stems from the higher chances of success with a living-donor organ as well as from moral and religious motives. In Israel kidney transplantation is not tradable in the free market and is fully funded by the state. The average cost of kidney transplantation in Israel is $61 714.50. Since the cost exceeds the utility and since the economic literature suggests that the funding of healthcare interventions should be provided up to the point where the costs of that funding equal the benefits that society derives from it, crucial revisions in public health policy should be made. Education may have a significant impact on the approach to kidney donation and organ donation in general.

Willingness to Pay for Preventive Dental Care Amongst Older Adults

OBJECTIVE

The aims of this study were (1) to investigate willingness to pay (WTP) for preventive and curative dental care procedures and (2) to determine the factors that influence older adults' WTP for dental care.

METHODOLOGY

Older, independently living adults from Singapore aged 60 years and older and eligible for government-subsidised dental care were nonrandomly recruited for this study. Data were collected using questionnaires and a clinical examination which recorded details of caries experience, number and distribution of posterior occluding contacts, prosthodontic status, and periodontal status. Using a contingent valuation method, participants were asked to rate WTP in Singapore dollars [SGD$] for 4 aspects of care: dental fillings, dental scaling, dental extraction, and disease prevention advice. Negative binomial regression was used to assess the relationship between the predictor variables associated with WTP for dental fillings, scaling, extraction, and preventive advice.

RESULTS

The mean value of WTP for a dental filling was SGD$30.23 (SGD$31.05), for scaling was SGD$30.28 (SGD$29.46), for dental extraction was SGD$35.08 (SGD$58.54). In a multivariate model, factors associated with higher WTPfees were as follows: (1) dental filling: age (younger), level of education (higher), and frequency of dental visits (regular); (2) scaling: level of education (higher), agree that dental problems affect overall health, and frequency of dental visits (regular); (3) dental extractions: age (younger), level of education (higher), frequency of dental visits (regular), and prosthodontic status (not wearing); (4) preventive advice: age (younger), gender (male), ethnicity (Chinese), level of education (higher), marital status (married), self-perceived oral health (good), and dental visits (regular).

CONCLUSIONS

The findings of our study suggest that older adults are willing to pay most for extraction and least for preventive advice.

Parents' preferences for preventive and curative dental services: A comparison between fissure sealant and composite filling using willingness-to-pay method

BACKGROUND

The early years of life play a significant role in the lifelong health of humans and parents have an important role in healthcare decision making. Thus, it seems necessary for policymakers and clinicians to be aware of how parents value pediatric health services. Willingness to pay (WTP) is a recommended method for measuring the stated utility of health services/goods or health states.

AIM

This study aimed to elicit and compare parents' WTP for health services such as fissure sealant and composite filling.

DESIGN

An originally developed questionnaire was used to guide interviews with a sample of 290 parents attending a public pediatric healthcare center. Related-samples Wilcoxon signed-rank test was performed for comparing the difference in absolute WTP amounts between the two services, and linear regression was used to assess the association between WTP and relevant variables using SPSS version 21.

RESULTS

Mean WTP for fissure sealant and filling was 269 724 and 555 327 Tomans, respectively, and the difference between them was statistically significant (P < .001). Higher WTP amounts found in both services were associated with income levels of 4 and 5 (P < .05).

CONCLUSIONS

Respondents highly valued the considered services and stated a significantly higher relative preference for filling. Public awareness should be promoted about the importance of prevention of oral health diseases and the attributes of the oral healthcare system services.

Parents' Willingness to Invest in Primary Oral Health Prevention for Their Preschool Children

There is growing evidence for the beneficial effects of starting oral health prevention early in life. Preventing dental caries in very young children requires considerable investment from parents. Therefore, this cross-sectional study aimed to explore parents' willingness to pay (WTP) and willingness to invest in time (WTIT) for primary oral health prevention in preschool children and describe whether these are related to the parents' demographic, socio-economic and behavioural characteristics. In a convenience sample of parents of preschool children aged six months to four years (n = 142), data were collected with questionnaires. On average, parents were willing to pay EUR15.84 per month, invest time for 1.9 dental visits per year, and spend 2.4 min per day brushing their child's teeth. A higher education level of the mother and having a child older than two were associated with a higher WTIT in brushing minutes per day (p = 0.03). In addition, parents who brushed their child's teeth more frequently were also more willing to invest in brushing minutes (p < 0.01) and money (p < 0.01). Findings emphasise the importance of early oral health interventions and the need to increase awareness of primary prevention's importance in maintaining healthy teeth and reducing possibly oral health inequalities.

Personality Traits and Annual Income Determine the Willingness to Pay for a Single Tooth Implant

The objective of this study was to evaluate the factors influencing the willingness to pay for a single tooth implant in Malaysia and to assess if an additional evidence-based patient education video increases the willingness to pay. A total of 100 subjects seeking single tooth replacement at the Oral Health Centre, International Medical University (IMU), Kuala Lumpur, Malaysia, were asked to complete questionnaires about personal demographics and personality traits. Subsequently, they were randomly allocated into two groups. Group C received a conventional patient-dentist interaction on treatment options for missing teeth, while Group EV received the same content with an additional evidence-based video on the survival rate and complications for each option from recent meta-analyses. Willingness to pay the median price and the highest price that the subjects were willing to pay were assessed by a structured bidding process. A higher annual income was significantly associated with willingness to pay the median price for a single tooth implant (χ² = 6.91, p = 0.03). Dominant personality traits of openness (r = -0.25), conscientiousness (r = -0.30) and agreeableness (r = -0.20) were negatively correlated with the highest price that the patients were willing to pay for a single tooth implant (Pearson's correlation test, p < 0.05). No significant difference in willingness to pay was found between Group C and Group EV (χ² = 0.05, p > 0.05). In conclusion, patient education strategies for single tooth replacements with dental implants should be customized based on a patient's personality and income to maximize effectiveness.

Prevalence of Missing Values and Protest Zeros in Contingent Valuation in Dental Medicine

Background: The number of contingent valuation (CV) studies in dental medicine using willingness-to-pay (WTP) methodology has substantially increased in recent years. Missing values due to absent information (i.e., missingness) or false information (i.e., protest zeros) are a common problem in WTP studies. The objective of this study is to evaluate the prevalence of missing values in CV studies in dental medicine, to assess how these have been dealt with, and to suggest recommendations for future research. Methods: We systematically searched electronic databases (MEDLINE, Web of Science, Cochrane Library, PROSPERO) on 8 June 2021, and hand-searched references of selected reviews. CV studies in clinical dentistry using WTP for valuing a good or service were included. Results: We included 49 WTP studies in our review. Out of these, 19 (38.8%) reported missing values due to absent information, and 28 (57.1%) reported zero values (i.e., WTP valued at zero). Zero values were further classified into true zeros (i.e., representing the underlying preference of the respondent) or protest zeros (i.e., false information as a protest behavior) in only 9 studies. Most studies used a complete case analysis to address missingness while only one study used multiple imputation. Conclusions: There is uncertainty in the dental literature on how to address missing values and zero values in CV studies. Zero values need to be classified as true zeros versus protest zeros with follow-up questions after the WTP elicitation procedure, and then need to be handled differently. Advanced statistical methods are available to address both missing values due to missingness and due to protest zeros but these are currently underused in dental medicine. Failing to appropriately address missing values in CV studies may lead to biased WTP estimates of dental interventions.

UK general population willingness to pay for scale and polish, and detailed and personalized oral hygiene advice

OBJECTIVES

Understanding the value the general population place on dentistry services is important for policymakers to aide service planning. Willingness to pay (WTP) is an economic method used to elicit the value of a good or service. The aim of this study is to estimate United Kingdom (UK) general population WTP for commonly provided scale and polish, and detailed and personalized oral hygiene advice (OHA), and to investigate what factors influence WTP.

METHODS

Participants completed an online hypothetical WTP survey for scale and polish and detailed and personalized oral hygiene advice. The estimation sample consisted of 1405 participants, nationally representative of the UK general population in terms of age and sex. Regression analysis was used to estimate WTP and determine what factors are associated with WTP. Analyses were conducted including and excluding protest answers.

RESULTS

The mean (SD) WTP for a scale and polish is £26.77 (£21.91) excluding protest answers and £24.80 (£22.71) for the full sample. The mean (SD) WTP for detailed and personalized OHA is £16.56 (£19.75) excluding protest answers and £12.77 (£22.28) for the full sample. Participants on higher incomes, private attenders and those who stated that maintaining clean and healthy gums was important had higher WTP for both services. Participants in Scotland and Northern Ireland were WTP less than their English counterparts, reflecting the different regional specific payment systems.

CONCLUSION

The general UK population value scale and polish, and detailed and personalized OHA. This study provides estimates of WTP for these services which can be used to inform resource allocation decisions.

Economic evaluations in the treatment and evaluation of patients with periodontal disease: A critical review

AIM

To evaluate the types and quality of reporting of economic evaluations carried out in the clinical management of periodontal disease over 32 years from 1987 to 2019.

MATERIAL AND METHODS

A systematic search of articles from 1987 to 2019 was conducted using PubMed, Web of Science, The Cochrane Central Register of Controlled Trials, Health Technology Assessment Database and Embase. The quality of the economic evaluations was assessed based on the Consolidated Health Economic Evaluation Reporting Standard checklist. Due to considerable between-study heterogeneity, a meta-analysis was not performed.

RESULTS

Twenty one publications were included. 11 studies used cost-effectiveness analysis, five used cost-minimization analysis, four used cost-utility analysis and two used cost-benefit analysis. Comparators, choice of health outcomes, estimating resources and costs were fully reported in all studies. Many studies had inadequate reporting in terms of estimating resources and costs, choice of health outcomes, characterizing heterogeneity and study perspective.

CONCLUSIONS

There has been an increase in health economics studies in the field of clinical periodontology over the past decade. Several studies did not report study perspective, and the health outcomes chosen were not relevant for some studies. Future studies should follow an economic evaluation checklist for high-quality reporting and consistency.

Parents' willingness to pay for children's spectacles in Cambodia

Background/aim

To determine willingness to pay for children's spectacles, and barriers to purchasing children's spectacles in Cambodia.

Methods

We conducted vision screenings, and eye examinations as indicated, for all consenting children at 21 randomly selected secondary schools. We invited parents/guardians of children found to have refractive problems to complete a willingness to pay for spectacles survey, using a binary-with-follow-up technique.

Results

We conducted vision screenings on 12 128 secondary schoolchildren, and willingness to pay for spectacles surveys with 491 parents/guardians (n=491) from Kandal and Phnom Penh provinces in Cambodia. We found 519 children with refractive error, 7 who had pre-existing spectacles and 14 recommended spectacles for lower ametropias. About half (53.2%; 95% CI 44.0% to 62.1%) of parents/guardians were willing to pay KHR70 000 (US$17.5; average market price) or more for spectacles. Mean willingness-to-pay price was KHR74 595 (US$18.6; 95% CI KHR64 505 to 86 262; 95% CI US$16.1 to US$21.6) in Phnom Penh and KHR55 651 (US$13.9; 95% CI KHR48 021 to 64 494; 95% CI US$12.0 to US$16.1) in Kandal province. Logistic regression suggested parents/guardians with college education (OR 6.8; p<0.001), higher household incomes (OR 8.0; p=0.006) and those wearing spectacles (OR 2.2; p=0.01) were more likely to be willing to pay ≥US$17.5. The most common reasons for being unwilling to pay US$17.5 were related to cost (58.8%). The most common barrier to spectacle wear was fear that spectacles weaken children's eyes (36.0%).

Conclusions

With almost half of parents/guardians unwilling to pay for spectacles at the current average market price, financial support through a subsidised spectacle scheme might be required for children to access spectacles in Cambodia.

A systematic review and meta-regression of studies eliciting willingness-to-pay per quality-adjusted life year in the general population

OBJECTIVES

From the demand-side perspective, the monetary value of one additional quality-adjusted life year (QALY) is estimated as willingness-to-pay per QALY (WTPQ). This study aims to summarize the methods and contexts of elicitation of willingness-to-pay per quality-adjusted life year (WTPQ) in the general population and to investigate the heterogeneity of WTPQ estimates.

METHODS

Meta-regression analysis was conducted using Comprehensive Meta-Analysis Software. Sensitivity analyses were undertaken by replacing the lowest and highest 5% and 2.5% of WTPQ by percentiles.

RESULTS

33 studies with 102 WTPQ estimates were included. The overall mean and median WTPQ estimates are $1,280,002 and $44,072, respectively. The meta-regressions demonstrated that types of health gain (quality of life or life length) and certainty of health outcomes are statistically significant factors. Furthermore, compared with online interviews, face-to-face interviews tend to yield lower WTPQ. Moreover, the declining trend of QALY gains and positive effect with statistical significance of the sample age were also noticed.

CONCLUSION

For valid and representative values of WTPQ, future researchers should therefore take into consideration various scenarios and investigate both health gain with certainty and uncertainty, health gain from both life length and quality of life, and different size of QALY gains.

Reorienting Oral Health Services to Prevention: Economic Perspectives

Despite the recognized need to change the emphasis of health services by shifting the balance from treatment to prevention, limited progress has been made in many settings. This is true in oral health, where evidence for preventive interventions that work has not been systematically exploited in oral health services. While reorienting health services is complex and context specific, economics can bring a helpful perspective in understanding and predicting the impact of changes in resource allocation, provider remuneration systems, and patient payments. There is an increasing literature on the economics of different prevention approaches. However, much of this literature focuses on the costs and potential savings of alternative approaches and fails to take into account benefits. Even where benefits are taken into account, these tend to be narrowly focused on clinical outcomes using cost-effectiveness analysis, which may be of little relevance to the policy maker, patient, and the public. Some commonly used economic approaches (such as quality-adjusted life years and incremental cost-effectiveness ratios) may also not be appropriate to oral health. Using alternative techniques, including wider measures of benefit and employing priority setting and resource allocation tools, may provide more comprehensive information on economic impact to decision makers and stakeholders. In addition, it is important to consider the effects of provider remuneration in reorienting services. While there is some evidence about traditional models of remuneration (fee for service and capitation), less is known about pay for performance and blended systems. This article outlines areas in which economics can offer an insight into reorientation of health systems toward prevention, highlighting areas for further research and consideration.

Economic evaluations in paediatric dentistry clinical trials

Economic evaluations play an important role in identifying the cost-effectiveness of alternative healthcare programmes, informing decisions surrounding funding and the allocation of resources. This paper outlines the basic principles of economic evaluation and how it can be conducted alongside a clinical trial. Furthermore, it considers the ways in which evidence from these studies can be used, and the challenges researchers are faced with when conducting economic evaluations in the field of children's oral health.

An overview of the methodological aspects and policy implications of willingness-to-pay studies in oral health: a scoping review of existing literature

Background

Demands for dental services seem to be beyond the capacities of most healthcare systems these days. Patient preferences have been increasingly emphasized to be considered in the joint decision-making process. Willingness-to-pay (WTP) is a recommended method for measuring the utility of health services; increasingly being used in recent decades. Taking these points into consideration, this article aims to provide an overview of the methodological aspects and policy implications of WTP studies in the field of oral health.

Methods

The research was conducted in ISPOR, PubMed and Google Scholar databases. In addition, reference lists of included articles were checked to identify the relevant studies. All studies published were included that were in the English language and reported using WTP for oral health-related goods and services. A data-charting form was developed by a focus group discussion panel of seven experts to derive the main methodological aspects of WTP. Also, Core policy suggestions were categorized through thematic content analysis of the included papers.

Results

The search strategy yielded 389 studies of which 52 were included. WTP studies in oral health show an increasing trend in global publications. The UK and Canada have a greater share in published material than in any other country. The dominant field of these researches is in restorative and prosthetic dentistry, and a wide range of different methodological aspects was documented. Policy suggestions were categorized in three main themes: (A) setting new tariffs or subsidizing the item, (B) provision of the item due to population preferences, and (C) improving literacy regarding the item.

Conclusions

An urgent need for a common framework regarding the design of WTP studies in dentistry seems paramount. Some policy suggestions seem not to be applicable, perhaps due to insufficient familiarity of the researchers with the complexities of the public policymaking process.

A Systematic Review of WTA-WTP Disparity for Dental Interventions and Implications for Cost-Effectiveness Analysis

Cost-effectiveness analysis is widely adopted as an analytical framework to evaluate whether health care interventions represent value for money, and its use in dentistry is increasing. Traditionally, in cost-effectiveness analysis, one assumes that the decision maker's maximum willingness to pay (WTP) for health gain is equivalent to his minimum willingness to accept (WTA) monetary compensation for health loss. It has been documented in the literature that losses are weighted higher than equivalent gains, i.e., that WTA exceeds WTP for the same health condition, resulting in a WTA/WTP ratio greater than 1. There is a knowledge gap of published WTA/WTP ratios for dental interventions in the literature. We therefore conducted a (i) systematic review of published WTA-WTP estimates in dentistry (MEDLINE, Web of Science, Cochrane Library, London, UK) and (ii) a patient-level analysis of WTA/WTP ratios of included studies, and (iii) we demonstrate the impact of a WTA-WTP disparity on cost-effectiveness analysis. Out of 55 eligible studies, two studies were included in our review. The WTA/WTP ratio ranged from 2.58 for discontinuing water fluoridation to 5.12 for mandibular implant overdentures, indicating a higher disparity for implant rehabilitations than for dental public health interventions. A WTA-WTP disparity inflates the cost-effectiveness of dental interventions when there is a substantial risk of both lower costs and health outcomes. We therefore recommend that in these cases the results of cost-effectiveness analyses are reported using different WTA/WTP ratios in a sensitivity analysis.

Should Medicaid include adult coverage for preventive dental procedures? What evidence is needed?

BACKGROUND

Medicaid programs may have a salient financial incentive to provide adult coverage for cost-effective preventive dental procedures because they face responsibility for catastrophic costs of dental disease. Whether there is sufficient evidence to support adult Medicaid coverage of preventive dental services is unclear.

METHODS

Using an optimal insurance model, the author examines what evidence there is to support coverage of cost-effective preventive dental services in Medicaid and what evidence gaps remain.

RESULTS

There is insufficient evidence to support adult Medicaid coverage for preventive dental procedures.

CONCLUSIONS

More research is needed to identify preventive dental procedures that are cost-effective from a Medicaid perspective, quantify the impact dental prevention has on dental-related health care costs and overall health care costs, and quantify the impact patient-side and provider-side financial incentives have on take-up of specific preventive dental treatments.

PRACTICAL IMPLICATIONS

Although Medicaid programs may have an interest in preventing catastrophic costs of dental disease (that is, dental-related emergency department visits), there is insufficient evidence for Medicaid programs to provide coverage for preventive dental procedures.

A comparison of cost and cost-effectiveness analysis of two- implant-retained overdentures versus other removable prosthodontic treatment options for edentulous mandible: A systematic review

Aim:

The aim of this study was to examine systematically the data published on the cost and cost-effectiveness of mandibular two-implant-retained overdentures compared to other removable prosthodontic treatment options for edentulous mandible.

Settings and Design:

It is a systematic review which analyses the available data from the prospective and retrospective studies and randomized clinical trials to find out costs and cost effectiveness of different removable treatment modalities for completely edentulous mandible. The study protocol was decided according to PRISMA guidelines.

Materials and Methods:

The search was limited to English literature only and included an electronic search through PubMed Central, Cochrane Central Register of Controlled Trials, and complemented by hand-searching. All clinical trials published up to August 2019 were included (without any starting limit). Two independent investigators extracted the data and assessed the studies.

Statistical Analysis Used:

No meta-analysis was conducted because of the high heterogeneity of data.

Results:

Out of the initial 509 records, only nine studies were included. The risks of bias of individual studies were assessed. Six studies presented data on cost and cost analysis only. The rest three articles provided data on cost-effectiveness. The overall costs of implant overdentures were higher than the conventional complete dentures. However, implant overdentures were more cost-effective when compared to conventional complete dentures. Single-implant overdentures are also less expensive than two-implant overdentures. Overdentures supported by two or four mini-implants were also reported as more cost-effective than conventional two-implant-supported overdentures.

Conclusions:

Two-implant-retained overdentures are more expensive but cost-effective than the conventional complete dentures. Two- or four-mini-implant-retained overdentures are less expensive than two-implant-retained overdentures, but there is a lack of long-term data on aftercare cost and survival rate of mini-implants. Single-implant overdentures are also less expensive than the two-implant-retained overdentures. The differences of the aftercare costs of different attachment systems for implant overdentures were not significant. There is a need of further studies on comparative cost-effectiveness of different types of implant overdentures.

Comparing how patients value and respond to information on risk given in three different forms during dental check-ups: the PREFER randomised controlled trial

BACKGROUND

This study aims to compare patient preference for, and subsequent change in, oral health behaviour for three forms of risk information given at dental check-ups (verbal advice compared to verbal advice accompanied by a traffic light (TL) risk card; or compared to verbal advice with a quantitative light fluorescence (QLF) photograph of the patient's mouth).

METHODS

A multi-centre, parallel-group, patient-randomised clinical trial was undertaken between August 2015 and September 2016. Computer-generated random numbers using block stratification allocated patients to three arms. The setting was four English NHS dental practices. Participants were 412 dentate adults at medium/high risk of poor oral health. Patients rated preference and willingness to pay (WTP) for the three types of information. The primary outcome was WTP. After receiving their check-up, patients received the type of information according to their group allocation. Follow-up was by telephone/e-mail at 6 and 12 months. Mean and median WTP for the three arms were compared using Wilcoxon signed-rank tests. Tobit regression models were used to investigate factors affecting WTP and preference for information type. Secondary outcomes included self-rated oral health and change in oral health behaviours (tooth-brushing, sugar consumption and smoking) and were investigated using multivariate generalised linear mixed models.

RESULTS

A total of 412 patients were randomised (138 to verbal, 134 to TL and 140 to QLF); 391 revisited their WTP scores after the check-up (23 withdrew). Follow-up data were obtained for 185 (46%) participants at 6 months and 153 (38%) participants at 12 months. Verbal advice was the first preference for 51% (209 participants), QLF for 35% (145 participants) and TL for 14% (58 participants). TL information was valued lower than either verbal or QLF information (p < 0.0001). Practice attended was predictive of verbal as first preference, and being older. Practice attended, preferring TL the most and having fewer than 20 teeth were associated with increased WTP; and living in a relatively deprived area or having low literacy decreased WTP. There were no significant differences in behaviour change on follow-up.

CONCLUSIONS

Although a new NHS dental contract based on TL risk stratification is being tested, patients prefer the usual verbal advice. There was also a practice effect which will needs to be considered for successful implementation of this government policy.

TRIAL REGISTRATION

ISRCTN, ISRCTN71242343. Retrospectively registered on 27 March 2018.

Presenting patients with information on their oral health risk: the PREFER three-arm RCT and ethnography

Background

A new NHS dental practice contract is being tested using a traffic light (TL) system that categorises patients as being at red (high), amber (medium) or green (low) risk of poor oral health. This is intended to increase the emphasis on preventative dentistry, including giving advice on ways patients can improve their oral health. Quantitative Light-Induced Fluorescence (QLF™) cameras (Inspektor Research Systems BV, Amsterdam, the Netherlands) also potentially offer a vivid portrayal of information on patients’ oral health.

Methods

Systematic review – objective: to investigate how patients value and respond to different forms of information on health risks. Methods: electronic searches of nine databases, hand-searching of eight specialist journals and backwards and forwards citation-chasing followed by duplicate title, abstract- and paper-screening and data-extraction. Inclusion criteria limited studies to personalised information on risk given to patients as part of their health care. Randomised controlled trial (RCT) – setting: NHS dental practice. Objective: to investigate patients’ preferences for and response to different forms of information about risk given at check-ups. Design: a pragmatic, multicentred, three-arm, parallel-group, patient RCT. Participants: adults with a high/medium risk of poor oral health attending NHS dental practices. Interventions: (1) information given verbally supported by a card showing the patient’s TL risk category; (2) information given verbally supported by a QLF photograph of the patient’s mouth. The control was verbal information only (usual care). Main outcome measures: primary outcome – median valuation for the three forms of information measured by willingness to pay (WTP). Secondary outcomes included toothbrushing frequency and duration, dietary sugar intake, smoking status, self-rated oral health, a basic periodontal examination, Plaque Percentage Index and the number of tooth surfaces affected by caries (as measured by QLF). Qualitative study – an ethnography involving observations of 368 dental appointments and interviews with patients and dental teams.

Results

Systematic review – the review identified 12 papers (nine of which were RCTs). Eight studies involved the use of computerised risk assessments in primary care. Intervention effects were generally modest, even with respect to modifying risk perceptions rather than altering behaviour or clinical outcomes. RCT – the trial found that 51% of patients identified verbal information as their most preferred form, 35% identified QLF as most preferred and 14% identified TL information as most preferred. The median WTP for TL was about half that for verbal information alone. Although at 6 and 12 months patients reported taking less sugar in drinks, and at 12 months patients reported longer toothbrushing, there was no difference by information group. Qualitative study – there was very little explicit risk talk. Lifestyle discussions were often cursory to avoid causing shame or embarrassment to patients.

Limitations

Only 45% of patients were retained in the trial at 6 months and 31% were retained at 12 months. The trial was conducted in four dental practices, and five dental practices were involved in the qualitative work.

Conclusions

Patients prefer personal, detailed verbal advice on oral health at their check-up. A new NHS dental practice contract using TL categorisation might make this less likely.

Future work

Research on how to deliver, within time constraints, effective advice to patients on preventing poor oral health. More research on ‘risk work’ in wider clinical settings is also needed.

Trial registration

Current Controlled Trials ISRCTN71242343.

Funding

This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 3. See the NIHR Journals Library website for further project information.

Cost-effectiveness of implant-supported dental prosthesis compared to conventional dental prosthesis

OBJECTIVE

To conduct a cost-effectiveness analysis of alternatives for rehabilitation treatment of mandibular edentulism in the context of the Brazilian Unified Health System (implant-supported total dental prosthesis versus conventional total dental prosthesis).

METHODS

A Markov model was developed to capture long-term clinical and economic outcomes. The model’s population was comprised of a hypothetical cohort of 1,000,000 patients, aged 55 years, with total mandibular edentulism and without medical contraindications for performing surgical procedures. The adopted analysis perspective was that of the Brazilian Unified Health System. Based on the proposed model, we calculated cost – in BRL, and effectiveness – measured by quality-adjusted prosthesis year (QAPY). The time horizon of the analysis was 20 years.

RESULTS

Considering a 5% discount in costs and effects, the incremental cost-effectiveness ratio of implant-supported total dental prostheses compared to conventional total dental prosthesis (BRL 464.22/QAPY) was lower than the willingness to pay threshold adopted in the model (BRL 3,050.00/QAPY).

CONCLUSIONS

The results of this economic analysis showed that the rehabilitation of mandibular edentulous patients by implant-supported total prosthesis is very cost-effective when compared to conventional complete prosthesis, considering the cost-effectiveness limits employed.

Psychometric properties of the Child Oral-care Performance Assessment Scale

OBJECTIVES

This study aimed to assess the psychometric properties of Child Oral-care Performance Assessment Scale (COPAS).

METHODS

Items for the instrument were developed and pilot tested. This questionnaire was implemented in the Australian National Child Oral Health Study 2012-2014, whose aims included the assessment of oral care performance. This nationally representative sample of 23 538 respondents with complete data was divided into five groups: a main validation group and four cross-validation groups, using blocked randomization. Two scales were constructed, full scale with 37 items (COPAS) and a partial scale with a subset of 31 items (COPAS-Partial). Internal consistency was assessed using Cronbach's alpha. Construct validity was assessed using correlation coefficients, and structural validity was ascertained in the main validation group and confirmed in the cross-validation groups using structural equation models.

RESULTS

Cronbach's alpha for COPAS was 0.95, and for COPAS-Partial was 0.94. The convergent validity of global satisfaction with oral care and the subscales was r = 0.29-0.51, and that with the overall scales was r = 0.59 for COPAS and r = 0.59 for COPAS-Partial. COPAS (Root mean squared error of approximation (RMSEA) = 0.06, Comparative fit index (CFI) = 0.90, Tucker-Lewis index (TLI) = 0.89, and Coefficient of determination(COD) = 0.99) and COPAS-Partial (RMSEA = 0.07, CFI = 0.91, TLI = 0.90, COD = 0.97) had adequate fit. Structural invariance was present (P-value = 0.97).

CONCLUSION

There was acceptable structural validity, construct validity and internal consistency in the models tested for COPAS and COPAS-Partial. COPAS has potential use in the evaluation of the delivery of dental services to children.

Willingness to pay for osteoporosis risk assessment in primary dental care

BACKGROUND

Fragility fracture related to osteoporosis among postmenopausal women is a significant cause of morbidity. The care and aftercare of these fractures are associated with substantial costs to society. A main problem is that many individuals suffer from osteoporosis without knowing it before a fracture happens. Dentists may have an important role in early identification of individuals with osteoporosis by assessment of dental radiographs already included in the dental examination. The aim of this study was therefore to investigate postmenopausal women's preferences for an osteoporosis risk assessment in primary dental care.

RESULTS

Most respondents (129 of 144 (90%)) were willing to pay for an osteoporosis risk assessment in primary dental care. The overall mean willingness to pay (WTP) including respondents that denoted none or zero WTP was 44.60 € (CI 95% 38.46-50.74 €) (median 34.75 €). A majority (80.6%) of the respondents that denoted WTP also gave a motivation for their answer. The two most common reasons denoted for being willing to pay for osteoporosis risk assessment were the importance of early diagnosis and preventive care to avoid fractures (41.0%) and the importance of knowledge of a risk of osteoporosis (26.4%). A majority of respondents (67.8%) considered it valuable if dental clinics would offer osteoporosis risk assessment.

CONCLUSIONS

Postmenopausal women seem to find it valuable to be offered osteoporosis risk assessment in primary dental care and are willing to pay for such a risk assessment. From a societal perspective early diagnosis of osteoporosis by risk assessment in primary dental care could prevent osteoporotic related fractures and benefit women's health and quality of life, as well as have a major impact on the health-care budget in terms of cost-savings.

A within-subject clinical trial on the conversion of mandibular two-implant to three-implant overdenture: Patient-centered outcomes and willingness to pay

OBJECTIVES

To examine the impact of adding a third midline implant with stud attachment to a mandibular two-implant overdenture on patient-oriented outcomes.

METHODS

In this pre-post design clinical trial, following the standard procedures, mandibular two-implant overdentures of 17 edentulous individuals (61.9 ± 6.6 years) were converted to three-implant overdentures by adding a stud attachment to an unloaded midline implant. Patient-oriented outcomes included patient expectations and satisfaction with implant overdenture as well as willingness to pay the cost of conversion. Data were collected at baseline and at the 6-week follow-up using visual analog and binary scales as well as open-ended questions. Statistical analysis included descriptive statistics, Spearman's correlation, Fisher exact test, Mann-Whitney U test, and the exact sign test.

RESULTS

After connecting the third midline implant to the mandibular two-implant overdenture, there was a statistically significant decrease in the anteroposterior movement (p = 0.005) as evaluated by clinicians. Moreover, study participants reported an increase in perceived stability of the overdenture (95% CI; 0.68-1.00, p = 0.002) and in their ability to speak (95% CI; 0.63-1.00, p = 0.008). The addition of a third implant met the expectations of 94% of patients in regard to lower denture stability, 100% for retention, and 82.4% for comfort. The mandibular three-implant overdenture increased patient general satisfaction over a short period of time, but this improvement was not statistically significant. About 80% of patients would recommend this type of prosthesis to their peers but only 47% of them would agree to pay a large increase in the cost of treatment compared to a two-implant overdenture.

CONCLUSIONS

The addition of a midline third implant to an existing mandibular two-implant overdenture resulted in several improved patient-reported outcomes.

Patients' preferences in periodontal disease treatment elicited alongside an IQWiG benefit assessment: a feasibility study

BACKGROUND AND PURPOSE

The German Institute for Quality and Efficiency in Health Care (IQWiG) previously tested two preference elicitation methods in pilot projects and regarded them as generally feasible for prioritizing outcome-specific results of benefit assessment. The present study aimed to investigate the feasibility of completing a discrete choice experiment (DCE) within 3 months and to determine the relative importance of attributes of periodontal disease and its treatment.

PATIENTS AND METHODS

This preference elicitation was conducted alongside the IQWiG benefit assessment of systematic treatments of periodontal diseases. Attributes were defined based on the benefit assessment, literature review, and patients' and periodontologists' interviews. The DCE survey was completed by patients with a history of periodontal disease. Preferences were elicited for the attributes "tooth loss within next 10 years", "own costs for treatment, follow-up visits, re-treatment", "complaints and symptoms", and "frequency of follow-up visits". Patients completed a self-administered questionnaire including 12 choice tasks. Data were analyzed using a random parameters logit model. The relative attribute importance was calculated based on level ranges.

RESULTS

Within 3 months, survey development, data collection among 267 patients, data analysis, and provision of a study report could be completed. The analysis showed that tooth loss (score 0.73) was the most important attribute in patients' decisions, followed by complaints and symptoms (0.22), frequency of follow-up visits (0.02), and costs (0.03) (relative importance scores summing up to 1).

CONCLUSION

A preference analysis performing a DCE can be generally feasible within 3 months; however, a good research infrastructure and access to patients is required. Outcomes used in benefit assessments might need to be adapted to be used in preference analyses.

Measuring the Monetary Value of Dental Implants for Denture Retention: A Willingness to Pay Approach

Purpose:

Two interforaminal dental implants in is a common treatment option for denture retention in edentulous patients. Economic methods to assess the patient’s quality of life include the willingness to pay (WTP) for implant treatment and willingness to accept (WTA) to forgo implant treatment. The purpose of this study was to assess the monetary value of implant retained complete dentures using WTP and WTA.

Methods:

We included a convenience sample of 16 patients from a previously published cohort study on the survival of immediately loaded implants in edentulous patients to assess WTP and WTA for this treatment option.

Results:

The average maximum WTP for implant treatment was 4606 (95% CI: 2991-6222) Swiss Francs. Out of the 16 patients, only 5 were willing to trade their implants for money, with a mean WTA of CHF 33'500 (range: 3000-100'000).All patients would agree to undergo the implant surgery procedure again.

Conclusion:

The results of the present study show that most patients are not willing to trade the increase in quality of life after implant surgery against money, suggesting that WTA exceeds by large WTP for the same health condition.