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Mey TM, Ogasawara K. Telehealth Consultation for Malaysian Citizens' Willingness to Pay Assessed by the Double-Bounded Dichotomous Choice Method. Malays J Med Sci 2024; 31:91-102. [PMID: 38456119 PMCID: PMC10917602 DOI: 10.21315/mjms2024.31.1.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 04/06/2023] [Indexed: 03/09/2024] Open
Abstract
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.
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Affiliation(s)
- Tan Mey Mey
- Graduate School of Health Sciences, School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Katsuhiko Ogasawara
- Graduate School of Health Sciences, School of Medicine, Hokkaido University, Hokkaido, Japan
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Hawsawi HS, Immurana M, Al-Hanawi MK. Socioeconomic Determinants of Willingness to Pay for Emergency Public Dental Services in Saudi Arabia: A Contingent Valuation Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15205. [PMID: 36429921 PMCID: PMC9690303 DOI: 10.3390/ijerph192215205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 10/29/2022] [Accepted: 11/08/2022] [Indexed: 06/16/2023]
Abstract
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.
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Affiliation(s)
- Halah Saleh Hawsawi
- Quality and Patient Safety Department, Al-Noor Specialist Hospital, Mecca 24241, Saudi Arabia
- Department of Health Services and Hospital Administration, Faculty of Economics and Administration, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Mustapha Immurana
- Institute of Health Research, University of Health and Allied Sciences, Private Mail Bag 31, Ho, Ghana
| | - Mohammed Khaled Al-Hanawi
- Department of Health Services and Hospital Administration, Faculty of Economics and Administration, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- Health Economics Research Group, King Abdulaziz University, Jeddah 21589, Saudi Arabia
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Aviles-Blanco MV. Economic evaluation of process utility: elucidating preferences for a non-invasive procedure to treat restenosis. HEALTH ECONOMICS REVIEW 2021; 11:27. [PMID: 34297212 PMCID: PMC8299597 DOI: 10.1186/s13561-021-00327-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 07/08/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND In health economic evaluation, utility associated with a health state is outcome-oriented and usually measured using the QALY methodology. Even though there is consistent evidence of utility not only being derived from outcomes but also from procedures, process utility has not been fully integrated in QALY calculations. The aim of this paper is twofold: first, to provide evidence of process utility associated with an alternative treatment to angioplasty, and second, to estimate a monetary value of such process utility using the willingness to pay (WTP) approach. METHODS A total of 1514 people were polled on their WTP to avoid angioplasty to have a drug-eluting stent (DES) implanted. WTP is estimated with a contingent valuation (CV) survey. Individuals are also asked if they would be WTP for a non-invasive procedure with similar results being achieved. WTP responses were analyzed using a double bounded (DB) logit model. RESULTS Most of the participants showed positive preferences for avoiding angioplasty, with an estimated mean WTP of €5692.87. Using QALY gains for avoiding angioplasty, varying from 0.0035 to 0.08 QALYs, our WTP estimate imply monetary values per QALY that range from €71,160.87 to €1,626,534.28. DISCUSSION A WTP of €5692.87 to avoid angioplasty imply a monetary value per QALY that greatly exceed the cost per QALY thresholds established in different countries to consider health programs as beneficial to society. Our results reflect how different methodologies for HTA may lead to different conclusions. From the ICER perspective, the cost that would make the treatment with pills option cost-effective, using a threshold of €40,000/QALY, would be €224. However, a cost-benefit approach could support health programs even with a higher cost. CONCLUSION WTP methodology captures outcome and process factors related to angioplasty as our WTP estimations are non-significantly different for the costs of angioplasty. WTP approach must be considered as a genuine alternative to QALY approaches to value process utility.
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Affiliation(s)
- Maria V Aviles-Blanco
- Department of Financial Economics and Operations Management, Faculty of Economics and Business Administration, University of Sevilla, Avda. Ramón y Cajal,1, 41018, Sevilla, Spain.
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Prevalence of Missing Values and Protest Zeros in Contingent Valuation in Dental Medicine. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147219. [PMID: 34299670 PMCID: PMC8307611 DOI: 10.3390/ijerph18147219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/30/2021] [Accepted: 07/02/2021] [Indexed: 12/26/2022]
Abstract
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.
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Saadatfar N, Jadidfard MP. An overview of the methodological aspects and policy implications of willingness-to-pay studies in oral health: a scoping review of existing literature. BMC Oral Health 2020; 20:323. [PMID: 33183293 PMCID: PMC7664028 DOI: 10.1186/s12903-020-01303-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 10/29/2020] [Indexed: 11/25/2022] Open
Abstract
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.
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Affiliation(s)
- Navid Saadatfar
- Department of Community Oral Health, School of Dentistry, Shahid-Beheshti University of Medical Sciences, Shahid-Chamran Avenue, Evin, Tehran, 19839, Iran
| | - Mohammad Pooyan Jadidfard
- Department of Community Oral Health, School of Dentistry, Shahid-Beheshti University of Medical Sciences, Shahid-Chamran Avenue, Evin, Tehran, 19839, Iran.
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Amilani U, Carter HE, Senanayake S, Hettiarachchi RM, McPhail SM, Kularatna S. A scoping review of cost-effectiveness analyses of school-based interventions for caries. Community Dent Oral Epidemiol 2020; 48:357-363. [PMID: 32548874 DOI: 10.1111/cdoe.12553] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The aims of this study were to: identify the evidence on cost-effectiveness of school-based interventions for caries prevention globally up to 2019; summarize key characteristics of interventions applied within this setting; summarize the reporting quality of previous studies; and to identify and analyse knowledge gaps. METHODS A scoping review of published literature on the cost-effectiveness of school-based interventions to prevent child tooth decay was conducted. A search in Medline, Cinahl and Embase was performed with no date restriction. Reporting quality of the included studies was assessed against Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. RESULTS Of the 738 records identified in the initial search, 15 studies met the pre-specified inclusion criteria. The majority were published after 2011 (n = 9,) and applied to high-income countries (n = 12). Nearly 80% of the studies assessed the cost-effectiveness of the interventions based on topical fluoride therapies and fissure sealants at school premises. Although, the outcome measures differed across the studies, almost all the caries preventive interventions were cost-saving or cost-effective when compared with usual care. Compliance with the CHEERS checklist differed. CONCLUSIONS There is evidence to suggest that school-based caries preventive interventions are cost-effective, and in some cases cost-saving. Further evidence is required from low- to middle-income countries to confirm the generalizability of these findings. Future studies should consider adopting Quality Adjusted Life Years as a generic outcome measure that would enable the cost-effectiveness findings to be compared across different types of interventions and diseases. Improved standardization and quality of reporting are also required.
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Affiliation(s)
- Uttara Amilani
- Queensland University of Technology, Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Brisbane, QLD, Australia.,Ministry of Health and Indigenous Medical Services, Colombo, Sri Lanka
| | - Hannah E Carter
- Queensland University of Technology, Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Brisbane, QLD, Australia
| | - Sameera Senanayake
- Queensland University of Technology, Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Brisbane, QLD, Australia
| | - Ruvini M Hettiarachchi
- Centre for Applied Health Economics, School of Medicine, Griffith University, Nathan, QLD, Australia
| | - Steven M McPhail
- Queensland University of Technology, Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Brisbane, QLD, Australia.,Clinical Informatics Directorate, Metro South Health, Brisbane, QLD, Australia
| | - Sanjeewa Kularatna
- Queensland University of Technology, Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Brisbane, QLD, Australia
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Mbada CE, Mamud SO, Odole AC, Omole JO, Oyewole OO, Ogundele AO, Fatoye FA. Development and clinimetric testing of willingness to pay tool for physiotherapy. PHYSICAL THERAPY REVIEWS 2019. [DOI: 10.1080/10833196.2019.1627703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Chidozie E. Mbada
- Department of Medical Rehabilitation, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Sunday O. Mamud
- Department of Medical Rehabilitation, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Adesola C. Odole
- Department of Physiotherapy, College of Medicine, University of Ibadan, Nigeria
| | - John O. Omole
- Physiotherapy Department, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Olufemi O. Oyewole
- Physiotherapy Department, Olabisi Onabanjo University teaching Hospital, Sagamu, Nigeria
| | - Abiola O. Ogundele
- Physiotherapy Department, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Francis A. Fatoye
- Department of Health Profession Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK
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Vernazza C, Anderson L, Ian Hunter A, Leck HC, O'Connor SD, Smith GR, Stokes RJ, Rolland S. The value of orthodontics: Do parents' willingness to pay values reflect the IOTN? JDR Clin Trans Res 2018; 3:141-149. [PMID: 29556552 DOI: 10.1177/2380084418756039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction Given the limited evidence about the benefits of orthodontic treatment, many health care systems have rationed access to orthodontic care with the Index of Orthodontic Treatment Need (IOTN) being one tool used to attempt to allocate resources based on need. However, it is not clear whether patient and public valuations of different levels of need (as described by the IOTN) reflect the resource allocation decisions. The aim of this project was therefore to determine the values parents placed on correction of malocclusions at different IOTN levels using the willingness to pay (WTP) technique. Method 401 parents of children attending hospital-based orthodontic clinics in the North of England were recruited to complete a questionnaire eliciting WTP for the correction of seven malocclusions with different IOTN scores. In addition demographic and orthodontic history characteristics were collected. Results were analysed with appropriate pairwise significance tests and regression. Results A significant difference in WTP was noted between all the possible pairs of malocclusions with the exception of overjets with moderate versus great need of treatments. At moderate levels, correction of crowding was valued less than overjet but this was reversed at great need levels. Very little of the variance in WTP was explained by the variables collected. When looking at factors affecting percentage difference between values for different pairs of malocclusions, in general, no factors predicted the magnitude of difference. Conclusion Median valuations for correction of malocclusions vary significantly for different levels of need (as judged by IOTN), with increasing levels of need generating higher values. However, there was a limited effect of demographic or orthodontic characteristics on the magnitude of percentage difference in values for correcting malocclusions different levels of need.
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Affiliation(s)
- Christopher Vernazza
- NIHR Clinician Scientist, Centre for Oral Health Research, Newcastle University, Framlington Place, Newcastle upon Tyne, UK. NE2 4BW, +44 (0)191 2088396
| | - Lauren Anderson
- Specialist Orthodontist, Milngavie Orthodontics, 13 Main Street, Milngavie, Scotland, G62 6BJ
| | - Andrew Ian Hunter
- Specialist Orthodontist, Dentalign Orthodontics, 55 Burscough Street, Ormskirk, Near Liverpool, UK. L39 2EL
| | - Helen Christine Leck
- Specialist Orthodontist, Windmill Orthodontics, 37 Heaton Road, Newcastle upon Tyne, UK. NE6 1SB
| | - Stephen Daniel O'Connor
- Post-CCST Orthodontist, Birmingham Dental Hospital, Mill Pool Way, Birmingham, United Kingdom. B5 7EG
| | - Gillian Rose Smith
- Post-CCST in Orthodontics, Charles Clifford Dental Hospital, 76 Wellesley Road, Sheffield, UK, S10 2SZ
| | - Richard Joseph Stokes
- Specialist Orthodontist, Dungarvan Orthodontic Practice, Priory House, Main St., Dungarvan, Co. Waterford, Ireland
| | - Sarah Rolland
- Clinical Senior Lecturer in Orthodontics, Centre for Oral Health Research, Newcastle University, Framlington Place, Newcastle upon Tyne, UK. NE2 4BW
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Tan SHX, Vernazza CR, Nair R. Critical review of willingness to pay for clinical oral health interventions. J Dent 2017; 64:1-12. [PMID: 28662842 PMCID: PMC5558873 DOI: 10.1016/j.jdent.2017.06.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 06/21/2017] [Accepted: 06/23/2017] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES This critical review aimed to identify, consolidate and evaluate the quality of Willingness to Pay (WTP) studies applied to clinical contexts in the field of dentistry. METHODS PubMed and Web of Science databases were systematically searched for relevant publications. Screening and data extraction was then performed. Primary literature in English-language were included to assess the WTP for oral health interventions, when the valuations were applied to a clinical measure. Twenty-six publications met the inclusion criteria. RESULTS WTP was elicited mainly via face-to-face interviews (13 publications) and questionnaires (12 publications). The majority (24) of publications selected an out-of-pocket payment vehicle. Eleven publications adopted a bidding method, nine publications adopted an open-ended format, and the remaining six studies adopted a payment card or choice method. Pre-testing was reported in only nine publications, and few studies accounted for starting point bias. Eight of 11 publications found that higher incomes were associated with higher WTP values. The female gender, a younger age and higher education levels were associated with a higher WTP in select studies. CONCLUSIONS Only a small minority of the studies used strategies to avoid well documented biases related to WTP elicitation. Cost versus benefit of many clinical scenarios remain uninvestigated. CLINICAL SIGNIFICANCE WTP studies in dentistry may benefit from pre-testing and the inclusion of a script to minimise hypothetical bias. They may also be better conducted face-to-face and via a shuffled payment card method. Income levels, and potentially education levels, gender and age, should be assessed for their influence on WTP values.
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Affiliation(s)
- Sharon Hui Xuan Tan
- Ministry of Health Holdings, Singapore 1 Maritime Square, 099253, Singapore.
| | - Christopher R Vernazza
- Centre for Oral Health Research, Newcastle University Framlington Place, Newcastle Upon Tyne, NE2 4BW, United Kingdom.
| | - Rahul Nair
- University of Adelaide, ARCPOH, Adelaide Dental School, Level 9, AHMS Building, Adelaide, SA 5005, Australia.
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Wambier LM, de Geus JL, Chibinski ACR, Wambier DS, Rego RO, Loguercio AD, Reis A. Intra-pocket anaesthesia and pain during probing, scaling and root planing: a systematic review and meta-analysis. J Clin Periodontol 2016; 43:754-66. [PMID: 27097588 DOI: 10.1111/jcpe.12565] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2016] [Indexed: 12/17/2022]
Abstract
AIM A systematic review/meta-analysis was performed to evaluate pain during probing, scaling and root planing using intra-pocket anaesthesia versus placebo in adult patients. METHODS A search was performed in PubMed, Scopus, Web of Science, Latin American and Caribbean Health Sciences Literature database, Brazilian Library in Dentistry, Cochrane Library and Grey literature. IADR abstracts, unpublished trials registries, dissertations and theses were also searched for randomized clinical trials comparing the clinical effectiveness of intra-pocket anaesthesia and placebo. Risk/intensity of pain was the primary outcome. The risk of bias tool from the Cochrane Collaboration was used for quality assessment. Meta-analysis was performed on studies considered at low risk of bias. RESULTS A total of 1740 articles were identified. Eleven remained in the qualitative synthesis, and nine studies were considered at "low" risk of bias for meta-analysis. Standardized Hedge's g mean difference for pain intensity using visual analogue scale and Heft-Parker pain scales was -0.576 (95% confidence interval [CI] -0.94 to -0.22; p = 0.002) and for verbal rating scale pain scale it was -1.814 (95% CI -3.38 to -0.245; p = 0.023). The odds ratio for the risk of pain was 0.025 (95% CI 0.003 to 0.25; p = 0.002) and the odds ratio for the need for rescue anaesthesia it was 0.358 (95% CI 0.174 to 0.736; p = 0.005). CONCLUSIONS The anaesthetic gel decreases the risk and intensity of pain during probing/SRP.
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Affiliation(s)
- Letícia M Wambier
- Department of Restorative Dentistry, State University of Ponta Grossa, Ponta Grossa, PR, Brazil
| | - Juliana L de Geus
- Department of Restorative Dentistry, State University of Ponta Grossa, Ponta Grossa, PR, Brazil
| | - Ana C R Chibinski
- Department of Restorative Dentistry, State University of Ponta Grossa, Ponta Grossa, PR, Brazil
| | - Denise S Wambier
- Department of Restorative Dentistry, State University of Ponta Grossa, Ponta Grossa, PR, Brazil
| | - Rodrigo O Rego
- Department of Dentistry, Federal University of Ceará, Sobral, CE, Brazil
| | - Alessandro D Loguercio
- Department of Restorative Dentistry, State University of Ponta Grossa, Ponta Grossa, PR, Brazil
| | - Alessandra Reis
- Department of Restorative Dentistry, State University of Ponta Grossa, Ponta Grossa, PR, Brazil
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McKenna G, Tada S, Woods N, Hayes M, DaMata C, Allen PF. Tooth replacement for partially dentate elders: A willingness-to-pay analysis. J Dent 2016; 53:51-6. [PMID: 27421987 DOI: 10.1016/j.jdent.2016.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 07/08/2016] [Accepted: 07/11/2016] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVES The primary aim of this study was to investigate partially dentate elders' willingness-to-pay (WTP) for two different tooth replacement strategies: Removable Partial Dentures (RPDs) and, functionally orientated treatment according to the principles of the Shortened Dental Arch (SDA). The secondary aim was to measure the same patient groups' WTP for dental implant treatment. METHODS 55 patients who had completed a previous RCT comparing two tooth replacement strategies (RPDs (n=27) and SDA (n=28)) were recruited (Trial Registration no. ISRCTN26302774). Patients were asked to indicate their WTP for treatment to replace missing teeth in a number of hypothetical scenarios using the payment card method of contingency evaluation coupled to different costs. Data were collected on patients' social class, income levels and other social circumstances. A Mann-Whitney U Test was used to compare differences in WTP between the two treatment groups. To investigate predictive factors for WTP, multiple linear regression analyses were conducted. RESULTS The median age for the patient sample was 72.0 years (IQR: 71-75 years). Patients who had been provided with RPDs indicated that their WTP for this treatment strategy was significantly higher (€550; IQR: 500-650) than those patients who had received SDA treatment (€500; IQR: 450-550) (p=0.003). However patients provided with RPDs indicated that their WTP for SDA treatment (€650; IQR: 600-650) was also significantly higher than those patients who had actually received functionally orientated treatment (€550; IQR: 500-600) (p<0.001). The results indicated that both current income levels and previous treatment allocation were significantly correlated to WTP for both the RPD and the SDA groups. Patients in both treatment groups exhibited little WTP for dental implant treatment with a median value recorded which was half the market value for this treatment (€1000; IQR: 500-1000). CONCLUSIONS Amongst this patient cohort previous treatment experience had a strong influence on WTP as did current income levels. Both treatment groups indicated a very strong WTP for simpler, functionally orientated care using adhesive fixed prostheses (SDA) over conventional RPDs. CLINICAL SIGNIFICANCE Partially dentate older patients expressed a strong preference for functionally orientated tooth replacement as an alternative to conventional RPDs.
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Affiliation(s)
- G McKenna
- Centre for Public Health, Queens University Belfast, United Kingdom.
| | - S Tada
- Department of Prosthodontics, Gerodontology and Oral Rehabilitation, Osaka University, Japan
| | - N Woods
- Centre for Policy Studies, University College Cork, Ireland
| | - M Hayes
- Cork University Dental School and Hospital, University College Cork, Ireland
| | - C DaMata
- University Dental School and Hospital, University College Cork, Ireland
| | - P F Allen
- Cork University Dental School and Hospital, University College Cork, Ireland
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12
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Greenspoon JN, Whitton A, Whelan T, Sharieff W, Wright J, Sussman J, Gafni A. Robotic Radiosurgery for the Treatment of 1–3 Brain Metastases: A Pragmatic Application of Cost-Benefit Analysis Using Willingness-To-Pay. Technol Cancer Res Treat 2016; 12:517-23. [DOI: 10.7785/tcrt.2012.500344] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
With the emergence of radiosurgery as a new radiotherapeutic technique, health care decision makers are required to incorporate community need, cost and patient preferences when allocating radiosurgery resources. Conventional patient utility measures would not reflect short term preferences and would therefore not inform decision makers when allocating radiosurgery treatment units. The goal of this article is to demonstrate the feasibility of cost-benefit analysis to elicit the yearly net monetary benefit of robotic radiosurgery. To calculate the yearly incremental cost of robotic radiosurgery as compared to fixed gantry radiosurgery we used direct local cost data. We assumed a standard 10 year replacement and 5% amortization rate. Decision boards summarizing the clinical scenario of brain metastases and the difference between robotic and fixed gantry radiosurgery in terms of immobilization, comfort and treatment time were then presented to a sample of 18 participants. Participants who preferred robotic radiosurgery were randomly assigned to either a low ($1) or high ($5) starting point taxation based willingness-to-pay algorithm. The yearly incremental cost of providing robotic radiosurgery was $99,177 CAD. The mean community yearly willingness-to-pay for robotic radiosurgery was $2,300,000 CAD, ρ = 0.03. The calculated yearly net societal benefit for robotic radiosurgery was $2,200,823 CAD. Among participants who preferred robotic radiosurgery there was no evidence of starting point bias, ρ = 0.8. We have shown through this pilot study that it is feasible to perform cost-benefit analysis to evaluate new technologies in Radiation Oncology. Cost-benefit analysis offers an analytic method to evaluate local preferences and provide accountability when allocating limited healthcare resources.
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Affiliation(s)
- Jeffrey Noah Greenspoon
- Department of Oncology, Juravinski Cancer Centre Division of Radiation Oncology, McMaster University, Ontario, Canada
| | - Anthony Whitton
- Department of Oncology, Juravinski Cancer Centre Division of Radiation Oncology, McMaster University, Ontario, Canada
| | - Timothy Whelan
- Department of Oncology, Juravinski Cancer Centre Division of Radiation Oncology, McMaster University, Ontario, Canada
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Ontario, Canada
| | - Waseem Sharieff
- Department of Oncology, Juravinski Cancer Centre Division of Radiation Oncology, McMaster University, Ontario, Canada
| | - James Wright
- Department of Oncology, Juravinski Cancer Centre Division of Radiation Oncology, McMaster University, Ontario, Canada
| | - Jonathan Sussman
- Department of Oncology, Juravinski Cancer Centre Division of Radiation Oncology, McMaster University, Ontario, Canada
| | - Amiram Gafni
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Ontario, Canada
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Carrasco-Labra A, Brignardello-Petersen R, Glick M, Guyatt GH, Neumann I, Azarpazhooh A. A practical approach to evidence-based dentistry: VII. J Am Dent Assoc 2015; 146:327-336.e1. [DOI: 10.1016/j.adaj.2015.03.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 03/10/2015] [Accepted: 03/13/2015] [Indexed: 01/10/2023]
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Listl S, Fischer L, Giannakopoulos NN. An economic evaluation of maxillary implant overdentures based on six vs. four implants. BMC Oral Health 2014; 14:105. [PMID: 25135370 PMCID: PMC4147876 DOI: 10.1186/1472-6831-14-105] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 08/13/2014] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The purpose of the present study was to assess the value for money achieved by bar-retained implant overdentures based on six implants compared with four implants as treatment alternatives for the edentulous maxilla. METHODS A Markov decision tree model was constructed and populated with parameter estimates for implant and denture failure as well as patient-centred health outcomes as available from recent literature. The decision scenario was modelled within a ten year time horizon and relied on cost reimbursement regulations of the German health care system. The cost-effectiveness threshold was identified above which the six-implant solution is preferable over the four-implant solution. Uncertainties regarding input parameters were incorporated via one-way and probabilistic sensitivity analysis based on Monte-Carlo simulation. RESULTS Within a base case scenario of average treatment complexity, the cost-effectiveness threshold was identified to be 17,564 € per year of denture satisfaction gained above of which the alternative with six implants is preferable over treatment including four implants. Sensitivity analysis yielded that, depending on the specification of model input parameters such as patients' denture satisfaction, the respective cost-effectiveness threshold varies substantially. CONCLUSIONS The results of the present study suggest that bar-retained maxillary overdentures based on six implants provide better patient satisfaction than bar-retained overdentures based on four implants but are considerably more expensive. Final judgements about value for money require more comprehensive clinical evidence including patient-centred health outcomes.
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Affiliation(s)
- Stefan Listl
- Department of Conservative Dentistry, Heidelberg University, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
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Augusti D, Augusti G, Re D. Prosthetic restoration in the single-tooth gap: patient preferences and analysis of the WTP index. Clin Oral Implants Res 2013; 25:1257-1264. [PMID: 24021020 DOI: 10.1111/clr.12264] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the preference of a patients' population, according to the index of willingness to pay (WTP), against two treatments to restore a single-tooth gap: the implant-supported crown (ISC) and the 3-unit fixed partial denture prosthesis (FPDP) on natural teeth. MATERIALS AND METHODS Willingness to pay values were recorded on 107 subjects by asking the WTP from a starting bid of €2000 modifiable through monetary increases or decreases (€100). Data were collected through an individually delivered questionnaire. The characteristics of the population and choices made, the median values and WTP associations with socio-demographic parameters (Mann-Whitney and Kruskal-Wallis tests), correlations between variables (chi-square test in contingency tables) and significant parameters for predicting WTP values obtained in a multiple linear regression model were revealed. RESULTS The 64% of patients expressed a preference for ISC, while the remaining 36% of the population chose the FPDP. The current therapeutic choice and those carried out in the past were generally in agreement (>70% of cases, P = 0.0001); a relationship was discovered between the anterior and posterior area to the same method of rehabilitation (101 of 107 cases, 94.4%). The WTP median values for ISC were of €3000 and of €2500 in the anterior and posterior areas, respectively. The smallest amount of money has been allocated for FPDP in posterior region (median of €1500). The "importance of oral care" for the patient was a significant predictor, in the regression model analysis, for the estimation of both anterior (P = 0.0003) and posterior (P < 0.0001) WTP values. The "previous therapy" variable reached and was just close to significance in anterior (P = 0.0367) and posterior (P = 0.0511) analyses, respectively. CONCLUSIONS Within the limitations of this study, most of the population (64%) surveyed indicated the ISC as a therapeutic solution for the replacement of a single missing tooth, showing a higher WTP index in the anterior area. Among investigated socio-demographic variables, the importance assigned by the patient to oral care appeared to influence WTP values of the rehabilitation, regardless the location of the single gap in the mouth.
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Affiliation(s)
- Davide Augusti
- Division of Oral Rehabilitation, Istituto Stomatologico Italiano, University of Milan, Milan, Italy
| | - Gabriele Augusti
- Division of Oral Rehabilitation, Istituto Stomatologico Italiano, University of Milan, Milan, Italy
| | - Dino Re
- Division of Oral Rehabilitation, Istituto Stomatologico Italiano, University of Milan, Milan, Italy
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Srivastava A, Feine JS, Esfandiari S. Are people who still have their natural teeth willing to pay for mandibular two-implant overdentures? ACTA ACUST UNITED AC 2013; 5:117-24. [PMID: 23857925 DOI: 10.1111/jicd.12057] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 04/13/2013] [Indexed: 11/27/2022]
Abstract
AIM Oral health in Canada and most developed and developing countries is funded by private payers, whose acceptance of treatment depends on their valuation of it. This study aims to determine how dentate individuals in Quebec, Canada, would value the benefits of mandibular two-implant overdentures based on their willingness to pay (WTP) for the treatment, either directly or with insurance/government coverage. METHODS A total of 39 individuals (23-54 years) completed a Web-based WTP survey that consisted of three cost scenarios: (a) out-of-pocket payment; (b) private dental insurance coverage; and (c) public funding through additional taxes. Variations in WTP amounts were measured using regression models. RESULTS Among respondents who were dentate or missing some teeth, average WTP out of pocket for implant overdentures was CAD$5419 for a 90% success rate. They were willing to pay an average CAD$169 as one-time payment for private dental insurance, with a one in five chance of becoming edentate. WTP amounts increased substantially with the probability of success of implant overdenture therapy. The results of regression analyses were consistent with theoretical predictions for education level and income (P < 0.05). CONCLUSIONS The results of this study, within its limitations, suggest that dentate individuals would be willing to pay a significant amount to receive mandibular two-implant overdentures if and when they become edentate.
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Affiliation(s)
- Akanksha Srivastava
- Division of Oral Health and Society, Faculty of Dentistry, McGill University, Montreal, QC, Canada
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Alolabi B, Shirali J, Bajammal S, Karanicolas PJ, Zlowodzki M, Gafni A, Bhandari M. The development of a decision aid to elicit treatment preferences for displaced femoral neck fractures. Indian J Orthop 2012; 46:22-8. [PMID: 22345803 PMCID: PMC3270601 DOI: 10.4103/0019-5413.91631] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Decision aids help physicians convey information to patients and enable patients to be involved in the decision-making process. There is a lack of use of decision aids in the orthopedic literature. The purpose of this study was to develop a decision board to elicit preferences for treatment of displaced femoral neck fractures in patients over 60 years old. MATERIALS AND METHODS We developed a decision board presenting descriptions and potential outcomes and complications of two treatment options, hemiarthroplasty (HA) and internal fixation (IF), for displaced femoral neck fractures. Five orthopedic surgeons evaluated the face and content validity of the decision board and 10 volunteers completed "scope tests" to determine the comprehensibility. We then presented the decision board to 108 study participants faced with the scenario of sustaining a displaced femoral neck fracture. Participants stated their preference for operative procedure and described the reasons for their choices. RESULTS The decision board achieved good face and content validity. All participants in the scope tests appropriately switched their preference to the other modality when probabilities were altered. Most participants found the decision board easy to understand and helpful in making an informed decision. Also, most participants were satisfied with the amount of information presented and with the use of the decision board as a decision making tool. Sixty-one participants (56%) chose IF as their operative procedure of choice quoting less blood loss, shorter operative time, and less invasiveness as the top factors that contributed to this choice. Participants who preferred HA (44%) did so primarily due to the lower re-operation rate. CONCLUSIONS The decision board is a useful and reliable tool to inform patients about the treatment options for displaced femoral neck fractures. They should be utilized by surgeons to incorporate patients' preferences into the decision-making process.
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Affiliation(s)
- Bashar Alolabi
- Department of Surgery, The University of Western Ontario, London, Ontario, Canada,Address for correspondence: Dr. Bashar Alolabi, St. Joseph's Health Centre, 268 Grosvenor Street, Room D0-213, London, ON - N6A 4L6, Canada. E-mail:
| | - Janhavi Shirali
- Department of Surgery, College of Medicine, Upstate Medical University, Syracuse, NY, USA
| | - Sohail Bajammal
- Department of Surgery, Umm Al-Qura University, Mekkah, Saudi Arabia
| | - Paul J. Karanicolas
- Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Michael Zlowodzki
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Amiram Gafni
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada
| | - Mohit Bhandari
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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Higgins KM. What treatment for early-stage glottic carcinoma among adult patients: CO2 endolaryngeal laser excision versus standard fractionated external beam radiation is superior in terms of cost utility? Laryngoscope 2010; 121:116-34. [DOI: 10.1002/lary.21226] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Abstract
BACKGROUND The optimal treatment for displaced femoral neck fractures in elderly patients is controversial. Compared with hemiarthroplasty (HA), internal fixation (IF) is associated with less operative trauma, bleeding, and possibly lower mortality at the expense of a higher reoperation rate and possibly increased cost. METHODS We estimated the costs from a third party payer perspective after 1 year of 2 strategies (HA and IF) for the treatment of femoral neck fractures in patients over the age of 60 years. Using a decision board, we elicited patient preferences for the 2 operative approaches and calculated the net benefit using the willingness-to-pay technique. RESULTS The 1-year projected cost of 1 IF was $18,100, and that of 1 HA was $15,843 (incremental cost of $2257 for each IF). Of 108 participants, 61 (56.5%) chose IF as the preferred treatment option and were willing to pay an average of $3.33 per month to have this option available if needed. In Ontario, the total incremental cost of performing IF in patients that choose it was $64,714,103, and the total societal benefit was $289,263,600, yielding a net benefit of $224,549,497. CONCLUSION The benefits of IF over HA outweigh the incremental costs from the perspective of a third-party payer. IF should be available to patients that choose it.
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Iskedjian M, Desjardins O, Piwko C, Bereza B, Jaszewski B, Einarson TR. Willingness to pay for a treatment for pain in multiple sclerosis. PHARMACOECONOMICS 2009; 27:149-158. [PMID: 19254047 DOI: 10.2165/00019053-200927020-00005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic neurological disease that affects 240 per 100 000 Canadians. Of these patients, 10-80% (average 70%) experience pain. Sativex is a cannabis-based drug recently approved for neuropathic pain. OBJECTIVES In this study, we determine individuals' preferences between two treatment options as well as the willingness to pay (WTP) for Sativex, expressed as the amount they would pay in insurance premiums to have access to that treatment. METHODS The WTP instrument comprised a decision board as a visual aid, and a questionnaire. A decision board helps clinicians standardize the presentation of treatment information. In this study, the decision board described two treatment options: a three-drug combination (gabapentin, amytriptyline, acetaminophen [paracetamol] {i.e. pills}) and the three-drug combination plus Sativex (i.e. 'pills and oral spray'). Information on efficacy and adverse effects was taken from trial data; wording was guided by a panel of neurologists and tested for clarity on lay people. The instrument was administered to 500 participants from Canada's general population using the bidding game approach. Descriptive statistics were calculated. RESULTS Mean (SD) age of participants was 39 (13) years, with a female : male distribution of 56 : 44. The decision board was presented in both English (85%) and French (15%). Of 500 interviewees, 253 (50.6%) chose the 'pills and oral spray'. Mean monthly WTP for the insurance premium for those who chose the 'pills and oral spray' was Can dollars 8 (SD +/- 15, median 4, range 0-200). CONCLUSIONS Assuming that 51% of the general population are willing to pay additional premiums as reported in this study, the premiums collected would cover the cost of Sativex for all Canadian MS patients experiencing pain, with a surplus.
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Tuominen R. Evaluation of three methods assessing the relative value of a dental program. Acta Odontol Scand 2008; 66:82-7. [PMID: 18446548 DOI: 10.1080/00016350801958274] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate three commonly used methods for preference measurement in medical and dental programs. MATERIAL AND METHODS In a questionnaire filled in by 156 first-year medical (n=120) and dental (n=36) students, they were asked to evaluate five programs, each costing approximately 2 million euros annually. The programs were helicopter ambulance service, MPR vaccination (measles, parotitis and rubella), breast cancer screening, 250 hip replacement operations, and a dental check-up program for 7-year-olds. RESULTS The respondents were willing to make the highest donations for running the helicopter ambulance service (39 euros) and least for the dental check-up programme (14 euros) (p<0.01). When using the visual analog scale (VAS) method to evaluate the importance of the five programs, MPR vaccination was considered the most important (score 88), and hip replacement operations and dental check-up the least important (scores 68) (p<0.01). With the rank order (RO) method, MPR vaccinations were ranked the highest (score 1.8) and hip replacement operations (score 4.2) and dental check-up (score 4.0) the lowest (p<0.01). The respondents considered VAS and RO methods significantly easier than the willingness to pay method (p<0.001). CONCLUSIONS It is concluded that depending on the nature of the information required, each of the three methods can be used for assessing preferences. The willingness to pay method seemed to be the most difficult to comprehend, but it provides more detailed and ready-to-use information for economic evaluations than the other two methods.
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The management of an endodontically abscessed tooth: patient health state utility, decision-tree and economic analysis. BMC Oral Health 2007; 7:17. [PMID: 18053267 PMCID: PMC2249570 DOI: 10.1186/1472-6831-7-17] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2006] [Accepted: 12/06/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A frequent encounter in clinical practice is the middle-aged adult patient complaining of a toothache caused by the spread of a carious infection into the tooth's endodontic complex. Decisions about the range of treatment options (conventional crown with a post and core technique (CC), a single tooth implant (STI), a conventional dental bridge (CDB), and a partial removable denture (RPD)) have to balance the prognosis, utility and cost. Little is know about the utility patients attach to the different treatment options for an endontically abscessed mandibular molar and maxillary incisor. We measured patients' dental-health-state utilities and ranking preferences of the treatment options for these dental problems. METHODS Forty school teachers ranked their preferences for conventional crown with a post and core technique, a single tooth implant, a conventional dental bridge, and a partial removable denture using a standard gamble and willingness to pay. Data previously reported on treatment prognosis and direct "out-of-pocket" costs were used in a decision-tree and economic analysis RESULTS The Standard Gamble utilities for the restoration of a mandibular 1st molar with either the conventional crown (CC), single-tooth-implant (STI), conventional dental bridge (CDB) or removable-partial-denture (RPD) were 74.47 [+/- 6.91], 78.60 [+/- 5.19], 76.22 [+/- 5.78], 64.80 [+/- 8.1] respectively (p < 0.05). Their respective Willingness-to-Pay ($CDN) were 1,782.05 [+/- 361.42], 1,871.79 [+/- 349.44], 1,605.13 [+/- 348.10], 1,351.28 [+/- 368.62] (p < 0.05).The standard gamble utilities for the restoration of a maxillary central incisor with a CC, STI, CDB and RPD were 88.50 [+/- 6.12], 90.68 [+/- 3.41], 89.78 [+/- 3.81] and 91.10 [+/- 3.57] respectively (p > 0.05). Their respective willingness-to-pay ($CDN) were: 1,782.05 [+/- 361.42], 1,871.79 [+/- 349.44], 1,605.13 [+/- 348.10] and 1,351.28 [+/- 368.62]. A statistical difference was found between the utility of treating a maxillary central incisor and mandibular 1st-molar (p < 0.05).The expected-utility-value for a 5-year prosthetic survival was highest for the CDB and the STI treatment of an abscessed mandibular molar (74.75 and 71.47 respectively) and maxillary incisor (86.24 and 84.91 respectively). This held up to a sensitivity analysis when the success of root canal therapy and the risk of damage to the adjacent tooth were varied. The RPD for both the molar and incisor was the favored treatment based on a cost-utility (3.85 and 2.74 CND$ per year of tooth saved respectively) and cost-benefit analysis (0.92 to 0.60 CND$ of cost per $ of benefit, respectively) for a prosthetic clinical survival of 5-years. CONCLUSION The position of the abscessed tooth and the amount of insurance coverage influences the utility and rank assigned by patients to the different treatment options. STI and CDB have optimal EUVs for a 5-year survival outcome, and RPD has significantly lower cost providing the better cost:benefit ratio.
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Sach TH, Smith RD, Whynes DK. A 'league table' of contingent valuation results for pharmaceutical interventions: a hard pill to swallow? PHARMACOECONOMICS 2007; 25:107-27. [PMID: 17249854 DOI: 10.2165/00019053-200725020-00004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Pharmaceutical expenditure represents a large percentage of total healthcare expenditure, and has thus received much attention within the economic evaluation literature. However, although the number of contingent valuation (CV) studies measuring willingness to pay (WTP) in healthcare has increased, little is known about the relative magnitude of values elicited across different interventions, diseases or countries, or the methodological comparability of these values. We address this gap by seeking to establish if it is feasible to use elicited WTP values in resource allocation, illustrated by attempting to compile a 'league table' of WTP values for pharmaceutical interventions. A review database was compiled for CV studies in healthcare published from January 1985 to December 2005. Of 210 studies identified, 40 considered pharmaceutical interventions. Values are presented as mean or median WTP values, adjusted where necessary to pound and $US for 2004/5. Lack of reporting in some instances of either the mean or median, together with heterogenous methods and infrequent reporting of costs, made 'league table' construction difficult. This raises questions about the use of existing studies for resource allocation decisions, despite the fact that most studies were seemingly undertaken for policy objectives. However, four interventions had more than one study, making it possible to compare the values elicited. The values elicited across studies were fairly consistent for two interventions (anti-hypertensive therapy and tumour necrosis factor [TNF]-alpha blockade for rheumatoid arthritis), whereas WTP values for insulin and post-operative emesis therapy were very divergent. No single methodological difference seemed to explain this pattern; however, the more methodological differences between studies the greater the likelihood of divergent values. A checklist, or minimum reporting set of information, is the first step towards improving the consistency of methods, and therefore values, published. In the longer term, a move towards the use of a reference case akin to that used for cost-utility studies would seem important if such studies are to be used for comparative purposes and thereby be relevant to resource allocation decision making.
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Affiliation(s)
- Tracey H Sach
- School of Community Health Sciences, University of Nottingham, University Park, Nottingham, UK.
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van Steenberghe D, Bercy P, De Boever J, Adriaens P, Geers L, Hendrickx E, Adriaenssen C, Rompen E, Malmenäs M, Ramsberg J. Patient evaluation of a novel non-injectable anesthetic gel: a multicenter crossover study comparing the gel to infiltration anesthesia during scaling and root planing. J Periodontol 2005; 75:1471-8. [PMID: 15633323 DOI: 10.1902/jop.2004.75.11.1471] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Periodontal scaling procedures commonly require some kind of anesthesia. From the patient's perspective, the choice of anesthetic method is a trade-off between the degree of anesthesia and accepting the side effects. The present study evaluates the preferences for a novel non-injection anesthetic product (a gel, containing lidocaine 25 mg/g plus prilocaine 25 mg/g and thermosetting agents) versus injection anesthesia (lidocaine 2% adrenaline) in conjunction with scaling and/or root planing (SRP). METHODS In a multicenter, crossover, randomized, open study patients were asked, after they had experienced both products, if they preferred anesthetic gel or injection anesthesia. In addition, the adequacy of anesthesia and occurrence of post-procedure problems were assessed. The patients were also asked about their willingness to return if they were offered anesthetic gel at their next visit and their maximum willingness to pay (WTP) for this option. RESULTS One-hundred seventy (170) patients at eight centers in Belgium were included in the study. There were 157 per protocol (PP) patients. A vast majority of the PP patients (70%) preferred the anesthetic gel to injection anesthesia (22%). The most common reason was less post-procedure numbness. Eighty percent (80%) of the patients expressed satisfactory anesthesia with the gel and 96% with injection anesthesia (P <0.001). Post-procedure problems were significantly less with the gel than with injection (P <0.001): numbness 15% versus 66%, unpleasant sensations such as soreness and pain 44% versus 63%, and problems connected with daily activities 19% versus 69%. The majority of patients (60%) who preferred gel were also willing to pay for it. A conservative estimate of the median WTP was $10.00. Furthermore, anesthetic gel would make almost every second patient (45%) more or much more willing to return for the next treatment. CONCLUSIONS The data suggest that a somewhat less profound anesthesia with gel is clearly preferred by the patients because of the low incidence of post-procedure problems as compared to conventional injection anesthesia. The median WTP is likely in excess of the acquisition cost of the product, which indicates a favorable cost-benefit ratio for the individual patient.
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Birch S, Sohn W, Ismail AI, Lepkowski JM, Belli RF. Willingness to pay for dentin regeneration in a sample of dentate adults. Community Dent Oral Epidemiol 2004; 32:210-6. [PMID: 15151691 DOI: 10.1111/j.1600-0528.2004.00156.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Measurement of individuals' valuation of dental treatments is important in the evaluation of new technologies. In this paper the value of dentin regeneration, a new treatment for teeth with reversible pulpitis, is measured based on what individuals say they would be willing to pay to receive the treatment. METHODS A total of 611 randomly selected dentate adults answered willingness to pay (WTP) and dental insurance questions. Detailed descriptions of the process and expected outcomes for dentin regeneration were presented to subjects as part of a larger study measuring preferences for different treatments. WTP was determined for two different levels of success for dentin regeneration. RESULTS At a success rate of 95%, the mean WTP for dentin regeneration was $262.70 (noninsured) and $11.00 per month (insured subjects). For success rate of 75%, the corresponding values were $210.90 and $9.20 per month. Multivariate analyses were used to identify any significant relationships between WTP and a range of variables covering socio-demographic, socio-economic, dental experience and oral health status variables. The findings indicate that individuals' valuations of treatments involve substantial unexplained variation. About half of the noninsured subjects would pay for dentin regeneration if it cost $200 per tooth. CONCLUSIONS The data on the WTP for dentin regeneration indicate that a substantial percentage of adults will pay for this new technology. This study provides for the first time an estimate of WTP for dentin regeneration among the population.
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Affiliation(s)
- Stephen Birch
- Department of Clinical Epidemiology and Biostatistics, Centre for Health Economics and Policy Analysis, McMaster University, 1200 Main Street West, Hamilton, Ontario L8N 3Z5, Canada.
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Matthews D, Rocchi A, Wang EC, Gafni A. Use of an interactive tool to assess patients' willingness-to-pay. J Biomed Inform 2001; 34:311-20. [PMID: 12123150 DOI: 10.1006/jbin.2002.1032] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Assessment of willingness to pay (WTP) has become an important issue in health care technology assessment and in providing insight into the risks and benefits of treatment options. We have accordingly explored the use of an interactive method for assessment of WTP. To illustrate our methodology, we describe the development and testing of an interactive tool to administer a WTP survey in a dental setting. The tool was developed to measure patient preference and strength of preference for three dental anesthetic options in a research setting. It delivered written and verbal formats simultaneously, including information about the risks and benefits of treatment options, insurance, and user-based WTP scenarios and questions on previous dental experience. Clinical information was presented using a modified decision aid. Subjects could request additional clinical information and review this information throughout the survey. Information and question algorithms were individualized, depending on the subject's reported clinical status and previous responses. Initial pretesting resulted in substantial modifications to the initial tool: shortening the clinical information (by making more of it optional reading) and personalizing the text to more fully engage the user. In terms of results 196 general population subjects were recruited using random-digit dialing in southwestern Ontario, Canada. Comprehension was tested to ensure the instrument clearly conveyed the clinical information; the average score was 97%. Subjects rated the instrument as easy/very easy to use (99%), interesting/very interesting (91%), and neither long nor short (72.4%). Most subjects were comfortable/very comfortable with a computer (84%). Indirect evaluation revealed most subjects completed the survey in the expected time (30 min). Additional information was requested by 50% of subjects, an average of 2.9 times each. Most subjects wanted this type of information available in the provider's office for use in clinical decision making (92%). Despite extensive pretesting, three "bugs" remained undiscovered until live use. We have demonstrated that the detailed information, complex algorithms, and cognitively challenging questions involved in a WTP survey can be successfully administered using a tailor-made, patient-based, interactive computer tool. Key lessons regarding the use of such tools include allowing the user to set the pace of information flow and tailor the content, engaging the user by personalizing the textual information, inclusion of tests of comprehension and offering opportunities for correction, and pretesting by fully mimicking the live environment.
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Affiliation(s)
- D Matthews
- Faculty of Dentistry, Dalhousie University, Halifax, Nova Scotia, Canada B3H 3J5.
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Matthews DC, Rocchi A, Gafni A. Factors affecting patients' and potential patients' choices among anaesthetics for periodontal recall visits. J Dent 2001; 29:173-9. [PMID: 11306158 DOI: 10.1016/s0300-5712(01)00009-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Dentinal hypersensitivity and recurrent disease may necessitate the use of anaesthetic during periodontal recall visits. However, an aversion to injections may affect patient compliance. The objectives of this study were to determine choices patients and 'potential' patients make when provided with information on the risks and benefits of alternative anaesthetic choices for root planing during periodontal recalls and to examine which factors influence these choices. METHODS Using an interactive computer tool, scenarios described the risks and benefits of root planing during periodontal maintenance and the anaesthetic alternatives (no anaesthetic, an experimental thermosetting gel anaesthetic and traditional local infiltration anaesthesia). Compliant patients for whom anaesthesia was recommended during recall cleanings were recruited from private periodontal practices (n=97). General population subjects (potential patients) were recruited by random digit dialing (n=196) RESULTS As dental insurance was one of the inclusion criteria, the sample was representative of a working population. Most subjects reported tooth sensitivity (recall 84.5%, general 59.9%). The majority of patients wanted some form of anaesthetic, either gel (recall 82.5%, general 81.0%) or local infiltration (recall 10.3%, general 16.4%). Fifty-five percent of subjects reported moderate or severe pain from their previous dental injection(s). Asked if they were to have a dental needle tomorrow, 52.5% would be somewhat or very anxious. Of those who chose gel, 63.47% would be more or much more willing to return for recall visits if the gel were available. Using multivariate logistic regression, concern about pain and anxiety associated with needles were the only statistically significant characteristics associated with anaesthetic preference. CONCLUSIONS Concern about pain and anxiety associated with needles dominates preferences for dental anaesthesia. The overwhelming preference for a non-injectable anaesthetic reveals a strong clinical need for such alternatives.
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Affiliation(s)
- D C Matthews
- Division of Periodontics, Dalhousie University, Halifax, B3H 3J5, Nova Scotia, Canada.
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