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.
1
Introduction
Expenditure on dental care is substantial globally . This expense is financed through insurance, government funding, out-of-pocket payments by individuals or a combination of these . Given that financial resources are limited, it is important that they are used efficiently. Economic evaluation can help ensure efficiency especially when prioritizing the care delivered with the available resources. In order to undertake economic evaluations, it is necessary to obtain an accurate and reliable measurement of the value placed on dental procedures.
Many studies have attempted to determine valuations in healthcare . These valuations include willingness to pay (WTP), Health Years Equivalent (HYE), Quality-adjusted tooth years (QATY) and Quality-adjusted life years (QALY). As there is a lack of preference based measures (such as QALY) , WTP remains an important measure of valuation that is applicable and available to dentistry that allows for economic evaluations that enable meaningful comparisons across various healthcare provision scenarios.
Willingness to pay (WTP) is a popular approach to the valuation of healthcare benefits . Willingness to pay refers to the maximum amount in monetary terms that an individual would be willing to sacrifice in order to obtain the benefits of a program . It may be elicited through a revealed preference approach, i.e. observed consumer choices, or through an expressed or stated preference approach – the contingent valuation method (CVM) . CVM allows for estimation of individuals’ WTP even in the absence of actual markets, such as in the valuation of public goods or new product developments. In principle, WTP allows us to capture the full economic value including non-use and passive benefits, and opportunity costs of an intervention; reflects individuals’ treatment preferences among potential alternative uses of monetary resources, and permits comparisons across interventions with entirely different outcome natures . WTP also allows for a direct cost-benefit analysis (CBA). When the costs and benefits of each intervention are known and correct decision making framework is applied, a thorough CBA aids resource allocation with maximisation of benefits out of a fixed budget . WTP may also be used in pricing and demand forecasts for individual healthcare services, or to determine the viability of healthcare programmes when used in conjunction with cost-effectiveness and cost-utility analyses (e.g. WTP per QALY) .
Despite its strengths, WTP has its share of criticisms . WTP elicitations are susceptible to biases, such as hypothetical bias, compliance bias, strategic bias, warm glow effect, yea saying bias, starting point bias and range bias. These are explained in detail elsewhere . Carson elaborated on the need for well-designed contingent valuation studies control for biases and yield more reliable measurements . Content validity in WTP studies, or the provision of adequate information to ensure respondents understand correctly what is asked of them, may be improved by providing a detailed description of the intervention, the objective of the WTP question, and pre-testing. Piloting of the survey ensures that respondents understand the benefits of the intervention, and give their true WTP value rather than a fair price of the intervention (incentive compatibility) . Other study parameters include an appropriate sample size and demographic distribution, acceptability to respondents, internal consistency, and reproducibility. WTP measures have been shown to have acceptable temporal stability over a short term and variable longer term stability . The sampling frame also requires consideration, as patients may have more familiarity with procedures, while the general population may provide a less biased perspective for the overall population. .
The WTP elicitation format may also influence the reliability of results. Contingent valuation can be carried out in a few ways, namely: (1) Open-ended format (OE), (2) Bidding game format (BG), (3) Payment card format (PC), (4) Dichotomous-choice format (DC) and (5) Double-bounded dichotomous-choice format (DBDC) . OE valuations are unrealistic and predisposed to strategic bias , while DC methods are susceptible to “yea-saying” bias , and have not been widely used in healthcare as they require a large and costly sample size . Alternatively, WTP can be determined using conjoint analysis as part of a Discrete Choice Experiment. The modes of WTP elicitation include survey questionnaires – mailed, online, paper copy, phone interviews, and face-to-face interviews. Besides critiquing elicitation methods such as open ended questions, Arrow et al. recommended the adoption of in-person interviews by experienced professional interviewers to motivate respondents to pay close attention to the details of WTP scenarios .
Studies pertaining to oral healthcare involve the elicitation of WTP values for periodontal treatments, orthodontic appliances, prosthodontic tooth replacements, oral medicine and oral surgery interventions, preventive care, as well as novel dental products and services. While the scope and number of dental-related WTP studies has expanded in recent years, there is a lack of studies that summarise and examine the quality of these WTP studies. This review therefore seeks to identify, consolidate, and evaluate the existing literature on Willingness to Pay applied to clinical contexts in the field of dentistry.
2
Methodology
This study reports a critical review that utilized a systematic search. It sought to identify and evaluate publications that assessed willingness to pay for oral health interventions in a clinical context.
2.1
Inclusion and exclusion criteria
Only original, English-language publications that included a primary study to assess WTP for oral health interventions applied in a clinical context were selected. Here the clinical context was operationalized as the administration of oral healthcare by oral health professionals in a healthcare facility. Reviews, including systematic and literature reviews, were examined to identify additional clinical publications and references, but were not included in the list of publications selected. Case reports, case studies, poster presentations, conference presentations, letters, news and editorials were similarly excluded. Studies that relied on simulations with hypothetical WTP values, without a direct WTP elicitation from respondents, were also excluded.
Various methods of measuring WTP were included in this review. They included, but were not limited to, direct measurements of WTP, conjoint analyses, discrete choice experiments, and contingent valuation. Valuations of benefit, in the form of WTP, made by direct recipients and/or payors (e.g. parents of school children) of oral health interventions were accepted. WTP elicitation from healthcare providers was also considered for inclusion. The payment vehicles included payment out-of-pocket, insurance payments and contributions to public tax-funded programmes.
2.2
Search strategy
An initial search was conducted on 2nd June 2016 to identify the relevant keywords. Searches for relevant publications were carried out using PubMed (MEDLINE) and Web of Science (WOS) databases. The PubMed database was searched using a combination of Medical Subject Headings (MeSH) terms, and general search terms/keywords in “All Fields” (non-field restricted search). The search strategy used the following search query: “Willingness to pay” OR WTP OR “Cost benefit analysis” (MeSH) OR “Time trade off” OR TTO OR “Discrete choice experiment” OR DCE OR “Conjoint analysis” AND “Dentistry”(MeSH) OR “Dent*”. Web of Science was searched using “All Databases”. The search query used was: (“Willingness to pay” OR WTP OR “Cost benefit analysis” OR “Time trade off” OR TTO OR “Discrete choice experiment” OR DCE OR “Conjoint analysis”) AND TOPIC: (Dent*). Time span was set to include “All years”, and the search language was English.
2.3
Management of records
The search results from each database were downloaded and imported in to EndNote X7.3.1. Duplicate records were removed, and relevant publications were retrieved. The selection of publications for inclusion was conducted first by title and abstract screening. If any publication did not have an abstract, the full article was used for screening. Titles and abstracts were reviewed by ST. Publications that met all the inclusion criteria were selected. For publications that met some, but not all the inclusion criteria, or were thought to be of questionable relevance, a second reviewer (RN) conducted an independent review and a consensus was sought. Full texts were retrieved for the selected publications and independently reviewed by the reviewers for inclusion. A final decision of the inclusion or non-inclusion of the publication was finalised thereafter, and the reasons for exclusion were recorded.
2.4
Selection of studies
A total of 2434 publications were identified, out of which 1246 were from PubMed, and 1188 from WOS. After removing duplicates, 1498 publications remained. Forty one publications were selected after the title and abstract screening. Nineteen publications were short-listed for a second review by RN. The full-text for these publications were extracted, and examined. ST and RN came to a consensus on the exclusion of 15 of the 19 publications and including the rest of the publications ( Fig. 1 ). Three publications appeared to have used the same data set of WTP values. The publications originated from a survey of 205 parents of primary school children in Thailand. As two of the publications analysed different aspects of WTP – the influence of dental setting and treatment modality, a sub-column was included to present the separate result findings in Table 1 . The third publication was excluded. Two publications in Canada also appeared to interview a common study sample of 196 respondents from the general population. As one of the publications additionally compared the WTP results with that of 97 periodontal recall patients , the other publication was excluded . In order to account for the various publications from one dataset, a distinction between the use of publications versus studies is maintained in this review. Here, the study refers to the overall research work that resulted in a dataset, and a study might result in multiple publications.
| Publication Title | Author (Year of Publication) Location | Sample Group (Sample Size) | Methodology: Pre-testing, Reliability | Mode of WTP elicitation | Results (key findings on WTP) |
|---|---|---|---|---|---|
| Different Dental Care Setting: Does Income Matter | Tianviwat, S., Chongsuvivatwong, V. et al. (2008a) Thailand | Parents (205) | Content validity and understandability of WTP questionnaire tested beforehand (10 dentists and 10 non-clinical stuff) | Face-to-face interview | Multilevel linear regression analyses reported higher WTP among higher income subjects for sealants in permanent teeth, fillings in permanent teeth, and extractions in primary teeth. However, the difference in WTP between the income groups was less for services provided in the mobile setting than for those provided in the hospital setting. |
| Pilot study (27 parents) | |||||
| Construct validity tested | |||||
| Prevention versus cure: Measuring parental preferences for sealants and fillings as treatment for childhood caries in Southern Thailand | Tianviwat, S., Chongsuvivatwong, V. et al. (2008b) Thailand | Multilevel linear modelling reported that mean WTP values in Thai Baht for sealants (Unadjusted Mean(SE) = 225.3(188.2)) and fillings (Unadjusted Mean(SE) = 225.6(203.0)) were not significantly different (p = 0.97). | |||
| Factors affecting patient valuation of caries prevention: Using and validating the willingness to pay method | Vernazza, C. R., Wildman, J.R. et al. (2015) UK, Germany | Patients (112) | Questionnaire piloted, minor changes to wording and layout made | Questionnaire | Mean WTP for the coating was £96.41 (SD = 60.61) . Based on linear regression analysis, no demographic or dental history factors were significantly associated with WTP. |
| Factors affecting the willingness to pay for implants: A study of patients in Riyadh, Saudi Arabia | Al Garni, B., Pani, S.C. et al. (2012) Saudi Arabia | Patients (100) | – | Face-to-face interview | 67% of respondents said they would be willing to pay the median price for the placement of an implant. |
| Logistic regression analyses found that the WTP amount increased proportionately with the family income. A higher mean WTP was found for private clinics compared to government dental clinics ( B = 1.073; p = 0.03) . | |||||
| Patient evaluation of a Novel Non-Injectable Gel | van Steenberghe, D., Bercy, P. et al. (2004) Finland | Patients (157) | Appropriateness of questions and scales pre-tested in pilot study (258 subjects) | Questionnaire (Electronic) | 70% of patients preferred anesthetic gel, while 22% of patients preferred injection anesthesia. A conservative estimate of median WTP was $10. |
| Pre-testing to ensure wording of questions and response options were easily understood and interpreted (10 Dutch speaking and 10 French speaking subjects) | |||||
| Perspectives towards Oral Mucositis prevention from parents and health care professionals in pediatric cancer | Ethier, M. C., Regier, D.A. et al. (2012) Canada | Parents (82), Health care professionals (HCP) (60) | – | Face-to-face interview | Interval regression analyses found no statistically significant differences in the WTP of parents and health care professionals (HCPs) to prevent severe mucositis (Average median WTP = CAN$5499 vs. CAN$5180; p = 0.81) , although both groups were willing to pay large amounts of money to prevent one episode of severe mucositis. HCPs were however, willing to pay significantly less than parents to prevent mild mucositis (β(SE) = −0.69(0.21); p = 0.03) . |
| Prosthetic restoration in the single-tooth gap: patient preference and analysis of the WTP index | Augusti, D., Augusti, G. et al. (2013) Italy | Patients (107) | – | Face-to-face interview | WTP median values for implant-supported crowns (ISC) were €3000 and €2500 in the anterior and posterior areas, respectively. Linear regression analyses reported that high oral care was associated with a higher WTP for the estimation of both anterior (B(95%CI) = 831.1(392.3–1269.9); p < 0.001) , and posterior areas (B(95% CI) = 841.1(433.2 – 1249.1); p < 0.001). |
| Putting Your Money Where Your Mouth is: Willingness to Pay for Dental Gel | Matthews, D., Rocchi, A. et al. (2002) Canada | Patients (97 − periodontal recall, 196 − general population) | Content of the decision aid was tested by 3 expert panels. Participants were questioned about their perception of the tool; its length, ease of use, interest level and comprehension of the clinical information | Questionnaire (Electronic) | Median WTP for dental gel was Can$20.00 (mean = Can$22.56) per visit for the general population, and Can$10.00 (mean = Can$16.67) for the recall population. The median WTP for monthly insurance premium for dental gel was Can$2.00 per month for both groups. Logistic regression showed that anxiety about future needles was associated with higher user-based WTP (p = 0.02), while concern about dental pain (p = 0.003) and the anxiety about past needles (p = 0.04) were significantly associated with insurance-based WTP. |
| The management of an endodontically abscessed tooth: patient health state utility, decision-tree and economic analysis | Balevi, B., & Shepperd, S. (2007) Canada | Teachers (40) | – | Face-to-face interview | The mean willingness-to-pay (Can$) for the restoration of a maxillary central incisor with a conventional crown, single tooth implant, conventional dental bridge and removable partial denture was 1782.05, 1871.79, 1605.13 and 1351.28 respectively. No statistical significance was found between willingness-to-pay utilities for the fixed restorative treatment and RPD options for molars and incisors based on one-way ANOVA. |
| A weak positive correlation was noted between the standard gamble and willingness-to-pay utility for maxillary central incisors (Pearson’s r = 0.217; p = 0.006) , and mandibular 1st molars (Pearson’s r = 0.196; p = 0.01) . | |||||
| Willingness to pay for implant therapy: a study of patient preference | Leung, K. C., & McGrath, C. P. (2010) Hong Kong | Patients (51) | – | Face-to-face interview | Mean WTP amounts for anterior and posterior tooth replacement were HK$11,000 and HK$10,000 respectively. No statistical difference was found between the two using the Wilcoxon’s signed rank test. |
| Linear regression models found a lower WTP for a posterior missing tooth was associated with the presence of missing teeth (B(SE) = −6686.9(1813.2); p = 0.001) . | |||||
| Willingness to pay for periodontal therapy: Development and testing of an instrument | Matthews, D. C., Birch, S. et al. (1999) Canada | Patients (24), Faculty (18) | Content and face validity assessed by 4 periodontists, 2 prosthodontists, and 2 general dentists | Face-to-face interview | Subjects were willing to pay more for coverage for themselves than for others. |
| Construct validity tested | Periodontal surgery was the preferred treatment for moderate to advanced periodontal disease, and was preferred over other choices (i.e. a higher WTP) for all income groups. Based on ANOVA, WTP was reported to be positively related to income level. | ||||
| Test-retest reliability, repeat questionnaire after 14–23 days | |||||
Out of the other 13 publications excluded, one publication was not available in English . We were unable to locate the full text for two publications . Two publications were meeting abstracts rather than published studies, while another two publications used conjoint analyses that did not include WTP measurements . Three publications did not measure WTP directly, but instead ran cost-effectiveness analyses at various hypothetical WTP levels . A publication on the WTP for community water fluoridation and another for toothbrushes , were excluded as they were interventions that were aimed at a community or group rather than individual clinical interventions. Another publication that measured WTP in terms of ‘desired cost’ for dental check-ups instead of the maximum price that respondents would pay was also excluded . Thus a total of 26 publications were included in the final selection.
2.5
Reporting of results
Results were presented in tables, with author(s), year of publication, and major findings listed. The publications were grouped according to their contingent valuation method, and the presence and mode of pre-testing, and mode of WTP elicitation were extracted and described. The effect of potential factors influencing WTP values were also summarized from multivariate analyses.
2
Methodology
This study reports a critical review that utilized a systematic search. It sought to identify and evaluate publications that assessed willingness to pay for oral health interventions in a clinical context.
2.1
Inclusion and exclusion criteria
Only original, English-language publications that included a primary study to assess WTP for oral health interventions applied in a clinical context were selected. Here the clinical context was operationalized as the administration of oral healthcare by oral health professionals in a healthcare facility. Reviews, including systematic and literature reviews, were examined to identify additional clinical publications and references, but were not included in the list of publications selected. Case reports, case studies, poster presentations, conference presentations, letters, news and editorials were similarly excluded. Studies that relied on simulations with hypothetical WTP values, without a direct WTP elicitation from respondents, were also excluded.
Various methods of measuring WTP were included in this review. They included, but were not limited to, direct measurements of WTP, conjoint analyses, discrete choice experiments, and contingent valuation. Valuations of benefit, in the form of WTP, made by direct recipients and/or payors (e.g. parents of school children) of oral health interventions were accepted. WTP elicitation from healthcare providers was also considered for inclusion. The payment vehicles included payment out-of-pocket, insurance payments and contributions to public tax-funded programmes.
2.2
Search strategy
An initial search was conducted on 2nd June 2016 to identify the relevant keywords. Searches for relevant publications were carried out using PubMed (MEDLINE) and Web of Science (WOS) databases. The PubMed database was searched using a combination of Medical Subject Headings (MeSH) terms, and general search terms/keywords in “All Fields” (non-field restricted search). The search strategy used the following search query: “Willingness to pay” OR WTP OR “Cost benefit analysis” (MeSH) OR “Time trade off” OR TTO OR “Discrete choice experiment” OR DCE OR “Conjoint analysis” AND “Dentistry”(MeSH) OR “Dent*”. Web of Science was searched using “All Databases”. The search query used was: (“Willingness to pay” OR WTP OR “Cost benefit analysis” OR “Time trade off” OR TTO OR “Discrete choice experiment” OR DCE OR “Conjoint analysis”) AND TOPIC: (Dent*). Time span was set to include “All years”, and the search language was English.
2.3
Management of records
The search results from each database were downloaded and imported in to EndNote X7.3.1. Duplicate records were removed, and relevant publications were retrieved. The selection of publications for inclusion was conducted first by title and abstract screening. If any publication did not have an abstract, the full article was used for screening. Titles and abstracts were reviewed by ST. Publications that met all the inclusion criteria were selected. For publications that met some, but not all the inclusion criteria, or were thought to be of questionable relevance, a second reviewer (RN) conducted an independent review and a consensus was sought. Full texts were retrieved for the selected publications and independently reviewed by the reviewers for inclusion. A final decision of the inclusion or non-inclusion of the publication was finalised thereafter, and the reasons for exclusion were recorded.
2.4
Selection of studies
A total of 2434 publications were identified, out of which 1246 were from PubMed, and 1188 from WOS. After removing duplicates, 1498 publications remained. Forty one publications were selected after the title and abstract screening. Nineteen publications were short-listed for a second review by RN. The full-text for these publications were extracted, and examined. ST and RN came to a consensus on the exclusion of 15 of the 19 publications and including the rest of the publications ( Fig. 1 ). Three publications appeared to have used the same data set of WTP values. The publications originated from a survey of 205 parents of primary school children in Thailand. As two of the publications analysed different aspects of WTP – the influence of dental setting and treatment modality, a sub-column was included to present the separate result findings in Table 1 . The third publication was excluded. Two publications in Canada also appeared to interview a common study sample of 196 respondents from the general population. As one of the publications additionally compared the WTP results with that of 97 periodontal recall patients , the other publication was excluded . In order to account for the various publications from one dataset, a distinction between the use of publications versus studies is maintained in this review. Here, the study refers to the overall research work that resulted in a dataset, and a study might result in multiple publications.
| Publication Title | Author (Year of Publication) Location | Sample Group (Sample Size) | Methodology: Pre-testing, Reliability | Mode of WTP elicitation | Results (key findings on WTP) |
|---|---|---|---|---|---|
| Different Dental Care Setting: Does Income Matter | Tianviwat, S., Chongsuvivatwong, V. et al. (2008a) Thailand | Parents (205) | Content validity and understandability of WTP questionnaire tested beforehand (10 dentists and 10 non-clinical stuff) | Face-to-face interview | Multilevel linear regression analyses reported higher WTP among higher income subjects for sealants in permanent teeth, fillings in permanent teeth, and extractions in primary teeth. However, the difference in WTP between the income groups was less for services provided in the mobile setting than for those provided in the hospital setting. |
| Pilot study (27 parents) | |||||
| Construct validity tested | |||||
| Prevention versus cure: Measuring parental preferences for sealants and fillings as treatment for childhood caries in Southern Thailand | Tianviwat, S., Chongsuvivatwong, V. et al. (2008b) Thailand | Multilevel linear modelling reported that mean WTP values in Thai Baht for sealants (Unadjusted Mean(SE) = 225.3(188.2)) and fillings (Unadjusted Mean(SE) = 225.6(203.0)) were not significantly different (p = 0.97). | |||
| Factors affecting patient valuation of caries prevention: Using and validating the willingness to pay method | Vernazza, C. R., Wildman, J.R. et al. (2015) UK, Germany | Patients (112) | Questionnaire piloted, minor changes to wording and layout made | Questionnaire | Mean WTP for the coating was £96.41 (SD = 60.61) . Based on linear regression analysis, no demographic or dental history factors were significantly associated with WTP. |
| Factors affecting the willingness to pay for implants: A study of patients in Riyadh, Saudi Arabia | Al Garni, B., Pani, S.C. et al. (2012) Saudi Arabia | Patients (100) | – | Face-to-face interview | 67% of respondents said they would be willing to pay the median price for the placement of an implant. |
| Logistic regression analyses found that the WTP amount increased proportionately with the family income. A higher mean WTP was found for private clinics compared to government dental clinics ( B = 1.073; p = 0.03) . | |||||
| Patient evaluation of a Novel Non-Injectable Gel | van Steenberghe, D., Bercy, P. et al. (2004) Finland | Patients (157) | Appropriateness of questions and scales pre-tested in pilot study (258 subjects) | Questionnaire (Electronic) | 70% of patients preferred anesthetic gel, while 22% of patients preferred injection anesthesia. A conservative estimate of median WTP was $10. |
| Pre-testing to ensure wording of questions and response options were easily understood and interpreted (10 Dutch speaking and 10 French speaking subjects) | |||||
| Perspectives towards Oral Mucositis prevention from parents and health care professionals in pediatric cancer | Ethier, M. C., Regier, D.A. et al. (2012) Canada | Parents (82), Health care professionals (HCP) (60) | – | Face-to-face interview | Interval regression analyses found no statistically significant differences in the WTP of parents and health care professionals (HCPs) to prevent severe mucositis (Average median WTP = CAN$5499 vs. CAN$5180; p = 0.81) , although both groups were willing to pay large amounts of money to prevent one episode of severe mucositis. HCPs were however, willing to pay significantly less than parents to prevent mild mucositis (β(SE) = −0.69(0.21); p = 0.03) . |
| Prosthetic restoration in the single-tooth gap: patient preference and analysis of the WTP index | Augusti, D., Augusti, G. et al. (2013) Italy | Patients (107) | – | Face-to-face interview | WTP median values for implant-supported crowns (ISC) were €3000 and €2500 in the anterior and posterior areas, respectively. Linear regression analyses reported that high oral care was associated with a higher WTP for the estimation of both anterior (B(95%CI) = 831.1(392.3–1269.9); p < 0.001) , and posterior areas (B(95% CI) = 841.1(433.2 – 1249.1); p < 0.001). |
| Putting Your Money Where Your Mouth is: Willingness to Pay for Dental Gel | Matthews, D., Rocchi, A. et al. (2002) Canada | Patients (97 − periodontal recall, 196 − general population) | Content of the decision aid was tested by 3 expert panels. Participants were questioned about their perception of the tool; its length, ease of use, interest level and comprehension of the clinical information | Questionnaire (Electronic) | Median WTP for dental gel was Can$20.00 (mean = Can$22.56) per visit for the general population, and Can$10.00 (mean = Can$16.67) for the recall population. The median WTP for monthly insurance premium for dental gel was Can$2.00 per month for both groups. Logistic regression showed that anxiety about future needles was associated with higher user-based WTP (p = 0.02), while concern about dental pain (p = 0.003) and the anxiety about past needles (p = 0.04) were significantly associated with insurance-based WTP. |
| The management of an endodontically abscessed tooth: patient health state utility, decision-tree and economic analysis | Balevi, B., & Shepperd, S. (2007) Canada | Teachers (40) | – | Face-to-face interview | The mean willingness-to-pay (Can$) for the restoration of a maxillary central incisor with a conventional crown, single tooth implant, conventional dental bridge and removable partial denture was 1782.05, 1871.79, 1605.13 and 1351.28 respectively. No statistical significance was found between willingness-to-pay utilities for the fixed restorative treatment and RPD options for molars and incisors based on one-way ANOVA. |
| A weak positive correlation was noted between the standard gamble and willingness-to-pay utility for maxillary central incisors (Pearson’s r = 0.217; p = 0.006) , and mandibular 1st molars (Pearson’s r = 0.196; p = 0.01) . | |||||
| Willingness to pay for implant therapy: a study of patient preference | Leung, K. C., & McGrath, C. P. (2010) Hong Kong | Patients (51) | – | Face-to-face interview | Mean WTP amounts for anterior and posterior tooth replacement were HK$11,000 and HK$10,000 respectively. No statistical difference was found between the two using the Wilcoxon’s signed rank test. |
| Linear regression models found a lower WTP for a posterior missing tooth was associated with the presence of missing teeth (B(SE) = −6686.9(1813.2); p = 0.001) . | |||||
| Willingness to pay for periodontal therapy: Development and testing of an instrument | Matthews, D. C., Birch, S. et al. (1999) Canada | Patients (24), Faculty (18) | Content and face validity assessed by 4 periodontists, 2 prosthodontists, and 2 general dentists | Face-to-face interview | Subjects were willing to pay more for coverage for themselves than for others. |
| Construct validity tested | Periodontal surgery was the preferred treatment for moderate to advanced periodontal disease, and was preferred over other choices (i.e. a higher WTP) for all income groups. Based on ANOVA, WTP was reported to be positively related to income level. | ||||
| Test-retest reliability, repeat questionnaire after 14–23 days | |||||
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