The monetary value of oral health :willingness to pay for treatment and prevention

Abstract

Introduction This thesis investigates two of the many dilemmas faced in oral health; whether policy makers and individuals should invest to reduce the risk of caries (decay) and whether an extensively decayed tooth should be saved or extracted (with or without a replacement). An understanding of patient preferences, as defined in health economics (utility), is vital to addressing such dilemmas. Although health state utility is the most accepted form of utility in healthcare, monetary valuation, in the form of willingness to pay (WTP), is more appropriate for dentistry but there is little evidence for its use. Method Two studies were undertaken using WTP. The studies are outlined in Table 1. Study name Interventions WTP elicitation Sample size Methodological experiments Molar tooth Treatment options for a non-vital molar tooth Face to face/ shuffled payment card 503 1. Part-whole valuation 2. Influence of real price Prevention New varnish for root caries prevention Questionnaire/ bidding card 167 1. Payment vehicles 2. Revealed & stated preference Table 1 Outline of the two studies in the thesis Results The Molar Tooth Study showed that approximately half the sample wished to save a tooth with a mean WTP of £373 (standard deviation 991). Econometric analysis showed that choice was influenced by previous dental experience and that WTP was not strongly related to any factors. The Prevention Study showed that mean stated preference for the intervention was £96 (standard deviation 55). Stated preference matched revealed preference in 55% of cases, with stated preference underestimating revealed preference in 30% of cases. Discussion Although some methodological issues remain, such as the discrepancy between stated and revealed preference, WTP is a useful measure of patient preference in oral health. The wide and apparently unpredictable range of values placed on oral health leave difficult questions for policy makers.