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Factors affecting willingness to pay for NHS-based orthodontic treatment

British Dental Journal (2022)Cite this article

Abstract

Objective To assess factors affecting willingness to pay for orthodontic treatment.

Methods An online discrete choice experiment and willingness to pay study was conducted on a convenience sample of 250 participants aged 16 and above over a four-month period. Participants completed a series of stated-preference tasks, in which they viewed choice sets with two orthodontic treatment options involving different combinations of attributes: family income; cost to patient; cause of problem; prevention of future problems; age; severity of the problem; and self-esteem/confidence.

Results Family income, cost to patient, cause of the problem, age and self-esteem/confidence were the most important attributes influencing participants' decisions to have orthodontic treatment. Participants felt that free NHS-based orthodontic provision should be prioritised for those under 18, regardless of family income, for those with developmental anomalies, particularly where self-esteem and confidence are affected, with younger participants (aged 16-24 years) strongly preferring full NHS funding for those under 18 years old (p = 0.007, 95% CI: 0.57-0.09) who dislike smiling in public, especially where self-esteem and confidence are impaired (p = 0.002, 95% CI: 0.16-0.71). Participants with high annual income had the highest preference for the NHS to fund treatment regardless of income (p = 0.02, 95% CI: 0.13-1.47) and placed an onus on addressing developmental anomalies (p = 0.004, 95% CI: 0.22-1.15). In total, 159 (63.6%) of those who would undergo treatment were willing to pay for it, with the majority (88%) open to paying up to £2,000 and only three participants stating the NHS should not contribute towards the cost of orthodontic treatment.

Conclusions Based on this pilot study, key factors influencing the decision to undergo treatment included family income, cost, the aetiology of malocclusion, age and self-esteem/confidence. It was felt that free NHS-based treatment should be given priority where self-esteem and confidence are impaired among young people. Further research to inform the priorities underpinning the provision of dental care and orthodontic treatment within the NHS is required.

Key points

  • Key factors influencing the decision to undergo orthodontics were assessed.

  • Pivotal considerations include family income, cost, the aetiology of malocclusion, age and self-esteem/confidence.

  • It was felt that free NHS-based treatment should be given priority where self-esteem and confidence are impaired among young people.

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References

  1. Mandall N A, McCord J F, Blinkhorn A S, Worthington H V, O'Brien K D. Perceived aesthetic impact of malocclusion and oral self-perceptions in 1415year-old Asian and Caucasian children in Greater Manchester. Eur J Orthod 2000; 22: 175-183.

  2. Javidi H, Vettore M, Benson P E. Does orthodontic treatment before the age of 18 byears improve oral health-related quality of life? A systematic review and meta-analysis. Am J Orthod Dentofacial Orthop 2017; 151: 644-655.

  3. Seehra J, Fleming P S, Newton T, DiBiase A T. Bullying in orthodontic patients and its relationship to malocclusion, self-esteem and oral health-related quality of life. J Orthod 2011; 38: 247-256.

  4. Johal A, Cheung M Y H, Marcenes W. The impact of two different malocclusion traits on quality of life. Br Dent J 2007; DOI: 10.1038/bdj.2007.33.

  5. Department of Health. Transitional Strategic Commissioning of Primary Care Orthodontic Services. 2013. Available at https://www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2015/09/orth-som-nov.pdf (accessed January 2022).

  6. Royal College of Surgeons. Commissioning guide: Orthognathic Procedures. 2013 Available at https://www.rcseng.ac.uk/library-and-publications/rcs-publications/docs/orthognathic-procedures/ (accessed January 2022).

  7. NHS. The NHS Constitution - the NHS belongs to us all. 2013. Available at https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/170656/NHS_Constitution.pdf (accessed January 2022).

  8. Department of Health. The new NHS - mondern. dependable. London, 1997. Contract No: Cm 3807.

  9. Lancsar E J, Hall J P, King M et al. Using discrete choice experiments to investigate subject preferences for preventive asthma medication. Respirology 2007; 12: 127-136.

  10. Gerard K, Lattimer V, Surridge H et al. The introduction of integrated outofhours arrangements in England: a discrete choice experiment of public preferences for alternative models of care. Health Expect 2006; 9: 60-69.

  11. Longo M F, Cohen D R, Hood K et al. Involving patients in primary care consultations: assessing preferences using discrete choice experiments. Br J Gen Pract 2006; 56: 35-42.

  12. Ubach C, Scott A, French F, Awramenko M, Needham G. What do hospital consultants value about their jobs? A discrete choice experiment. BMJ 2003; 326: 1432.

  13. Wordsworth S, Skåtun D, Scott A, French F. Preferences for general practice jobs: a survey of principals and sessional GPs. Br J Gen Pract 2004; 54: 740-746.

  14. Drummond M F, Sculpher M J, Torrance G W, O'Brien B J, Stoddart G L. Methods for the economic evaluation of health care programmes. Oxford: Oxford University Press; 2005.

  15. Lancaster K J. A New Approach to Consumer Theory. J Politic Econ 1966; 74: 132-157.

  16. Mangham L J, Hanson K, McPake B. How to do (or not to do) … Designing a discrete choice experiment for application in a low-income country. Health Policy Plan 2009; 24: 151-158.

  17. Baltussen R, ten Asbroek A H A, Koolman X, Shrestha N, Bhattarai P, Niessen L W. Priority setting using multiple criteria: should a lung health programme be implemented in Nepal? Health Policy Plan 2007; 22: 178-185.

  18. Youngkong S, Teerawattananon Y, Tantivess S, Baltussen R. Multi-criteria decision analysis for setting priorities on HIV/AIDS interventions in Thailand. Health Res Policy Syst 2012; 10: 6.

  19. Vernazza C, Anderson L, Hunter A I et al. The Value of Orthodontics: Do Parents' WillingnesstoPay Values Reflect the IOTN? JDR Clin Trans Res 2018; 3: 141-149.

  20. Olsen J A, Smith R D. Theory versus practice: a review of 'willingnesstopay' in health and health care. Health Econ 2001; 10: 39-52.

  21. Donaldson C, Farrar S, Mapp T, Walker A, Macphee S. Assessing community values in health care: Is the 'Willingness to pay' method feasible? Health Care Anal 1997; 5: 7-29.

  22. Kenealy P, Frude N, Shaw W. The Effects of Social Class on the Uptake of Orthodontic Treatment. Br J Orthod 1989; 16: 107-111.

  23. Carlsson F, Mørkbak M R, Olsen S B. The first time is the hardest: A test of ordering effects in choice experiments. J Choice Model 2012; 5: 19-37.

  24. Lancsar E, Louviere J. Conducting Discrete Choice Experiments to Inform Healthcare Decision Making: a user's guide. Pharmacoeconomics 2008; 26: 661-677.

  25. Hill M, Fisher J, Chitty L S, Morris S. Women's and health professionals' preferences for prenatal tests for Down syndrome: a discrete choice experiment to contrast noninvasive prenatal diagnosis with current invasive tests. Genet Med 2012; 14: 905-913.

  26. Dong D, Ozdemir S, Mong Bee Y, Toh S-A, Bilger M, Finkelstein E. Measuring High-Risk Patients' Preferences for Pharmacogenetic Testing to Reduce Severe Adverse Drug Reaction: A Discrete Choice Experiment. Value Health 2016; 19: 767-775.

  27. Czoli C D, Goniewicz M, Islam T, Kotnowski K, Hammond D. Consumer preferences for electronic cigarettes: results from a discrete choice experiment. Tob Control 2016; DOI: 10.1136/tobaccocontrol-2015-052422.

  28. Reed Johnson F, Lancsar E, Marshall D et al. Constructing Experimental Designs for Discrete-Choice Experiments: Report of the ISPOR Conjoint Analysis Experimental Design Good Research Practices Task Force. Value Health 2013; 16: 3-13.

  29. Hollinghurst S, Banks J, Bigwood L, Walter F M, Hamilton W, Peters T J. Using willingnesstopay to establish patient preferences for cancer testing in primary care. BMC Med Inform Decis Mak 2016; 16: 105.

  30. Smith R D. The relationship between reliability and size of willingnesstopay values: a qualitative insight. Health Econ 2007; 16: 211-216.

  31. Fleming P, Colonio-Salazar F, Waylen A et al. Prioritising NHS dental treatments: a mixed-methods study. Br Dent J 2022; DOI: 10.1038/s414150213824-z.

  32. Vernazza C R, Steele J G, Whitworth J M, Wildman J R, Donaldson C. Factors affecting direction and strength of patient preferences for treatment of molar teeth with nonvital pulps. Int Endod J 2015; 48: 1137-1146.

  33. Leung K C M, McGrath C P J. Willingness to pay for implant therapy: a study of patient preference. Clin Oral Implants Res 2010; 21: 789-793.

  34. Vernazza C R, Wildman J R, Steele J G et al. Factors affecting patient valuations of caries prevention: Using and validating the willingness to pay method. J Dent 2015; 43: 981-988.

  35. Mossey P A. The Heritability of Malocclusion: Part 2. The Influence of Genetics in Malocclusion. Br J Orthod 1999; 26: 195-203.

  36. NHS England. Guides for commissioning dental specialties - Orthodontics. 2015. Available at https://www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2015/09/guidcommsorthodontics.pdf (accessed January 2022).

  37. Hurley J. Chapter 2 - An overview of the normative economics of the health sector. In Culyer A J, Newhouse J P (eds) Handbook Health Economics. pp 55-118. Amsterdam: Elsevier, 2000.

  38. Brazier J, Ratcliffe J, Saloman J, Tsuchiya A. Measuring and Valuing Health Benefits for Economic Evaluation 2nd ed. Oxford: Oxford University Press, 2017.

  39. Whitehead S J, Ali S. Health outcomes in economic evaluation: the QALY and utilities. Br Med Bull 2010; 96: 5-21.

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Funding

This study was funded by the British Orthodontic Society Foundation.

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Authors and Affiliations

  1. Professor of Orthodontics, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK

    Padhraig S. Fleming

  2. Lecturer, Queen Mary University of London, London, UK

    Fiorella Colonio-Salazar

  3. Senior Lecturer in Social Sciences, School of Oral and Dental Sciences, University of Bristol, Bristol, UK

    Andrea Waylen

  4. Visiting Professor, Dental Material Science, University of Bristol, Bristol, UK

    Martyn Sherriff

  5. Professor of Orthodontics, Queen´s University Belfast, Belfast, UK

    Donald Burden & Ciaran O´Neill

  6. Professor of Epidemiology, Bristol Dental School, Bristol, UK

    Andy Ness

  7. Professor of Orthodontics, Child Dental Health, Bristol Dental School, Bristol, UK

    Jonathan Sandy

  8. Professor of Orthodontics, Bristol Dental School, University of Bristol, Bristol, UK

    Tony Ireland

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  1. Padhraig S. Fleming
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  2. Fiorella Colonio-Salazar
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Correspondence to Padhraig S. Fleming.

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Fleming, P., Colonio-Salazar, F., Waylen, A. et al. Factors affecting willingness to pay for NHS-based orthodontic treatment. Br Dent J (2022). https://doi.org/10.1038/s41415-022-3878-6

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