Critical review of willingness to pay for clinical oral health interventions

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.

Keywords: Contingent valuation; Cost-benefit analysis; Dentistry; Oral health; Willingness-to-pay.

Figure 1

Flow of studies through the inclusion process.