Abstract
Cost-effectiveness analysis is widely adopted as an analytical framework to evaluate whether health care interventions represent value for money, and its use in dentistry is increasing. Traditionally, in cost-effectiveness analysis, one assumes that the decision maker’s maximum willingness to pay (WTP) for health gain is equivalent to his minimum willingness to accept (WTA) monetary compensation for health loss. It has been documented in the literature that losses are weighted higher than equivalent gains, i.e., that WTA exceeds WTP for the same health condition, resulting in a WTA/WTP ratio greater than 1. There is a knowledge gap of published WTA/WTP ratios for dental interventions in the literature. We therefore conducted a (i) systematic review of published WTA-WTP estimates in dentistry (MEDLINE, Web of Science, Cochrane Library, London, UK) and (ii) a patient-level analysis of WTA/WTP ratios of included studies, and (iii) we demonstrate the impact of a WTA-WTP disparity on cost-effectiveness analysis. Out of 55 eligible studies, two studies were included in our review. The WTA/WTP ratio ranged from 2.58 for discontinuing water fluoridation to 5.12 for mandibular implant overdentures, indicating a higher disparity for implant rehabilitations than for dental public health interventions. A WTA-WTP disparity inflates the cost-effectiveness of dental interventions when there is a substantial risk of both lower costs and health outcomes. We therefore recommend that in these cases the results of cost-effectiveness analyses are reported using different WTA/WTP ratios in a sensitivity analysis.
Highlights
Cost-effectiveness analysis is widely adopted as an analytical framework to evaluate whether health care interventions represent value for money [1]
If the incremental cost-effectiveness ratio (ICER) is below a threshold value, the intervention is considered as cost-effective and is adopted, while an ICER above the threshold value is considered as cost-ineffective, and such a health care intervention is rejected
willingness to accept (WTA)/WTP ratios for dental interventions, (ii) that the WTA/WTP ratio may be higher for implant rehabilitations than for public health interventions, and (iii) that the WTA/WTP ratio may impact the results of a stochastic cost-effectiveness analysis and should be part of the economic evaluation
Summary
Cost-effectiveness analysis is widely adopted as an analytical framework to evaluate whether health care interventions represent value for money [1]. The number of published cost-effectiveness analyses in dentistry has substantially increased over the last 40 years [2,3]. The analytical tool of cost-effectiveness analysis is the incremental cost-effectiveness ratio (ICER), which represents the ratio of the difference in costs between two interventions (incremental costs) by the difference in effects (incremental effects) [4]. If the ICER is below a threshold value (i.e., the ceiling ratio), the intervention is considered as cost-effective and is adopted, while an ICER above the threshold value is considered as cost-ineffective, and such a health care intervention is rejected. The ceiling ratio is often interpreted as the decision maker’s maximum willingness-to-pay (WTP) per unit of Healthcare 2020, 8, 301; doi:10.3390/healthcare8030301 www.mdpi.com/journal/healthcare
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