Prevalence of Missing Values and Protest Zeros in Contingent Valuation in Dental Medicine.

Pedram Sendi,Arta Ramadani,Michael M Bornstein

doi:10.3390/ijerph18147219

Abstract

Background: The number of contingent valuation (CV) studies in dental medicine using willingness-to-pay (WTP) methodology has substantially increased in recent years. Missing values due to absent information (i.e., missingness) or false information (i.e., protest zeros) are a common problem in WTP studies. The objective of this study is to evaluate the prevalence of missing values in CV studies in dental medicine, to assess how these have been dealt with, and to suggest recommendations for future research. Methods: We systematically searched electronic databases (MEDLINE, Web of Science, Cochrane Library, PROSPERO) on 8 June 2021, and hand-searched references of selected reviews. CV studies in clinical dentistry using WTP for valuing a good or service were included. Results: We included 49 WTP studies in our review. Out of these, 19 (38.8%) reported missing values due to absent information, and 28 (57.1%) reported zero values (i.e., WTP valued at zero). Zero values were further classified into true zeros (i.e., representing the underlying preference of the respondent) or protest zeros (i.e., false information as a protest behavior) in only 9 studies. Most studies used a complete case analysis to address missingness while only one study used multiple imputation. Conclusions: There is uncertainty in the dental literature on how to address missing values and zero values in CV studies. Zero values need to be classified as true zeros versus protest zeros with follow-up questions after the WTP elicitation procedure, and then need to be handled differently. Advanced statistical methods are available to address both missing values due to missingness and due to protest zeros but these are currently underused in dental medicine. Failing to appropriately address missing values in CV studies may lead to biased WTP estimates of dental interventions.

Highlights

In times of increasing pressures to contain healthcare resource consumption, there is an increasing interest in valuing dental healthcare goods and services using economic methods such as contingent valuation (CV) [1,2]
There may be different reasons for missing values in CV studies: (i) the respondent refuses to respond to the question, (ii) the respondent does not understand the WTP exercise and does not provide a WTP value, or (iii) data may get lost due to investigator or computational error
If data are missing completely at random (MCAR), the dataset without missing values is a representative subsample of the complete dataset, and missingness does not depend on the observed as well as unobserved data [13,70]

Summary

Introduction

In times of increasing pressures to contain healthcare resource consumption, there is an increasing interest in valuing dental healthcare goods and services using economic methods such as contingent valuation (CV) [1,2]. CV studies were first used in environmental economics for valuing goods and services for which no free real-world market exists, but have gained more attention in healthcare, and more recently, in dental medicine [1,2,5,6,7]. The number of contingent valuation (CV) studies in dental medicine using willingness-to-pay (WTP) methodology has substantially increased in recent years. CV studies in clinical dentistry using WTP for valuing a good or service were included.

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Discussion

Conclusion